Blood works better in colour to cut hospital queues
Dwyer, head of the department of health management at Flinders University school of medicine, says Australia, the UK and the US are all working on principles of redesigning hospital care, ‘‘ but no one has cracked it entirely’’.
‘‘ One of the fundamental problems with the way hospitals work is they have not been managing the end-to-end process of care for the patient as a whole.
‘‘ Each hospital department is working on its own but no one is looking at the whole.
‘‘ Where change has worked is where the people delivering the care have stood back and looked at all the steps involved.’’
Dwyer was involved in evaluating another pioneering project — based at John Hunter Hospital in Newcastle, NSW — which saw a 50 per cent drop in patients experiencing access block when it was first introduced in 2003. And the improvements have been sustained.
The Maggie Project, named after an 87-year-old widow who endured 55 days in hospital after falling and breaking her hip, also used similar principles to improve the way patients moved through the hospital.
The results led to the NSW Government committing $70 million over three years to drive reform statewide under the badge of ‘‘ Clinical Services Redesign’’.
Funding is due to run out mid-next year but ongoing support is likely, says Tony O’Connell, director of performance improvement for NSW Health.
And while the recent furore over the state of Sydney’s Royal North Shore Hospital is a clear indication the scheme has far from solved NSW’s hospital crisis, O’Connell says the gains have been significant.
Although the state’s performance on access block had been deteriorating since 1999, things started to look up as soon as Clinical Services Redesign was introduced, O’Connell says.
‘‘ We met the national benchmark statewide for the first time since 1999 at the end of 2006 and have been around this level ever since.
‘‘ This is a significant achievement in the face of rising attendances at emergency departments and admissions through ED to the wards.
‘‘ There is so much more to be done — we are not where we want to be but we have reached the best performance we have had.’’
Francis believes his FASTPaTH system could help NSW — in fact he has pitched the idea to all state health ministers.
But there has been a lack of response from other states other than Queensland.
According to O’Connell, NSW is aware of the system — and supportive of it — but only if individual hospitals decide it is right for them.
NSW is keen to avoid a ‘‘ one-size-fits all’’ approach because it doesn’t want to impose statewide solutions on local staff, who he says are less inclined to get on board with change if they’re not driving it themselves.
Even emergency medicine doctors concede that NSW might actually be on the right track.
‘‘ In terms of access block NSW has taken steps in the right direction in the past three years though they could do more,’’ says Associate Professor Drew Richardson, chairman of road trauma and emergency medicine at ANU medical school.
Richardson says while all states seem to be looking at some form of redesigning their hospitals, the evidence shows NSW is the only state having any real success.
But in his view, the key to emergency department problems is, and always has been, a lack of available beds.
‘‘ You can redesign the flow in ED as much as you like but if you don’t make the beds available elsewhere in the hospital it won’t make any difference.’’
O’Connell agrees that more beds are part of the solution but he says if you don’t redesign your business processes in hospital wards, patients stay in these beds for too long, and this just leads to emergency departments being clogged with patients who can’t get admitted. Francis concurs. ‘‘ It’s not just about building more beds — that is not the solution. We have to be smarter with what we have got.’’