I think that I am in the same situation now, and I am not so happy to take the responsibilty for problem areas. The problems are bigger when the economical knowledge at the central administration “have delay” to response to the changing world. I think that the divisions should have more power to decide their operational movements and investments in wide range. Also you must have risk-investments. So I think that you should have more financial and law knowledging people at you own administration, or at least good consulting opportunities. The decision power should be concentrated more on you and your own division. This is because there really are so many people waiting for ready-made solutions.
I think that most efficient way to improve handovers is to have standard structured information “table”, where you can see the most important information. Problems are caused at the borderline zone when there are different patients records, IT system. You must transfer the information putting it again to other IT system. I think that most of communication failures are caused by medication deviations. Therefore there should be a system, that you can also follow those failures and mistakes. In few years we would have the epic system, I hope that we would have benefit to improve the processes!?
I know, this can be a real problem. At our institution, we don`t have any surgeon specific slots, so called fixed OR day for certain surgeon. We don´t have this ambulatory office problem, because there is only one queue, such for very specific procedures, there are surgeon specific queue OR plans are done for 1 week at a time. I think surgeon specific OR days are a better system because it enhances the utilization rate of the OR time. Our unit aims to focus the baseline cases at the beginning of the week because the intensive care stay is key element for patient flow. If we operate very complicated cases at first two days of the week, we will have cancellations by the end of the week because of ICU beds.
The surgical flow should be maintained evenly, but problems would be caused by emergency cases etc. (dissections, rupture, TX etc.). If the OR requires a bit of other support services and there is no need for an ICU stay, the weekly program can be better planned. You can also change the week program easily after certain time or have two week –three week plan with different OR slots. The proposal is that you will give them, certain slots, which be changed after certain time frame.
Also the unit staffing would cause difficulties, but it is manageable when you have more freedom to do that (strong unions etc). So you should have more moveable staffing. We have also “hired” beds from other departments for a busy season.
We have implemented two registration kiosks at the main entrance (1) and before the registration nurse (1). The utilization rate is still low 20%. We have now hired a spesial worker to advise the patients how to use the kiosks. It is special challenging, when the patient have many different medical visits at the same day. I think that after hiring a new employee, the utilization rate is increasing.
The software should be easy to use, it should identify the patient barcode, it should advise the patient and it should also print important materials.
Online scheduling is extreme challenging when we are dealing with highly spesialized area. It is far more easier when we can provide web site contact (chat) or mobile contact number where we can advise the customer. More easier it is in chronic diseases where customers need monthly, annually to visit doctor e.g. in certain chronic diseases. Also the group of customers is important at least at the beginning. Younger patients learn quickly. Piloting is extremely important, and you need excited people to champion the model. When we know the visit types etc for certain doctor, we can also customize the IT so that online scheduling will work smoothly.