An independent analysis of the Dunedin Hospital "putting the patient first" pilot found it made some improvements for patients but did not result in a permanent change to the emergency department culture.
The pilot, which ran over several months in late 2008 and early 2009, encouraged emergency department staff to use lean thinking methods, similar to those used in Toyota manufacturing, to identify and eliminate waste.
In a report, lead researcher on the review team from the University of Otago School of Business, Dr Richard Greatbanks, said measured against the objectives of the national programme it was part of, the Dunedin pilot could be considered a success.
Dr Greatbanks said introduction of a fast-track process had contributed significantly to reduced waiting times by nearly three hours for patients with non-urgent conditions.
It had also improved times for those waiting for radiology by about 18 minutes, an improvement of 40%.
Reorganisation of the department had also allowed nursing staff to spend more time on patient care.
However, there had not been a permanent change to the quality improvement culture of the emergency department.
Providing staff with necessary resources, particularly time to undertake improvement projects, would be a critical and essential first step in this quality culture development.
Dr Greatbanks repeated earlier observations of the project which said that reducing the time spent in the emergency department to less than six hours was mostly outside the direct control of emergency department staff.
This was because patients could not be transferred out of the department to the rest of the hospital fast enough.
Dr Greatbanks said the project needed to be seen as a first step for the whole of the hospital to adopt the "putting the patient first" philosophy.
There was ambiguity about authority and leadership of the pilot project and this had taken up time on the project which might have been better spent on improvements.
Because the project facilitators were seen by staff to be the leaders and owners of the project there was weak evidence of staff continuing to sustain the changes made.
Dr Greatbanks also referred to the need for any future project to have friendlier and applicable language.
Translating production language such as that used in the Toyota lean thinking methods into a health context would help understanding of the process.
Commenting on the report at the Otago board hospital advisory committee meeting this week, chief operating officer Vivian Blake said people were used to doing things "on the smell of an oily rag", but the report had shown that to improve the quality of services, appropriate resources had to be allocated.
The improvement programme was long term, which would take three to five years.
The board has been working on a "putting the patient first" draft quality plan.
It includes looking at how to shorten stays in the emergency department.
One of the health targets the board is required to meet is having 80% of patients admitted, discharged or transferred from the emergency department within six hours. Since July last year, February is the only month when the board achieved this, with other months being between 67 and 77%.
The draft quality plan says health care should be safe, effective, patient-centred, timely, efficient and equitable.
