Achieving NEAT Forum 2013

“Transforming NEAT Performance:The Executive Role

Dr Richard Ashby AMChief Executive

Metro South HealthBrisbane, Australia

Introduction and Background

Metro South Health

Health in Metro South

• 7 Public Hospitals• 17 Community Health Centres• 1 Residential Aged Care Facility

and 2 Special PurposeFacilitiesPlus• 600 General Practices, Allied

Health Clinics and Community Pharmacies

• 5 Private Hospitals• >150 NGOs

• 3856 sq Km• 4 Local Government Areas• 122 SLAs• >1,000,000 Residents• 2.1% Indigenous• 28% Born Overseas• 22% Socially

Disadvantaged• 12,000 staff• $1.85 Billion

Metro South Health

Metro South activity in 2012-13• 186,886 hospital admissions• 42,804 operations• 713,238 outpatient attendances• 249,608 emergency department attendances• 464,874 community health occasions of service• 8.9 million Medicare services (Commonwealth)

The Challenge 2012-13

Metro South Health

Governance• New Board, Executive Structure, 47 new functions

Funding• Upfront Productivity Dividend $60m• 2012/13 MYEFO cuts ($18.8m)• 2013/14 Growth (1.5%)• 2013/14; 2014/15 ABF Funding

Activity• Compound activity growth 3-4% pa, ED growth 6% (Population 2.4%)

Time Limited Redundancy Program• Mandatory MOHRI Reduction = 650FTE

+Complex Services returning• Organ and Tissue Transplantation• TB Services• Public Health

Metro South Health

Overall Performance Highlights 2012-13• Operating Surplus $19.3m (2010/11 $41m deficit)

• MOHRI FTE 710 (6.5%)

• Activity exceeded target by 6260 WAU ($25m)

• Total productivity dividend >$100m

• NEAT 52% 73% (PAH 28% 66%)

• NEST Cat 1 8%

• Cat 2 3%

Cat 3 10%

Metro South Health

Overall Performance Highlights 2012-13 cont’d

• Ambulance “bypass” ceased, ramping reduced >50%• Emergency Department “DNW’s “reduced 50%• Hospital Standardised Mortality Rate <70 all facilities• Relative Stay Index <90 all facilities• Cost per WAU < National Efficient Price• Patient Satisfaction >90%• PAH –”best clinical governance system in Australia” (ACHS 2013)

(45% “Met with Merit”, No recommendations)• Highest research funding ever.

Transforming NEAT Performance

Princess Alexandra Hospital

Wooden spoon

Courier Mail14/12/12

NHPA report2011-12

Metro South Health

What was happening at PAH?

• 840 bed tertiary hospital serving Metro South HHS– Trauma Centre, Cardiac Centre, Transplant Centre, Cancer Centre– 40% admission rate with 90% occupancy– 56,000 ED presentations at PAH; 50% arrive by ambulance;

• New ED opened November 2010– 25 acute cubicles and 5 resus bays– Mental Health Assessment Unit– Ambulatory Care, 14 bed Short Stay Ward– In-house Radiology

• New Medical Assessment and Planning Unit (MAPU) opened February 2011– 30 beds (including Chest Pain Centre)

Ramping at Princess Alexandra Hospital

Early Initiatives

Metro South Health

February 2012 – “a seminal moment”

• Royal Perth Hospital 90% of discharged patients meet NEAT

• Princess Alexandra Hospital 26% of discharged patients meet NEAT

2012 ED Cultural Change

Metro South Health

KPMG Its Time Project – Jan-Aug 2012:

• February 2012: NEAT Forum; Clinical Council

• March 2012: ED Short Stay Ward process

• June 2012: ED consultant in Ambulatory Care

• June 2012: Changes to Mental Health patient

processingand rapid transfer to MH waiting area

• June 2012: Avoidance of unnecessary transit throughED for some admissions

Metro South Health

Other Interventions

• NEAT Taskforce; NEAT Clinical Review

• Improved data and reporting (Daily)

• Improved patient flow and bed management

• Logistics Nurses

• “No bypass” rule (October 2012)

• Study Tour – Royal Perth, SCG, Alfred etc.

Metro South HealthOutcomes:PAH:

• NEAT February 2012 (27.6%) October 2013 (65%)

• NEAT Admitted (31%), NEAT Discharged (78%)

• ED Waiting Times ATS1 100%ATS2 88.8%ATS3 76.1%ATS4 88.1%ATS5 97.7%

• Patient off stretcher 30 minutes (90%)

• Did not wait 0.9% (2011- 8%)

Metro South Health

Metro South HealthThe Challenge:

NEAT Target ED Discharge in 4 hours Optimised

Admission in 4 hours required

70% (2012) 95% 26%

77% (2013) 95% 46%

90% (2015) 95% 82%

Metro South HealthBrisbane hospital makes big recovery •by: Clifford Fram, AAP National Medical Writer•July 25, 2013 6:41PM A Brisbane hospital improved after having the slowest emergency department in Australia last year. Source: AAP A QUEENSLAND hospital has bounced back from the shame of having the slowestemergency department in Australia.

Princess Alexandra Hospital's emergency department was singled out in 2012 for itstardiness, meeting time targets for only 33 per cent of patients.

On Thursday it was named as the most improved based on 2013 figures, with 62 per centof patients making it out of the department within the targeted four hours.

"We have gone from from being far and away the worst to at least being in the middle of the pack," said Dr Andrew Staib, the deputy director of emergency department.It was a multi-faceted effort, he said. "But there is still a lot of work to do."Queensland was the best performed state in Australia for the March 2013 quarter, with 11of its 24 major hospitals meeting its 77 per cent target, according to National Health

Performance Authority figures published on the MyHospitals website

Metro South Health

Executive Role: Lead Change!!

• Create “burning platform” . (Reputation, quality, funding)• Establish diagnostic and clinical redesign processes – no two

hospitals are the same!• Establish and empower clinician-led change group (NEAT Taskforce)• Focus on largest cohorts with the worst performance• Monitor safety• Reinforce success!

Metro South Health

Thank you…..

Questions?