Managing a busy hospital

No offense to Dot McKeen, but one thing I probably won’t miss when I leave CM Health is a ‘Dot Day,’ which for those of you who don’t know is an email that goes out from Dot, GM of Middlemore Central telling us the Hospital is full. Let’s face it no-one wants to get a Dot Day email, however, when it comes your way, it triggers a chain reaction activating people across the hospital and primary care into action.

The main aim of a ‘Dot Day’ is to help reduce the grid lock in ED and free up some beds so patients can be admitted. It’s quite a slick operation and requires clinicians to review potential discharges, follow-up referrals to other health care providers and transfer any patients waiting to go home to the Discharge Lounge. Additional orderlies are rostered on to help with transfers and our colleagues in primary care are called upon to look at their referrals to hospital services to help ease some of the pressure.

It’s like a well-oiled machine, designed to get everyone working together to make sure our patients continue to get the best care and experience. So my question is if everyone springs into action when the hospital is full, how can we embed this well-oiled approach to help reduce demand on a day-to-day basis?

A few years ago we launched our ‘6 Hours Can Be Ours’ campaign, which had the audacious goal of admitting, discharging or transferring 95% of patients from Emergency Care within 6 hours. While many people initially saw this as an ED initiative, its success for the past few years is due to a whole of system approach. From our cleaners to our doctors, people across the organisation could see how they made a difference to the patient experience and how bottlenecks around the hospital could have a huge impact on patient flow and ultimately patient care.

As we head into the winter months, it’s important that we use the lessons from the ‘6 Hours Can Be Ours’ campaign to improve patient flow. If you are a clinician and can get down to see your patients earlier so they can go home sooner, that’s a win-win for you and your patients. If you have a discharged patient taking up a bed while waiting for test results, why not send him or her to the Discharge Lounge. Maybe chase up that referral to see if your patient can be seen or transferred sooner.

The question we should be asking ourselves is if this was our loved one, what kind of care and service would we expect? Would we be prepared to wait several hours in ED because there was a bottleneck somewhere in the system? It’s up to everyone to make sure the patient journey keeps flowing.

If we work together we can improve the experience and care our patients receive, while improving our job satisfaction and morale. We can all go home at the end of our shift knowing we put our patients at the core of everything that we do.


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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