Use of workflow model in aged care leads to positive outcomes, project finds

The adoption of a workflow model widely used in the business world and acute care has brought about efficiencies and reduced adverse events in aged care, a consultant will tell the upcoming LASA National Congress.

The adoption of a workflow model widely used in the business world and acute care has brought about efficiencies and reduced adverse events in aged care, a consultant says.

A 26 per cent decrease in the rate of falls and a saving of $100,000 per month in reduced use of agency staff are among the benefits a large Western Australian facility has experienced having implemented a review and overhaul of its workflow procedures.

As part of an 18-month project funded by a Health Workforce Australia grant, the facility adopted Lean Thinking, an organisational model to optimise human work processes that developed out of a study of Toyota.

During the peak of the project, staff sick leave dropped by around 50 per cent and was maintained for the duration of the project, according to Pam O’Nions, a former registered nurse and consultant with healthcare advisory Qualitas Consortium, which was part of the project.

Ms O’Nions will tell the upcoming Leading Age Services Australia National Congress that the methodology, which was widely used in acute care but new to aged care, focussed on creating efficient workflow.

Pam O'Nions
Pam O’Nions

“The focus was on having staff working to the highest level of their qualification and skill,” she told Australian Ageing Agenda ahead of her presentation.

The project involved a review of scope of practice for all staff, workforce management within the facility, and collaboration between the facility and external agencies.

To that end the project involved working with St John Ambulance and the local hospital to enhance their relationship with the facility and their understanding of its capacity, and to improve resident transfers, Ms O’Nions said.

“We looked at all roles in the facility, making sure the care staff were working to the highest level of their competence and allowing the registered nurses and the enrolled nurses to focus on delegation, supervision and that higher level decision making.”

The project identified that, while the system at the site was designed so that “medication competent care workers” could administer medications, ENs were sometimes doing that work, which meant they were not working to their full capacity, Ms O’Nions said.

Similarly, a review of the ICT systems found that documentation processes were often inadvertently taking RNs away from client care.

Use of data

The project involved the extensive use of data, with baseline measurements taken in areas including adverse incidents, staff, resident and family satisfaction. Crucially, this data was shared with staff and families, Ms O’Nions said.

The analysis identified that a major expense for the facility was the use of agency staff related to unplanned staff absenteeism, while the highest clinical incidents were falls, particularly in the secure dementia area. Furthermore, a clear correlation between staff sick days and resident falls became apparent.

“That was the moment where quantifiably we could say to the staff, it’s you that makes the difference, it’s you who knows the residents, where they should be, if they have their walking frame, hearing aids or glasses on.

“Sick leave dropped by 50 per cent the next day and was maintained for the duration of the project, and has continued to remain much lower than previously. The agency costs reduced by $100,000 a month… there was an audited $700,000 saving in salary costs.”

In terms of lessons learned during the project, Ms O’Nions said it was crucial that all staff were engaged in the process, which was assisted by sharing data.

The LASA National Congress takes place from 11–14 October at Melbourne Convention and Exhibition Centre. 

Tags: bethanie, health-workforce-australia, LASA 2015, leading-age-services-australia, Pam O’Nions, Toyota,

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