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#FixIt: The Ryde Hospital Fracture Clinic Redesign Project

Project Added:
19 July 2016
Last updated:
19 August 2016

#FixIt: The Ryde Hospital Fracture Clinic Redesign Project

Summary

Ryde Hospital refurbished its Fracture Clinic, developed an information sheet for patients and created a streamlined model of care, to reduce waiting times and improve the patient experience.

View a poster of this project from the Centre for Healthcare Redesign graduation, August 2015.

Fixit poster

Aim

To improve the satisfaction of patients and carers attending the Fracture Clinic at Ryde Hospital by 25% within 12 months.

Benefits

  • Improves patient satisfaction and waiting time.
  • Educates patients on what’s involved in a visit to the Fracture Clinic.
  • Provides a more comfortable waiting area for patients and their carers.
  • Improves the use of hospital resources.
  • Improves staff satisfaction, through well-designed workspaces and patient flow.  

Background

The Ryde Hospital Fracture Clinic is an outpatient orthopaedic service that typically sees 80 patients each Friday afternoon. Demand has continued to increase over time, with a 150% increase in patient numbers since 2012.

The Fracture Clinic requires a significant use of hospital resources, including 15 staff members across multiple disciplines for approximately five hours per week. Many of these staff need to manage Fracture Clinic patients in addition to their regular workload, such as radiologists who are required to perform x-rays and scans for clinic patients in addition to inpatients and those in the Emergency Department.

An audit conducted in October 2015 found the average waiting time in the Fracture Clinic was 81 minutes. A satisfaction survey of 99 patients and carers at this time found only 47% of patients were ‘very satisfied’ with the service provided, with several complaints received by clinic staff. The key reasons for this dissatisfaction were long waiting times, a poor clinic environment and no explanation of what was involved in a visit to the Fracture Clinic. The ineffective booking process and lack of clinic governance also caused dissatisfaction and reduced morale among staff in the Fracture Clinic.

To address these challenges, the #FixIt project was established to improve the clinic environment, reduce waiting times and improve patient flow. It was anticipated that improving the efficiency of the clinic would also reduce its impact on other areas of the hospital during clinic times, such as radiology services.

Implementation

  • A Clinic Manager was appointed, to take responsibility for the overall coordination and operational management of the Fracture Clinic.
  • The appointment booking process was refined, with implementation of electronic bookings, appointments for specific areas and a better spread of appointment times.
  • The patient journey was mapped and a streaming system developed, which allows patients to avoid having to wait for services they may not need.
  • A patient information sheet was developed, to educate patients on what to expect at the Fracture Clinic prior to their appointment.
  • The waiting room was refurbished, with broken and worn-out equipment replaced and maintenance conducted on the lift and air-conditioning. New curtains, waiting rooms chairs and a TV were installed, with magazines, drinking water and footrests for patients with lower limb ailments provided.
  • A Clinic Concierge was appointed, to answer patients’ questions and help them with directions during clinic times.

Project status

Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Key dates

1 August 2015 – 31 December 2016

Implementation site

Ryde Hospital, NSLHD

Partnership

Centre for Healthcare Redesign

Evaluation

A full evaluation will be conducted in December 2016, with measurement of the following outcomes compared with baseline results obtained in October 2015:

  • patient waiting times
  • patient and carer satisfaction levels
  • completion and use of patient streaming system
  • number of patients who receive the information sheet prior to their appointment
  • workplace attendance rate of the Clinic Concierge.

Lessons learnt

  • Stakeholder involvement at every phase of the project is important. There are always more stakeholders than initially expected, so creating stakeholder maps with input from as many people as possible will help identify all relevant stakeholders.
  • People tend to present solutions in the diagnostics phase and diagnostics in the solution design phase. An assertive leader with a clear idea of objectives is very useful when running sessions with stakeholders. Careful recording of information by the team will capture great ideas, even if they arise at unexpected times.

Further reading

  • NSW Agency for Clinical Innovation. Specialist Outpatient Services Framework Draft. Sydney: Ministry of Health; 2015.
  • Maister D. The Psychology of Waiting Lines. In: Czepiel J, Solomon MR, Suprenant C, editors. The Service Encounter. Boston:  D.C. Heath and Company, Lexington Books; 1985.
  • Stewart D, Lee K et al. Hornsby Hospital Fracture Clinic Project. Sydney: Hornsby Ku-Ring-Gai Hospital, Northern Sydney Local Health District; 2015.

Contact

Cayley Smith
Acute Physiotherapy Team Leader
Ryde Hospital
Northern Sydney Local Health District
Phone: 02 9858 7558
Cayley.Smith@health.nsw.gov.au

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