Presentation on theme: "Planning ahead – priorities for the future"— Presentation transcript:
1 Planning ahead – priorities for the future Debbie JohnstonThursday 24th January 2013, Haydock
2 Session - ObjectivesUnderstand the national PPAT results and key challenges your regionExplore what strategies have been successfulConsider your plan to address the PPAT report recommendationsIdentify priority areas for actionPlan for your future requirements
5 PPAT‘Experience has shown that endoscopy services that achieve the objectives of the PPAT will sustain a low wait service without the need for waiting list initiatives and other resource intensive methods for reducing waits’
7 Most Achieved Measures – Nationwide % Achieving2.3Waiting times monitored and reviewed at least weekly at unit and business unit/directorate level89%2.6There is sufficient pooling to maintain differences in waits to less than two weeks92%3.3There is a booking office that is readily accessible to patients and endoscopy staff93%2.5Patients on waiting lists are booked in turn95%2.4Waiting lists are restricted to three categories: 2 week wait, urgent and routine97%
8 Most Achieved Measures – The North % Achieving4.3Start and finish times are agreed with the responsible endoscopist86%2.3Waiting times monitored and reviewed at least weekly at unit and business unit/directorate level89%4.2There are scheduling templates for each session agreed with the responsible endoscopist and that optimise utilisation of the list3.3There is a booking office that is readily accessible to patients and endoscopy staff93%2.4Waiting lists are restricted to three categories: 2 week wait, urgent and routine96%Have flipcharts for each measure and ask them to share what they specifically have in placeExercise
9 Key National challenges 60% of organisations do not have electronic scheduling systems to facilitate efficient booking and scheduling that enable effective capacity planning.Manual diary systems are used very widely.Manual systems do not allow collection of quality data required to inform service redesign and effective planning.57% of services indicated that they were unable to make estimates of the demand for endoscopy in a 1-5 year time frame.
10 Key national challenges 53% of services reported:Poor or absent development plans in anticipation of future demandsInsufficient flexibility in the job plans of endoscopists to enable backfilling of funded capacity52% of services do not apply robustly the Appropriateness standard of the endoscopy GRS.Vetting and validation practices are not clearly defined and there is inconsistency for new and surveillance procedures42% of endoscopy units do not routinely collect data to identify capacity constraints and to improve the productivity of the service.
11 Least Achieved Measures – The North % Achieving3.6There are one-stop clinic(s) in place providing (where appropriate) same-day assessment, endoscopy and treatment35%3.2Process mapping +/- lean redesign of the booking process (involving all staff and all types of endoscopy) has been completed and acted upon. Thereafter this is reviewed annually29%4.4Room utilisation data (such as start and finish times and room turnaround times) is collected, collated, reviewed and acted upon. The achievable utilisation (the percentage of scheduled time a patient is in the procedure room) varies depending on case mix and type of list. For a scheduled day case list room utilisation of 80% should be achievable.
12 Least Achieved Measures – The North % Achieving4.1Endoscopy productivity data is collected through the GRS productivity tool (or equivalent) and results analysed and acted upon to identify capacity constraints and to improve the productivity of the service32%5.2There is sufficient flexibility in the job plans of endoscopists to enable backfilling of funded (i.e. staffed) capacity
13 Key concernOf particular concern is the lack of forward planning because there is insufficient information on which to make decisions.Business planning is generally weakClosed discussion-exercise. What are the key requirement of a business plan.
14 5 Commitments ….. Commitment to the patient experience Commitment to qualityCommitment to timelinessCommitment to efficiencyCommitment to the teamWhat needs to change ?
18 Service Improvement Pre-assessment Skill mix Plan for the future… Know what your patients wantSkill mixPatient choiceUnderstand your serviceMaximising capacityPlan for the future…
19 Recommendations For endoscopy teams and their organisations Endoscopy team leads must work more collaboratively with their organisations and commissioners to achieve joint understanding and responsibility for the planning, business development and improvement of the serviceMore widespread adoption of processes and IT systems for collection of data on demand, capacity, utilisation and booking.All units that are not obviously in control of their waits (manifest by long waits in HES, DM01 or GRS) should complete the PPAT online at least annually with an appropriate action plan.
