Patient Smart FAST - Enhancing our organisational capabilities

What is FAST?


Patient Smart FAST is an applied training and mentoring programme custom designed for Waitemata DHB by an in-house quality improvement specialist.  It aims to enhance organisational capabilities in quality improvement, problem solving and project management.

What are we trying to achieve?

Our aim is to improve participants' skill in quality improvement, structured problem solving and quality project implementation.

By developing our workforce and continuously improving our processes proactively, we should achieve safer, more effective and efficient care, improve staff satisfaction and achieve better health outcomes for our patients.

Why develop a training programme

Professor Don BerwickProfessor Don Berwick, in a recent review (Aug 2013) of the National Health Service (NHS) in England, highlighted the importance of quality training and capability building for improving the safety of patients.  He recommends[1]:

"Mastery of quality and patient safety sciences and practices should be part of initial preparation and lifelong education of all health care professionals, including managers and executives.  The NHS should become a learning organisation.  Its leaders should create and support the capability of learning."

FAST quotes

  1. Berwick, Don.  A promise to learn - a commitment to act: Improving the Safety of Patients in England.  National Advisory Group on the Safety of Patients in England.  © Crown copyright 2013.  2901213.  August 2013.  Produced by Williams Lea.

What we did

  • Designed and developed a "learning and mentoring programme" to develop our workforce with quality and innovation competencies, including structured problem-solving, quality improvement methods, project and process management.
  • Empowered FAST participants to implement patient-focused projects leading to patient safety and quality outcomes.


Our FAST methodology

FAST 4 stepsGiven a problem, it is natural for us to leap straight into solving the problem without first considering what the end goals are, root causes, or how we can track the project's progress.

To address this, FAST is designed as a structured methodology with four phases:  Find & Define, Analyse, Solve and Track.  FAST challenges participants to use a "look before you leap" paradigm:

  • consider strategic aspects and define an initial approach to solve the problem
  • analyse the data
  • look for traditional and creative mitigation to the problem
  • track the progress leading to the quantifiable outcome

FAST competencies

Participants come to the course with a work place project so that theory and learning can be applied to their real life projects (usually 1-3 participants per project).  The participants lead the projects themselves with guidance and mentoring from the in-house FAST facilitator.  The learning method is highly participative with a strong focus on learning by examples, just in time learning, and on the job training.

The FAST programme covers the following broad disciplines:  strategic management, process management, problem solving and soft skills like leadership and team dynamics.

Participants gain knowledge in quality improvement, creative problem solving, process management, statistics, project management, team and leadership skills.  The also gain insights in cross-functional teamwork, group facilitation, and the importance of the voice of the customer.

FAST spiritApart from the methodology, FAST encompasses a spirit of FUN, ACCOUNTABILITY, SIMPLICITY, and TEAMWORK, all vital to an organisation's effectiveness and efficiency.

Did we make a difference?

FAST Wave 1 group2011: The beginning

The first wave of the FAST programme commenced in May 2011.  Training, support, mentoring for FAST projects started with two clinically-led, patient-focused projects.  One of the projects, "Smokefree", achieved positive results and feedback.

FAST I-Chart from Smokefree ECC NSH projectFeedback from Wave1: Dr Andrew Ewens, Clinical Leader, Emergency Department Waitemata DHB (FAST Smokefree project):

"This course was very beneficial to me as most of it was new information, and what I already had an idea of was presented in a new way.  I know I will use this method of approaching projects in the future as well as the current project.  I felt Ken made the environment very welcoming and friendly.  I would recommend this course to others who are starting out on projects." 


In August 2013, the eighth wave of training was completed, with hard and soft savings estimated over $600,000 for all projects in 20 months.  Over 20 projects are now registered in the FAST project repository, providing a valuable source of organisational learning, information and reference.

FAST projects to date




Smokefree project, meeting the smoking cessation target in our emergency departments

ACC revenue within district nursing service

An in-depth review of current therapy assistants' capabilities and utilisation


Printing cost savings

Waste minimisation initiative

Optimising admission rate in the stroke unit at North Shore Hospital


Waitemata DHB QUIT-CAUTI:  Reducing Catheter Associated Urinary Tract Infections (CAUTI)

Improving Hand Hygiene Practice in the Emergency Departments (ED) and Assessment & Diagnostic Units (ADU)

Deceased care, improving time to release


Reducing Pyxis override rates

Counties Manukau DHB:  Improving physiologically unstable patient (PUP) compliance


Improving induction of labour pathway to ensure optimal outcomes for women and their babies

Counties Manukau DHB:  Investigating a framework that best captures the experience of the consumer

Investigating consumer engagement within Waitemata DHB mental health services

Palliative care:  Improving concordance with Saf-T-Intima protocol


Improving child youth and family referrals by Waitemata DHB services

Improving the turnaround time of clinical typing

Improving diabetes care


Reperfusion:  Improving 'door to balloon time' for heart attack patients (time from arrival in ED with a heart attack to first balloon inflation of a coronary artery in the catheter lab)

Optimising hire equipment practices and expenditure

Avoiding unnecessary or repeat requests for urine cultures

Collaborative approach to laboratory specimen transportation


  • Developer, facilitator and mentor:  The in-house quality improvement specialist developed the FAST programme and is on hand to mentor and continuously improve and support the programme.
  • The participants:  As this initiative is knowledge based, key enablers are the participants themselves.  We seek keen and early adopters as participatns in the programme.
  • The projects:  The projects are the key measure and catalyst for the FAST programme.  The projects are approved by the Clinical Governance Board (CGB) to ensure positive benefits to our patients.
  • Cross-functional team deployment:  Whilst the FAST programme was initiated by the quality improvement team, collaboration with Awhina Health Campus and Workforce Development is vital to FAST success and dissemination.
  • A rich repository of projects for reference and learning:  As the programme matures, the growing repository of projects provides a valuable reference for future quality projects and learning.
  • Top management support:  In any change management programme, top management support and commitment is vital to the success of the programme.


  • Readiness for change:  Participants need to be ready to learn and apply new concepts, disciplines and ideas.
  • Buy-in from management:  It is vital to get support and 'buy-in' from management.
  • Time constraints:  Especially for clinical staff members.  We need to acknowledge and appreciate the extra work, over and above normal duties that is required by the participants.

Key lessons

  • Importance of soft skills communication and stakeholder engagement, especially voice of customer (patient).
  • Learn by doing and examples are effective learning strategies. Mentoring sessions provide on the job learning, confidence and assurance.


  • 4 waves of training per year.
  • FAST project repository.
  • Awhina Leadership Development Framework.
  • FAST on Waitemata DHB Quality web page (intranet) and Quality newsletter.
  • FAST annual conference.
  • Regional collaboration with participation by Counties Manukau DHB and NDSA in the FAST programme.
  • 2012 Winner of "Excellence in Workforce Development & Innovation Award" in Waitemata DHB Health Excellence Awards.

Where to from here?

The FAST initiative is designed as a sustainable programme to change the way Waitemata DHB staff members think about problem solving and quality project implementation.  The FAST programme is being continuously improved to ensure a world class quality education programme is sustained.

For more information contact:
Ken Kok
Quality Improvement Specialist, Principal FAST developer
Waitemata District Health Board
Private Bag 93-503, Takapuna 0740
Mob:  021 654 806

Winner of "Excellence in Workforce Development & Innovation Award" in Waitemata Health Excellence Awards 2012