Problems anticipated included patchy engagement with the project; a low-trust, blaming culture; and lack of a clear organisational vision to which people could be aligned.
"What is our mission statement? What's our philosophy?" he asked during a presentation to the Otago District Health Board hospital advisory committee meeting yesterday on the project which began last October.
He said he had tried to find a philosophy statement on the board's website and was not sure he ever did.
Dr Kerruish is one of the members of the team for the pilot project, which was designed to introduce the Toyota vehicle manufacturer's lean thinking methods to reduce waste, increase efficiency and improve patient flow.
The pilot is part of a national programme called "Optimising the Patient Journey" being tested in various hospital departments in several locations.
He told the meeting he was more convinced than ever using the methods throughout the hospital would provide more health care with the available money giving better results, but the culture had to be right to allow that to happen.
In earlier statements, he made it clear he expected culture change to be the most difficult aspect, and yesterday he told the committee the problems he foresaw were common in places where the lean thinking methods had been introduced.
He suggested contracting health consultants Studer Group, or similar, to assist with building a strong accountability structure to ensure staff behaviour was aligned with the vision.
Responding to a question from committee member Louise Rosson about whether the project had achieved what had been hoped, Dr Kerruish said he knew that "lowering the water level" would make the rocks stick out, but it was a matter of finding a way to deal with those rocks.
Speaking after the meeting, Dr Kerruish said about 90% of emergency department staff had been supportive of the project.
Staff, including himself, were spending less time looking for things, and it was estimated that this freed up 20 minutes a day, time which could be devoted to patients.
Committee chairman Richard Thomson said the challenge for the committee was working out what it could do to help.
The meeting was told by project facilitator Monica Blaser that changes had been made to improve the treatment of patients with suspected deep vein thrombosis (DVT). In 2008, 388 patients a year presented at the department with this problem, and had to wait an average of three hours and 38 minutes.
They were often referred by general practitioners who had carried out similar tests to those which would be done by hospital staff.
Ninety percent of the patients were found not to have DVT.
One of the difficulties with GP treatment was that they did not have access to Clexane, a hospital-only prescription drug used for blood thinning in these cases.
Several depots have been set up through clinics in Dunedin and Mosgiel giving doctors access to this medicine.
A standard assessment had also been introduced for use by the GPs who were then able to refer patients directly to the vascular laboratory for scans if patients met the criteria, bypassing the emergency department altogether.
Dr Kerruish said the initiative could save 1200 hours of waiting for patients annually and was focusing on what was best for the patient.
Emergency department changes include:
• Emergency department entrance altered.
• Waiting room signs improved.
• Resuscitation room, central station, drug room and resource room reorganised.
• Staff have an extra 20 minutes a day to spend on patient care.
• Some procedures simplified.
• Senior doctor/senior nurse teams used on weekday afternoons to speed up treatment of non-acute patients.
• Systems altered for better treatment by GPs over suspected deep vein thrombosis, avoiding need for emergency department visit.