20 Recommendations For endoscopy teams and their organisations Development plans for the workforce should anticipate future demandsThe Appropriateness standard of the GRS must be applied robustly. Vetting and validation practices should be more clearly defined and more consistently appliedProcess improvements recommended by NHS improvement should be routinely applied (Endoscopy-rapid review 2012).
21 What should you do next? Focus on Leadership Use available data map trendsFocus on service organisationUse Tools to baseline where you are atPlanning, productivity and assessment tool (PPAT)GRS Productivity toolRoom utilisationDevelop a more flexible WorkforceDevelop model pathways
22 “Bowel Scope” Screening: Implications for Practice Dr Neil HaslamNW BCSP QA MeetingJanuary 2013
23 Presentation - objectives To understand the timetable and plan for roll out of FS screeningTo understand the demand from FS screening and what capacity is required:where the capacity can/should be deliveredoptions for the endoscopist workforce
24 Projections of underlying growth pressure (blue line) for colonoscopy and flexi-sigmoidoscopy activity plus additional activity from cancer strategy commitments (pink line)24
25 Efficacy of a once-only flexible sigmoidoscopy After 11 years of follow-up, in people who had the screening:Cumulative incidence, including prevalent cancers detected at screening, reduced by50% for distal cancers (rectum and sigmoid colon)33% for colorectal cancer overallColorectal cancer mortality was reduced by 43%No sign of a lessening of effect at longer follow-up times1 life saved per 200 people screened?25
26 Improving OutcomesFlexible sigmoidoscopy (FS) is an alternative and complementary bowel screening methodology to Faecal Occult Blood (FOB) testing. …… Based on trial figures, experts estimate the programme would prevent around 3,000 cancers every year.The DH has committed to invest £60 million over the next four years to incorporate FS into the current bowel screening programme …In addition, NHS Cancer Screening Programmes will be looking at how the more accurate and easier to use immunochemical FOBt can be introduced into the programme potentially to increase uptake and to provide more accurate results.
27 Timeline for development 2011/12 development year for Flexi-sig2012/13 piloting of Flexi-sig2013/14 first wave roll out of Flexi-sig= 30% country open by 31 March 20142014/15 second wave roll out of Flexi-sig= 60% country open by 31 March 20152016 roll out complete
28 Preparing to deliver Flexi-sig screening One-off invitation to all people aged 55 years (with self –referrals up to age 60)Process is different to FOBt screening and screening colonoscopy delivery at local levelMay require some reconfiguration of large screening centresDifferent infrastructure and will need detailed capacity and demand planning
29 This is primary care? It is like primary care because Patients don’t have to attendThe service has to be local and convenientThe service has to be an acceptable experienceMost patients are normal when examinedIt is relentless
30 Best estimate of demand The initial estimates of demand were 6000/million base population each yearIt is expected that in some areas uptake could be higher than originally expected and demand could be as high as 8000/million/yearIt will be different in different demographic areas and opt in for year olds is an unknown quantityThe pilot sites will proved more certaintyScreening centres should prepare for demand between 6,000 and 8,000/year per million until pilot centres start screening
31 Estimating FS numbers 1.6% of population is aged 55 years For a half million population= 8000 FS invites per annum= 160 FS invites per week (50 weeks)Assume 50% uptake =8 FS lists (80 people) per weekPLUS an additional 5% referred for a screening colonoscopy ( 4 people per week)
32 Local delivery of Flexi-sig Innovative ways of workingPotential to use community sites and ITCs (JAG approved)JAG investigating pre-accreditation of new facilitiesWorking evenings and weekends (this age group will mostly be in employment)Must ensure flexi-sig lists are always available – cannot cancel lists when you have invited them in first place!
