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New Zealand Benchmarking Group Meeting 15 October 2008

New Zealand Benchmarking Group Meeting 15 October 2008. Feedback from Day 1. Trend # codes per patient (Otago were rapped on the knuckles 5-6 years ago) Explain CCL in briefings (and explain link to PCCL) Clarify acute-arranged classification ? Can HRT get coding audit results

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New Zealand Benchmarking Group Meeting 15 October 2008

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  1. New Zealand Benchmarking Group Meeting15 October 2008

  2. Feedback from Day 1 • Trend # codes per patient (Otago were rapped on the knuckles 5-6 years ago) • Explain CCL in briefings (and explain link to PCCL) • Clarify acute-arranged classification • ? Can HRT get coding audit results • Ethnicity in customised briefings - M / I / O • Check Auster2 Readmission rate • Confidence intervals for averages in customised briefings? • Casemix adjust complication rates • Macro security tutorial • Vidhya - Hawkes Bay - ? Why no DOSA rate in customised briefings • Want more explanation on Glen Day Sieve • Aquilo – check time to be seen, Nurse vs Doctor

  3. Agenda

  4. Health Roundtable The Health Roundtable … An Innovation Clearinghouse • Non-profit membership group • Founded 1995 • Share problems • Share solutions • Provides informal network

  5. 53 Organisational Members –107 Hospital facilities ( ) Denotes number of Organisational Facilities

  6. NZ Members

  7. Roundtable Code List - North

  8. Roundtable Code List - South

  9. Health Roundtable Data Analysis HOSPITAL KPIs Emergency Data Cancellation Indicators Intensive Care Clinical – Major Events Workforce Casemix Presentations Time to be seen Time to disposition INPATIENT CASEMIX Summary Reports: CSG, DRG Customised Briefings Departmental Reports Screening Reports Casemix Analyst EMERGENCY PRESENTATIONS

  10. Basic Comparisons

  11. Basic Comparisons

  12. Relative Stay Index – Adjusting for Differences • Based on all member facilities in Australia and New Zealand in 2003/2004 • Over 2 million inpatient episodes • Benchmark is Average Length of Stay for 8000 combinations of: • DRG 5.0 • Six age groups (0, 1-16, 17-49, 50-64, 65-79, 80+) • Emergency SameDay/Emergency Multi-day/Elective • Regular admission or Transfer in • Discharge destination (Home, Transfer, Died, Other) • Complexity: “Complex” if 3 or more disease chapters • Where at least 20 episodes of the same combination found. For rarer combinations, benchmark is set to actual length of stay • Over 90% of episodes were compared to a group benchmark

  13. Basic Comparisons

  14. Basic Comparisons

  15. Basic Comparisons

  16. Where are the major opportunities?

  17. # NOF -- DRG Family I08 Short lag to theatre necessary, but not enough To have short length of stay

  18. Stroke – DRG Family B70

  19. Inpatient Casemix Analysis Options

  20. Peers selected based on a similarity score, calculated on the following indicators • Episode Count • Complex case rate • Emergency (acute) rate • Average age • Discharge home rate • LOS, RSI • Emergency (acute) readmission rate • Principal procedure, principal diagnosis

  21. For a High LOS report, four hospitals must be found with lower LOS and RSI Exemplars must not: • Be less than a third your size • Have a longer LOS or RSI • Discharge home 25% less patients than you • Have an acute (emergency) readmit rate > 25% above yours • Have an average age 25 years higher or lower than yours • Have a complex case rate < 25% lower than yours • Have an acute rate 25% higher or lower than your rate

  22. Customised Briefing Stroke

  23. Group Discussions • What would be considered international good practice from patient and carer perspective in five years? (timing, access & level of acute care, rehabilitation care, home care) • What improvements could you make to move toward this good practice through process redesign? (no major capital funding)

  24. Good Practice for Stroke – Prevention • Increase community awareness of “window of opportunity” for stroke patients for access to thrombolysis

  25. Good Practice for Stroke - Access • Early assessment • Diagnosis at point of presentation • Early connection with rehab team • Within an hour of home • Equivalent access to facilities for all demographic groups • Access to diagnostics within four hours of presentation • Access to specialist stroke unit

  26. Good Practice for Stroke - Treatment • Early acute thrombolysis • GP administers thrombolysis • Dedicated (cohort) stroke unit • Multi-disciplinary team • Stroke unit supported by AH staff 24/7 • Follow NZ guidelines • Early mobilisation • LOS – treatment within 6 days

  27. Good Practice for Stroke – Rehabilitation • Timely access and transfer to rehab • Community based teams where possible • Community based intervention • Critical .mass of clinical team required • Home, day, inpatient facility as needed • Social / family dynamics impact education for all stakeholders • Clear, seamless link for specialist rehab services if required • Coordinate with GP

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  29. Emergency Data Review

  30. Key Performance Indicator Review

  31. Hospital KPI Summary - Fury

  32. Hospital KPI Movement

  33. 421 – Return to ED <14 Days now high

  34. 421 Increasing rate- 11.6% in Feb 2008

  35. 112 – Improving Triage 2 time to be seen

  36. KPI – Indicators to Select?Indicators to Develop?

  37. New KPI Suggestions • Average minutes per session per specialty • Average time per procedure by procedure • % bed days not in home service ward / unit • % medical patients transferred to ICU • Physician FTE per acute medical weis • Time referral to treatment (e.g. NHS 18 week target) • Time accepted to waitlist to surgery • Patient throughput (% of beds) • Conversion rates referral  acceptance  first specialist appointment  follow-up  treatment  discharge • Clinical costing for top 5 DRGs • Weekend discharges as % of all discharges • % of discharges before 11am

  38. Formal Structure

  39. Lean Linkages for Sustained Change

  40. Lean Philosophy • Stop to fix problems • Go to the gemba (“where the truth is”) • Empower staff to solve problems • Correct the problem – 24 hours • Continuous, small-step improvement

  41. Lean Thinking Extended to healthcare in 2000’s From “Going Lean in the NHS” – Feb 2007

  42. Value Add (Typically 5-15% value add) OUT IN Non Value Added Waste Waiting Overproduction Rejects Motion Processing Inventory Transport Staff Utilisation ED Ward Theatre XRay

  43. Improvement Process • Creating fast and flexible flow by eliminating waste • Building a culture to stop and fix problems, to get the quality right the first time • Learning to continually improve the process • Locally led • Creating value and patient focused

  44. What’s Your Aim? • Bold Goal: 25 words or less • Patient centred Complete assessment and develop coordinated treatment plan for 95% of ischemic stroke patients within 24 hours of patient arrival by June 2009 Clear, objective goal Specific sub group Clear target date Discharge 60% of medical patients by 10amon their day of discharge by June 2009

  45. Business Case Test • Clear aim and timeframe? • Planned interventions to achieve aim? • Clear measures of success? • Identified champion and stakeholders? • Experimental – plan, do, study, act cycle? • Benefits identified? • Costs identified? • Risks identified?

  46. Aim Statements

  47. Aim Statements

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