Clinical Redesign helpsĀ deliverĀ better healthcare outcomes

Key Resources

Clinical Redesign: General

Clinical redesign is the application of process redesign and change management in order to map, review and redesign the patient journey in healthcare to meet demand and ensure that care is safe, efficient and cost-effective. This includes increasing the value for the patient and the provider through reducing waste, making better use of existing resources, improving access to services and lowering total costs. The key principles of redesign are: (i) to recognise the centrality of the patient through adopting a 'patient's - eye view', (ii) to describe, analyse and redesign work processes, (iii) to measure the components of these processes and finally (iv) to recognise the expertise of those who work at the forefront of the health system.

Traditional approaches to solving the problems of healthcare often involved each department only addressing the problems in its immediate area. However, this tactic was unable to solve problems which resulted from poor overall design, or the detached stages of a patient's journey through multiple departments. Hence, clinical process redesign is concerned with improving patient flow by making the pathways simpler and ensuring a better transfer between departments. Despite the apparent benefits of these methodologies in programs across Australia, a lack of solid evidence is still problematic, including a rigorous evaluation of methodologies and the publication of research findings to assure evidence of sustainable change. 

Education and Redesign Methodologies

Flinders Medical Centre, South Australia: Redesigning Care

Department of Health, Victoria: Redesigning Hospital Care Program (RHCP)

New South Wales: Agency for Clinical Improvement (ACI)

Queensland: Clinical Access and Redesign Unit

Western Australia: Health System Improvement Unit

Australian Resource Centre for Healthcare Innovations (ARCHI)

Ko Awatea

The Institute for Healthcare Improvement (IHI)

Elective Surgery Access

Emergency Department Access

Hospital Flow

  • There is evidence that increasing hospital capacity can alleviate ED overcrowding. However, simply increasing ED capacity without a concomitant increase in inpatient beds appears to have little effect, as capacity issues within individual hospitals also contribute to access block. Despite the likelihood of a significant reporting bias, there is considerable evidence that Lean is an effective tool for improving hospital emergency departments and the wider health sector. 

    Most studies reported significant improvements in Emergency Department (ED) Length Of Stay (LOS) and in the proportion of patients who did not wait to be seen by a physician. Common interventions included: streaming of lower acuity patients, establishment of a patient flow/journey coordinator, facilitating clearer communication between ED and inpatient wards, discharging patients earlier and a more team-oriented model of care. 

  • Harris A, Sharma A. Access block and overcrowding in emergency departments: an empirical analysis. Emergency Medicine Journal. 2010;27(7):508-11.
  • Richardson DB. The access-block effect: relationship between delay to reaching an inpatient bed and inpatient length of stay. Medical Journal of Australia. 2002;177(9):492-5.
  • Showell, C, Ellis, L, Keen, E, Cummings, E, Georgiou, A, Turner, P. An Evidence-based Review and Training Resource on Smooth Patient Flow, eHealth Services Research Group, University of Tasmania, Australia (on behalf of the Ministry of Health, New South Wales Government), 2012.