Scheduling elaine kemp
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Scheduling - Elaine Kemp National Improvement Lead NHSIQ Domain 3 Presentation from the Productive Endoscopy Workshop, Tuesday 15th October 2013 at Ambassadors Bloomsbury , London, WC1H 0HX This meeting brought together teams from around the country, and embarked on creating and testing the productive endoscopy toolkit. The aim of the day is to allow time with your team for sharing of experiences and exchange of good practice, learn how to apply lean techniques and hear the impact of successfully implemented case studies.
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Scheduling elaine kemp
- 1. Scheduling Elaine Kemp National Improvement Lead NHSIQ Domain 3
- 2. Scheduling module looks at • Improving the flow of information and patients • Reducing errors/delays • Eliminating unnecessary duplication …… for the patient as well as for ourselves Today we will take a high level look at – • • • • • The scheduling game – reminder of how scheduling effects flow Demand and Capacity – the balancing act Utilisation – why it’s important Procedure Times – what do we measure and why Rework – removing the waste
- 3. Does it sometimes feel like this?
- 4. The scheduling game Goal – reminder of the impact scheduling has on patient flow, individuals within the process and the opportunity to review current ways of working to reduce waste • Groups of 5 people on each of the 4 tables • Each person choose a role/perspective – Patient, Nurse, Endoscopist, Clerical Staff, Trust Manager • Read the scenario and create your 1st schedule – Discussion • Create your 2nd schedule – Discussion • Feedback
- 5. What is the ideal scheduling process? • • • • What is the ideal scheduling team? Demand and Capacity Utilisation Procedure Times Rework – removing the waste • • • • Multi skilled Defined roles Trained Valued
- 7. Demand and Capacity so what? Demand is due to increase DH Modelling showed 10-15% year on year lower GI increase over 5 years, by 2016 could mean 75% If you don’t match the amount of work coming in with the actual ability to do the work what happens? Demand is not the measure of how much work you do – it’s the measure of how much work you are being asked to do Capacity – is this the amount of work you could do, plan to do, schedule or deliver? How many points should we schedule? How many of each procedure should be scheduled?
- 8. Example Trust Endoscopy Project Capacity 450 394 400 383378 375 397394 387 377 372 357 345 350 342 340 333 329 313 299 292 300 291 290 277 277 264 253 250 Hours 229 200 171 161 150 100 50 34 32 17 16 10 4 0 0 0 0 32 13 5 0 0 0 0 0 Baseline 2011/12 Jun Jul Demand Aug Actual Capacity Sep Oct Extra Capacity Nov Activity Dec Jan Theoretical Capacity Feb Mar
- 9. Demand and Capacity Top Tips • • • • • • • • • • • Keep it simple to start and keep it consistent Meaningful, real time, used and displayed Count it all – inpatients and surveillance Use your PTL – add a column for points Policy and procedure - SOP Predict the predictable – holidays, winter If your demand is above your capacity be careful of asking for more resources without checking utilisation Remember you could reduce demand Developmental creep – new services Training and development Be careful using data – process not people, inclusive, no surprises
- 10. Utilisation What is the optimum utilisation 80%, 90%, 100%? What do we mean by utilisation? Sessions affected by delays On day DNA/CNC Endoscopist late 54 26 24 20 Patient unprepared 17 Slow admission process 181 Changes to session 35 Over runs 38 Cannualtion 38 Other commitments 42 Patient information 141 47 Courses/Teaching Waiting for scopes 49 Sscheduling error 94 Lack of nursing or BCS Private activity Portering delays Out of 847 sessions - lost 862 hours due to under running and 80 over running
