Using governance and patient flow strategies to improve healthcare service efficiency
Amanda Kivic A B and Laureen Hines AA Healthcare Improvement Unit, Clinical Excellence Queensland, Department of Health, Queensland Health, 15 Butterfield St, Herston, Qld 4006, Australia. Email: Laureen.Hines@health.qld.gov.au
B Corresponding author. Email: Amanda.Kivic@health.qld.gov.au
Australian Health Review - https://doi.org/10.1071/AH19256
Submitted: 21 November 2019 Accepted: 12 May 2020 Published online: 8 October 2020
Journal Compilation © AHHA 2020 Open Access CC BY-NC-ND
Abstract
The aim of this case study was to share lessons learned regarding strategies likely to increase healthcare service efficiency. Following quality assurance review of statewide Hospital in the Home (HITH) average length of stay (ALOS) and readmission data, Queensland’s Department of Health observed that for some of the highest volume diagnoses seen in Queensland’s HITH services in 2017, services that used a public–private partnership (PPP) model of care achieved a shorter ALOS than services using a traditional public model of care without demonstrably poorer patient outcomes. To understand the reasons for the differences in ALOS, ALOS and readmission data from 2017 for 10 high-volume diagnoses were retrospectively compared for five HITH services. Two of the services used a PPP and three used a public HITH model of care. Additional data were collected to determine similarities and points of difference regarding how the services operated in 2017. Hospitals that used a PPP HITH model of care achieved shorter ALOS for eight of the 10 diagnoses, with the difference ranging from 0.94 to 5.98 days. Differences between how the PPP and public HITH services operated in 2017 were identified. The findings suggest that the use of governance strategies, criteria-led discharge and financial incentives is likely to support safe shorter lengths of stay.
What is known about the topic? Although sometimes challenging to implement and sustain, the use of governance and patient flow strategies is reported in the literature to support efficient healthcare service delivery.
What does this paper add? An opportunity to compare the efficiency outcomes of two different models of care that were implemented for the same service type concurrently statewide, and where the trial lasted for 4 years, is rare. Review of the learnings from this study may be useful to inform the design of efficient healthcare services. In addition, this paper contains information that may be helpful to those who wish to set up or evaluate a HITH service, or, enter into a PPP.
What are the implications for practitioners? (1) The use of patient flow strategies warrant prioritisation as using them is likely to improve service efficiency. (2) The processes employed to collect, review and use data to govern and make decisions should be carefully considered as they also are likely to affect efficiency. (3) Funding models can be used to influence efficiency.
