Manukau Courier : November 30th 2010
8 MANUKAU COURIER, NOVEMBER 30, 2010 NEWS Toyota model used to fix waiting times Counties Manukau Dis- trict Health Board has taken a leaf out of Toyota's problem-solving manual in a bid to reduce the length of time patients spend in Middlemore Hospital's emergency department. Toyota's proved method of taking problems apart and building solutions has paid dividends for the health board, the first large health board to reach the government's target of 95 percent of patients being assessed, cared for and either transferred to a ward or discharged home from the emergency depart- ment in under six hours. The secret to its suc- cess required strong leadership from the highest level. The board and chief executive were committed to the pro- gramme and made sure that all staff were aware that achieving the target was everyone's respons- ibility. There was a clear expectation that health boards would be publicly accountable for their progress. The emergency depart- ment is the front door'' to the hospital, achieving the target required com- mitment from staff work- ing throughout the hos- pital because a clogged emergency department is often a sign of blockages at various stages of a patient's journey through the hos- pital system. Problems discharging patients can have a trickle-down effect right to the front door. Emergency care clini- cal head Dr Vanessa Thornton has led the process at Middlemore Hospital. When you break the steps down there are a number of contributing factors that can cause delays to a patient's treatment and care,'' she says. These include dupli- cation, communication problems, wide variation in care, insufficient capacity and bottlenecks in patient flow -- slowing the whole patient journey.'' Dr Thornton says her group tapped in to Toyota's A3 tool kit which involves three steps: Defining the prob- lem; researching the pro- ble; implementing plans to fix the problem. The plan is sketched out on one A3-size piece of paper -- hence the name. And if the first sol- ution doesn't work, tweak it a little, measure the outcomes and keep going until you've found the solution. Because this approach involves all staff, there's ownership of the problems and solutions from the start, Dr Thorn- ton says. It's a way of looking at old problems with fresh eyes. In one sense, meeting the target was the easy bit; sustaining it is an ongoing challenge. We can't afford to take our foot off the accelerator. Like all quality improvement program- mes, it's a continual pro- cess. More than a year on, we're now at the stage of seeing how we can further refine processes. We're fortunate to have a general manager who has made it his pri- ority to ensure success. He's had a group work- ing to clear roadblocks on the operational side of things and the results speak for themselves. We were given the freedom to change the way we work to make a positive difference for patients. It's really gratifying to know that you're mak- ing a difference. It used to be the norm to have patients lined up on trol- ley beds in corridors -- now it's the exception. Another positive spin- off is the way it's lifted the mood of the depart- ment -- it's a much nicer place to work when there's a greater sense of teamwork.'' The Middlemore team gave the programme a brand -- Six hours can be ours'' -- and used it in all its communications about the changes being trialled and introduced. The group made a series of posters featuring staff members claiming the six hours can be ours'' catch- phrase. It also produced a DVD to play at orien- tation for all new recruits. Staff are given lanyards emblazoned with the brand and it's on the agenda of all team meetings. There's no way you can miss it,'' Dr Thorn- ton says. Now that the changes are embedded, it's busi- ness as usual for us. While it's great to have made the six-hour target, if you ask any patient whether it's a good thing, I'm sure most of them would say that six hours is still too long to be in a hospital emerg- ency department.'' 400 register for 111 texts More than 400 people have registered for the new 111 text service for the deaf and hearing impaired since it launched last month. And emergency ser- vices have already responded to several 111 texts. The first callout was for the Fire Service to a rubbish fire out of con- trol. Deaf Aotearoa chief executive Rachel Nobel says the text 111 service is incredibly empower- ing'' for the deaf com- munity. Deaf and hearing impaired people who can't use a phone to call 111 must register to be able to use the emerg- ency text service. Go to www.deaf.org.nz to get an authorisation code to register for the 111 text service.
November 26th 2010
December 2nd 2010