Fiona Stanley Hospital

EMM Conference25th March 2013

Di Mantell General Manager

Fiona Stanley Hospital ProjectDelivering a Healthy WA 2

• Background to Fiona Stanley Hospital

• Engaging with non clinical executives to drive major clinical change

• The challenges in building a business case with little quantifiable data

• Sustaining staff buy in and engagement throughout the project.

• Questions?

Fiona Stanley Hospital

Presentation Outline

Fiona Stanley Hospital ProjectDelivering a Healthy WA 3

• Project budget $2 billion, including $255.7 million of Federal Government funding for State rehabilitation service

• 783 beds, including 140-bed State rehabilitation service

• 83% single patient rooms in main hospital

• 6,300 rooms in the main hospital

• 16 wards (24 beds each)

• 29 imaging rooms

• 16 theatres plus two shelled

• 135,000m2 gross area (excluding car parks)

• 15 kms from Perth CBD – easy to access

• Practical completion 23 December 2013

Background - Project scope

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Background - Project scope

2014/2015(demand modelling data)

Emergency presentations 88,568

Outpatient attendances 440,264

Inpatient separations 55,236

Staff FTE 2,800 clinical 1,100 non-clinical

Beds 783 (643 + 140 tertiary rehabilitation)

Operational Commencement in April 201485% of activity for FSH will come via the Emergency Department

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• Full range of acute medical and surgical services

• State burns service

• State rehabilitation service

• State-of-the-art emergency department

• Comprehensive cancer services

• Renal transplantation and dialysis services

• Mental health facility with mother and baby unit

• Obstetrics, neonatology and paediatric services

• Onsite pathology facility and diagnostic support services

• Western Australian Institute for Medical Research

Background - Key services and facilities

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In the beginning...

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July 2009 – The cleared site

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January 2013 – the current progress

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Fiona Stanley Hospital

Map of the Site

State Rehabilitation

Service

Main Hospital

EducationMental Health

Decked Car Park

Pathology

Decked Car Park

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• The State has a Facilities Management Contract in place with Serco for the provision of facilities management and for all non clinical services for Fiona Stanley Hospital This contract was awarded to Serco in July 2011

• Serco is responsible for the delivery of 28 integrated non-clinical services which each have a service specification and key performance indicators.

• Serco undertake all procurement for FSH [$441m]

• Serco provide ICT infrastructure which linksto WA Health Information Network [ICT]

Background - Facilities Management (FM)

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Fiona Stanley Hospital

Facilities Management (FM)

Reception

Patient Catering

Linen*

Safety & Incident Management

Vehicle & Traffic Management*

External Patient Transport

Health Records Management & Clinical Coding

Audio Visual Services

Human Resource Management –

Clinical Staff

Transitional

ICT Services

Cleaning

Internal Logistics

Help Desk & Communications

Waste Management

Property Management

Supplies Management

Management & Integration*

Estates**

Grounds Maintenance

Managed Equipment Service

Child Care

Energy & Utilities

Pest Control

Fleet Management

For Development

*Part of the services scope (distribution & car parking)

** Includes traditional Building Management services

Hard Facilities Management Soft Facilities Management Technology and Support Services

Scheduling & Billing

Patient Entertainment

System

Pre-Operations –includes FFE procurement

Sterilisation

Electronic RecordsManagement

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So we had a Plan:

• We wanted an Electronic Medication Management [EMM] system

• An EMM that would provide

– enhanced patient safety

– efficient business processes

– improved governance

• And if we also achieved

– a paper-less environment

– HMSS level 7

– data capture for future ABF

– All of that – that would be awesome!!!!

Engaging with non clinical executives to drive major clinical change

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• is a two-way process involving organizations working to engage employees and the latter having a degree of choice as to their response

• is measurable, with some variability in the evidence gained by different measurement tools

• correlates with performance and innovation.

