Shaping Surgical Services Bridging Strategy and Operational Delivery Phil McLoughlin, Associate Medical Director, Surgery Arlene Wood, General Manager, Surgery Gillian Birrell, Senior Charge Nurse, Urology

Challenges to Service Change

What three main things can you see which contribute to successful or failed services changes?

Challenges to our Service Population demographics Aging population Increased co- morbidities Workforce difficulties FY rota compliance Access to senior clinical decision maker & maintaining emergency and elective services across three sites Access TTG targets Increased cancelled surgeries Patient pathways Multiple patient pathways across three sites

Before SSS -The “General Surgery Commission” Top down approach Problem orientated focus “sort out current problems” No planning for the future

How Was SSS Different? Clinically driven and led Managerially facilitated Future thinking “blank canvas” from CEO

What Would You Need For This

Clinical engagement Time to focus Data and evidence Organisational support Belief, trust and commitment

Engaging Clinicians in Quality Improvement (Health Foundation 2009) Give evidence that can be trusted Harness patient power Peer pressure not paper pressure Build capability and capacity Encourage a team approach Allocate time and resource

What Was Needed Shaping Surgical Services Organisational Commitment Transparency of discussions Involvement of clinical teams

What Would You Ask?

What We Asked What do we currently do well?What do you think we could and should do better?How should we aim to deliver a 24/7 surgical service?How could we improve patient experience and the patient journey?How would you like us to engage with you and keep you informed?

What Would You Expect To Hear

What we heard.. The “killer phrases” that require leadership intervention We provide high quality care and we’re proud of itWe can’t do anything unless we have the right workforceNothing is going to change anyway!Why can’t you include us in planning our own services?There isn’t any money anywayWhy is this time going to be different?

Shaping Surgical Services – What Is It? Working in partnership with: Patients, Public Partners and communities Feedback from patient experience Clinical teams and managers SSS work stream members SSS Programme Board members Clinically driven, managerially facilitated programme for service improvement and redesign

Moving to Action - SSS What would your priorities be? Who agrees them? How would you identify them? Why are they the important ones?

What we Did – Opportunities for Engagement Ward sessions Sub speciality sessions Site specific events Public partner events and patient involvement Staff questionnaire, microsite and

Using what was heard Over 700 comments from 400 stakeholders Thematic coding 7 priorities to build our programme around

SSS Priorities Identified By Patients, Public Partners And Staff Understand patient pathways Optimise emergency model Balance of regional / tertiary / local services Optimise use of accommodation and footprint Develop workforce, education and training Understand and strengthen links with Primary care Make IT and eHealth work better for patients and staff

Eurovision in Tayside

SSS Work Streams Identify, scope and develop generic pathways that improve the patient’s journey through primary and secondary care Creation of eModel for published pathways Clinical pathways Understand challenges to patient flow across Tayside Patient flow Critically review the current range of service provision across Tayside Service sustainability and development Use a modern integrated approach to workforce planning, in order to build an up to date and comprehensive information and intelligence manual Workforce

All groups required to know preferred service model to continue work

Understanding our Service – current state Ninewells Emergency General Surgery Urology Vascular Surgery 24/7 service Elective Specialist surgery General surgery Vascular Surgery Urology Bariatric PRI Emergency General Surgery Service delivered Monday – Friday Elective General Surgery Colorectal Urology Stracathro Emergency None Elective General Surgery Urology

Understanding our Patient Profile and Demand Average weekly emergency admissions 29 (PRI) –(6 per day) Average weekly emergency admissions 104 (NW) –(15 per day) Average weekly elective admissions 26 (PRI) –(5 per day) Average weekly elective admissions 65 (NW) –(13 per day)

Stopping Change In Its Tracks – seeing the concerns and reality Our patients are going to need to travel more Our emergency patients will have to travel instead of being cared for locally We’ll reduce equity of care Our patients already travel between sites All GS emergencies already come to NW from Friday to Monday We currently deliver some of our elective surgery at a single site

Our Message – What Our Option Appraisal is all About Not about reducing services Not about making access to services more difficult for those who need them Not about building one site up at the expense of another About maximising opportunities for delivering high quality services About providing equitable care to all patients in NHS Tayside About providing a sustainable model with right care, right staff and the right place

Why Do An Options Appraisal Identify the preferred clinical option Inform decisions about service delivery model Engage with clinical and public stakeholders Discuss openly the need for change Ensure clinical ownership of service redesign

Our Business Planning Process Engage with stakeholders Openly discuss results from option appraisal Creation of Business Cases for 2 proposed options Agree final business case Engage and include again!

Lessons Learned Leadership The right leadership is essential – both clinical and managerial Ensure organisational support Engagement Make sure that stakeholders not only feel included, but really ARE Use clinical expertise and knowledge Planning Be open and transparent in discussions Plan for the future not for the now

Questions