Diagnostics1. Process Mapping: Findings - Barriers in engaging

new services to BHC – aging infrastructure, waitlistprocess, service governance, staffing profile andadministration across smaller facilities.

2. Data Analysis: Findings - CHHC DOS KPI notmeeting 2% benchmark.

3. Staff Interviews: Findings - 88% perception wasof decreased service confidence in smallerfacilities; inefficient utilisation of resources withwaitlist, management & referral processes.

4. Patient Stories: Findings - 50% patients reportedthey chose not to go to the smaller sites due aginginfrastructure perception of older equipment.

SolutionsCapital works funding has allowed Infrastructuredevelopment and new equipment purchases at BHC.This provides the opportunity for an innovative conceptto establish new services with a centralisedPerioperative governance for co-ordination of surgicalactivity across MHC and BHC.Centralising the waitlist for Macksville & Bellingen willallow movement of activity between sites to maximisetheatre utilisation - effectively regarded as One Entitywith 2 theatres.An associated centralised Preadmission patient triage& screening service complements this, allowingefficiency in managing Requests for Admission (RFA),patient safety, management and appropriate facilityallocation.

AcknowledgementsSteering Committee: Dr Theresa Beswick GM, Kath Boman, Dr Emma Bendall, Andrew Manz, Margaret Laidley, Leonie Sens

Project Team: Janelle Goodall, Lisa Slater, Nicky Aldred, Christine Taylor.aylor

ConclusionThe project outcomes are transforming servicedelivery and patient care in the MNCLHD whileimproving access, safety and consumersatisfaction. The new structure is demonstratingimprovements in process efficiencies andNetworking relationships. The project has requireda broad level of stakeholder engagement, sponsorsupport, and ongoing resources. Commitment isrequired to ensure the effective surgical serviceprovision at BHC and MHC continues to deliverthese efficiencies while supporting CCN SurgicalServices.Lessons Learnt• Strong leadership and effective communication• Clinician and patient engagement • Resource management• The project requires dedicated time as

unexpected roadblocks can threaten outcomes

Contact: Lisa.slater@ncahs.health.nsw.gov.auJanelle.goodall@ncahs.health.nsw.gov.au

RFA • Received at HCF Booking Office

Triage (HCF

Waitlist)

Pa ent sent LOO

(Generic) Scheduling

Pre‐procedure ‐ PAC / GPA Referral

Admission Surgery Post surgery Discharge

Issue Three: Inappropriate 

staffing to efficiently manage the service

Issue Two: Limited PAC processes for Day Only patients

Issue one: Independent waitlists

Results

New Structure

Current Status

Implementation eMR and PAC

screening

Staff at MHC and BHC

supporting service across

both sites

GP Anaesthetist engaged in

supporting new services

Lisa Slater – Perioperative NUM Macksville Health Campus

Janelle Goodall – Deputy Director of Nursing Bellingen Health Campus

Lisa Slater – Perioperative NUM Macksville Health Campus

Janelle Goodall – Deputy Director of Nursing Bellingen Health Campus

Case for changeProcedural allocation across the Coffs Clinical Network ina four-year period showed Coffs Harbour Health Campus(CHHC) to be at capacity - increased activity at MacksvilleHealth Campus (MHC), and decreasing activity atBellingen Health Campus (BHC). This lead to asuccessful application for Rural funding for capital worksat Bellingen to improve the ability to introduce newSurgical services.It was identified that and increase in Day of Surgery(DOS) cancellations at CHHC were a result of increasingEmergency surgeries and this lead to exploration ofsession availability at smaller facilities to support electivesurgery.Process mapping indicated barriers in engaging newservices to BHC, the waitlist process, service governanceand FTE in nursing and administration across smallerfacilities. Root Cause Analysis indicated a decreased ofconsumer confidence at smaller facilities.

CurrentStructure

GoalTo improve patient experience and access to efficientsurgical services and increase theatre capacity atperipheral facilities, improving ability to meet KPIs relatingto Elective Surgical Access Performance (ESAP) targets,Day Of Surgery (DOS) Cancellations & Theatre utilisation.Objectives1. Improve the patient experience – Enable better accessto surgical services by increasing surgical allocation atBHC from 150 to 390 by June 2016.2. Improve the health of populations – Enabling increasedservice capacity with successful commissioning of newservices at BHC by February 2016.

Sustaining changeThe implemented solutions will be sustained by:

Monthly reports to Surgical services meeting Attendance at monthly Network waitlist meeting Quarterly Review of Patient and staff surveys Clinical Indicators (IIMS, Audits, ESAP Targets) Number of Hits from Website (HealtheTube). Ongoing service and staff development Development proposal for Network surgical

service re-branding and promotion to reflectNetwork approach within the community.

Proposal for funding Central managementmodel at BHC & MHC to provide ongoinggovernance and efficiencies in managingresources with service growth.

Project  Initiation Diagnostics Solution Design ImplementationPlanningImplementationCheck point Evaluation

Evaluation of service, workflows, Quick Wins, mentoring and coaching

Process Mapping workshops, patient & staff surveys & Tagalongs, audits. Stakeholder interviews

Mock trialing workflow, develop Task list, weekly Project team/Steering Committee meetings

Monthly performance reports, Patient & staff surveys,

Survey Data Analysis, Compilation of issues

Steering committee, Project Team initiation. Communication Plan

Method

Centre of Healthcare Redesign methodology was used for this project

MHC/BHCMHC/BHC

MKS OT

BEL OT

Networking waitlist

Networking waitlist CHHCCHHC

OT 1

OT 2

OT 3

OT 4

OT 5

MHCMHC

OT 1

BHCBHC

OT 1

CHHCCHHC

OT 1

OT 2

OT 3

OT 4

OT 5

First Cataract Patient at BHC – Dawn Lawless with Dr Lim, Dr Radford & NUM Lisa Slater

Coffs Coast Surgical ServicesBellingen - Coffs Harbour - Macksville