Rigorous diagnostics

Anne-Maree Szauer Improvement lead Quality and Safety Branch

Orientation session

Aims of the rigorous diagnostic phase

Identify constraints across the patient journey Engage key staff in the process ready to implement change Dispel the myths!

Orientation session

Activities of the diagnostic phase

Health service data Brainstorming Process Mapping Sampling Tool Involving Patients and carers

Orientation session

Activities
Health service data Brainstorming Process Mapping Sampling Tool Involving Patients and carers

Orientation session

You collect the data

The minimum data set Patient level data patient unit record number (de-identified) gender date of birth postcode. Event details date of first referral referral source date placed on clinic list appointment date clinic speciality interpreter required reason for visit visit outcome next scheduled visit.
Orientation session

We prepare the measures

percentage (%) of new patients percentage (%) of follow up patients percentage (%) of daily did not attend (DNA) rate percentage (%) of patients discharged from outpatient services percentage (%) of patients discharged from outpatient services to primary health services time between initial referral and appointment date patient time waiting for outpatient services.

Orientation session

Easy to use!
Data

Orientation session

Activities
Health service data Brainstorming Process Mapping Sampling Tool Involving Patients and carers

Orientation session

Brainstorm to generate ideas, views and perceptions about patient flow in outpatients

Orientation session

Activities
Health service data Brainstorming Process Mapping Sampling Tool Involving Patients and carers

Orientation session

Process mapping is a method for depicting a process, material or information flow in a diagrammatic form. Map minimum of two whole system patient journeys Include community/GP interface

Orientation session

A patient journey within outpatients

Ultra Sound, Breast Core Biopsy, Out Patient
10.12 Patient arrives at ultra sound 10.20 Patient shown cubicle and asked to change into gown 10.24 Patient sits back down in waiting area 10.26 Patient called into examination room by nurse, Patient asked to make herself comfortable on the couch and the Radiologist explains the procedure and that the process will take about 20 minutes

Example of Process Map

10.29 Radiologist checks patients past ultra sound images, the lump is deeper than he had anticipated

10.28 Examination starts, ultra sound gel is applied, the radiologist checks the ultrasound screen 10.32 Radiologist marks area for core biopsy gun to penetrate. Explains that the needle will be inserted briefly, but will give pt LA first, pt is concerned about 2 needles being used, asks if she can be repositioned, and asks if lump is cancer or cyst. Radiologist explains that it is probably a fibramoma (a bristly type lump which are fairly common). Patient says she does not want surgery. Radiologist says that she can discuss this with MS Shah

10.30 Radiologist explains that the lump looks benign, that he will measure its size and reassures the patient that he would be surprised if it was a . Explains to patient that the biopsy sample will give the definitive answer

This is the first part of a three part process map of which in its entirety was too detailed to successfully display.

Orientation session

A whole system patient journey

Patient feels unwell Sees GP Referral letter sent Prioritised by consultant

Added to OP pending list Review in clinic Diagnostic tests Patient attends OP clinic

Appointment sent

Added to waiting list Patient attend PAC Patient admitted for operation transfer home

letter sent
Orientation session

Activities
Health service data Brainstorming Process Mapping Sampling Tool Involving Patients and carers

Orientation session

Sampling tool
Ask staff to identify the key delays Chart delays for each patient each day Total at end of time period
Orientation session

Activities
Health service data Brainstorming Process Mapping Sampling Tool Involving patients and carers

Orientation session

Patient,carer and relative involvement

Small sample to gain consumer input Use the tools one to one with patients

Orientation session

Completion of diagnostic phase

Review the results and priorities the constraints that are causing the most disruption to the largest patient group. Identify the improvement team Develop the action plan

Orientation session

Handy hints
Share the workload Gain as many views as you can Use this phase to find the constraints and test assumptions Start a PFCII network! Enjoy the focus on patient process Have fun!!!!!!
Orientation session

Q u e s t i o ns?

Orientation session

Team planning time

Orientation session