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Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
Whole Systems Improvement a Business Case for Quality
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Whole Systems Improvement a Business Case for Quality

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NHS Tayside and the Atos Origin Alliance have developed a robust and successful culture of Continuous Improvement (CI) and change through a programme of organic development ‐ Steps to Better …

NHS Tayside and the Atos Origin Alliance have developed a robust and successful culture of Continuous Improvement (CI) and change through a programme of organic development ‐ Steps to Better Healthcare ( StBH). This session will share experience from the StBH programme with particular focus on how we can learn from and accelerate positive Quality outcomes in a person‐centred and sustainable manner.

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  • 1. WHOLE SYSTEMS IMPROVEMENT<br />
  • 2. CONTENT<br />Overview of NHS Tayside and the challenges facing it<br />The NHS Tayside improvement journey<br />Centre for Organisational Effectiveness<br />A Whole Systems Approach<br />The Improvement Programme and Projects<br /><ul><li>Virtual Ward Demonstrator
  • 3. Medicine for the Elderly Demonstrator
  • 4. Outpatients Efficiency Demonstrator</li></ul>The Benefits<br />
  • 5. THE BALANCING ACT….<br /><ul><li>NHS Tayside delivers healthcare to over 400000 patients with a budget in excess of £750m. We employ over 14000 staff and provide a comprehensive range of primary, community and acute hospital services for the populations of Angus, Dundee and Perth and Kinross.
  • 6. NHS Tayside’s principal health organisations comprise the NHS Tayside board, the single delivery unit and the Community Health Partnerships in Angus, Dundee and Perth & Kinross.
  • 7. Meeting Scottish Government Efficiency & Productivity SR10 challenge, £27.4m in 2010, £30.0m in 2011/12following November’s budget.
  • 8. Continuing to deliver against the Scottish Patient Safety Programme and meeting the demands of the recently announced NHS Scotland Quality Strategy
  • 9. Demographic challenge around Older People’s services</li></li></ul><li>HEALTHCARE DEMAND IS GROWING<br />A new Ninewells<br />Hospital by 2031!<br />NHS Tayside<br />+148 beds 2016<br />+517 beds 2031 <br />
  • 10. IMPROVING QUALITY REDUCING COSTS<br />Our Choice<br />Surviving – the 5%<br />Thrive – the 95%<br />
  • 11. 2009-2011 – A TACTICAL JOURNEY<br />TACTICAL<br />STRATEGIC<br />PRODUCTIVITY & EFFICIENCY<br />SERVICE OPTIMISATION<br />CRES<br />TRANSFORMATION<br />DEALING WITH <br />THE 5%<br />SPENDING THE 95% BETTER<br />
  • 12. 2010-2012 – A BLENDED APPROACH<br />TACTICAL<br />STRATEGIC<br />PRODUCTIVITY & EFFICIENCY<br />SERVICE OPTIMISATION<br />TRANSFORMATION<br />CRES<br />CRES<br />DEALING WITH <br />THE 5%<br />SPENDING THE 95% BETTER<br />
  • 13. 2010-2012 KEY OUTCOME AREAS<br />TACTICAL<br />STRATEGIC<br />PREVENTION OF ADMISSION<br />IMPROVED DAY CARE<br />INTERMEDIATE CARE<br />CARE HOME INTERFACE<br />MEDICATION REVIEWS<br />CASE MANAGEMENT IMPROVED PATHWAYS<br />HOUSING / HOMECARE SUPPORT<br />ENABLING TECHNOLOGY<br />IMPROVED SERVICE LIASON AND DISCHARGE<br />REDUCE LENGTH OF STAY AND BED DAYS<br />INTEGRATED HEALTH AND SOCIAL CARE SERVICES<br />VIRTUAL WARDS<br />WORKFORCE REDESIGN<br />SELF CARE AND ENABLEMENT<br />COST MINIMISATION<br />WORKFORCE EFFICIENCY<br />TELEHEALTH / TELECARE<br />NEW MODELS OF CARE- DEMENTIA, FALLS AND END OF LIFE<br />WORKING WITH COMMUNITIES -<br />COPRODUCTION<br />
