Sustainable work systems

Using Sustainable Work Systems, a district health board is on track to slash the time taken to book appointments by two-thirds – making life easier for patients, releasing time and money for improvements to other services, and helping clerical staff feel better about their work than they have for years.

Whk Clerical Staff photo

Some of the clerical staff at Whakatane hospital. Left to right back row: Kerry Hutchings, Jodie Skinner, Viv Murfitt, Suzanne Johnson, Susan Douthett, Raniera Hudson. Middle row: Laura Austin, Michelle Harte and Maree Hyndman. Front row: Karen Burke and PSA delegate Tiare Williams.

While productivity has become another name for job cuts, the PSA has been leading the way to lift productivity while raising job satisfaction and improving services.

Sustainable work systems (SWS) is a PSA-led initiative to improve work practices and systems that involves the experts, the people who actually do the work, in finding ways to remove waste and streamline processes.  

In July last year, the PSA and the Bay of Plenty District Health Board agreed to embark on a pilot using SWS with the administration staff who schedule appointments in the Whakatane and Tauranga hospitals.

The findings of the SWS analysis were revelatory. The health board discovered that to book a single acute appointment, administration staff had to spend an average of five hours making phone calls, locating information, preparing files and talking to doctors.


The problems

One problem was a high level of rescheduled appointments, caused in part by the way doctors’ leave was recorded. Doctors often took leave at short notice, forcing last-minute rescheduling. Even if they gave plenty of notice, it didn’t always reach the administration staff in time because the paperwork was so slow.

Staff might book in two weeks' worth of appointments, only to find they all had to be rescheduled.

Another cause of rescheduled appointments lay in the way appointment times were allocated. Patients were given an arbitrary time determined by the hospital and sent to them by letter. Often, they might not get the letter at all, or the time might not be one they could make.

To tackle these problems, the health board is introducing an electronic notice that allows clerical staff to see when doctors are on leave as soon as their notice is booked. In addition, doctors have agreed to give at least six weeks' notice of leave.

At the same time, the hospital is shifting to a patient-centred booking system, in which patients are sent a letter asking them to ring up and make a time.

This means no appointment is entered into the system unless a patient has actually committed to being there. Patients' lives have been made easier and fewer appointments need to be rescheduled.

As a result of the SWS changes, the hospital expects to cut the time taken to book acute appointments from five hours to one and a half hours, and the time taken to book an elective appointment from two hours to 50 minutes.


How it works

The SWS approach draws on an approach called Lean thinking, which in turn stems from the Japanese firm Toyota's attempts to produce cars more efficiently.  What’s distinctive about SWS is the relationship built between management and union members to identify waste and improve systems.

At the Bay of Plenty health board, the training organisation Skills4Work spent four months training around 40 clerical staff in SWS methods. These include systems to:

  • Find the largest sources of waste in the flows of information and work
  • help staff identify and tackle the true causes of problems, rather than their symptoms
  • Ensure suggestions for improvement are logged and progress tracked.

Everything in SWS is done jointly. Each major project – such as the patient-centred booking system – is jointly led by a delegate and a senior manager. All decisions have to be based on consensus.

The health board expects the savings made in streamlining the scheduling process to more than repay the costs of training staff in the SWS process. Every cancelled appointment costs the hospital money. As well as the cost of expensive facilities standing idle, the hospital forgoes $460 in government funding for every cancellation.


Listening to staff suggestions

Other changes have been suggested by administration staff, in many cases fixing problems they have known about for years. To ensure good ideas are not lost, the health board has instituted an electronic system where staff can file suggestions for improvement. These are then discussed at the weekly meeting of the joint management/delegate committee.

Every suggestion – big or small – is recorded and its progress tracked so that staff can see, at any moment, what is happening to their suggestion and then hold the committee to account.

In one example, doctors on rotation frequently left the hospital before completing the updates to patients' records that rescheduling staff needed. Now, doctors' work is checked by a coordinator and they are not allowed to leave without having completed the required paperwork.

As Trish Gilmore, a delegate from Tauranga hospital, put it: "How do you find out what's happening, unless you talk to the people who do the job?"

The union's role in the project has been vital, according to everyone involved. For staff, the PSA’s involvement has given them confidence that the project will be used to improve services, not cut jobs or reduce conditions, and that has made their participation possible.                                                                               

As the major projects are still being implemented, it will be several months before we have firm data on SWS's success. But those involved are delighted by the way it has improved services and, crucially from staff's point of view, made their working lives more fulfilling.


Getting everyone on board

PSA delegates confessed they had been worried about how they would find the time to be involved in SWS but seeing results – in the form of suggestions being implemented, and improvements happening already – has turned that around.

One delegate's expertise in scheduling is now so highly valued that key meetings don't take place without her.

"To see the results that we have had from the programme – that has been a huge change. Also with managers at the higher level, the working relationship there has really improved,” said Tiare Williams, a PSA delegate at Whakatane hospital.

As another PSA member said: "It made me feel like an integral part of the DHB, rather than just a number, which I had felt previously."

Skills4Work chief executive officer Rosalie Webster says  SWS  "could work anywhere, because every workforce has work processes and has decision-making processes to get things done, so the tools can be applied to any of those work processes."

Penny Sanderson, a manager at the health board, sums up the situation: "As management, we don't have all the answers. Administration staff don’t have all the answers [either]. The beauty of SWS is that between us we can come up with solutions – which is what happened.”


This article is from the September 2011 issue of the PSA Journal. You can read back issues of the Journal by clicking here.