33 Proposed invitation process Screening Centre to set up FS screening clinics and appointment slots on BCSSHub to send pre-invites (8 weeks in advance)Hub sends invites and timed appointment and reply slip (6 weeks)Enemas posted once confirmation of attendance received (up to 2 weeks before)Presumption of normality and advice to phone helpline otherwiseIndividual attends for Flexi-sig“Opt-in” for those agedPossible “opt-in” for visually impaired (60-64)
34 Local delivery of Flexi-sig (2) Invitations with booked appointmentsWill require overbooking of listsMust have capacity should everyone attend10% may require administration of enema on siteNeed greater pool of endoscopists than FOBT screeningSSPs to attend listDedicated Programme manager (for BSCP and FS)increased admin role for booking of lists
35 FS Examination Comfort is paramount Only examine as far as comfort allowsRecord if sub-optimal extent or prepEntonox allowed but no sedationOnly one test allowedFunding £400 per “booked” test for whole programme
36 Colonoscopy Referral Guidelines Any patient with a polyp >10mmAny patient with, on a histological report3 or more adenomasAn adenoma with villous or tubulovillous componentAn adenoma with high-grade neoplasia (dysplasia)Patients with 20 or more polyps which are >3mm, hyperplastic in appearance and above the distal rectum
37 The following patients may be referred for colonoscopy in the Bowel Cancer Screening Programme: Any patient with suspected adenomas, which fit criteria for removal but where this may not be appropriate at initial flexible sigmoidoscopy screening exam e.g.On anti-coagulant or antiplatelet therapy (though biopsies can be taken if required)Patient intolerance of procedure / discomfortMultiple suspected adenomas (e.g. >6),At risk of vCJDA patient with a polyp which is technically difficult to remove e.g. due to poor access, in an unstable position, or recurrence in a previous polypectomy scar
38 Suitablity assessment Presumed suitableSent contraindications with invitationSuitability only assessed if subject contacts the Hub to discuss a possible contraindicationSuitability initially assessed by the HubFacility for the Hub to refer to the Screening Centre
39 Self referrals (Opt ins) Registered with GP linked to SC offering FS ScreeningAge inclusiveNo FS Invitation due dateNot ceased, seeking further data or surveillanceNo previous FS screening episode
40 Current workforceAll accredited screening colonoscopists are automatically accredited for FS screening
41 Eligibility Of New Workforce Attached to Centre with an Internal MentorMinimum of 300 lifetime lower GI endoscopiesAble to remove lesions <10mm including by submucosal lift (confirmed by colleague)Able to place endoscopic tattoosAble to accurately assess the size of the lesionSkilled in lesion recognition
42 Application criteria Lifetime lower GI numbers > 300 Lifetime perforation rateIn preceding 12 months:No of Lower GI procedures > 150Polyp detection ratePolyp removal rateComplication ratePLUS: 4 formative DOPyS to be submitted
43 Formal assessment To be held in local screening centre Internal and external mentors will assessOne hour MCQDOPS or DOPyS examination of 2 consecutive casesProvisional accreditation awarded until KPIs for 100 cases signed off by external assessor
44 Formal assessment (2)If KPIs not reached after 300 procedures or within 9 months, provisional accreditation expires (and new application required)Unsuccessful applicants would be allowed to re-sit twice in a 12 month periodExpect FS endoscopists to undertake at least 400 FS per annum
46 Appendix 2 Demand Capacity SC activity Link GP practices to FS sites Set up FS Screening Clinic ListsHub activityGenerate FS Invitations by site(Appt date – 8 weeks)Send FS Pre-invites(Appt date – 8 weeks)Self Referral / reopen requestsSend FS InvitationsInc. appt details(Appt date – 6 weeks)Appt re-bookings / cancellationsProcessFS Response SlipsHandleSuitability Assessment phone callsProcessDecline RequestsSendReminder letters(Appt date – 4 weeks)Manage Overbooked / Under-bookedFS ListsProcessescalated suitability assessmentsConfirmFS Clinic Lists(Appt date – 2 weeks)Maintain Maps and directions to FS sitesSendFS Confirmation letter(Appt date – 2 weeks)SendBowel Prep(Appt date – 2 weeks)SendNon-Response letters(Appt date – 2 weeks)Add appt details to local PAS(Appt date – 2 days)Attend appointment