  • 14. Identifying the areas<br />for improvement.. <br />WHOLE SYSTEMS ANALYSIS<br />Assess the performance of the <br />whole health system with respect to<br />local and national targets<br />Identify areas of existing & potential <br />constraints within the whole system<br />To consult with stakeholders across<br />the whole system & recommend<br />areas of priority<br />Assessing the management<br />information requirements to support <br /> better patient flow management<br />
  • 15. STEPS TO BETTER HEALTHCARE<br />Tayside Centre for Organisational Effectiveness www.t-coe.org.uk<br />IMPROVEMENT ACADEMY<br />INNOVATION HUB & E HEALTH<br />DEVELOPMENT&SUPPORT<br />Mental Health<br />Theatre Capacity <br />Workforce Efficiency<br />Integrated Care<br />Older People<br />Mental Health<br />Optimising Facilities<br />Prescribing Medicines<br />Others Labs, Maternity<br />Finance Support<br />Scenario Planning, Financial Baselines, Benefits Tracking, Business Cases<br />Workforce Support<br />Workforce Modelling, Engagement & Communications with staff <br />Comms Support<br />Communications with public and staff <br />OE Support<br />Organisational Effectiveness support (includes eHealth)<br />
  • 16. NHS Tayside <br />–<br />first phase strategic improvement projects<br />Elective<br />Urgent & Emergency<br />Community Care Services<br />End to end pathway in <br />Improve Flow in Medical <br />Orthopaedics<br />Wards<br />Develop use of <br />Community Nursing <br />-<br />Community Hospitals <br />-<br />patient contact <br />Variation in referral <br />improve use/flow<br />Time /anticipatory care<br />rates<br />Reduce multiple <br />admissions in over 75's<br />AHP activity <br />-<br />Community Diagnostics <br />Referral Mgt <br />–<br />Whole<br />rebalance the activity <br />-<br />to support Community <br />System Approach<br />towards community<br />Hospital model<br />Improve efficiency<br />In Outpatients<br />Streaming access for <br />U&E patients<br />Deliver effective and<br />Efficient Theatre and<br />Surgery<br />Enhance the Ambulatory <br />i<br />Care service offered in <br />ward 15<br />Clinics<br />Information provision <br />and coding (e.g. The <br />Gap)<br />Prescribing<br />Quality Discharge <br />Communications<br />Patients still on <br />Medicines at Admission <br />medicines they no <br />Prescribing Practice<br />(ADRs)<br />longer need<br />Atos, Atos and fish symbol, Atos Origin and fish symbol, Atos Consulting, and the fish symbol itself are registered trademark<br />s o<br />f Atos Origin SA. <br />October 10<br />©<br />2006 Atos Consulting. Private for the client. This report or any part of it, may not be copied, circulated, quoted without pr<br />io<br />r written approval from Atos Consulting or the client.<br />WHOLE SYSTEM ANALYSIS –PHASE 1<br />
  • 17. INTEGRATED CARE(VIRTUAL WARDS) - THE CHALLENGE<br /><ul><li>Emergency admissions and associated bed days not hitting HEAT T12 target..
