Parallel Session 2.6 (Re)Connecting with Meaning and Motivation
Upcoming SlideShare
Loading in...5
×
 

Parallel Session 2.6 (Re)Connecting with Meaning and Motivation

on

  • 349 views

 

Statistics

Views

Total Views
349
Views on SlideShare
338
Embed Views
11

Actions

Likes
0
Downloads
1
Comments
0

1 Embed 11

http://www.nhsscotlandevent.com 11

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • Get them to then line up in room in order of how much willing to pay –but once have most and least get them to space out as if room is the spectrum so you can see visually whether they cluster around a similar amount. Ask the most and least just to say why they put that much. Aim of this is just to get them to see that they put different financial values on the benefits – suspect they will cluster around a certain amount but there will also be outliers. Will come back to this at later stage when talk about how CCA treats non-financial benefits and why it doesn’t look to put a financial value on it – as leaves it open for each individual to put that value on.
  • Pick up any other one-off costs that were shouted out in previous exercise here.
  • Assuming inflation is zero so don’t have to get into Net Present Value issues and discounting as this is just an overview. Need to check with Paul if going to pick this up in costing bit
  • In terms of second question – refer back to initial exercise and highlight that it is worth different amounts to different people. Talk about traditional approach to economic analysis would be to put a financial value against the hot water on demand and being warm. However financial value can be very finger in air and also people can put a value on to make business case stack up. Cost consequence says lets not do this – lets just state the non-financial benefits and leave decision makers to put their own value on them. Is a more transparant way of doing things.
  • So this is what you would consider when doing a CCA for a change initiative. Traditionally we don’t think about the non-recurrent costs of making the change – but these can be significant and need to be thought about. Also in terms of transferring learning – it is useful for other areas to see how much time it took to make the change.
  • Give them a couple of mins to discuss and then get them to shout out the addition information they need – which include Cost of installing the central heating and any other non-recurrent costs Current amount spent on heating bills Predicted amount once central heating installed
  • So in terms of working out your outcome and process measures – we’ve promoted the concept of driver diagrams. Nothing fancy here – just saying work out what your aim is – and then which bits of the system you will need to work on to deliver that aim. The advantage of them is that they help to show that it is rarely just one thing you have to work on to deliver an aim.
  • First step is to identify where the non-financial consequences are Then you want to think about how you might measure them And then you need to think about proportionality – how much work is involved in measuring them and decide whether the benefits of measuring outweigh the costs.
  • Give them a couple of mins to discuss and then get them to shout out the addition information they need – which include Cost of installing the central heating and any other non-recurrent costs Current amount spent on heating bills Predicted amount once central heating installed

 Parallel Session 2.6 (Re)Connecting with Meaning and Motivation Parallel Session 2.6 (Re)Connecting with Meaning and Motivation Presentation Transcript

