Derwent Valley Medical Centre – small changes lead to big improvements in patient access to care

Events

Derwent Valley Medical Centre joined the APCC Program to learn about implementing new systems that would help improve patient access to care. they successfully tested and implemented ideas they learnt through attending APCC workshops. The team  now has a greater focus on shared learning, improving team skills and strengthening partnerships with other health services within their division.

Location: New Norfolk, Tasmania.
Staff: 7 GPs (3 full time, 4 part time), 4 practice nurses (2 RNs, 2 ENs), 4 administration staff and  a practice manager.
Patients: At commencement of the Program (October 2008) there were 5,812 active patients, which has grown to 6,610 (May 2010).
Goal: To implement new systems in the health service which allow for more timely access to GPs and decrease unmet demand.

Background

Derwent Valley Medical Centre (DVMC) provides 90% of their primary healthcare to the Derwent Valley and surrounding areas, including patients at the local aged care facility. Visiting specialists include a psychologist, exercise physiologist, podiatrist, diabetes educator, urologist, as well as pathology services. The local hospital, New Norfolk District Hospital, is nearby with allied health services and community nursing available at the hospital.

Process

The challenge for the staff at DVMC was to undertake small, manageable and achievable changes that could result in improvements to their systems of care, in order to improve their patients access to care.  Attending APCC workshops gave the practice nurses the opportunity to see that other health services shared similar issues with access to care.
They were also able to hear how other health services had made improvements – by taking small, manageable steps towards a larger overall goal.
At the health service, the team developed an appointment advice fact sheet (included below), based on the ‘12 minute slip’ resource seen at one of the APCC workshops. The fact sheet included information about:
• the time allocation for a standard appointment
• booking a longer appointment and when this would be appropriate, and
• DVMC’s reasons for implementing this new process.

The fact sheets were printed on coloured paper, laminated and placed on each chair in the waiting room, with the aim that patients would read the sheet while waiting for their appointment and then leave it on the chair for the next patient to read.
Patients provided positive feedback about the appointment advice fact sheet and reception staff noted an improvement of patients respecting the demands on doctors’ appointment times. The staff at DVMC also tested and then implemented the ‘traffic light’ system, another idea learnt at an APCC workshop. The ‘traffic light’ system works by coding each GP’s availability at the beginning of each day, so reception staff can book appointments accordingly.

The coding is as follows:

• RED – Can this patient see another doctor if this visit is not for a follow up.
• YELLOW – Book with caution, offer an alternative doctor.
• GREEN – These Doctors are available for booking.

A sign is displayed in the waiting room notifying patients of this system so they understand why they may be prompted to book in with an alternate GP.

Outcomes

Through their involvement in the APCC Program, DVMC has had the opportunity for their staff to pause and review their systems of care.

Specific outcomes include:

  • Nurse roles have expanded – the nurses have taken on a leadership role within the health service. They now complete Health Assessments, GP Management Plans and 4yr old Health Checks, in addition to running nurseled immunisation clinics.
  • Improved access to GPs and fewer appointments running overtime, which is largely attributed to the increased patient awareness of consult times and the need to make a double booking for multiple problems.
  • There is a stronger focus on improving team skills, a greater understanding of individual staff roles and improved communication. The team have shared what they have learnt from involvement in the Program with other Collaborative participants through regular gatherings over dinner, facilitated by their Division; General Practice South (GPS).
  • The practice nurses also pass on information and resources they have been exposed to through the Program to health services not directly involved, through Practice Nurse Network meetings, facilitated by GPS.
  • The health service value the ability to track how they are performing by collecting data and analysing it on a monthly basis. The benefits of measuring improvements are both tangible – statistics provide good evidence upon which to base future decisions; and intangible – improved communication and the confidence to deal with issues that affect the health service.

Achieving these outcomes has meant better outcomes for patients, a happier working environment for staff and doctors and a more sustainable health service

At the 2010 bi-annual Quality in Practice awards, DVMC was presented the ’2008 Australian General Practice Accreditation Limited (AGPAL) Practice of
the Year’.

Looking Forward

Using quality improvement skills and tools learnt through the Program and ideas ‘borrowed’ from their peers, DVMC will continue to test changes to make improvements. DVMC also plans to continually strengthen their relationships and networks with other health services and their Division.

Conclusion

The team at Derwent Valley Medical Centre successfully tested then implemented two initiatives for improving access to care at their
health service. These two simple changes made a significant improvement in patient access to care. The team is focused on continuing the APCC philosophy of sharing ideas, strengthening team work and collaborating with other health services in their Division.

“Involvement in the Program helped us to recognise where there were opportunities for improvement. There will always be room for improvement as systems change
on a daily basis, but we now feel that we have a better team approach to make the necessary changes.”
– Annette Tomkinson, Practice Manager

Level 5, 19 Grenfell St Adelaide SA 5000
PO Box 3645 Rundle Mall SA 5000
ABN 21 122 939 299
www.improve.org.au

T +61 8 8422 7400
F +61 8 8231 6690
Toll Free 1800 771 522
E enquiries@improve.org.au

The Australian Primary Care Collaboratives Program is funded by the Australian Government Department of Health and Ageing and delivered by Improvement Foundation Australia © Improvement Foundation 2010

YOU MAY HAVE NOTICED AT TIMES WE RUN LATE…….

Being late is annoying for patients and stressful for staff and doctor.
We are keen to fix our continual lateness. One of the problems is that our consultations are running over time.
Just 4 Minutes extra per consultation means that the doctor is 1 Hour late at the end of the morning!

You can help by….
1. Being aware that your time with the doctor will be about 12/15minutes
2. Being understanding if the doctors suggests you come back to address remaining issues. (perhaps make a list to share with the doctor, ask our reception staff for a pad and pen)
3. Understanding that a ‘fit in’ appointment is for really urgent ‘can’t wait’ conditions on the day, and deal Only with that One Urgent problem.

Thank you for taking the time to read this slip, we look forward to your co-operation in this matter

DERWENT VALLEY MEDICAL CENTRE

 

February 26, 2014

IMPROVEMENT FOUNDATION
Level 8, 19 Grenfell St Adelaide SA 5000 | PO Box 3645
T: (08) 8422 7400 | TOLL FREE (within Aust): 1800 771 522 | F: 08 8231 6690 | E: enquiries@improve.org.au

The Improvement Foundation acknowledges the Traditional Custodians past and present on whose land we walk and we live.

TQCSI Quality Certified
ISQua