  • 18. Challenge around Health Population Management (HPM)
  • 19. Lack of effective collaboration between Health and Social Care
  • 20. Alignment of e Health with key HEAT T6-T12 outcomes
  • 21. Key improvement areas:</li></ul>Reduce over 65’s Emergency Beds<br />More effective HPM<br />Effective MDT working<br />Reduction in Polypharmacy<br />
  • 22. INTEGRATED CARE(VIRTUAL WARDS) - THE APPROACH<br /><ul><li>Next future state workshop brought together over 70 integrated care professionals and patient groups…
  • 23. Followed up by local sessions in CHP areas…
  • 24. NHS Tayside worked with partners to develop new HPM toolset – PEONY2
  • 25. Test of Change Demonstrators set up in each CHP
  • 26. Wider collaboration with Social Care, Voluntary Sector and Social Care
  • 27. Align outcomes with LDP, HEAT and Reshaping of Older People’s services</li></li></ul><li>STEP TO BETTER HEALTHCARE – INTEGRATED CARE<br />Art of the probable?<br />What do you<br />See?<br />Tayside<br />Community<br />Today<br />Tayside<br />Community<br />Tomorrow<br />What now?<br />Make it real!<br />‘Test of Change’<br />Demonstrators<br />LEARN<br />DESIRE<br />ADOPT<br />What do you<br />Want?<br />We are<br /> here<br />23/08/11<br />Prioritise<br />Outcome<br /> based<br />response<br />Align<br />Benefits<br />Realisation<br />Our Future<br />Truly needs<br />Based!<br />Impact<br />Assessment<br />Initial Outcome Areas<br /><ul><li>T12 Emergency Bed Days over 65’s
  • 28. T6 Long Term Conditions admissions
  • 29. Patient experience
  • 30. Releasing Time for Community Care
  • 31. Medication Concurrence</li></li></ul><li>IHI CARE CO-ORDINATION MODEL<br />Person Centred<br />For people with multiple needs<br />Personalised Multi-channel interface<br />Family, associated assets<br />Family<br />Social Care<br />Peer Groups<br />Carer/s<br />Voluntary<br />Goals(G)<br />Co-ordination(C)<br />PATIENT<br />IDENTIFICATION<br />OUTCOMES<br />Value<br />Proposition<br />Service<br />Design<br />Service<br />Delivery<br />Supporting with enabling technology<br />CARE CO-ORDINATOR<br />Feedback<br />Feedback<br />Predictive Risk<br />Tools<br />GP Systems<br />Community Information Systems<br />Telehealth<br />Telecare<br />Performance Management<br />Business Analytics<br />
  • 32. ANGUS CHP – PATIENT PROFILE<br /> Virtual Wards focusing on <br />Tier 4 , Innovative Step Down <br />Services are key to success! <br />Macro Integrator<br />NHS Tayside and Angus Council<br />LEVELS OF CARE<br /> 724<br />2%<br />LTC<br />Population<br />North West<br />187<br />North East<br />191<br />South<br />346<br />LEVEL 4<br />INTENSE <br />CASE <br />MANAGEMENT<br />VIRTUAL<br />WARD<br />ANTICIPATORY<br />CARE PLANS<br />PATIENT <br />PASSPORTS<br />CASE<br />MANAGEMENT<br /> 10148<br />28%<br />LTC<br />Population<br />LEVEL 3<br />CASE<br />MANAGEMENT<br />North West<br />2631<br />North East<br />2673<br />South<br />4844<br />PRO-ACTIVE<br />CONTACT<br />SUPPORTING<br />SELF CARE <br />70%<br />LTC <br />Population<br />LEVEL 2<br />SUPPORTED <br />SELF CARE<br /> 25372<br />North West<br />6577<br />North East<br />6684<br />South<br />12111<br />PRO-ACTIVE<br />CONTACT<br />SUPPORTING<br />SELF CARE <br />LEVEL 1<br />HEALTHY<br />COMMUNITIES<br /> 72487<br />66%<br />Overall<br />Population<br />North West<br />18790<br />North East<br />19096<br />South<br />34601<br />LTC’s<br />Asthma<br />6101<br />COPD<br />2056<br />Diabetes<br />4698<br />HBP<br />16423<br />CHD<br />5318<br />Obesity<br />11854<br />PREDICTED RISK PROFILE<br />MICRO INTEGRATORS<br />