MacLeod and Clarke [2009]

Engagement

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Erlandson and Ludeman (2003) argue that:

when administrators talk about physician engagement, they are generally speaking in code for what they would like physicians to do but cannot get them to do; but when physicians speak about engagement, they are speaking in code for what they already give that is not appreciated, valued or supported by the administration.

Ref: Medical engagement Too important to be left to chance John Clark [2012]

Engagement for clinicians is well described

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Ottawa Hospital Canada & Hewitt Associates:

“A physician is considered to be engaged when they display all three of the following engagement behaviours:

• consistently SAY positive things about the organisation as a place to practice

• intend to STAY and continue practice at the organisation

• STRIVE to achieve above and beyond what is expected in their daily role

It was acknowledged that engagement takes time, and that disengagement has the potential to be sudden and precipitous.

NHS Institute and the Academy (2011)

Engagement for administrators is not [well described]!

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• Despite clinicians having been “cut off at the precipice” a number of times and many years of talking and planned business cases at WA public hospitals.

• The Executive Team need to be convinced [by the FSH Project Team] of clinician engagement and consultation in the EMM proposal.

• So what did the clinicians want:

– Nursing and pharmacy sought automated dispensing cabinets

– Intensivists sought a Clinical Information System

– Parts of the oncology community wanted software but had not been able to organise themselves

– Pharmacists didn‘t believe robotics would be funded and so it wasn't seriously considered

– Computerised medicine carts were not considered at all

– FSH needed a paperless solution to integrate into the Electronic Health Record

Engaging with non-clinician executives to drive major clinical change – or How do we get what we want?

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• We knew many clinicians remained keen

– WA Therapeutic Advisory Group – were engaged

– Many clinical forums were established for ICCIS, Oncology

– Chief Pharmacists’ Forum – were very interested

– Department of Health – Pharmaceutical Services Branch – had a watching brief

• Health Information Network [ICT] – may be interested if it didn't’ distract from their already enormous workload to “stand up” FSH – this was not their priority

• SMHS Executive – needed to be convinced

• New Children’s Hospital EMM Project Team were keen to leverage off FSH work

EMM – Engaging with stakeholders

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Stakeholders each had a different focus:

• GM Finance – quantifiable savings / ABF data / ROI / funding source

• GM Safety, Quality and Performance – decreased medication errors, S&Q focus

• GM Corporate Operations – budget containment and stock management

• Area Director of Nursing and Midwifery – ease of staff to adapt to a new system

• Area Director of Clinical Services – time taken to train doctors

• Executive Director Strategy and Corporate HIN – systems integration and impact on other clinical systems.

• Clinicians – when can we have it?

EMM – Engaging with non-clinical executives to drive major change

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• there is a large amount of clinical research and emotion about what is wrong with the traditional medication system

• there is less information that is accurate/ auditable, quantifiable and defensible

• our proposal was to articulate a Medication Management model that could be applied across a number of sites & understood by non clinicians – as we were to solve all things for all people

• the dilemma of being a brand new site is the potential to leverage innovation at FSH for other sites – the disadvantage is, if it doesn’t work for everyone then no one may get anything

• the business case was to include:

– pharmacy automation

– software

o Specialised – ICU & Oncology

o Generalised – Electronic Prescribing & Medicines Administration (EPMA)

o System Integration

o Return on Investment report – with harvestable and non-harvestable benefits

Building a Business Case

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• A number of reports had been published citing recommendations with respect to processes, procedures, governance and technology.

– Deloitte. Robotic Dispensing Automation in Pharmacy; Sydney, 2010

– Australian Commission on Safety and Quality in Health Care. Electronic Medication Management Systems — A Guide to Safe Implementation, 2nd edition, ACSQHC, Sydney, 2012

– CCC Misconduct Procedures in WA Public Sector Health

– OAG Report July 2012

– Review of Controls over pharmaceuticals 2012

Building a business case

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Fake doctor steals drugs by: Paul Lampathakis From: The Sunday Times May 05, 2012 4:38PM

http://www.perthnow.com.au/news/fake-doctor-steals-drugs/story-e6frg12c-1226347618575

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• Taking note of the specific focus of each of the executives how do you push that button?

