Saving 20,000 Days

Earlier this week I sat in on the third Learning Session for 20,000 Days. As you know, this campaign is aimed at reducing the demand on our hospital by giving back 20,000 well and healthy days to the community by July 1 this year.

The learning session was a great opportunity to bring the teams involved in the 13 intervention areas together to reflect on their progress. As I listened to the presentations, I was struck by the connections that have formed between people involved in the campaign. Groups with natural affinities have begun working together to find common ground and share the benefits of what they are doing.

Speaking at the third learning session
Acknowledging “good collaborative work” at the third learning session

One of the best examples of this is the work of the SMOOTH and Transitions of Care teams. The Transitions of Care team has been working to improve discharge planning and transitions of care across the hospital and the community, resulting in shorter stays in hospital with better outcomes. Meanwhile SMOOTH (Safer Medicines Outcomes on Transfer to Home) have been providing plans for high risk people on how to manage their medications at home, preventing re-admissions to hospital. It just so happens that the work that the Transitions of Care team has been completing to set Goal Discharge Dates for patients really assists the SMOOTH team with prioritizing their medication planning. Goal discharge dates are just that – a discharge date set at a patient’s admission to enable all teams to plan ahead and ensure that a patient receives all the care they require without unnecessary hold ups. Through participation in 20,000 Days, the SMOOTH team have been able to capitalize on this innovation. Where previously they had almost been taking a ‘stab in the dark’ approach as to which patient to see first, they are now able to prioritize patients based on the expected Goal Discharge Date.  It’s really heartening to see this collaboration happening spontaneously and teams working together to improve the care we deliver. A real win-win situation.

The other impressive thing that struck me from my time at the learning session was the almost tangible sense of excitement in the air that comes from bringing together enthusiastic people and empowering them to make change happen. There was a real energy and buzz in Ko Awatea’s lecture theatre, and people were genuinely excited to be working out how to improve experiences for our patients. Our approach through 20,000 Days has been to train our staff and build a cohort of people who are experienced at using the tools of improvement science. The spin-off effect is that the skills are reusable and can be applied in other areas outside the campaign. It’s a sustainable solution to some of the problems facing healthcare globally and speaks to that wise proverb: Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for life.

The sum total of our efforts through the 20,000 Days Campaign is that we have saved 15,533 bed days (to February 2013). This is a magnificent achievement, without which Middlemore Hospital would have undoubtedly seized up, especially during the harsh winter we had last year. Our key indicators, such as length of stay and admissions, are also all coming down to the levels we were seeing a few years ago (check out the campaign webpage for more information/data). It can often feel like change happens incredibly slowly in health and that improvements take years to bring about. This time, however, thanks to the efforts of everybody across the system, I really do feel that we are not just stopping but actually beginning to turn in a new, and very promising, direction.

Of course, the most important benefits of a campaign such as this one are for our patients and their family/whaanau. It’s all very well talking about bed days – a currency we all understand in healthcare – but what does this actually mean for patients experiencing our system, or their family/whaanau who are looking after them? Dr David Grayson, the Clinical Lead of 20,000 Days, was telling me earlier about a Counties Manukau family who bumped into someone from the VHIU (Very High Intensive Users) team while they were in Middlemore Hospital recently. The grandmother of the family had had several admissions to Middlemore until the VHIU team got involved as part of 20,000 Days. With the team’s help, the family were able to manage their grandmother’s condition much better at home. Though she has now passed away, they were so grateful for the wrap around service and the opportunity to care for her in the comfort and familiarity of their own home. In another real life example, also involving the VHIU team, a patient went from not attending half of his outpatient clinics to 100% attendance and the successful completion of much-needed toe surgery. Thanks to the team’s intervention, he is now aspiring to use a manual wheelchair, play the guitar again and regain the ability to go out when he needs to. As important as it is for us to save bed days and reduce demand on our hospital, it is stories like this that really convey to me the enormous value of what we’re doing for everybody involved.

As we approach July 1, we’re on track to achieve our 20,000 days saving but can by no means rest on our laurels, especially with another winter looming. It’s still really important that everybody continues to focus on the contribution they can make and, like the SMOOTH and Transition of Care teams, works together to maximise savings across the system. Meanwhile, we are looking to select projects for Phase 2 of the campaign, which will aim to save another 20,000 days from July 1 onwards. We will be holding a ‘Dragon’s Den’ style panel to pick projects that we think will have the greatest impact on bed days. Some of the work that has been completed this year will also become business as usual as we continually strive to deliver increasingly high quality care.

Like many of you, I’m looking forward to the weekend, in my case to watch Wales take on England in the Six Nations decider at Cardiff Arms Park. It will be an amazing game with a brilliant atmosphere, and if Wales win the pubs will run dry. It is, however, slightly unusual for me to contemplate watching a Six Nations game on what will probably be a sunny Sunday morning in my shorts. For years, I’ve been watching this tournament during cold winters and something doesn’t feel quite right!

Geraint

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Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

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