  • 33. ENSURE OUTCOMES ARE DELIVERED….<br />Project <br />Definition<br />Statement<br />Benefits <br /> Statement<br />Project <br /> Status<br /> Report<br />Is used for:<br />Stating your case for change<br />Current state analysis<br />Evidence / Data<br />Envisaged Change<br />Summarise benefits<br />Is used for:<br />Define benefits in detail<br />Define appropriate measures<br />Summarise enabling changes ( PP&T)<br />Summarise milestone tracking<br />Is used for:<br />Report on delivery progress.<br />Report on Benefits Realisation against plan.<br />Escalate to Project Board or EMT for decision, support etc<br />Multi- disciplinary Project <br />Board, Clinical and <br />Finance essential <br />
  • 34. RESHAPING CARE FOR OLDER PEOPLE – OUTCOMES 1<br />
  • 35. RESHAPING CARE FOR OLDER PEOPLE – OUTCOMES 2<br />
  • 36. User<br />Device<br />Access<br />TECHNOLOGY ENABLING INTEGRATED CARE<br />Applications<br />Security<br />Service<br />Complex <br />Case<br />Management<br />Collaboration Tools<br />Glue<br />Staff ID<br />Virtual<br />Database<br />Case<br />Management<br />Clinical Portal<br />RBAC<br />Pro-active<br />Contact<br />PMS<br />GP<br />Community<br />Health&<br />Social<br />TELEHEALTH<br />PREDICTIVE RISK<br />TELECARE<br />BUSINESS ANALYTICS<br />Prevention<br />Integration Platform<br />
  • 37. INTEGRATED CARE(VIRTUAL WARDS) - THE BENEFITS<br /><ul><li>Test of change demonstrators commenced March 2011 following introduction of PEONY2…
  • 38. Enabling technology being fully utilised
  • 39. Aligning with local improvement initiatives eg CMR in Angus, Case Management and ACP’s across Tayside..
  • 40. Envisaged benefits across Patient Access, Service Redesign and Patient Experience:</li></ul>Drive effective attendance at A&E<br />Reduction in unscheduled bed days<br />Effective discharge models<br />Focus on the right patients<br />Increase value multi-disciplinary team time<br />Net CRES of £1.5-2.0m per annum.<br />
  • 41. MEDICINE FOR THE ELDERLY-BUSINESS CHALLENGE<br /><ul><li>No standardised operating procedures, resulting in unwarranted variation at each stage of the patient journey..
  • 42. Over 40% of all patient admissions are elderly, and will GROW!
  • 43. Variation in LoS across MfE wards..
  • 44. Average LoS higher that ‘best of breed’, around 28 days..
  • 45. Discharge planning not always linked to EDD..
  • 46. Issues around capability and capacity of downstream services..</li></li></ul><li>MEDICINE FOR THE ELDERLY- OUR APPROACH<br /><ul><li>NHS Tayside Service Improvement team and Atos supported an MDT through a pathway redesign process…
  • 47. A collaboration of extensive healthcare experience and application of LEAN thinking…
  • 48. Initial review highlighted large amounts of waste and variation
  • 49. 7 key improvement areas identified:</li></ul>Admission Criteria <br />Inpatient management <br />Discharge planning<br />Social work redesign<br />Staffing profile <br />Co-located wards <br />Step up / Step down <br />
  • 50. MEDICINE FOR THE ELDERLY- BENEFITS<br /><ul><li>Wide variety of Service Improvements achieved, qualitative and financial…
  • 51. Patient focus and removing waste has delivered a higher quality more cost effective service…
  • 52. Key outcomes/benefits achieved:</li></ul>Reduced inappropriate admissions<br />Reduced Length of Stay (28-18 days)<br />Lower re-admissions<br />Closure of 2 wards<br />CRES in excess of £1.4m per annum.<br />
  • 53. OUTPATIENTTHE CHALLENGE<br /><ul><li>10% DNA’s across Tayside in 2009..
  • 54. 3990 clinics were cancelled across Tayside in Tayside in 2009…
  • 55. 189 clinics were cancelled within 6 weeks notice in 2009…
  • 56. 85,922 patient appointments were moved in Tayside in 2009, 50% by the hospital..