47 Planning For FS Screening Calculate Demand and CapacityDevelop the workforce neededPlan to deliver FS locallyLook for local JAG accredited facilitiesAppoint a dedicated Programme manager
48 Flexi-sig screening – How far can you go...... with planning, given what we currently knowBillie MooresNW QA Director - BCSP
49 Presentation - objectives Brief overview of FSLook at projected demandLook at models of deliveryWorkforce issuesKnown, unclear, unknown
50 Projections of underlying growth pressure (blue line) for colonoscopy and flexi-sigmoidoscopy activity plus additional activity from cancer strategy commitments (pink line)50
51 Timeline for development 2011/12 development year for Flexi-sig2012/13 piloting of Flexi-sig2013/14 first wave roll out of Flexi-sig= 30% country open by 31 March 20142014/15 second wave roll out of Flexi-sig= 60% country open by 31 March 20152016 roll out complete
52 What do we know? Colorectal cancer mortality was reduced by 43% DH have committed £60 million over next 4 yearsWill be part of the bowel cancer screening programme – ‘BowelScope’Activity will be linked to current bowel cancer screening centresNo bowel cancer screening centre will have enough capacity ‘in-house’Tariff payment of £400/scope (?)52
53 Preparing to deliver Flexi-sig screening One-off invitation to all people aged 55 years (with self –referrals up to age 60)May require some reconfiguration of large screening centresDifferent infrastructure and will need detailed capacity and demand planningNeeds to convenient, local, accessiblePeople don’t have to attendCan’t stop once started
54 Best estimate of demand The initial estimates of demand were 6000/million base population each year – now thinking possibly 8000/millionIt will be different in different demographic areas and opt in for year olds is an unknown quantityThe pilot sites will proved more certaintyScreening centres should prepare for demand between 6,000 and 8,000/year per million until pilot centres start screening
55 What does this mean for NW? 2013 – 95,000 people will turn 55. Increase to 97,000 next yearAssuming 50% uptake52 weeks/year12 on a list76 – 78 additional lists/week5% refer for colonoscopy15 – 16 additional lists/week
56 Estimating FS numbers For a half million population = 8000 FS invites per annum= 160 FS invites per week (50 weeks)Assume 50% uptake =8 FS lists (80 people) per weekPLUS an additional 5% referred for a screening colonoscopy ( 4 people per week)
57 Proposed invitation process Screening Centre to set up FS screening clinics and appointment slots on BCSSHub to send pre-invites (8 weeks in advance)Hub sends invites and timed appointment and reply slip (6 weeks)Enemas posted once confirmation of attendance received (up to 2 weeks before)Presumption of normality and advice to phone helpline otherwiseIndividual attends for Flexi-sig“Opt-in” for those aged
58 Local delivery of Flexi-sig Innovative ways of workingPotential to use community sites and ITCs (JAG approved)JAG investigating pre-accreditation of new facilitiesWorking evenings and weekends (this age group will mostly be in employment)Must ensure flexi-sig lists are always available – cannot cancel lists when you have invited them in first place!
59 Local delivery of Flexi-sig (2) Invitations with booked appointmentsWill require overbooking of listsMust have capacity should everyone attend10% may require administration of enema on siteNeed greater pool of endoscopists than FOBT screeningSSPs to attend listDedicated Programme manager (for BSCP and FS)increased admin role for booking of lists
60 What next? Talk to screening centre Workforce planning Start nowTraining packages in development - reply to/contact David Holt, QA Co-ordinatorFirst wave bids will get a decision soonCall for second wave this yearThink creatively
61 Sanchoy Sarkar Phd FRCP Consultant Endoscopist & Gastroenterologist. Improving Capacity in Endoscopy Services “Lessons from the 3 Session Day”Sanchoy Sarkar Phd FRCPConsultant Endoscopist & Gastroenterologist.
