Appendix 3 - 1
MidCentral Hospital & Specialist Services 90-day action plan:Q1 2024/25
1
Acute flow Relevant plan: Acute Flow Improvement Plan
RELEASED UNDER THE OFFICIAL
Focus for Q1 24/25
Actions and timeframes
Rationale
Measures of success
Responsibilities
RAG Rating
(b) Reducing average length
•
Finalise
standard operating procedures re holding orders, which enable the safe transition of eligible patients from ED to
MidCentral’s hospital flows when hospital
•
Reduction in average length of stay.
Actions are ultimately owned by
of stay in hospital.
inpatient beds in advance of/until formal admission is completed by the relevant speciality (NB: research shows that holding
occupancy is between ~92-95%. Ensuring
•
Reduction in time from ED referral to
Hospital & Specialist Services’
orders are associated with a decrease in length of stay, without increase in measures of under-triage [admitting patient to
occupancy remains in this range requires
ward transfer.
Group Director of Operations for
ward bed when higher care is necessary] or over-triage [admitting patient to ward bed when discharge from ED is
reducing patients’ length of stay, to the
•
# of patients transferred under holding
MidCentral.
appropriate) (August).
extent appropriate.
orders.
•
Work with the
national Clinical Leader for Acute Care to identify further opportunities to reduce inpatient length of stay (eg
•
Increase in SSED for admitted patients.
Execution of actions is
use of ‘waiting for what’ procedure to identify and escalate discharge blockers) (August).
principal y supported by
Hospital & Specialist Services’
(a) Improving timely
•
Ramp up the
‘2 before 10’ initiative, which requires inpatient wards to identify 2 x patients suitable for discharge before the
Bringing forward MidCentral’s average time
•
Reduction in average time of day
Delivery Unit.
discharge from inpatient
start of the next (morning) shift and discharge them by 1000 (July onward).
of day discharge, and increasing the rate of
discharge.
hospital wards.
•
Ensure that clinicians are
rounding on patients suitable for discharge first to speed up discharges (unless there are
weekend discharging, is critical to freeing
•
% discharges before 1000.
Support wil also be provided by
medical y unstable patients that need to be attended to) (July onward).
up inpatient beds for patients to ‘flow’ into.
•
Increase in weekend discharge rates.
Service Innovation &
•
Institute
criteria-led discharge for inpatient specialties, with specific focus on use during weekends (August).
•
# of patients discharged via criteria-
Improvement.
•
Build
operational cadence to drive performance improvement.
led discharge.
•
Create a
discharge lounge to assist in the flow of patients identified for discharge that day (September).
•
Utilisation of discharge lounge
Specialist support wil be
•
Create opportunities for
Early Supported Discharge (September).
provided by Jo Gibbs.
(c) Diverting and discharging
•
Increase
use of ED redirects, such as issuing practice plus (same day, after hours service) vouchers (July onward).
Reducing pressure on MidCentral’s ED via
•
% of ED redirects.
patients direct from ED.
•
Trial the use of a
Nurse Practitioner with the ED wait room to run a ‘fast track’ (ie assist with treatment and discharge of low
safe redirection of patients to alternative
•
# of patients discharged from ED via
acuity patients) (July).
care settings frees up capacity to treat and
fast track.
•
Extend ED
work area out of hours into fracture clinic to enable improved treat and discharge performance.
discharge patients direct from ED and
•
Increase in SSED for non-admitted
•
Complete the
Children’s ED build and progress associated model of care.
attend to patients requiring admission in a
patients.
timelier manner.
2 Clinical leadership & culture Relevant plan: Culture Improvement Plan
Focus for Q1 24/25
Actions and timeframes
Rationale
Measures of success
Responsibilities
RAG Rating
(a) Setting clear
•
Execute
communications strategy about MidCentral’s values and expectations of staff re how these are embodied via
Embedding values-led behaviour at
•
Increase in staff engagement with
Actions are ultimately owned
expectations about values-
workshops, regular updates, and 1:1 meetings (from July).
MidCentral is foundational to facilitating a
communications products. (eg weekly
by Hospital & Specialist
led behaviour: bringing Te
•
Create a
values-led leadership toolkit for people leaders, which includes practical examples of ‘how to say yes’, and ‘if the
shift in culture – wherein ‘culture’ signifies
newsletters, intranet stories, videos)
Services’ Group Director of
Mauri a Rongo (the Health
answer is no – how to have that conversation, and why it matters’ (July).
how values are embodied through
•
Staff engagement in workshops (NB:
Operations for MidCentral.