  • 57. High percentage of patient appointment moves DNA on new appointment(50%)…
  • 58. 23% on new capacity and 17% of review capacity are lost against the planned templates…</li></li></ul><li>OUTPATIENTS – THE CHALLENGE<br /><ul><li>Analysis, diagnostic and redesign work resulted in four major workstream areas:</li></ul>Detailed clinic redesign methodology skills transferred to line management teams…<br />Identify variation and waste with OP clinics then remodel service..<br />Implement an NHS Tayside wide access policy <br />Test of change around patient booking process and implement a central booking function..<br />Review workforce plans to evaluate the current and future staffing models..<br />
  • 59. OUTPATIENTS – THE BENEFITS<br /><ul><li>It is envisaged that the project will deliver a number of quality improvements:</li></ul>Reduction in number of cancelled clinics, reduced DNA’s and number of moved patients..<br />Improve OP clinic effectiveness by matching capacity and demand to ensure LDP and national targets are achieved..<br />Improve clinic utilisation rates..<br />Workforce- improve nursing skills mix profile through implementing a skills register and flexible resource bank thus reducing banks staff and OT..<br />Envisaged savings of £2m by March 2012..<br />
  • 60. CAPACITY BUILDING IS…<br />An approach to the development of sustainable skills, organisational structures, resources and commitment for healthcare improvement <br />Hawe et al: 1999<br />
  • 61. CHARACTERISTICS REQUIRED TO DELIVER IMPROVED OUTCOMES<br />Quality improvement education programme <br />Evidence based learning<br />Leadership development<br />Build<br /> Infrastructure<br /> & Capacity<br />Alignment:<br /><ul><li>Will and commitment
  • 62. Vision
  • 63. Strategy
  • 64. Culture
  • 65. Measurement
  • 66. Learning organisation</li></ul>Technology & Innovation<br /><ul><li>Real time measurement and information systems</li></ul>Priorities maintained during crises <br />Stability of general management and <br />program management <br />Supporting and enabling staff in their “day job” of improvement<br />Adaptive internally and externally<br />Ref: Staines 2009<br />
  • 67. TAYSIDE CENTRE FOR ORGANISATIONAL EFFECTIVENESSwww.t-coe.org.uk<br />Mobilisation of trained experts in quality improvement organisational development and leadership to support improvement work.<br />The focus of this expertise will be mobilised to support front line staff and clinicians to build capability in improvement methodology and support key improvement programmes<br />Real time information and measurement resources to support quality improvement of clinical services.<br />Enhance spread and share of good practice through use of technology e.g. Clinical Portal, Clinical Dashboards.<br />Improvement <br />& <br />Development<br />Support<br />Technology <br />Enabling <br />Health<br />Develop an innovative education and training resource to build further out capacity and capability in improvement science.<br />A dynamic approach to knowledge transfer which supports our “All teach: All learn” philosophy in support of quality improvement.<br />Knowledge <br />Management<br />Improvement <br />Academy<br />
  • 68. MAKING BETTER PLACES,MAKING PLACES BETTER<br />Our Stretch Challenge 2011-2015<br />“ those who are less able to coproduce and use public services as a resource in their lives, experience much more negative outcomes”<br />This accounts for 40% of public sector expenditure in Scotland<br />
  • 69. Transformation<br />Transformation<br />Division<br />Improvement<br />Improvement<br />>25%<br />>25%<br />Redesign<br />Redesign<br />Improvement<br />Improvement<br />Organisational scope<br />5<br />-<br />25%<br />5<br />-<br />25%<br />Streamlining<br />Streamlining<br />Improvement<br />Improvement<br />~5%<br />~5%<br />Department<br />Work processes<br />Business processes<br />Business objectives<br />Work processes<br />Business processes<br />Business objectives<br />Content scope<br />Content scope<br />THE TRANSFORMATION JOURNEY TO 2015…<br />Whole<br />System<br />Analysis<br />Improvement Action Weeks<br />
  • 70. SUMMARY<br /><ul><li>A whole system approach is key..
  • 71. Identify high impact projects and prioritise resource..
  • 72. Leadership aligned with core personal objectives key..
  • 73. Skills transfer critical to accelerate Continuous Improvement across whole system..
  • 74. Quality improvement with associated CRES can be achieved..
  • 75. Early engagement of whole system stakeholders essential..
  • 76. Pro-active internal/external communication policy..
  • 77. Build on best practice evidence and focus on reducing unwarranted variation…</li>

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