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Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
Workshop 2: Overview
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Workshop 2: Overview

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  • Team A – SteveIssue A1: How do we stop prescribing too many medicines?Issue A2: How do we improve medication change implementation initiated in hospitals?Issue A3: How do we improve timely access to medicine? 
  • special monitoring, and review/approval from CCG  or hospitals  
  • Invite relevant stakeholders, information governance..
  • Transcript

    • 1. Safer Medicine Managementamongst Older PeopleLiving in their Own Homes2nd workshop13 June 2013http://hsi.cloudapp.net/
    • 2. http://hsi.cloudapp.net/Project - Aim• To create Integrated pathwaysfor Safer medicines managementamongst Older PeopleLiving in their Own Homes2
    • 3. http://hsi.cloudapp.net/Three Workshops1. To develop the whole system understanding Top priority issues to be addressed2. To develop solutions for improvementSpecific ideas to address the issues3. To develop implementation plans Detailed plans for idea implementation3
    • 4. 4
    • 5. http://hsi.cloudapp.net/Team• Team A: Steve Rogers• Team B: Leigh Sayer• Team C: Amalin Dutt5
    • 6. http://hsi.cloudapp.net/Top issue - Team A• How do GPs and pharmacies make surethat patients are in active partnershipson medicine management?6
    • 7. 7HospitalsGeneralpracticesDistrictnursesCommunitypharmaciesHospitalpharmaciesSocial careworkersVoluntaryservices(e.g.AgeUK,EPP* )AmbulancesDrugcompaniesEquipmentsuppliersDistributorsMedicaldeviceagencyRehapservicesMedicinecontrolagencyBackstagecommunicationFrontstagecommunicationPatientsPhonePostFaxInternet@NHS emailPhoneemiswebpharmacyIT systemHospitalpatientrecordCare agencyworkersIASFamily &friendsVisitingbooks
    • 8. 8
    • 9. 9- Patient takes medicinePatient with low on medicineWhen patient/carer does it him/herself- Patient/carer fills in the repeat prescription slip- Patient/carer drops the repeat prescription slip at GP (visit/call?)- Patient/carer collects repeat prescription (within 48 hrs?)- Patient/carer drops repeat prescription to pharmacyWhen pharmacy has agreed to act on behalf of patient(prescription collection service)- Pharmacy contacts patient (every patient?)- Pharmacy fills in the repeat prescription slip- Pharmacy drops the repeat prescription slip to GP- Pharmacy collects a repeat prescription from GPPatient at home with sufficient medicineNew (repeat) prescription at pharmacyPatient admittedto hospitalWhen patient needs hospital care- Patient goes to hospital- Patient takes own medicine to hospital (?)When patient ready to go home- Hospital discharges patient- Hospital provides medicine for 0/2/4 weeks?- Hospital informs GP and pharmacy?- Pharmacy checks prescription- Pharmacy contacts GP for enquiry (if required)- Pharmacy dispenses medicinePatient seenby GP or nurseWhen patient has appointment at GP- Patient visits GPWhen no change in medicine- Patient goes homeWhen need for medicine change- GP issues prescription- GP calls pharmacy (?)- Patient drops it to pharmacyWhen pharmacy offers delivery and patient chooses to get it- Pharmacy delivers medicine to patients homeOtherwise- Patient/carer collects medicinePatient at home with sufficient medicine(over 4 medicines)Medicine dispensed (ready to be collected)
