The Department of Microbiology at Royal Prince Alfred Hospital reconfigured its staff rosters, to better manage peaks and troughs in specimen processing. This optimised staff workflow and enhanced the delivery of services to the local health district.
Aim
To reduce the number of specimens processed during peak periods by 30 per cent within 12 months.
Benefits
- Reduces turnaround time of pathology specimens.
- Reduces after-hours workload and costs associated with overtime.
- Improves clinical management and health outcomes of patients.
- Improves staff satisfaction with workload and expectations of service delivery.
Background
The Department of Microbiology provides pathology services to Royal Prince Alfred Hospital and the Chris O’Brien LifeHouse, which care for a diverse range of complex and high-risk patients. Prior to the project, the Department was facing pressures of increased workload and increased expectations of service delivery. A management review conducted in October 2016 found the Department was:
- relying on overtime to provide after-hours support for respiratory nucleic acid and hepatitis serology tests
- relying on overtime to maintain waste management services during public holidays
- relying on overtime to cope with the increasing Sexual Health Service workload received after hours
- delivering inconsistent services on weekends
- coping with a large number of specimens in the molecular section each weekday morning
- receiving complaints from staff about the increasing weekend workload
- receiving complaints via the Incident Information Management System (IIMS) from local health district staff about a respiratory nucleic acid test not performed on weekends.
It was determined that a review of resources was required, to better match staff rosters to the observed peaks and troughs in specimen processing.
Implementation
- A project proposal was developed in December 2016 and presented to staff and the Health Services Union.
- Staff consultation was undertaken in January 2017, comprising an open forum to discuss concerns about the proposal, an invitation to share concerns with the Health Services Union and a comparison of existing services with current requirements.
- Discussion sessions on the design and development of a staff roster were held in February 2017, with a review of the draft roster undertaken in March 2017.
- A proposed roster was shared with staff and the Health Services Union in April 2017, with consultation with the Union taking place in May 2017.
- The proposed roster provided additional staffing resources out of hours, and enhanced the level of services offered to the local health district after 5pm Monday to Friday, as well as weekends and public holidays.
- The proposed roster provided additional services that were not available prior to implementation, including:
- a full bacteriology plate reading service, operating seven days a week
- a full molecular service, operating seven days a week
- an extended molecular service, extended from 5pm to 9pm
- an extended serology service, operating six days a week.
- The proposed roster was introduced in July 2017, with modifications made and implemented in September 2017.
- A survey of local health district staff was undertaken in November 2017 to gain feedback on the trial roster.
- The final review and implementation of new rosters occurred in December 2017.
Status
Sustained – The project has been implemented and is sustained in standard business.
Dates
December 2016 - December 2017
Implementation sites
Department of Microbiology, Royal Prince Alfred Hospital, Sydney Local Health District
Partnerships
Clinical Excellence Commission. Clinical Leadership Program
Results
- The number of specimens processed during peak periods reduced from a median of 114 between June and October 2016, to 81 (30 per cent reduction) between June and October 2017.
- Overtime expenditure was reduced by 14.49 per cent within the 12-month period.
- Instrument use increased by 33 per cent, facilitating improved response times to clinical events with public health implications.
- Turnaround times for respiratory molecular testing improved, with the number of specimens tested and reported on the day of receipt increasing from 40 per cent to 61 per cent following implementation of the new rosters.
- Staff and client surveys conducted in November 2017 recognised improvements to the provision of services and acknowledged that the redesign of rosters addressed issues recognised in the October 2016 management review.
Lessons learnt
- Strong leadership is about motivating teams in pursuit of a shared vision or purpose.
- Being cognisant of perceived fears enhances relatability with staff and aids the consultation process.
- Recognising the impact of change, using empathy and a holistic perspective also aids the consultation process and facilitates a better negotiation process.
- Staff were able to understand the reasons for change while also having a forum to provide their input, making them feel valued as contributors to the change process.
Contact
Bobby Dimitrijovski
Laboratory Manager, Department of Microbiology
Royal Prince Alfred Hospital
Sydney Local Health District
Phone: 02 9515 7545
bobby.dimitrijovski@health.nsw.gov.au