62 Lecture Model Need and background (The evolving story) 3 Session Day Our Service re-designChallengesKey aspects of implementationData on the 3 session day in practice
63 Models Expanding Capacity (4 to 6 sessions per Day) 3 Session Day ( )Extra Room (9-5)Rm1-EVRm 2-EvRm 1-PMRm 2-PMRm 3-PMRm 1-PMRm PMRm 1-PMRm 2-AMRm 3-PMRm 1-AMRm2-AM
64 Models Needs Extra Room 3 session day (Extended Day) Space (plant) BuildStaffEquipmentStaff (more)Staff (work differently)Staff (cooperation)
66 Driver’s for Change in Activity PHASE 1: Introduction BCSPPHASE 2: Abolition of Barium Enema & pending JAG VisitWaiting Time Diagnostics 9 weeksSurveillance 18months
67 3 Session Working in Practice Monday to Thursday3 Sessions working (8.30 am to 8.30pm)Changed Capacity to 63 Sessions300 procedures per WeekOGD/COLON/BCSP/EUS/In-patients3 Rooms; Usual- colon + in-patient + other
68 Advantages Increase Capacity with Limited Plant Staff Advantages Nursing Staff- Day off during weekEndoscopists- Session off during the weekEvening List Better working environmentPatient AdvantagesPatient choiceConvenienceOGD after WorkColonoscopy All prep on day of procedureRarely DNA
69 Patient Preference V. Willing Don’t Mind Unwilling Willing 85% of patients don’t mind or are willing evening lists
79 Successful Implementation Workforce & Job PlanningList SchedulingSupportEndoscopist of the DayWeekly Activity MeetingsEndoscopy Lead & Nurse ConsultantWeekly meeting with Endoscopy ManagerEndoscopy User Group QuarterlyEducation (Facilitator-B7, APEX, Nurse Education Sessions, TREATS)
83 Safety- Adverse Events Serious:1 respiratory arrest- Reversal Given & Crash Team calledPost EMR Bleed- Patient readmissionOther:Endoscopist called away for emergency- Cancelled in-patientsAdmin-Endoscopist Communication- Booked list & No endoscopist
84 Problems Lists continually over-running People getting Tired and Sickness (cover)Staff Turnover- Willing & UnwillingStarting on time of each sessionCovering Evening Lists (Back-fill)Coping with Unexpected- Emergencies
87 Conclusions: From what I know now Get another room!!Planning; Under resourced for staffing, constant struggle- Solid maths (opportunity)Get the team right (teamwork & Skill mix)Workforce Flexibility & Job planningScheduling (Shared lists-competencies)Support & communication
97 Quick Demand Planning for 2018 OGD 1.8% of popFS 0.8% of popColon 1.4% popAverage DGH (300,000)5400 OGDs2400 FS4200 colons
98 Post-PPAT Plans− Created detailed action plans to improve productivity− Instigated different ways of working, with a particular focus on pre-assessment− Reviewed online tools− Commenced weekly formal planning meetings in place of ad hoc reactive management− Reviewed productivity, 7 day service & reporting systems− Met with managers to improve efficiency of unit and reduce waste and standardise room utilisation− Helped others to develop their services via SHA role, publications in frontline gastro etc…− Completed a baseline PPAT and committed to review regularly− Reviewed demand and capacity for BCSP and how this could be managed better Each regional group has committed to organising a follow up workshop in each region in the next 12 months The JAG has agreed to use the PPAT objectives framework during assessments for accreditation and maintenance of annual accreditation
99 PPAT Key Recommendations: Units 1. Endoscopy team leads must work more collaboratively with their organisations and commissioners to achieve joint understanding and responsibility for the planning, business development and improvement of the service2. More widespread adoption of processes and IT systems for collection of data on demand, capacity, utilisation and booking. available3. All units that are not obviously in control of their waits should complete the PPAT online at least annually with an appropriate action plan4. Development plans for the workforce should anticipate future demands5. The appropriateness standard of the GRS must be applied robustly.6. Process improvements recommended by NHS improvement should be routinely applied (Endoscopy-rapid review 2012)
100 PPAT Key Recommendations: Commissioners 1. Commissioners need to better understand the impact of endoscopy on clinical outcomes and the future demand for endoscopy, particularly from bowel cancer screening2. They should work with endoscopy teams and provider organisations to agree future demand and make plans for meeting it3. Should demand to see evidence of effective vetting against guidance and of high productivity
101 PPAT Key Recommendations: JAG 1. The JAG should use the PPAT objectives framework during JAG assessments for accreditation and maintenance of annual accreditation2. The JAG should train its assessors to be able to review the evidence of effective planning and high productivity3. JAG accreditation should not be held back if a service does not have its waits completely under control provided it has achieved high scores on the PPAT that can be validated by JAG assessors.4. The JAG should assess the appropriateness item more robustly at the time of accreditation and perhaps require level A (rather than level B) for future accreditation
102 Drivers For Change Best Practice Tariff Any Qualified Provider (AQP) Loss of 5% of Tariff if non-JAG AccreditedAny Qualified Provider (AQP)NHS ChoicesFlexi Sig ScreeningPPAT or equivalent to be included in GRS
