Patient Management Task Force

Project Director - Mr Geoff Lavender

Welcome to the Home Page of the Patient Management Task Force. Here you will find information regarding the Task Force activities.

Project Overview

The last two years have seen a significant increase in demand pressures on the public acute health care sector. These pressures have been strongest in the metropolitan health services, but the phenomenon is common to many advanced health systems both in Australia and overseas. In Victoria, this was reflected in an increase in elective surgery waiting lists in 1998-1999 as the system responded to emergency demand by containing elective surgical effort. In 1999-2000 there were further continuing system-wide pressures on access through emergency departments and on waiting lists. Despite targeted growth funding in sub-acute services and other alternatives to hospital admission in 2000-01, system stress has continued as measured by 12-hour waits for emergency admissions and ambulance bypass. Efforts to understand the causes of these issues (and to identify solutions) have become increasingly clouded by the emergence of a range of sometimes conflicting anecdotal evidence.

Numerous factors have been put forward as contributors to these issues. In many cases, there is very little evidence supporting such assertions, no matter how plausible any of them may appear to be on the surface. They include:

• advances in technology allowing more treatments to be provided to older and sicker people than has ever been possible in the past
• increasingly sophisticated consumer and provider expectations in relation to treatment availability and its application
• a reduction in the availability of general practitioners for home visits and out of hours care
• a reduction in the number of aged residential care places available to meet demand and/or a geographical maldistribution of these places
• a growing tendency for nursing homes to transfer unwell residents to hospital emergency departments rather than make use of alternatives to hospitalisation
• the potential for over-treatment of this nursing home group because of poor information about previous medical history and prognosis
• societal changes which have effectively reduced the capacity of the informal carer network in the community
• inadequate recognition of the importance of sub-acute care and rehabilitation alongside the continuum of acute care
• the structure and educational background of the health workforce which may not have kept pace with changing care options
• increased workplace stress
• inefficient in-hospital patient management processes which lead to patients unnecessarily occupying hospital beds when (at least) equally effective alternatives may be available

Evaluating, testing and acting on these possible contributing factors requires further analysis, planning and strategic development at the individual health service, State Government and Commonwealth levels in the medium and longer term.

Against this background, a Patient Management Task Force was established to undertake a short focused review of patient management practices across the metropolitan public health care system. This group was set up not just to gather data, but also to contribute to achieving change.

The project incorporated:

• a systems approach to reviewing current patient management practices and processes across the health sector
• a collaborative approach that involved wide consultation with stakeholders, particularly clinicians and health service management through their representative bodies
• an action oriented model of review that provided short and medium term strategies for change

The Task Force identified essential patient management practices across the metropolitan public health care system, identified and prioritised areas of improvement, and made recommendations on measures (including incentives) to support the necessary change in practice and enable ongoing monitoring.

The project can be considered as having two major dimensions:

1. to identify essential bed management processes and practices. Key features of this were a comprehensive analysis of data and information from the major metropolitan public hospitals in relation to bed management processes, including decision criteria across all care-types.
2. to identify patient management systems across the metropolitan public health care system and disseminate key learnings . Key features of this included utilisation of the EQuIP standards approach to ensure all areas of the continuum of care were reviewed.

The project had a principal focus on 11 metropolitan hospitals. These were:

• The Alfred Hospital (Bayside Health)
• Austin and Repatriation Medical Centre
• St. Vincent's Hospital
• Royal Melbourne Hospital (Melbourne Health)
• Monash Medical Centre/Dandenong Hospital (Southern Health)
• Frankston Hospital (Peninsula Health)
• Box Hill/Maroondah Hospitals (Eastern Health)
• Western Hospital (Western Health)
• Northern Hospital (Northern Health)

The project outcomes included:

• the preparation of papers that identified specific areas of essential practice
• the evaluation of existing key performance indicators in relation to patient management
• the documentation of effective incentive schemes and other system supports
• an identifiable contribution to system awareness of, and focus on, sustainable changes to patient management across the public health sector.

Updated 1 December 2001

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