    • 10. - Patient takes medicinePatient with low on medicinePatient admittedto hospitalWhen patient needs hospital care- Patient goes to hospital- Patient takes own medicine to hospital (?)When patient ready to go home- Hospital discharges patient- Hospital provides medicine for 0/2/4 weeks?- Hospital informs GP and pharmacy?Patient seenby GP or nurseWhen patient has appointment at GP- Patient visits GPWhen no change in medicine- Patient goes homePatient at home with sufficient medicine(over 4 medicines)When need for medicine change- GP issues prescription- GP calls pharmacy (?)- Patient drops it to pharmacy
    • 11. Patient with low on medicineWhen patient/carer does it him/herself- Patient/carer fills in the repeat prescription slip- Patient/carer drops the repeat prescription slip at GP (visit/post)- Patient/carer collects repeat prescription (within 48hrs?)- Patient/carer drops repeat prescription to pharmacyWhen pharmacy has agreed to act on behalf of patient(prescription collection service)- Pharmacy contacts patient (every patient?)- Pharmacy fills in the repeat prescription slip- Pharmacy drops the repeat prescription slip to GP- Pharmacy collects a repeat prescription from GPNew (repeat) prescription at pharmacy- Pharmacy checks prescription- Pharmacy contacts GP for enquiry (if required)- Pharmacy dispenses medicineMedicine dispensed (ready to be collected)
    • 12. 12Patient at home with sufficient medicineWhen pharmacy offers delivery and patient chooses to get it- Pharmacy delivers medicine to patients homeOtherwise- Patient/carer collects medicineMedicine dispensed (ready to be collected)
    • 13. http://hsi.cloudapp.net/Top issue – Team B• How do we make medicinesthat require special consideration,available to patients in a timely manner?13
    • 14. 14- Patient takes medicinePatient with low on medicineWhen patient/carer does it him/herself- Patient/carer fills in the repeat prescription slip- Patient/carer drops the repeat prescription slip at GP (visit/call?)- Patient/carer collects repeat prescription (within 48 hrs?)- Patient/carer drops repeat prescription to pharmacyWhen pharmacy has agreed to act on behalf of patient(prescription collection service)- Pharmacy contacts patient (every patient?)- Pharmacy fills in the repeat prescription slip- Pharmacy drops the repeat prescription slip to GP- Pharmacy collects a repeat prescription from GPPatient at home with sufficient medicineNew (repeat) prescription at pharmacyPatient admittedto hospitalWhen patient needs hospital care- Patient goes to hospital- Patient takes own medicine to hospital (?)When patient ready to go home- Hospital discharges patient- Hospital provides medicine for 0/2/4 weeks?- Hospital informs GP and pharmacy?- Pharmacy checks prescription- Pharmacy contacts GP for enquiry (if required)- Pharmacy dispenses medicinePatient seenby GP or nurseWhen patient has appointment at GP- Patient visits GPWhen no change in medicine- Patient goes homeWhen need for medicine change- GP issues prescription- GP calls pharmacy (?)- Patient drops it to pharmacyWhen pharmacy offers delivery and patient chooses to get it- Pharmacy delivers medicine to patients homeOtherwise- Patient/carer collects medicinePatient at home with sufficient medicine(over 4 medicines)Medicine dispensed (ready to be collected)
    • 15. http://hsi.cloudapp.net/Top issue – Team C• How do we improve appropriate accessto and use of the range of MedicinesCompliance Aids?• How can we improve the medicinesre-ordering process?15