103 What Have We Done? Is there a problem? What has helped/worked? What are the barriers?
105 Aims of the session Set context of the work with 23 sites Update on where we are and what we hope to achieveTo highlight some top tips we foundTo allow you to self score against ‘top tips’Determine future support sites may need(Sign up to e-bulletin)
106 ContextAsked to look at capacity ahead of the bowel cancer awareness campaignUnderstand the issues & challenges sites were experiencingIdentify opportunities to increase capacity through improved productivity (no detrimental impact to quality)Look at both the clinical & admin processesIdentify innovative solutions to some of the challenges currently experienced by many sitesShare our experience and learning from the world of improvement
107 Review approach – site selection Identified 14 sites from reviewing DM01 returns & profiling the waiting lists over the last year – some with rising waits / some notNot an exact science, but confident we had a range of sites, those that had waiting list issues and those that seemed to be in control & meeting targets14 visits in 3 weeks – one day on siteOutput - report for each site & publication for the wider NHS
108 What do we know? Huge amount of work has already been done Overwhelming increase in referrals (43% reported by one trust)Workforce issues remain: Staff working extremely hard & over a long period of timeStaff working weekends & evenings to clear backlogExtended working days 8am – 9pm / 3 session days6/7 day workingInnovative solutions to the most common challenges
109 NHS Improvement Staff Locations FionaBLisaCHannahDJanineEElaine1 Wrightington, Wigan and Leigh NHS Foundation Trust2 The Pennine Acute Hospitals NHS Trust3 Royal Bolton Hospital NHS Foundation Trust4 Central Manchester University Hospitals NHS Foundation Trust5 Bradford Teaching Hospitals NHS Foundation Trust6 Mid Staffordshire NHS Foundation Trust7 Peterborough & Stamford Hospitals NHS Foundation Trust8 James Paget University Hospitals NHS Foundation Trust9 Hinchingbrooke Healthcare NHS Trust10 The Ipswich Hospital NHS Trust11 Milton Keynes Hospital NHS Foundation Trust12 Luton & Dunstable NHS Foundation Trust13 Gloucestershire Hospitals NHS Foundation Trust14 Kings College Hospital NHS Foundation Trust15 Guy’s & St Thomas’ NHS Foundation Trust16 South London Healthcare NHS Trust17 Surrey & Sussex Healthcare NHS Trust18 Royal Cornwall Hospitals NHS Trust19 Royal Devon & Exeter NHS Foundation Trust20 Portsmouth Hospitals NHS Trust21 West Sussex Hospitals NHS Trust22 Brighton & Sussex University Hospitals NHS Trust23 East Sussex Healthcare NHS TrustSites:A5B2314NHS Improvement Staff LocationsEndoscopy :Agreed Sites1C687D9E10111312214151617232021221918
110 Review approach - method Met with the key people on site, exec lead, clinical lead, unit manager etcWalked the clinical process from a patients perspectiveWent through the admin process in detailLooked for service improvement opportunitiesProcess issues (admin, clinical, decontamination)Leadership: (nurse leadership, ops management, clinical engagement & leadership)Service improvement – understanding & capability(including information & data)Listened to the staff
111 What did we find? Delays to start times of lists Delays in the middle of lists,Waiting for scopes, interpreters, bleeps & interruptionsOver runs & under runsLists not being fully utilised40 sessions lost in one month at one TrustPoor communication results in lost opportunities to flex job plans & training listsAnnual leave policy in place but not adhered toHigh DNA rates – due to complex admin processes - 16% at one trustCancellations on the day – anti-coagulation issues, co-morbidity drug issuesPhones not answered in department/patients can’t get through to cancel /change appointmentsInformation on the above not fed back to staff therefore not tackling the issue
112 What else? Points system - used as a guide but can also be a barrier Wide variation in number of points per session & length of sessionAlways more points on a list at weekendsRoughly reflects process timeNeed to account for changeover timeMust not squeeze procedure time (risk of compromising on quality gains)There are opportunities for productivity gains
113 1. Understand your service Understand and know yourDemandCapacity - utilisation ratesActivityDNA ratesDo you know where you are losing capacity?