  • Understanding the potential andevaluating the actual impacts of change
  • Today• Cost Consequence Approach to modelling and evaluating the impact of change• How CCA is being used nationally• Some simple techniques for using it in practice to evaluating change• Challenges in using the approach• Chance for you to have a go at impact analysis
  • Introduction toCost Consequence Analysis
  • PAIRS EXERCISE You’ve just moved into a 3 bedroom house that has no central heating, it is heated by plug in electric heaters. Your hot water is via an immersion heater. You expect to stay in this house for about the next 4 years. You need to make a decision whether to progress with getting central heating installed.In pairs discuss what other information you need to make the decision.
  • Recurrent costs of the changeMonthly gas and electricity bills prior to change £250 Predicted monthly gas and electricity after £150 making change Monthly recurrent savings £100
  • INDIVIDUAL EXERCISE• You do your sums and work out that if you have it installed, over the next 4 years you will save £4,800 pounds in gas and electricity bills.• Assume it makes no difference to the value of your house.• Please write on a piece of paper the maximum amount you would be willing to pay over and above the financial break even point to have central heating installed - including on demand hot water.• You can have minus figures – so you might say that you would only install it if overall you saved at least £1,000
  • Non-recurrent costs of change• Cost of installing central heating (including redecoration) = £6,000.• Costs of hotel room you book for two nights as can’t face the mess = £200
  • So will you make the change?• Non recurrent costs = £6,200• Recurrent savings = £100 per month• Assume that housing market is such that it adds no value to how much your house is worth.• Assuming inflation is zero, after 4 years you have saved £4,800 in bills giving you a net cost of £1,400• Who would install the central heating?
  • Differences in perceived value• Different people in the room will place a different value on the benefit of being warm and having on- demand hot water.• Traditional economic analysis puts a financial value on non-financial benefits – fraught with problems.• CCA doesn’t – it just states non financial and hence enables decision makers to have transparent discussions about the value within their context.
  • Cost Consequence Analysis• Non-recurrent costs of making change• Recurrent costs/savings of making change• Non-financial impacts of change – both positive and negative - just state – don’t try to put financial figures on
  • Cost Consequence AnalysisAspects of CCA ExampleNon recurrent costs of • £5,200 costsmaking change • £100 per month recurrentRecurrent costs/savings savings • Warm houseNon financial impacts • Hot water on demand
  • QUESTIONS ON OVERALL APPROACH
  • Nationally using CCA to..• Model the potential impacts of changes eg – Falls bundle – Anticipatory care planning• Evaluate the actual impacts of changes eg – Dementia Demonstrators – Poly-pharmacy work
  • Applying it in practice Scenario Modelsof the potential impact of changes
  • Using CCA approach to model impact of adopting new interventions• Work led by primary,community and outpatients workstream of Quality and Efficiency Support Team• Developing spreadsheets so NHS Boards/CHPs can scenario model the impact of adopting new interventions• Exploring models for • Falls Bundles (near to completion) • Anticipatory Care Planning (next priority) • Hospital at Home and Community Assessment of Intermediate Care • Telehealth for COPD
  • Using CCA approach to model impact of adopting new interventionsBy quantifying PATIENT BENEFITS now and in future Identify relevant patient groups and events Extract potential clinical benefits from studies Apply to relevant patient groups in Scotland and measure change in clinical eventsBy quantifying RESOURCES now and in future Identify resources required under current pathway Identify change in activities with new recommendation Identify resources associated with change, including disinvestment
  • Using CCA approach to model impact of adopting new interventions By quantifying COSTS now and in future  Identify costs of current clinical events  Identify potential savings from the reduced clinical events  Identify cost of resources associated with changes Allows you to answer question of whether potential cost savings exceed cost of implementation and annual operations, and to also play in the clinical benefits to the discussion
  • Example from MSK ModellingTotal cost of the Ayrshire & Arranpathways Existing NHS 24 Existing NHS 24 Change Savings pathway pathway pathway pathway in events Total events Total costs (million)GP appointments 109,992 104,726 5,265 £3,959,695 £3,770,141 £189,554Outpatients 14,995 13,496 1,500 £4,015,759 £3,614,183 £401,576NHS 24 calls 10,834 -10,834 £167,933 -£167,933Physiotherapy appointments 69,760 45,490 24,270 £4,190,276 £2,732,447 £1,457,829of which:GP referrals 44,160 24,558 19,602 £2,652,560 £1,475,122 £1,177,437Self referrals 14,080 14,080 £845,744 £845,744GP suggested 11,520 11,520 £691,972 £691,972NHS 24 20,932 -20,932 £1,257,325 -£1,257,325Do not attends 4,378 2,778 1,601 £109,454 £69,440 £40,014MRI 698 684 15 £150,806 £147,664 £3,142X-rays 8,333 7,600 733 £546,561 £498,479 £48,083Prescribed NSAIDs 9,171 9,316 -145 £59,115 £60,053 -£938Prescribed Analgesics 10,214 9,658 556 £49,687 £46,984 £2,703Total events and costs of pathways 47,229 13,081,352 11,107,323 1,974,030 In the CCA modelling will add in the clinical benefits as well as the financial impacts