    • 16. 16- Patient takes medicinePatient with low on medicineWhen patient/carer does it him/herself- Patient/carer fills in the repeat prescription slip- Patient/carer drops the repeat prescription slip at GP (visit/call?)- Patient/carer collects repeat prescription (within 48 hrs?)- Patient/carer drops repeat prescription to pharmacyWhen pharmacy has agreed to act on behalf of patient(prescription collection service)- Pharmacy contacts patient (every patient?)- Pharmacy fills in the repeat prescription slip- Pharmacy drops the repeat prescription slip to GP- Pharmacy collects a repeat prescription from GPPatient at home with sufficient medicineNew (repeat) prescription at pharmacyPatient admittedto hospitalWhen patient needs hospital care- Patient goes to hospital- Patient takes own medicine to hospital (?)When patient ready to go home- Hospital discharges patient- Hospital provides medicine for 0/2/4 weeks?- Hospital informs GP and pharmacy?- Pharmacy checks prescription- Pharmacy contacts GP for enquiry (if required)- Pharmacy dispenses medicinePatient seenby GP or nurseWhen patient has appointment at GP- Patient visits GPWhen no change in medicine- Patient goes homeWhen need for medicine change- GP issues prescription- GP calls pharmacy (?)- Patient drops it to pharmacyWhen pharmacy offers delivery and patient chooses to get it- Pharmacy delivers medicine to patients homeOtherwise- Patient/carer collects medicinePatient at home with sufficient medicine(over 4 medicines)Medicine dispensed (ready to be collected)
    • 17. http://hsi.cloudapp.net/Aim of Today’s workshop• To develop specific solutions to address topissues17
    • 18. http://hsi.cloudapp.net/Workshop - Purposes• To develop ideas which you would never havehad if you are alone• To challenge ourselves• To learn new thinking and methods• To have fun18
    • 19. http://hsi.cloudapp.net/When What Who14.00-14.10 Summary of the last workshop Amalin DuttStephen RogersLeigh Sayer14.10-14.25 Lean thinking Ran BhamraThomas Jun14.25-14.40 Causes/Outcome Understanding Group discussion14.40-14.55 Benchmarking solution showcase Priyal ShahMike BerezaSanjay Ganvir14.55-15.15 Idea Generation and Selection Thomas JunGroup discussion15.15-15.20 Service prototyping Thomas Jun15.20-16.30 Solution Development Group work16.30-16.45 Solution presentation 5 min for each group16.45-17.00 Summary and plans Amalin Dutt and Thomas JunWorkshop219
    • 20. Criteria for the winning idea• Short-term ideas (3 months) • Long-term ideas (5 years)20√ Focused on Users’ Needs√ Supporting Integrated Care√ Cost-Effective√ Sustainable√ Ready-to-be–implemented √ Wide impact
    • 21. http://hsi.cloudapp.net/Methods to be used• Systems thinking: Looking at big pictures• Design thinking: Users, Doing Not just Talking• Proactive risk thinking: Structured what-if• Lean thinking: Flow thinking21
    • 22. http://hsi.cloudapp.net/Design thinkingDiscover Define Develop Deliver22
    • 23. http://hsi.cloudapp.net/Lean thinking• What is it?1. Origins & Purpose2. A set of tools3. An enabler of change4. A philosophy5. Think Lean23
    • 24. http://hsi.cloudapp.net/Lean thinking1. Origins & Purpose– Japanese manufacturing– Toyoda (Toyota)– Global since 1980s24
    • 25. http://hsi.cloudapp.net/Lean thinking1. Origins & Purpose– Improving the flow of service or product– Eliminating waste– Improving quality– Reducing cost25
    • 26. http://hsi.cloudapp.net/Lean thinking2. A set of tools– Understanding waste» Meets an explicit customer requirement» Cannot be shown to be performed more economically– Fool proofing (Poke Yoke)– Continuous improvement (Kaizen)26
    • 27. http://hsi.cloudapp.net/Lean thinking272. A set of tools
    • 28. http://hsi.cloudapp.net/Lean thinking• Fool proofing (Poke Yoke) e.g.28Fuelling area of car has three mistake-proofing devices:• Filling pipe insert keeps larger, leaded-fuel nozzle from being inserted• Cap tether does not allow the motorist todrive off without the cap• Cap is fitted with ratchet to signaltightness and prevent over-tightening.