115 2. Know what your patients want Over and above your twice yearly surveys:Voice of the patient/referrer – comment cardsNPS – Friends and Family testUse of patient diaries (map the emotional journey!)Use the patients to shape the service – Endoscopy User GroupMake improvements as a direct result of patient commentsFeedback your improvements to patients – make it visiblePatient choiceDirect bookingGP referral – straight to testDo patients get enough notice?Phone lines/staff to answer queries and take calls from patientsPre-assessmentReduces DNA’s/cancellationsOne stop (two stop)Nurse ledPatient information/DVDConsented at same time
116 Traffic Summary for Endoscopy Total CallsTotal Calls AnsTotal Calls BusyTotal Calls Unans3472732520376313628101829232492211530166234
117 3. Maximise capacity Flexible workforce – pooled lists Contingency plan for dropped listsAnnual leave policies for all staffA pool of endoscopists on whom you can draw (rotational registrars, research registrars, GP’s, associates etc.)An escalation policyNurse led:ConsentCannulationDischargeNurse endoscopists:Upper and lower proceduresBackfill for consultantsAudit start/stop/interruptions to lists with reasons for delaysConduct a changeover times audit – how long should it take? – wide variationProcess timings – how long are patients in the department?
118 Areas for improvement start & stop times Whips Cross – audit December 2011Monitored electronically and by nursing staffList started on time – 32%Mean delay – 21minsMain reasons for delay –Staff delay – 45%Patient Late – 25%Scope delay – 20%4 months later – April 2012List started on time – 50%Mean delay – 11 minsMain reasons for delayPatient late – 50%Over running list 30%Scope delay 20%
119 Day 1ReasonDay 2Day 3Day 4Day 5Day 6Scheduled start timeActual start timeScheduled finish timeActual finish timeVarianceTotals for Room 1 AMTotals for Room 1 PMTotal Variance Room 1Daily total for Room 1Totals for Room 2 AM
120 Start & Stop Times Audit Utilisation of Rooms:Overall 68.4 % total utilisation
121 4. Plan for the future Long term planning Expand your capacity in a sustainable way – unlikely to be WLI/affording IS servicesModel your demand – IMAS toolTake into account future service developments/new procedures/work from out of area – is there a business case/SLA?Inform CCG’s of any rise in demand (Use NICE/MoM)? Evening sessions/3 session days/ 7 day working options before capital builds
122 5. Make endoscopy important Make the Trust consider endoscopy to be a priority – work with exec leadRaise your profile and that of future demands/ potential income generation – secure support from your information teamWork with commissioners and share the good things you are doingIntegrate into board/PTL/bed meetings issues and improvements from the unit
123 Where are we now? Sites progressing well 2 workshops held lots of guest speakers who have improved their serviceSites have showcased their achievements so far – poster displayCreating a competitive edge!Lots of PDCA cycles taking place
124 New Appointments Appointed 3 new National Clinical Advisors Mark Welfare, Consultant Gastroenterologist , Northumbria Healthcare TrustEd Seward, Consultant Gastroenterologist, Whipps Cross HospitalTim Trebble, Consultant Gastroenterologist, Portsmouth Hospital NHS TrustAssociate – 1 day per weekHarriet Watson, Colorectal Nurse Consultant, currently at Dorset , moving to Guys & St Thomas
125 Clinical Advisors Areas of Focus Help us to work on “ straight to test” – drawing on their collective experienceClinical LeadershipLink into Cancer NetworksDevelop models to increase capacity in a sustainable way i.e. 3 session days / 7 day services
126 Share & support & Next steps Recognise we are only working with 23 sites (the challenges are probably similar)Supported 10 PPAT workshops – to get the message out to non-test sitesHappy to share any tools, templates, presentations and our experiencesLots of contacts where improvements have been implemented and work wellWebsite/Publications/Workshops/Buddying sites/e-bulletinWorking with the Institute on “Productive Endoscopy”
127 Rapid Action! Do Now: key areas of focus Really understand your capacity & demand dataPerform start/stop audits – make the results visibleLook at how many dropped lists you have per week – and challenge the reasonsCollect how many points are actually booked onto each listUnderstand the real reasons for DNA’s/cancellations
128 Rapid Action! Do Next: key areas of focus Count the number, duration and reasons for interruptions to lists – drill down to the detailChangeover between patients audit – agree a gold standard and measure yourselves against itComplete process timings template – how long are patients in the department for?Implement daily huddle – to foster a culture of problem solving ‘on the hoof’
129 Rapid Action! Do Later: key areas of focus Look at workflow – patient/staff/kit/information – quantify motionRemove unnecessary vetting, consenting, cannulation, discharge by consultantReview work plans - nurse endoscopists & succession plan with HR/Business ManagerInstigate weekly capacity meetings
130 Happy for you to sign up to our free e-bulletin Thank youHappy for you to sign up to our free e-bulletin