With the 2015 deadline drawing closer, hospitals will need to refocus strategies and refine their methods to drastically improve performance on both NEAT and NEST.
So we recently interviewed four Australian health care leaders to discuss how they plan to achieve their NEST and NEAT targets:
Dr Chris May, Director of Emergency Medicine, Redland Hospital
Judy Willis, Principal Policy Analyst, NSW Ministry of Health
Dr Kathryn Zeitz, Executive Director Improvement, Central Adelaide Local Health Network
James Lind, Director of Access and Patient flow Unit, Gold Coast University Hospital
[CC] What are the biggest implications for you hospital of not meeting NEAT & NEST?
Judy Willis: The implications are not just about the financial rewards from NEST and NEAT but a lost opportunity to ensure that our systems and processes meet the requirements of our business. It’s about working more efficiently, ensuring that patient safety standards are met and hopefully a better outcome for patients.
Dr Kathryn Zeitz: The biggest implication is not for the hospital but for the patients. We know the longer the time spent in the emergency department the poorer the outcomes for patients. We also believe we need to increase the number of patients receiving their surgery within clinically recommended times.
Dr Chris May: The implications of not meeting NEAT and NEST include: new work contracts include KPIs around certain Health Service targets. Loss of incentive funding and Implications for accreditation.
James Lind: The biggest implication in my opinion is that the quality care of patients will be compromised as both NEAT and NEST are really surrogates of “wellness” of the hospital system. I am not aware, at an HHS level, of any financial penalty for not achieving this target.there is however at a system manager level, but unsure who this translate down to individual HHS at present.
[CC] What are the 3 most important strategies you will implement to ensure your institution can get the balance right?
- Getting patient flow right….not just surgical or medical but patient flow systems that are designed to get a result.
- Communication between departments/individuals. Understanding the impact on others of any change to delivering the service.
- Tackling the issues that have always been too hard. Cutting surgery is always the easy option but to tackle variations in LOS and practice for medical patients’ needs to be addressed.
Dr Kathryn Zeitz:
- We have to better understand capacity management and patient flow. Demand is predictable and capacity is manageable. A stronger knowledge base about capacity and demand for both the ED and inpatients is imperative to creating solutions that actually solve the problem.
- Clinical redesign is a key focus for us. We need to empower staff to change the way they work that results in putting the patient first.
- Finally, reducing time in ED and time in inpatient beds by reducing waste and delays, this not only includes reducing external delays i.e. disability patients and access to residential care facilities but internal delays such as access to diagnostics, transport, specialist consultation and the list goes on.
Dr Chris May:
- Opening a 10 bed SSU with expanded model of care
- Improving triage times
- Employing accelerated decision making (rapid assessment teams) and defined substreaming with allocated tams
It is a hospital wide initiative not restricted to single departments having single points of focus that deal with NEAT and NEST at the same time. We need good real time information and data to base decisions upon.
[CC] What are the biggest challenges you face when striving to achieve your hospitals targets?
Judy Willis: Budget and activity targets are not always compatible.
Dr Kathryn Zeitz: The greatest challenge is creating a culture where by the patient is considered first. The problem with targets is that staff don’t believe in a target but at the same time forget that target actually represents better care. People change, getting staff to change the way they think and act about patient flow is the greatest challenge.
Dr Chris May: There’s not enough inpatient beds or secondary services which means substantial transfers of patients, barriers to rapid admission processes and not enough resources to continue NEAT improvements.
James Lind: This is all about maintaining quality care of patients, the targets are surrogates of this.
Do you face similar challenges? We’d love to hear your thoughts.
These speakers will also be speaking at the upcoming Balancing NEAT and NEST Conference to be held on 25th & 26th February 2014 in Sydney.