The pathway to achieving success in a highly complex and dynamic environment

Sandie Lenehan ND Surgical Services LBHN

◦ 13 Operating Theatres◦ 3 Endoscopy Procedure Room◦ 3 Surgical Wards – Total of 84 Beds◦ 2 Central Sterilising Departments◦Out Patients Department◦ Intensive Care Unit – 7 Funded Beds◦Wound and Stomal Therapy Service

Metro South Hospital and Health Board

Health Service Chief Executive

Metro South Health Executive

Version 2.0 March 2017

Logan Bayside Network Executive

Surgical Services Executive * Director of Surgery Logan Bayside Network

* Nursing Director Surgical Services Logan Bayside Network

Surgical Services Management Committee – Redland Hospital

Division of Surgery Management Committee – Logan Hospital

Theatre Scheduling Committee Redland Hospital

General Surgery Department

Perioperative Services Including Endoscopy & Central Sterilising

Units

Stradbroke Unit

Orthopaedic Department

Gastroenterology Department Including Hepatology Services &

Inflammatory Bowel Disease Services

Intensive Care UnitIncluding MET and ICON Services

Theatre Management Committee

Theatre Scheduling Committee Logan Hospital

Anaesthetic Department Including Acute Pain Service

General Surgery Department Including Acute Surgery Unit &

Paediatric General Surgery

Department of Otolaryngology, Head and Neck Surgery

Orthopaedic Department

Endoscopy Unit Including Queensland Bowel Cancer

Screening Program &Endoscopy Assessment Clinic

Perioperative Medicine Department

Wound Management & Stomal Therapy Services

Surgical Units – 2H & 2I

Perioperative Services

Central Sterilsing Unit

Elective Surgery Bookings Unit

Elective Surgery Bookings Unit Anaesthetic Department Including Acute Pain Service

Logan Bayside Network Division of Surgery

Organisational Chart

Outpatients Department Nursing Only

No vision Poor culture Two separate surgical services Inconsistent operational procedures and

governance Resource inequities Different Models of Care for the wards Differences in Elective surgery coordination Different KPI’s monitored

Develop, maintain and communicate a consistent long term vision for the service

Putting the patient at the centre of care Improving efficiency Driving value Become an employer of choice

Whilst always embracing the idea of continuous change

Pit Crews … Coordinated by design… acquire an ability to recognise when

you’ve succeeded and when you’ve failed for patients.Atul Gawande (2011) - “Cowboys and Pit Crews”

Vision for the Surgical Division Logan Bayside Health Network

To make Logan Bayside the best public hospitals for patients to have surgical care and the best

hospitals for staff to work and train in to provide this care.

Projects – there was work required in every area to support the theatre efficiency we needed

Recruitment – employing the right people at the right time for the right (key) positions

Culture – valuing staff through programs such as Pathway to Excellence

Consistency – whilst being prepared for the emergence of new services, Hospital, HHS and Federal priorities

1. Improving the Pre Op Processes (iPoPs)2. Redesigning the Patient Journey Project3. The Productive Operating Theatre (TPOT)4. Enhanced Recovery after Surgery (ERAS)5. Acute Surgical Unit (ASU)6. Formula 1 Theatre Transformation and

Engagement Review (F1TTER)7. 23 Hour Model of Care8. Electronic Booking Management System9. Perioperative Services Pre-Admission & Day of

Surgery Admission Model of Care

No dictionary has ever been able to satisfactorily define the difference between "complete" and "finished." However, during a recent linguistic conference, held in London, England, and attended by some of the best linguists in the world, Samsundar Balgobin, a Guyanese linguist, was the presenter when he was asked to make that very distinction.

The question put to him by a colleague in the erudite audience was this: “Some say there is no difference between ‘complete’ and ‘finished.’ Please explain the difference in a way that is easy to understand.”

Mr. Balgobin’s response: “When you marry the right woman, you are ‘complete.’ If you marry the wrong woman, you are ‘finished.’ And, if the right one catches you with the wrong one, you are "completely finished".

Balanced budget Almost fully recruited to 96FTE Meeting activity targets Meeting treat in turn KPI’s No long waits in all categories HRT exemplar for LOS No nursing leave liability Sick leave managed and decreased Improved professional profile of the

department

AS4187/2014 Mandatory Compliance - 2019 Logan 77% - as at Nov 2016 Redland 81% - as at Nov 2016

CED Operating Theatre Efficiency Guideline(based on QAO Audit of QLD Health Operating Theatres) Recommendations 5,6 & 7 - as at Oct 2016◦ Logan 12 met & 2 partially met◦ Redland 12 met & 2 partially met

CED Proposed Start On Time KPI

Late Start

Early Start

At the same time; - we are working toward NEAT (new D.O.S.A

preparation area being built)- we are working on the Surgical OPD targets- Undergoing accreditation for 2 sites- Implementing a new International Nursing

Quality Assurance framework

Set a clear meaningful and achievable Vision or goal for your service

Make that Vision central to all decisions Keep a focus on the Vision even when dealing

with competing priorities Don’t keep “resetting” the long term strategy”

reframe any necessary changes within your overall vision

Investment is required across the service to support the efficiencies in theatres.