  • Applying it in practiceEvaluating the impacts of changes Step One Map the expected impact of your change
  • Depending on what Reduction in we use reduced admissions to time for all sorts of care homes and potential impacts Individuals acute hospitals Reduce better CPN time supported providing in the -ve means has opposite post Increased number impact to that in box arrow community diagnostic of people points to so in this case support accessing assistive means decrease in no of -ve referrals technologyIncrease Increased number Benefits of IncreaseAZ Increased of people with referring Increased in number number of anticipatory care for number ofsupport of people people plans diagnosis referrals toworker diagnosed accessing improved OACMHTstime with AZ and more for dementia support Increased number visible to diagnosis of people receiving GPs appropriate post Reduce diagnostic Experience time from information improved referral to satisfaction with individual service receiving Increased number providers post of people where diagnostic Talking Points is support being used Increased Increased Better links referrals of waiting Increased referrals to local people with lists for to locality link communities dementia to lunch offices lunch clubs clubs
  • If exercising with Positive impact on others, increased mental wellbeing social contact Initially feel more Giving up working out 5 tired, but longer days a week term more energy -ve -ve Increase in joint painWork out Increase in calories5 days a out A new meweek Increase calorie intake Spend more money on food Costs Use more shower gel Take more more showers Depends on whether water is metered Better mental wellbeing Have to stop doing something, impact Less time depends on what stop doing
  • Depending on what Reduction in we use reduced admissions to time for all sorts of care homes and potential impacts Individuals acute hospitals Reduce better CPN time supported providing in the -ve means has opposite post Increased number impact to that in box arrow community diagnostic of people points to so in this case support accessing assistive means decrease in no of -ve referrals technologyIncrease Increased number Benefits of IncreaseAZ Increased of people with referring Increased in number number of anticipatory care for number ofsupport of people people plans diagnosis referrals toworker diagnosed accessing improved OACMHTstime with AZ and more for dementia support Increased number visible to diagnosis of people receiving GPs appropriate post Reduce diagnostic Experience time from information improved referral to satisfaction with individual service receiving Increased number providers post of people where diagnostic Talking Points is support being used Increased Increased Better links referrals of waiting Increased referrals to local people with lists for to locality link communities dementia to lunch offices lunch clubs clubs
  • Applying it in practice Step TwoIdentify what impacts have measurable financial consequences attached
  • Depending on what Green shading we use reduced = Impact which time for all sorts of can be costed. potential impacts Individuals Reduce better CPN time supported Reduction in providing in the admissions to post Increased number care homes and community -ve diagnostic of people acute hospitals support accessing assistive technologyIncrease Increased number Benefits of IncreaseAZ Increased of people with referring Increased in number number of anticipatory care for number ofsupport of people people plans diagnosis referrals toworker on accessing improved OACMHTstime Dementia AZ and more for QOF support Increased number visible to diagnosis registers of people receiving GPs appropriate post Reduce diagnostic Experience time from information improved referral to satisfaction with individual service receiving Increased number providers post of people where diagnostic Talking Points is support being used Increased Increased Better links referrals of waiting Increased referrals to local people with lists for to locality link communities dementia to lunch offices lunch clubs clubs
  • Recurrent Costs Actual prior to Actual at change Jul 2012 Difference Comments Alzheimer Scotland Support Worker Team £51,772 £87,245 -£35,473 Team increased from 1.6 to 2.6 WTE Overall use of assistive technology increased by £60,000 over period of Social Care Costs project. Attributed 50% of this cost to this change as data showed that 50% of Costs of increased use increases in referrals came from AS of assistive technology -£30,000 support workers This is an esimate of the value of CPN band 7 = 4 hours 4 hours Same time spent on post diagnostic support Weekly CPN time spent band 6 = 16 hours 4 hours - 12 hrs prior and after change. These costs may Health Costs on post diagnostic band 5 = 24 hours 16 hrs - 8 hrs not releasable but highlight how much support band 3 = 26 hours 8.5 hrs - 15.5 hrs resource has been released for other £53,907 £26,021 £27,886 work.Summary of Social care £51,772 £87,245 -£65,473 These are real costsRecurrent Costs Health care £53,907 £26,021 £27,886 This is the value of hours released Issue around impact on hospital and care home admissions
  • Applying it in practice Step ThreeIdentify what impacts have non financial consequences