• You utilize all of the information that has been amassed & you focus it – not waffle; but make it poignant

• Financial

– get accurate, quantifiable data

– demonstrate harvestable benefits

– demonstrate how this data can be applied to Activity Based Funding modelling

– be honest if some benefits are not harvestable

– demonstrate a pathway for implementation that can be linked to a funding source

– is this a one off payment or a journey piece?

– invest in expertise in developing the ROI to make your case defensible

– a degree of independence will assist your case

Safety, Quality and Performance

– get quantifiable solutions that will reconcile findings from all of the previous reviews

– demonstrate the systems audit capability

– articulate how medications will now be delivered in a closed loop system

Building a business case – Pushing those buttons

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• Summary of Quantifiable Financial Benefits

• The following table sets out the quantifiable financial benefits over the 10 year assessment period. Each benefit is identified either as ‘harvestable’ (i.e. that is deliver cash savings) or ‘non-harvestable’, where the realised financial benefit is reinvested to deliver further non-financial benefit (e.g. medical and nursing time savings, which are not expected to result in real reductions in such staff, however will enable greater staff focus on safety and quality).

Building a business case – Pushing those buttons

Ref Benefit Harvestable (Yes / No )

1 Reduction in adm itted patient costs as a result of a reduction in adverse

drug events.

Yes

2 Reduction in costs associated with re-admissions as a result of improved

medication reconc iliat ions on discharge.

Yes

3 Reduction in holding costs of stock on hand due to dispensary efficiencies. Yes

4 Reduction in ward drug costs due to improved tracking and control of

drugs.

Yes

5 Reduction in medical pract itioner time associated with manual medication

processes.

No

6 Reduction in nurs ing time associated with manual medication processes. No

7 Reduction in pharmacist s taff ing costs as a result of efficiencies in drug

dispensing.

Yes 1

8 Reduction in pharmacy tec hnician and pharmacy assistant staffing costs

as a res ult of eff iciencies in drug dispensing.

Yes1

9 Increased PBS revenue due to improved claim ing of PBS scripts. Yes

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Corporate

– get accurate, quantifiable data that will measure stock levels

– Increased security system for medication management & legible records

– Governance process to address corporate obligations identified in a number of reviews

Area Clinical Leads [Nursing, Medical and Allied Health]

– standardized approach to medication administration

– “foolproof” tracking of medications administered

• enhanced patient safety

Chief Executive

– get quantifiable solutions that will reconcile findings from all of the previous reviews

– demonstrate how investing in this system will save patient’s lives

– how will this provide my executives the data they need to do their job

Building a business case & – keep pushing [those buttons]

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Sustaining Staff Buy in & Engagement throughout the process

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• The FSH and NCH will provide WA hospitals with the confidence to begin adopting systems.

• WA experience will collectively grow:

– HIN – understand the systems & integration layer

– Clinical staff – skilled & competent

– Governance groups – delivery of safe patient care

– Cost effective patient care

– Accurate costings per episode of care

• EMM solutions and CLMM will be the norm not the exception

EMM – Sustaining momentum

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• You have to believe in the vision

• You have to be prepared to fight for what you believe in

• The timeframes will be crazy

• If you can’t explain it to people– then you might as well be talking in tongue OMG & ROFL

• You should utilise everything at your disposal

– clinicians who want it

– FM who can procure it

– someone who is prepared to keep pushing the message

EMM – Sustaining momentum

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�Because someone has to believe

�Someone has to break the mould

�Someone has got to set the new standard for WA Health

�Because patients deserve it

Remember Why YOU did it

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Disbelief in magic can force a poor soul into believing in government and business.

Tom Robbins

Thank you – questions?

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