Dr Michael Daly Executive Director Clinical Governance, Metro South Health 20 April 2018 | HFMA Congress

The Future Hospital Model:

Value Based Sustainability

“The problem isn’t knowing what to do, its how to do it that is the

challenge”

Mary Dixon-Woods, Centre for Health Services Research, Cambridge

“The necessary changes are cultural as much as technical and leadership is an essential

ingredient”Leape, Berwick, BMJ 2000

What is the state of Australia’s healthcare system?

• Great health system

• Universal healthcare• Amongst longest life expectancy

in world• Amongst lowest perinatal

mortality• Highly trained and expert

clinicians• %GDP on health consistent with

OECD peers

What are we left with?

@jmhuddleston

Human Capacity

“The pathway to higher quality is the same pathway to reduced cost”

Dr Gary Caplan, President and CEO Virginia Mason

TodayBeginning ofTime

PercentageRisk of Dying

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100

50

Timeline

Individual’s lifetime risk of death since time began

• 82 year old male with severe COPD and pancreatic cancer was hospitalized for bowel obstruction.

• Postoperative delirium• Postoperative respiratory failure• Pain meds held• Per nursing notes:

– patient routinely called out in pain– family members consistently asked

that he be kept comfortable.

• Average pain score was 8/10 in the 24 hours preceding death.

• Patient was made comfort care only and died within hours.

@jeannehuddleston

Joshua Bright: A Good Death

Can patients have a “good”

death?

Brent Dykes, Forbes Blog post Apr 26, 2016

Intern cannulation credentialing

Medical students and JHO cannulation training

International medical graduates

Interhospital transfer cannula

surveillance

VAST established

Inpatient PIVC Bloodstream Infection (BSI)

ieMR report implemented

IV starter kit introduction

MAKE IMPROVEMENT

SIMPLEEach clinician needs to be

able to access a quality ‘expert’

Best in class?

Workforce Capability to Improve

• Improvement Science– Tier 1 Introduction to Improvement Science– Tier 2 Improvement Fundamentals– Tier 3 Formalised Training (Green Belt)

• Manage 4 Improvement• Leadership and Continuous Improvement

training• IMPROVEMENT EXPERTS

Empowering staff and creating a groundswell of front line problem solvers

Initial Quality Improvement Initiatives

• Virtual Fracture Clinic• Radiology hours realigned to need• Reducing late stage pressure injuries• Manage for Improvement projects (24)

Better care and better value

fhttps://qheps.health.qld.gov.au/loganb/future-hospital

Promoting Professional Accountability Program

Will it Work?

Will the Status Quo Work?

SNAAP Results: Effectiveness

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Standard Notice SNAAP

% R

espo

nder

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Survey results accurately reflected day-to-day level of Q&S in the organisation

Strongly agree

Agree

SNAAP Results: Efficiency

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6-12 monthsbefore

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Perc

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Time range prior to onsite arrival of surveyors

All participants OWS

All participants SNAAP

Percentage of day spent preparing for accreditation