Cutting waste and inefficiency improves productivity and patient care.
Government pressure on healthcare providers to reign in ballooning costs is relentless. It places an enormous burden on hospitals to deliver services at lower cost without compromising patient safety and quality of care.
Is this possible? Yes. But it requires a change in thinking and a strong focus on improving processes and systems. The Victorian Health Priorities Framework 2012-2022 report summed this up when it said:
“Evidence indicates that reorganising care around the patient with teams that are accountable to each other and to patients, and are supported by information systems that guide and drive improvements, has the potential to eliminate waste, reduce medical errors and improve outcomes – at lower total cost.”
This evidence is strongly supported by a recent project undertaken by Vative Healthcare and St Vincent’s Hospital Melbourne – St George’s Health Service to improve the clinical handover process from morning to afternoon nursing staff. The project delivered:
- A 100-minute saving per day in handover time
- Incorporation of patient feedback in the redesign of the handover process
- Bedside handover involving the patient in planning and decisions
- Reduced duplication of information
- Reduced potential for error
- Reallocation of staff to high value tasks
- Compliance with national standards in patient care and safety
- Clinical tools and education supports for handover processes.
“In many of our projects, client teams often say the root cause of their problems is insufficient staff,” says Karen Barker, Director of Vative Healthcare. “But adding more staff to a broken or inefficient process usually just costs the system more, without delivering an improvement in quality of care.
“We actually need to fix the hundreds of processes which occur in hospitals every day and which waste time and resources. With expert guidance and a commitment to continuous improvement, hospitals can achieve significant financial and patient benefits in a relatively short timeframe.”
How the 100 minute saving was achieved
The project began with direct observation of clinical handover processes in two units at St George’s in Kew. Clinical handover policies were reviewed, patient focus groups established expectations for patient inclusion in handover, and staff focus groups contributed to handover information and document redesign.
Existing processes involved the morning staff handing over to the nurse unit manager, the manager conducting a ‘safety briefing’ the afternoon staff, and one-on-one consultations between morning and afternoon staff at nurses’ stations.
“There was a lot of repetition which wasted time, left information open to interpretation and created a high risk of error,” Ms Barker says. “Now the handover is conducted at each patient’s bedside, allows 100 per cent patient involvement and results in only high risk issues being referred to the nurse unit manager.”
Information is transferred using the ISBAR framework and is now captured on the plan of care rather than simply on handover sheets which are discarded.
Maryanne Welch, General Manager Aged & Community Care, Director of Nursing St. George’s Health Service, St Vincent’s Hospital says the units were able to achieve the 100 minute saving due to the support and engagement from Vative.
“We have saved around 600 hours a year that can now be devoted to direct patient care, and have introduced bedside handover in line with national standards for patient care and safety,” she says.
Vative Healthcare assists clients increase productivity and improve patient-centred care by reducing waste and inefficiencies. Key outcomes from recent metropolitan and regional projects include:
- 100-minute daily time saving for clinical patient handover
- After hours admissions processing cut from 37 to 13 minutes
- After hours clerical processes cut from 6 to 2
- 37% reduction in surgical start time delays
Vative achieves significant business improvements for clients through solutions which are simple, realistic and highly effective. Providing consultancy and training services, Vative’s 45-strong team includes Lean and Six Sigma excellence coaches with extensive health, business management, academic, engineering and trade backgrounds.
Vative training ensures staff understand continuous improvement methodology, enabling change to be driven from the bottom up as well as top down. Frontline staff are given problem solving tools, and with leadership support they can achieve significant, sustainable gains in areas including clinical, non-clinical, environment and national standards in safety and quality.