MEDIA RELEASE
Focus on Emergency Department waiting times ratings not enough
Real, grassroots change is needed at our nation’s DHBs and hospitals, says Kaizen Institute NZ CEO Danie Vermeulen
AUCKLAND, Wednesday 25TH November, 2009 - In May of this year, Minister of Health Tony Ryall set new standards for
Emergency Department waiting times in the nation’s hospitals. Figures released this week show that limited real
improvement has been made. No DHB managed to meet the minister’s target of 95 percent of patients admitted to a ward,
discharged or transferred within six hours.
However, while Ministry targets provide some focus, they are only helpful in comparing “slices” of the DHBs’
performances, says Kaizen New Zealand CEO Danie Vermeulen. “The targets only paint part of the picture,” he says, “and
merely identify the symptoms of the wider problem.”
Across the board, holistic change is Vermeulen’s prescription for the DHBs. “There is still room for “window-dressing”
target numbers without fully recognising wider up-steam and down-stream impacts,” he says, “and while focusing on these
few magic numbers, other important – and in this case life or death – issues may be missed.” For instance problems
extend far outside of the emergency room, as the minister has admitted. Vermeulen suggests a change in the way DHBs
think about the ED. “ED is not a silo or a function – it is part of a value stream that extends throughout the
hospital.”
Hospitals and health boards in New Zealand and elsewhere have attempted to implement generic solutions and theories
adopted from elsewhere or from management ‘gurus’. But this “copy and paste” solutions is ineffective, says Vermeulen.
“It is the nurses, doctors, administrators and others who work at the “ground level” who are best suited to identify the
root causes of New Zealand’s healthcare issues and challenges and to come up with the best solutions.”
Attempts at improvement from the top can only go so far. In order to create meaningful grassroots change, says
Vermeulen, DHBs should develop their own holistic strategic framework and adopt the principle of ‘Kaizen’: “everyday,
everywhere improvement by everyone.” This means more than simply asking hospital staff what they think once in a while
at a focus group. “They should be deliberately taught, supported and encouraged to look for, define and implement their
own continuous improvement,” Vermeulen says. “For solutions to be relevant and sustainable, they must be accepted, owned
and implemented by those who know best - the people who deal every day with real patients in the waiting rooms, wards,
theatres, rehabilitation programs, and administrative offices.” He notes that this involvement should not just be
limited to staff, but should include patients, people across functions and across DHBs, and suppliers.
Vermeulen argues that in order to create a culture change, DHBs need a clear strategic framework. “This means a healthy
mix of quality, delivery and cost measurements and relevant training and support so that DHBs can develop and
continuously improve their own creative and sustainable solutions to the real problems,” he says. “This is the best
investment that the Government and senior management can make in New Zealand’s healthcare, and will equip DHBs’ own
experienced staff to set their own best practice standards.”
In order to meet the ministry’s targets, focusing merely on the targets is, to Vermeulen, not enough. “Holistic change
from within will take a bit longer, but it will be real, sustainable and efficient.”
About KAIZEN Institute NZ
Established in 2006, KINZ focuses on the key areas of quality, costs, logistic, staff motivation, safety, technology and
environment within an organisation to make it more streamlined and efficient by eliminating waste and providing a
business process improvement framework.
For more information see http://nz.kaizen.com/
ENDS