Presentation on theme: "Oxford Radcliffe NHS Trust"— Presentation transcript:
1 Oxford Radcliffe NHS Trust A Practical Approach To Improving patient flow using The Theory of ConstraintsOxford Radcliffe NHS Trust
2 Oxford Radcliffe Hospitals Trust The Trust has nearly 1,500 beds400,000 people attended outpatients112,000 patients were admitted90,000 accident and emergency attendees7,000 babies were delivered.Over 10,000 staff work in the organisation
3 What is The Theory of Constraints? Eliyahu Goldratt first used in industry -Thinking ToolNot a set of solutionsFocus for ChangeWhole systems approachSimple common sense steps
4 TOC Process = 5 Steps (Step 0 - Map the System) Step 1 - Identify the ConstraintStep 2 - Get the most out of the constraintStep 3 - Support the systems constraintStep 4 - Elevate the systems constraintStep 5 - Go back to step 1
5 Rate Limiting Step – Weakest Link ReferralOPDWaitinglistPre –assessmentsurgeryOPD1006060502512
6 Types Of Constraint Find The rate limiting factor: Physical bottleneck – a capacity limited resourceThinking Constraint – ‘We’ve always done it like that’Policy Constraint – an organisational policy whether written or believed
7 Constraint V Bottleneck Bottleneck: Any resource whose capacity is less than the demand placed upon it.Constraint: Bottlenecks come and go. A constraint limits the whole systems performance over an extended period of time.
8 Benefits of Mapping Gain Agreement on what is ‘Whole System’ Identify True ConstraintHighlight queues & time spanIdentify other bottlenecks/issuesStarting point for redesignStep 5 – Cause & effect
9 TOC as a Generic Tool Principles may be applied to any whole System GynaecologyPND & UltrasoundMaxilloFacial/ OrthodonticsUrologyFinanceHorton General Hospital
10 Case Study – Horton General District general hospital = 240beds2000 –2001 Long Trolley WaitsHigh Cancellation of electives due to”no beds available”.
11 Introduction Of TOC April 2001 – Capacity group formed April 2001 – TOC Workshop for key stakeholdersMay 2001 – System mapping and analysis
12 HGH – Identify the Constraint MedicineDischargeA&ETreatmentPCTSurgerySocial CareWaiting ListDischarge+Trauma& Ortho
13 5 Steps of TOC Step 1 – Identify the constraint = Nursed beds Step 2 –Get the most out of the constraint =24hour stays, bed usage by A&E.Location of Day case patients
14 Step 2 – Get the most out of the constraint! Not about working harder.Constraint should only work on core role – otherwise capacity wasted.Nursed beds – most appropriate use of bed stock & nursing activityStarting point for analysis
15 Maximise Efficiency A&E PCT Information 24 hour or less time as IP Referrals intoA&EA&EPCTInformationNursed bedsWaiting ListInpatient orDay case
16 Information25% of admissions through A&E stayed 24 hours or less – of those:- 25% non specific chest pain- 18% self harmMinimal day case activity found in inpatient areas.PCT – A&E used appropriately by GP’s
17 Information V Anecdote Many decisions about waiting times are based on anecdote not fact!
18 5 StepsStep 3 Support the constraint New ways to offload the constraint.Emergency transfer beds – existing areaDischarge Lounge – Old children's wardDischarge ward
19 5 Steps of TOC Step 4 – Elevate the constraint Discharge Beds - increase in capacityNew build for Emergency transfer BedsStep 5 – Go Back
20 Results so far…. Trolley waits reduced Over 80% of patients are admitted within 4 hours of decision to admit in A&ENumber of elective cancellations reduced.
24 Lessons LearntMore efficient to “pull” patients through the system than “push”Process mapping essential to understand the systemAccurate, focused information is needed to diagnose problems and to measure success.
25 SummaryTheory of Constraints – Common Sense approach to whole systems efficiencyPromotes ownership of the problem by the staff delivering the service.Needs high level Sponsorship if it is to be effective.