  • Depending on what we use reduced time for all sorts of Individuals Reduction in Reduce potential impacts better admissions to CPN time supported care homes and providing in the acute hospitals post Increased number community -ve diagnostic of people support accessing assistive technologyIncrease Increased number Benefits of IncreaseAZ Increased of people with referring Increased in number number of anticipatory care for number ofsupport of people people plans diagnosis referrals toworker diagnosed accessing improved OACMHTstime AZ and more for support Increased number visible to diagnosis of people receiving GPs appropriate post Reduce diagnostic Experience time from information improved referral to satisfaction with individual service receiving Increased number providers post of people where diagnostic Talking Points is support being used Increased Increased Better links referrals of waiting Increased referrals to local people with lists for to locality link communities dementia to lunch offices lunch clubs clubs
  • Non Financial Consequences Potential non-financial measures Direction of expected changeService user and carer satisfaction with post diagnostic support received ImproveNumber of people diagnosed with dementia (as per QOF register) IncreaseNumber of people receiving post diagnostic support IncreaseNumber of people with Dementia using assistive technology to maintain independence IncreaseTime from referral to individual receiving post diagnostic support ReduceNumber of people with Dementia with anticipatory care plans IncreaseNumber of referrals to locality link officers IncreaseNumber of referrals for people with Dementia to lunch clubs IncreaseNumber of individuals where Talking Points is being used IncreaseNumber of referrals to Older Adult CMHTs Uncertain
  • Applying it in practice Step FourIdentify your non-recurrent costs
  • Non-recurrent Costs Costs associated with staff time spent on project AfC Band Hours spent (or Midpoint on project equivalent) Costing (£)1 Other Comments Includes advertising costs, interview Recruitment costs for new post £1,500 costs etc band 7, band Awareness raising with exisitng staff 2 hours each 6 x2, band 5, £172 around additional post and how will work band 3 9 Hours of Health Project ManagementNon-recurrent Project manager time 18 hours band 7 £402 and 9 Hours of social work project management Costs Info Analyst - re data for evaluation 7 hours band 6 £131 Finance input re costings 4 hours band 5 £61 Admin time 12 hours band 3 £130 Consultant Psychiatrist 2 hours £106 Salary TOTALSummary of non recurrent costs - Health care £801 £801Summary of non recurrent costs - Social Care £201 £1,500 £1,701
  • Hourly rate adjusted for Enter Staff Role Pay Scale Weekly Hourly employer Hours Total or Pay Banding midpoint* rate (£) rate (£) costs (24%) worked** cost (£) AfC 1 14,008 269 7.16 8.88 0.00 AfC 2 14,987 287 7.66 9.50 0.00 AfC 3 17,118 328 8.75 10.86 0.00 AfC 4 19,933 382 10.19 12.64 0.00 AfC 5 24,059 461 12.30 15.26 0.00 AfC 6 29,464 565 15.07 18.69 0.00 AfC 7 35,184 675 17.99 22.31 0.00 AfC 8a 42,850 822 21.92 27.18 0.00 AfC 8b 50,351 966 25.75 31.93 0.00 AfC 8c 59,799 1,147 30.58 37.92 0.00 AfC 8d 71,642 1,374 36.64 45.43 0.00 AfC 9 86,721 1,663 44.35 55.00 0.00 SMgr A 50,873 976 26.02 32.26 0.00 SMgr B 58,377 1,120 29.86 37.02 0.00 SMgr C 66,989 1,285 34.26 42.48 0.00 SMgr D 75,735 1,453 38.73 48.03 0.00 SMgr E 86,908 1,667 44.45 55.12 0.00 SMgr F 99,729 1,913 51.01 63.25 0.00 SMgr G 114,441 2,195 58.53 72.58 0.00 SMgr H 131,324 2,519 67.16 83.28 0.00 SMgr I 150,696 2,890 77.07 95.57 0.00 FHO 1 23,928 459 12.24 15.17 0.00 FHO 2 29,763 571 15.22 18.88 0.00 Specialist Reg 38,374 736 19.63 24.34 0.00 House Officer 23,928 459 12.24 15.17 0.00 Senior HO 33,416 641 17.09 21.19 0.00 Consultant 83,829 1,608 42.87 53.16 0.00 Speciality Doctor 52,546 1,008 26.87 33.32 0.00 Associate Specialist 51,667 991 26.42 32.77 0.00Clinical Medical Officer 38,857 745 19.87 24.64 0.00 Sen Clin Med Officer 55,994 1,074 28.64 35.51 0.00 Total (£) 0.00
  • Bringing it all together
  • Health Social CareNon-recurrent costs £801 £1,701Recurrent -£27,886 (productive £65,473 (actual costs)costs/savings savings)Non financial • 80% of individuals receiving post diagnostic support reporting satisfied or highly satisfied (baseline of 40%)consequences • 100 more people per year received post diagnostic support (30% increase) • Reduction in time waiting from diagnosis to support from 4 months to 2 weeks • Reduction in waiting time for CPN support from 6 months to 1 month • 10% increase in no of people diagnosed* • 30% increase in no of people with dementia using assistive technology to support independent living* • 10% increase in no of people with dementia with anticipatory care plans* • 10% reduction in referrals to OACMHT* *There are other changes in the system that may have also impacted on this measure.Not yet able to Impact on use of care home beds and acute hospitalevaluate beds longer term
  • More detailed analysis should sit behind the summary e.gNo of individuals currently with named contact worker providing support Number of Individuals Accessing Post Diagnostic Support 70 60 New model of post diagnostic support 50 implemented 40 New Alzheimer 30 Scotland post diagnostic support worker started 20 10 0 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12
  • Issues• Data Reliability• Proportionality – effort vs benefits of data collection (sampling)• Costing – access to relevant data• Non-recurrent costs – difficulties collecting• Cash releasing vs efficiency gains• Qualitative as well as quantitative• Outcomes as well as process measures• Statistical significance• When to use CCA for evaluation
  • Pairs Exercise (10 mins) Using CCA to manage and evaluate impactsPick a change that one of you is involved with at the moment and have a go at doing an impact map
  • Discussion/Questions?