1. 18 Weeks Diagnostic Project RSCH Key features Demand and capacity work - + ongoing data Process mapping Workforce review Administration redesign Adjustments to PAS systems (oasis) PPI Communications with project team Test request form redesign (include mobile+email etc) Identify equipment requirements

2. Data Examine templates for all clinics and assess the capacity available Calculate the demands on the service on a weekly basis Establish where extra capacity is required Examine where slots are wasted due to bookings or DNA rates Establish what the ideal template would look like and use this to work towards your goal Some examples……………..

3. Template before re-design work What was missing: In-patient work Stress echo, TOE, bubble/contrast studies Paediatrics Compare log book with work recorded on PAS systems – highlight any missing work

4. Comparing the log book with the activity on PAS (oasis). WeekLog bookPAS 02/Jul/2007:08/Jul/2007 46 09/Jul/2007:15/Jul/2007 4340 16/Jul/2007:22/Jul/2007 5559 23/Jul/2007:29/Jul/2007 4432

5. Echo before changes MonTueWedThuFri AM: OP AM OP AM OP / OP OP AM OP PM OP PM OP PM

6. Echo post changes MonTueWedThuFri AM: OP One stop AM OP One stop Toe OP Bubble AM OP One stop AM One stop OP Stress Contrast AM One stop OP PM One stop OP PM OP One stop PM OP One stop PM OP PM

9. Process mapping Map placed on wall, all staff individually added their sections. Repetitive/ no value steps highlighted, including general admin processes, technical staff performing admin duties. Highlighted that new referral form for investigations was needed and that poor quality referrals needed to be returned.

12. 19/11/07 TOTAL188541510258 Outpatient Waiting List0-2 wks3-5 wks6-9 wks 10-12 wk s 13+ wk s TOTAL Audiology - Adult audio vestibular assessment442 10 Audiology - Hearing Aid Assessment2 1 3 Echocardiogram90 Exercise Tolerance Testing26 Peripheral Neurophysiology5642121 111 Urodynamics108 18

13. Admin re-design Admin within clinical measurements was very fragmented A staff member was recruited full time and 2 other admin staff were moved to all work together out of a central point this provides cross cover for all bookings All tests are now booked by these staff and echo was removed from a centralised bookings service to give greater control Patients from 4 th Feb can book directly as they leave a clinic for their investigations Next steps – investigations on the day as a move towards one stop.

14. PAS adjustments Adjustments to PAS were necessary to capture all activity done and ensure fields were available to select if patients choose to wait >2 weeks for investigations. All tests were booked as a follow on from a consultant visit so it was not possible to generate a waiting list. They are now all booked as new. All in patients/ patients attending for echo from clinic are now captured as ‘one stop’ and there are 4 spaces per day on the clinic templates to reflect this. Any additional work can be overbooked. Admin staff were given training in the new PAS functions and cardiac physiologists were given training in completing outcomes on PAS

16. PPI PPI to date for the project has included a questionnaire to gage opinion about having a cardiac investigation, and a comments box placed within clinical measurements. Future work will include a further questionnaire post redesign work to look for improvements As PAS adjustments take account of patients email and mobile numbers then text/email appointment reminders will begin, and will be evaluated by the patient pathway coordinator for outpatients.

17. Equipment needs identified Additional cuffs for ambulatory BP machine Extra memo/loops (greatest wait for tests) Additional analyser (audit) More lifecards for holter monitors

18. Communications with team The project team meet every 3 to 4 weeks formally to review progress. The progress logs from rapport are emailed out to all the team. A newsletter is produced every 2months to update the extended team on developments of the project Educational half days have been utilised as brain storming sessions and the process maps that all staff contributed too were presented for discussions. It was here staff were able to highlight equipment inadequacies A questionnaire for the cardiac physiologists was also completed and incentivised with a voucher Regular visits to department to discuss any issues staff had.

19. Workforce Admin staff – 2 additional posts Physiologists – ATO, Band 5, Band 8a, Student positions

20. Any questions? clairejohnson@nhs.net Deena.robinson@nhs.net