A story of Service Enhancement: Our Healthcare Home Journey
Mauri Ora • A large general practice with 10,000 domestic and 2,500 international students • 10 FTE GPs, 10 FTE Nurses, 19 FTE Counsellors and 9 FTE Support Staff • Psychiatrist • Visiting Dermatologist • Health Coach • Health Improvement Practitioner (psychologist)
Before Healthcare Home……….. • Traditional GP Centric model • Under- utilised nursing workforce managing acute demand and task orientated • Wait times • Abandoned call rates • No capacity for on the day demand • Not achieving clinical quality indicators • Dysfunctional relationship with our Primary Health Organisation a major funder representing 40% of the Health Service’ annual income
What is Health Care Home? “ A patient centred approach which enables primary care to deliver a better patient and staff experience, improved quality of care, and greater efficiency ”.
THE FOUR CORE DOMAINS OF HEALTH CARE HOMES Improved access to general practice for patients Actively managed care for patients with complex health needs in partnership with our local hospital Facilitated expanded roles and a team based approach within the general practice team Future proofing general practice, fit for the future Valuing patients time and input
Urgent and Proactive Care Routine and Preventative Business Efficiency & Unplanned care Care Sustainability GP Triage of same Year of Care and/or Patient Portal Lean processes and day requests Shared Care Plan standardisation Extended hours of Multi disciplinary Team Patients involvement in Expanded team – PCPA, service care decision making Clinical Pharmacists, Nurse Prescribers Improved Community and Pre-work for planned Off stage space telephony (not Specialist Integration consultations missing requests for care) Other options to Longer planned Measuring patient HCH Implementation plan face to face consult appointments experience (e.g. telephone)
Urgent and Proactive Care Routine and Preventative Business Efficiency & Unplanned care Care Sustainability GP Triage of same Year of Care and/or Patient Portal Lean processes and day requests Shared Care Plan standardisation Extended hours of Multi disciplinary Team Patients involvement in Expanded team – PCPA, service care decision making Clinical Pharmacists, Nurse Prescribers Improved Community and Pre-work for planned Off stage space telephony (not Specialist Integration consultations missing requests for care) Other options to Longer planned Measuring patient HCH Implementation plan face to face consult appointments experience (e.g. telephone)
Longer planned appointments Off stage space especially for mental health What we had already Developing nurses to Phones off the started the top of their scope front desk Support team morning huddle
What we did ………………… Urgent and Proactive Care Routine and Preventative Business Efficiency & Unplanned care Care Sustainability ➢ ➢ ➢ Focused on our ➢ Workforce diversity No casual patients Stopped seeing casual registered patients patients focused on our ➢ ➢ Telephony Project Changed to a nurse registered patients ➢ Expanded our MDT led telephone ➢ ➢ Extended Hours meetings triage service Longer appointment times for complex issues ➢ ➢ ➢ Appointment planning Student participation Develop GP triage ➢ for peak times group Telephony Project ➢ Established nurse ➢ ➢ ➢ Room standardisation Tu Tumu Waiora led clinics Extended Hours project ➢ ➢ ➢ Team building and Developed Nurse Student participation ➢ Piki Tu Ora project resilience work Prescribing role group ➢ ➢ Supported staff training No non urgent and development walk ins ➢ Communication across the University
Extended Prioritised care hours for registered patients Nurse led GP triage telephone Same day triage requests service Establish Telephony W Nurse led Project What we are clinics doing now Expansion of Improved Nursing Roles IPIF targets Morning Monthly MDT huddles across meetings all teams Measuring patient experience
Routine Wait Time 18 16 A Year of 14 Improvement! 12 10 8 6 4 2 0
Contacts Per Month 7000 6000 A Year of Improvement! 5000 4000 3000 2000 1000 0
Dropped call rate by Month (%) 35.0% A Year of 30.0% Improvements! 25.0% 20.0% 15.0% 10.0% 5.0% 0.0%
Next Steps…… • Complete year of care shared care planning • Pre-work for planned consultations • More lean process and standardisation • Alternative options to face to face consultations • Patient portal
CHALLENGES AHEAD ………. ➢ Patient Management System ➢ Ongoing workforce diversification ➢ Youth Health Literacy ➢ Funding permanent positions ➢ DNA’s ➢ Sustained performance The future 2019
Questions ……
Recommend
More recommend