Charter) to life.
•
Require al staff to complete a new national
eLearning module on Te Mauri a Rongo (from July).
practices, process, and relationships.
mandatory for people leaders).
•
Majority % of staff having completed
Execution of actions is
eLearning module on Te Mauri a Rongo.
principal y supported by People
•
Improvement in relevant Ngātahitanga
& Communications’
INFORMATION Pulse Survey scores.
Organisational Culture and
Development Team.
(b) (Re)establishing trust
•
Close the loop on the Feb 2023 Culture and Climate Review by communicating its findings and resultant/subsequent actions
Changing MidCentral’s culture requires
•
Improved RMO and SMO engagement
with medical staff.
with the medical workforce and unions (July).
buy-in from the medical workforce.
via strengthened communications
Support wil also be provided by
•
Strengthen channels for
meaningful engagement with RMOs and SMOs to ensure open, two-way communication with
MidCentral must demonstrate that it has
channels.
the Chief Clinical Officer, and
leadership, and that information is received in a timely, direct, and appropriate way (from July).
heard their concerns, and that it’s taking
•
RMO and SMO participation in peer
Interim Chief Wellbeing Officer.
•
Establish
regular support mechanisms for RMOs and SMOs, including monthly online drop-in peer support groups, regular
action accordingly.
support groups.
topic-specific sessions (eg on dealing with pressure, stress, and burnout), and using external providers for confidential,
•
RMO and SMO attendance at support
Relevant unions (eg Association
individual support needs (including profession-specific counselling services) (from July).
sessions.
of Salaried Medical Specialists)
•
RMO and SMO uptake of external
wil be engaged throughout.
support services.
•
Improvement in relevant Ngātahitanga
Pulse Survey scores.
(c) Building psychological
•
Launch the
Up Speak programme to enable staff to resolve interpersonal difficulties and address poor behaviour on the
MidCentral needs to build an environment
•
Rollout of Up Speak programme.
safety across the
ground, in real-time, supported by relevant training (eg active bystander workshops) (August).
where everyone is accountable for their
•
Positive feedback on staff
organisation.
•
Create
new pathways for resolution of grievances and employment-related issues, encouraging issues to be resolved
behaviour, and were speaking out about
implementation of Up Speak strategies.
without escalation (where appropriate), via restorative options, or outside of MidCentral (as necessary)(August).
unacceptable behaviour is actively
•
Establishment of resolution pathways.
ACT (1982)
encouraged.
•
Staff utilisation of new resolution
pathways.
•
Improvement in relevant Ngātahitanga
3
Pulse Survey scores.
Quality & safety Relevant plan: Quality and Safety Improvement Plan
Focus for Q1 24/25
Actions and timeframes
Rationale
Measures of success
Responsibilities
RAG Rating
(a) Reducing the number of
•
Institute
Standard Operating Procedures re patients who wait >24 hours in the ED, wherein such patients must be prioritised
It’s unacceptable to have patients waiting
•
Reduction in # of patients waiting >24h
Actions are ultimately owned by
long-waiters in the
for the first bed that becomes available, an incident report must be completed, and a debrief must take place at the morning
in ED for a significant period of time
in ED.
Hospital & Specialist Services’
Emergency Department.
meeting (July onward).
without clinical justification. Setting clear
Group Director of Operations for
expectations that this situation won’t be
MidCentral.
tolerated is imperative.
Execution of actions is
principally supported by the
(b) Agreeing MidCentral’s
•
Conduct a
clinically-led review of MidCentral’s current model of acute care with relevant clinicians, via a facilitated-process
MidCentral’s clinical pathways for acutely
•
Establishment of clear clinical
national Clinical Leadership
current, and future, models of
(July - August).
il and deteriorating patients are not well
pathways for ED, CCU, HDU, and ICU.
Team.
care for acutely il and
•
Establish
clear clinical pathways for the ED, Coronary Care Unit, Higher Dependency Unit, and Intensive Care Unit, and
defined. Reaching consensus among
•
Agreement of associated
deteriorating patients.
corresponding clinical governance mechanisms (September).
clinicians is critical to ensuring safe
responsibilities and processes.
Specialist support wil be
•
In concert with the aforementioned clinical pathways, agree the
purpose of each department/unit, staff
roles and
management of such patients and
•
Increase in appropriate use of units
provided by Dr Andrew Connolly.
responsibilities,
referral processes, and
points of communication within and between teams and services (September).
achieving hospital flow.
(eg having no patients discharged
from direct from ‘higher care’ units).
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