Australia’s health needs are growing and changing. This has been a trend since before COVID-19, and while the pandemic has certainly exacerbated demands on the healthcare system, it’s not the only factor creating more pressure.
People living in Australia are facing less access to bulk billing in primary care and a simultaneous increase in costs of living, risks of developing chronic health issues, and many community groups experience inequities when it comes to accessing healthcare.
While this is happening, each state and territory are also challenged with the task of getting on top of healthcare workforce shortages and burn out, ambulance ramping, a growing population in general, climate crises and more.
Healthcare providers need to continuously evolve in order to meet the needs of changing presentations in patients and remain accessible. It is not enough to be maintaining the status quo.
Investing in and practicing improvement science is one of the most practical ways for healthcare providers to do this.
What improvement science is and why it’s important
Quality improvement (QI), or improvement science, is part of one of the longest standing and commonly used management frameworks across health services in Australia and globally. QI enables health services to deliver services that are safe and efficient, and to maintain their accreditation in the 8 national health standards.
While QI has similarities to lean, six sigma, human centred design, a unique application to healthcare is the Jurian triangle which entails quality planning, control, improvement.
Quality planning entails strategies, frameworks and capabilities, quality control ensures clinical governance structures and activities are in place while quality improvement supports this by both addressing any issues and running continuous improvement activities.
The Jurian Triology visualising how the 3 quality areas work together over time. Source: Jurian Triology
How teams run improvement projects
Quality improvement projects or initiatives typically run as a series of methodical phases; Plan, Do, Study, Act (PDSA) cycles, similar to design sprints. It incorporates partnering with stakeholders impacted by a service (whether they deliver or support delivery of a service, or receive it and/or care for someone receiving it) to complete co-planning, co-design and co-evaluation.
Improvement projects also use quantitative data that can be gathered about a system and service which often results in artefacts such as process maps and identifying seasonal or patient cohort variation.
The PDSA phases generally follow setting objectives (Aim statements), running tests, gathering and analysing the data (using tools such as run charts), and creating recommendations and actions based on results and insights. The cycle then repeats as many times as is needed and is feasible.
This process is very similar to running design sprints in service design, though uses different terminology and tools. Common tools used in Improvement science include
- Aim statements
- Run charts
- Fishbone diagrams, also known as cause and effect diagrams
- Driver diagrams
- Process maps
Improvement project case studies
Education package and procedural changes: improving lumbar puncture success rates in febrile neonates in NSW (The Children’s Hospital at Westmead, 2017)
- Lumbar puncture is a procedure used especially in emergency settings to rule out meningitis in newborns (you can read more about it in this journal article by the researchers and improvement specialists who led the project)
- The project looked at changing procedure details such as equipment used and positioning of equipment as well as staff education
- Went through 2 PDSA cycles over 6 months. Based on feedback, the team changed part of the equipment used in procedures and the related education content from the first and second cycle.
The project resulted in an increase in success rates of the procedure, which in turn impacted distress levels in the patient’s families and carers. The team developed a teaching package for clinical staff and gained insights for running future improvement projects and delivery of education packages
More about the project and Journal article
New triage pathway
Nurse and allied health led triage of patients referred to functional gastrointestinal disorders clinic in VIC (Alfred Health, 2018)
- Functional Gastrointestinal Disorders Clinic at Alfred Health designed a new triage pathway to reduce wait times for patients and improve patient experience
- Symptoms of irritable bowel syndrome (IBS) are growing within Australia, as is bowel cancer in young people globally
- Through design and testing iterations and better understanding the patient cohort’s needs, the clinic was able to improve patient engagement by going from paper to digital questionnaire delivery, 1:1 to group sessions and more
- Design features: support lines, group education sessions
The project outcomes were lower wait times and more patients seen, improved patient experience, education and outcomes, more treatment options, reduced cost per patient. More details about the project
Outcomes
Comparison of clinical activity under old
Number of new patients seen
- 2017: 216
- 2018: 594
- Change: 175%
Total number of patients seen
- 2017: 628
- 2018: 926
- Change: 47.5%
Total number of patient occasions of care
- 2017: 1,358
- 2018: 2,482
- Change: 82.8%
Table of patient number increases from the Project Summary Document downloaded via overview on Safer Care Victoria
The current QI practice in Australia
States and territories in Australia have regulatory agencies who provide wealth of resources, education and facilitation support for healthcare providers in their jurisdiction, such as the Clinical Excellence Commission in NSW, Safer Care Victoria and Clinical Excellence Queensland. Many healthcare services have improvement advisors and teams.
How Dort can help
Healthcare providers can seek guidance from external consultants, such as Dort. Partnering with external stakeholders has advantages as at Dort, we’re able to take an outside perspective and then embed ourselves within your team. We can offer coaching on the improvement process and/or work with you to assess the challenges, identify the causes and implement changes.
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