CCDM is a whole of hospital approach - and it’s delivering results
The Bay of Plenty District Health Board provides health services to around 215,000 people. Its annual revenue is $640 million, and in the last financial year it spent $1.75 million each day on health services for its community – funding over 39,000 acute and elective discharges and 60,000 ED attendances over 12 months.
Bay of Plenty DHB was one of the first to implement Care Capacity Demand Management (CCDM) in 2009, prompted by its close working relationship with the New Zealand Nurses Organisation.
As a pilot site it spent 18 months developing and testing its tools, including the ‘Hospital At a Glance’ screen that allows the entire hospital to see how well it’s functioning, and identify wards or departments that aren’t.
Bay of Plenty DHB has helped write the book on best practice for the programme, and CCDM is delivering results.
It is transforming Tauranga hospital – patients are having shorter stays in hospital, nurses and other medical staff are reporting greater satisfaction levels and the whole hospital is more efficient and effective.
The DHB says it has noticed a marked improvement in the amount of time nurses are spending with their patients, with the variance in time they are spending with patients (actual time vs projected time) reducing from almost 6% to around 2% in three years. This translates into improved efficiency and reduced risk of understaffing in busy periods.
It’s one of our key initiatives
Director of Nursing, Julie Robinson says CCDM is more than just a nursing programme – it’s a ‘whole of organisation’ approach to providing better and more efficient care to patients.
Bay of Plenty DHB helped develop the ‘Hospital at a Glance’ screen which allows all departments to assess in one glance how the entire hospital is functioning, using a traffic light system. It was based on Air New Zealand’s operation centre, and allows medical staff to make realtime decisions to move staff or resources to where they are needed most.
TrendCare is the computer system responsible for providing the data that runs CCDM. It measures patient ‘acuity’ (how sick a patient is) against staffing requirements.
Julie says they had being using TrendCare since 2002 to report on nursing hours, and the number of nursing hours required, but using CCDM complemented this and allowed them to make even more accurate projections
"Our entire organisation had to understand this isn’t just a nursing issue. That Ah Ha! Moment came about a year into the pilot project – realising the importance of care capacity management."
Little changes make big differences
Julie says after analysing the Hospital At a Glance screen, they realised having Emergency Department (ED) staff help out in the acute medical ward for an hour or two each morning sped up hand over and transition of care before the ED got too busy.
"Prior to this there was a belief we would need ED staff in the ward for up to eight hours a day to make a difference. But what we found from doing this work was that an hour or two in the morning can be incredibly helpful and get staff, patients and the ward into a more steady state”.
Using the Mix and Match component of CCDM they were able to see they had too many nurses in the Assessment, Treatment and Rehabilitation Ward overnight and not enough during the day by looking at the pattern of work, and the type of work being done.
TrendCare allows staff to accurately provide the required staffing for the type of patients in each ward.
"That was really useful information for wards to have – to change our staffing patterns. Another thing we did was start our healthcare assistant half an hour earlier so hand over was done sooner. There’s been a load of little gains along the way.”
And all of this means even better services for patients. Julie says their patient satisfaction rate sits in the low nineties, and they tell staff they think the hospital runs well It’s the little things for patients that really matter.”
CCDM helps nurses deliver the right care, at the right time to the right patients.
Improving the DHB’s bottom line
CCDM has meant Tauranga Hospital hasn’t had to increase the number of commissioned beds since 2008 – but they have increased the number of patients they are seeing.
Julie says they had built an additional three wards to accommodate future growth in patients, but have been able to delay opening them since they started using CCDM.
This has been achieved by a reduction in the Length of Stay for patients, meaning fewer beds are needed.
A shorter length of stay for patients can be achieved when a hospital is working in its most efficient state, and there are fewer delays for patients to receive tests, scans or treatment.
“The Operations Centre lets us look at patients of length of stay outliers (those who are staying longer than expected for their case type) and we’ve had a particular focus in the operations centre on reviewing those to see how we can manage them better” says Julie.
The DHB estimates CCDM has helped it save $436,000 in the 2011/2012 year – and that’s a conservative estimate.
The environment is also safer for patients – since the introduction of CCDM there has been a reduction in harm from falls, and the standardised mortality rate.
The future with CCDM
Julie says in today’s world, DHB’s need to work smarter. When it comes to deciding whether or not to implement CCDM, she says ‘Why wouldn’t you?! Everybody wants to have staff who enjoy their work. Everybody wants safe patient outcomes and we all want to have efficient organisations”.
CCDM ensures health providers are using real data to inform the drive for evidence-based practices
“The fundamental thing is that you have to look at the patients, patient acuity and the work load required to care for patients. That’s fairly crucial in the whole concept. If you’re looking for an evidence-based process, this is extremely helpful. Plus there’s all the knowledge built up from all the places doing it along the way. As a sector, let’s learn and use that knowledge to make the whole sector better.”