    • 29. http://hsi.cloudapp.net/Lean thinking3. Enabler of change– Improvement project process4. Philosophy– “The only people who do not make mistakes are those thatdo nothing”– “The most dangerous kind of waste is the waste we do notrecognize”29
    • 30. http://hsi.cloudapp.net/Lean thinking5. Think Lean– Question the status quo– Why is something done in a particular way?– What are the perceived problems?– What is the root cause of an issue?– Where do we see waste – time, quality of service,unnecessary repetition, metrics, patients at risk?30
    • 31. http://hsi.cloudapp.net/Aim of Today’s workshop• To develop specific solutions to address topissues– To explore a specific issue in greater depth– To describe the best desired outcome for the problemsituation31
    • 32. http://hsi.cloudapp.net/ 32IssueAim of Today’s workshopSolutionIdealFinalResultCauseCause
    • 33. http://hsi.cloudapp.net/The Five WHYS• What is it?– A chain of WHY questions used to dig below theoutward symptoms of an issue• How is it done?– Answer the WHY questions using a convincingexplanation leading back from the original issue33
    • 34. http://hsi.cloudapp.net/The Five WHYS• WHY can patients not get a prescription fromthe doctor recommending it?• WHY does it take so long to get aprescription which requires hospitalapproval?• WHY is there communication breakdownbetween hospitals and GPs?34
    • 35. http://hsi.cloudapp.net/Ideal Final Results• What is it?– A description of the desired outcome• How is it done?– Can the desired outcome achieved without any system,only with existing resources?• Why is it used?– Help to overcome our psychological inertia– Help to reach breakthrough solutions35
    • 36. http://hsi.cloudapp.net/Ideal Final Results• The right amount and type of medicines areavailable when needed without any system.• The right amount and type of medicines areadministered on time without any system.• No medicine, but still long term health care ofthe elderly are well managed.36
    • 37. Medicine Management – Workshop21) Issue description Group No.Pageof2) The Five WHYS 3) Ideal Final Results; a description of the desired outcome
    • 38. Medicine Management – Workshop21) Issue descriptionHow do we make medicines that require special consideration, available topatients in a timely manner?Group No.2Page1 of 32) The Five WHYS 3) Ideal Final Results; a description of the desired outcome1. Why can patients not get a prescriptionfrom the doctor recommending it?2. Why does it take so long to get aprescription which requires hospitalapproval?3. Why is there communication breakdownbetween hospitals and GPs?4. …5. …Medicines (right amount and type) are alwaysavailable when required?
    • 39. 15 MinutesThe Five WhysIdeal Final Results39
    • 40. Benchmarking Solutions40
    • 41. http://hsi.cloudapp.net/Service Prototyping• What is it?– Some form of mock-up of the service system• “Roleplay” style conversation• Detailed creations involving active user participation and props• Why is it used?– To test the service solutions being proposed– To help iterate design solutions41
    • 42. http://hsi.cloudapp.net/Service Prototyping42
    • 43. 43EMIS supportscheckingGPreceptionistgives a newprescriptionGP receptionistcollects the whitepartPharmacy ITsystemPharamcistdispensesmedicinePharmacist receivesprescriptionPhysicalevidenceService UserActionsFrontstageService ProviderActionsBackstageService ProviderActionsSupportProcessesGP issues anewprescriptionPharmacyreceptionareaInternet,phone, postofficePharmacist givesmedicinewhitepartPharmacywaiting areaRepeatprescriptionformBlister pack,dosagedispenser,bottle, etcLINE OF INTERACTIONFill in andsubmit thewhite partto GPVisit GP andcollect arepeatprescription(within 48 hrs)Visit pharmacyand drop arepeatpresciptionCollectmedicineTakemedicineLINE OF VISIBILITYINTERNAL INTERACTIONGPReceptiondeskPharamcistcontacts GP forenquiry
    • 44. http://hsi.cloudapp.net/Workshop344When What Who14.00-14.10 Summary of the lastworkshopStephen RogersAmalin Dutt14.10-14.20 NHS change model Thomas Jun14.20-14.50 Barriers and drivers Group discussion14.50-15.00 Business model canvas15.00-15.30 Business case development Group discussion15.30-15.40 Gantt chart example15.40-16.00 Gantt chart development Group discussion16.00-16.30 Final presentation All16.20-16.40 Workshop evaluation All16.45-17.00 Award and conclusion Amalin Dutt

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