Student: Ben Seers
Supervisors: Paul Abernethy, Professor Les Toop, Dr Simon Brokenshire [Dept Public Health & General Practice and Pegasus Health]
Sponsor: Partnership Health Canterbury
Over the next ten years, Canterbury's population of over 500,000 is expected to grow by 17%, and the proportion of our population over the age of 65 is expected to rise from 13% to 18%. These demographic changes (among others) will place increasing strain on an already stretched health system, as more people require and expect health services of a high standard. Therefore the current system must somehow transform itself, in order to provide the best care possible to the community which we are all a part of.
The hospital Emergency Department (ED) is a key element of our health system, and in Christchurch the ED already sees over 75,000 patients a year. This number is expected to rise significantly as our population changes over the next ten years, placing ever increasing pressure on this service which is so important to the health of our population. Plans are already underway in Christchurch to prepare for this increasing demand, with the Canterbury Clinical Network leading the way.
The Canterbury Clinical Network is a collaboration of health leaders from throughout Canterbury, with the aim of embracing, facilitating, and implementing the changes our health system requires to deal with its swelling requirements, so as to make healthcare “Better Sooner More Convenient” for all. One aspect of this plan is of particular relevance to this project; the Acute Demand program looks to move care away from hospitals and into the community. The Canterbury Clinical Network will see that patients which can be safely managed in the community are supported in moving away from services provided by the hospital (for example the ED), towards General Practice (GP) teams such as the 24 Hour Surgery (24HS) located on Bealey Ave.
The 24HS provides a service which offers cover for many of Christchurch's GPs and their patients, representing around 105 General Practices. It provides the 24 hour patient care which GPs are otherwise individually responsible for, and in return each GP works at the facility about once a month. The 24HS is in fact the only facility in Christchurch to offer drop-in medical care 24 hours a day year round (excluding the ED), which places it in a unique position with relation to the Acute Demand program. This program will see a significant proportion of the patients who currently arrive at ED after hours, instead going to the 24HS for urgent but minor medical care, leaving the ED to look after the patients with more serious needs.
This presents a significant business opportunity for the 24HS, which (unlike most General Practices) relies on user fees for the majority of its income. However, in its current state the 24HS is already at times finding itself at maximum capacity, being subject to unpredictable patient attendance, and the limitations of the facility it occupies, with waiting times often extending beyond sixty minutes. The aim of this project therefore, was to help improve efficiency, the flow of patients around the facility, and reduce waiting times, thereby increasing the value patients receive from the service, while increasing capacity.
This was achieved in two ways. Firstly, research was carried out regarding queue theory, patient flow, waiting times, and efficiency in healthcare. This provided a thorough understanding of what method should be used, along with the tools needed to analyse the system, plus a framework for the development and recommendation of suggestions. The practical aspect of the project then required collection of numerous hours of patient flow data, which could later be used to show objectively exactly how the system worked, and how improvements could be made. Data collection entailed recording the journeys of a random selection of patients as they moved through the system, observing the movements between different stations (such as doctors consultation or waiting for an x-ray), and timing how long all of the processes took. The subsequent collation of these data and visual representation in a flowchart proved valuable tools for looking at waiting times and waste, so that the suggestions made could help reduce these factors, while maintaining a high standard of care.
The above data collection processes yielded some valuable information, such as the average time a patient spends in the facility, and how much time the average patient spends waiting compared with their overall length of visit. It also allowed for observations to be made regarding simple inefficiencies in the system, such as patients asking receptionists about information which could easily be placed on a sign. In-depth analysis of data then allowed a collection of recommendations to be made which if implemented, could produce quantifiable results by removing significant amounts of waiting time. One such recommendation suggested making changes to reduce the total number of times a patient sees a doctor during a visit. This is justified through the observation that much of a patients waiting occurs after their initial consultation while they wait to see the same original doctor, who is often occupied attending to another patient. By having tests such as x-rays done before the initial consultation, the patient will only need to see a doctor once per visit, and these periods of waiting will be removed potentially cutting waiting times by up to twenty minutes for some patients (although this must be balanced against the dangers of increased radiation exposure).
Although the original aim of the project was to investigate patient flow, the more valuable recommendations originated from the research into improvement in healthcare. Suggestions here looked at the value of staff as a resource for improvement, and the nature and implementation of changes, including ways to build a staff culture of continual improvement. An example of these proposals is illustrated in developing a staff suggestion box system, which is easily able to be integrated into current IT solutions. This would be coupled with a commitment from the senior management team to encourage staff to make suggestions, and to respond or act on all suggestions so that employees feel their suggestions are worthwhile. This approach helps create improvement, as staff generally have the greatest understanding of the systems they work in, and are often far more qualified than external observers to make suggestions. The commitment from senior management ensures the potential of ideas are realised, while empowering staff and developing a culture of change and improvement.
The improvements suggested by this project all aim to develop the 24 Hour Surgery in some way, be it through reducing waiting times, or improving staff satisfaction. Changes in healthcare will be vital for ensuring that services stay afloat over the next ten years, as they struggle to balance between stretched resources and increasing demand. The 24 Hour Surgery has shown throughout this project to have the initiative and perseverance to bring about necessary change in a positive way, and the information produced by this project should provide them with the tools to continue to do so.