MJA
MJA

Applying clinical process redesign methods to planned arrivals in New South Wales hospitals

Donald G MacLellan, Patrick C Cregan, Brian C McCaughan, Tony J O’Connell and Katherine M McGrath
Med J Aust 2008; 188 (6): S23. || doi: 10.5694/j.1326-5377.2008.tb01670.x
Published online: 17 March 2008
Diagnosing the problems with planned arrivals

A number of factors contributing to the problems resulting from planned arrivals have been elucidated in the diagnostic phase of the redesign method. They are discussed in the following sections.

The redesigned planned patient journey

The main components of the planned patient journey, once redesigned, will facilitate the management of an efficient, cost-effective, safe and high-quality service. Integrating the components requires that management take responsibility for the whole patient journey, avoiding multiple managers and multiple interfaces. The components of the patient journey are described below.

Preadmission processes

The Pre-Procedure Preparation Toolkit (PPPT)6 is an essential determinant for success and defines the processes to prepare the patient medically, socially and administratively. In the Clinical Services Redesign Program, it was recognised that patients should not be required to visit the facility for anaesthetic assessment unless absolutely necessary. Thus, a triage system has been adopted which uses a standardised patient health questionnaire — this is an internationally accepted practice.

The preadmission process is also used to assess patients’ postdischarge needs and to ensure that appropriate plans and resources are in place when patients are ready for discharge after their procedures (eg, home-based rehabilitation following hip replacement surgery, home help, etc).

Conclusions

Applying clinical redesign methods to the planned patient journey has successfully allowed management to recognise the blocks and inefficiencies, and to facilitate the development of solutions for improvement. The redesign solutions require committed clinician support and strong managers to ensure their implementation, and a robust performance management system for sustainability. With these in place, the improvements are unquestionably impressive, not only in terms of efficiency, safety and quality gains but also for enhancing patients’ experiences.

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