- 11. Process Times – What do we measure and why? Process TIME (mins) STAFF MEMBER Admission Staff Patient booked into Admissions 5 Poplar Nurse Patient registers in Poplar Poplar Nurse Patient gets changed/Toilet 5 Endoscopy Nurse Consent 5 Doctor or Nurse specialist Patient taken to ENDOS Suite Endoscopy Nurse OBS checked 5 Doctor or Nurse specialist Procedure undertaken (flexi-sig)** 15 Endoscopy Nurse OBS checked 5 Endoscopy Nurse Report Completed 5 Endoscopy Nurse Scope cleaned & Documented 30 Endoscopy Nurse Patient returned to Poplar ward 5 Poplar Nurse Patient in Recovery(OBS checked etc) 30 Poplar Nurse Future Mgt and Discharge 5 Doctor or Nurse specialist Red Yellow Green Blue Green Blue Blue Blue Blue Yellow Green Add a staff member Allocate a colour to each step
- 12. ID Thurs pm Lists (actual in + out times) 1.25 PM 1:30 PM 1:35 PM 1:40 PM 1:45 PM 1:50 PM 1:55 PM 2:00 PM 2:05 PM 2:10 PM 2:15 PM 2:20 PM 2:25 PM 2:30 PM 2:35 PM 2:40 PM 2:45 PM 2:50 PM 2:55 PM 3:00 PM 3:05 PM 3:10 PM 3:15 PM 3:20 PM 3:25 PM 3:30 PM 3:35 PM 3:40 PM 3:45 PM 3:50 PM 3:55 PM 4:00 PM 4:05 PM 4:10 PM 4:15 PM 4:20 PM 4:25 PM 4:30 PM 4:35 PM 4:40 PM 4:45 PM 4:50 PM 4:55 PM 5:00 PM 5:05 PM 5:10 PM 5:15 PM 5 5 5 5 5 20 5 5 5 30 30 5 Scheduled Time Waiting in unit Admission Staff Poplar Doctor or Nurse Specialist Endoscopy Nurse 5 5 30 5 5 40 5 5 20 5 5 65 5 5 100 5 5 110 5 5 5 5 5 30 30 20 5 16/01/2003 5 5 5 5 5 30 30 20 5 5 5 5 30 30 5 Thurs afternoon list- Actual times ‘in’ & ‘out’ of Endoscopy room showing wait times for procedure on unitNB this is not procedure time but times the patient enters and leaves the procedure room 5 5 20 5 5 5 30 30 5 5 20 5 5
- 13. Removing Waste – rework caused by rescheduling, DNA’s, CNC, rebooking Do you know what your rework rate is? A simple calculation how many of the above as a percentage of your activity Case Study from a Trust - Rework rate of 25% Identified causes using 5 Why’s • Patients rescheduling – patients advised by letter of a date, no choice (particularly the surveillance patients), wrong procedure, redo, abandoned • DNA’s – patient didn’t understand, incomplete prep, got cold feet, letter not received in time • CNC – too short notice, procedure not required, staff or information unavailable • Schedule – endoscopists alerting the schedule, no notice period enforcement, other commitments irregular and took priority, adjusting case mix last minute because of waiting list pressure • Waiting list initiatives – last minute, clinically staffed no extra admin, not enough notice for patients, no advantages. • Urgent demand – rearrange work to allow for 2WW and inpatients
- 14. Top Tips • • • • • • • • • • • • • Review your rework rate occasionally, know your waste rate daily/weekly Measure, share, display and act on the information Optimum lead in time – 4 weeks Access - allow patients choice and ensure opportunity to ask questions Phone log/glitch log – who is giving answers about what? Regular review of patient information – BY PATIENTS Adherence to notice periods and consequence – escalation policy – shared data Pooling of lists Nurse endoscopists – Consultant endoscopist Remove fire fighting – plan 6 weeks ahead recurring Use technology – text reminders Dig deep for root cause in persistent problems Solutions – from other services in your trust or other local endoscopy units
- 15. More Resources NHS IQ website http://www.nhsiq.nhs.uk/ NHS Improvement website http://www.improvement.nhs.uk If you have a great example let us know … What scheduling systems are you using and linked to which unit systems and trust hospital systems? Link to our website to read the rapid review document : http://www.improvement.nhs.uk/documents/endoscopyreview.pdf