Endoscopy Capacity & Productivity Service Improvement Review. Fiona Thow Scientific Advisor to the CSO
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1 Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO
2 Review approach site selection Identified 12 sites from reviewing DM01 returns & profiling the waiting lists over the last year some with rising waits / some not Cross referenced to GRS returns (via JAG) Used local & national intelligence e.g. cancer networks, IST, screening leads Not an exact science, but confident we had a range of sites 12 visits in 3 weeks one day on site
3 Review approach - method Service improvement opportunities Short-term & longer term capacity Process issues (admin, clinical, decontamination) Leadership assessment ( nurse leadership, ops management, clinical engagement & leadership) Trust infrastructure level of priority, escalation & integration into service delivery Service improvement understanding & capability (including information & data)
4 High level findings Clinical process Delays to start times of lists Delays in the middle of lists, but in addition waiting for scopes, interpreters, bleeps & interruptions High DNA rates due to complex admin processes +/- no pre-assessment (then not utilised due to inflexibility of working between rooms) Cancellations on the day anti-coagulation issues, co-morbidity drug issues Lack of monitoring or feed back mechanism of the above / shared ownership of issues/ action plan to address (or publishing as KPI s)
5 Delayed start times List nibbles Examples of data Good examples of recording sheets, with codes that are fed into management meetings pro-actively used Endoscopists didn t like it and nothing really happened with the information, no information to support need for more scopes
6 Day Date Room No List start time Doctor arrival time List Start time List finish time Monday 3-Oct-11 AM :05 09:35 12: :55 09:10 13: :05 09:18 11:35 PM :35 14:05 16: :00 14:00 15:30 3 NO LIST Tuesday 4-Oct-11 AM :10 09:10 12: :15 09:30 10: :05 09:30 13:20 PM :10 14:20 18: NO LIST :15 14:20 16:25 Wednesday 5-Oct-11 AM :55 09:00 13: :20 09:30 13: :05 09:20 13:05 PM :00 14:14 17: :05 14:30 18: :40 14:30 17:30
7 Thursday 6-Oct-11 AM :50 08:53 12: :00 09:15 12:25 PM :20 09:20 11: :15 14:20 18: :00 15:05 15:55 3 NO LIST Friday 7-Oct-11 AM 1 NO LIST :00 09:15 12: :10 09:20 11:45 PM 1 NO LIST :10 14:20 17: :00 14:05 17:35 14Hrs 35mins 6 Hrs 45mins Total in 1 week = 21hrs 20 mins
8 DNA s & cancellations High DNA rates reported at 10%, or 1-2 per day (one site 16%) High numbers of cancellations on the day particularly OGD Sites who pre-assess colons have fewer cancellations as have sorted anti-coagulation issues or co-morbidities & appropriate prep OGD health questionnaire & telephone preassessment, plus reminder service One site rings all patients who DNA to find out why?
9 DNA s & cancellations
10
11 Admin reasons for DNA & Cancellations Under pressure no choice given next available slot sent out 2 nd class post significant delays Telephones often unmanned Huge amount of rework (25%) Patients query often anti-coagulation or comorbidities (clinical queries) See direct booking as too difficult!(often last minute list cover problems or no clear or adhered to leave policies)
12 Insert Admin map - current
13 Insert Future state direct booking map
14 Uncovered / dropped sessions Annual leave policies not adhered to (could be a Trust wide problem) No agreement to cover leave routinely Some gained extra sessional payments Sometimes nursing cover but no endoscopist.whole team WLI on a Saturday! Poor communication resulted in lost opportunities to flex job plans & training lists Sites with experienced nurse endoscopists could manage list cover effectively Some nurse endoscopists under utilised due to job plans
15 Week 1 Monday 05/12/2011 Tuesday 06/12/2011 Wednesday 07/12/2011 Thursday 08/12/2011 Friday 09/12/2011 AM PM AM PM AM PM AM PM AM PM Room 1 Dr. H Dr. J Dr. B Dr. E Dr. E Dr. B Room 2 Dr. J Dr. G Dr. G Dr. D Dr. A Dr. D Dr. H Dr. I Week 2 Monday 12/12/2011 Tuesday13/12/ 2011 Wednesday 14/12/2011 Thursday 15/12/2011 Friday 16/12/2011 AM PM AM PM AM PM AM PM AM PM Room 1 Dr. H Dr. B Dr. F Dr. E Dr. B Dr. F Room 2 Dr. J Dr. D Dr. A Dr. H Dr. B Dr. I Session Used Session Lost Unbooked
16 Variability of points system Points system used as a guide (but also a barrier) long history Roughly reflects process time Doesn t account for turnaround time Do NOT want to squeeze procedure time (risk of compromising on quality gains) There are opportunities for productivity gains in turnaround times ( Pull system ) Saw a pod system on one site
17 Points System Site Session length No. of points Training No.of points 1 4 Hrs 10 (11) Hrs hrs 12 (am) 10 ( pm) (some do 15 some do 8) 4 4hrs 12(am) 10(pm) hrs 12(am) 10(pm) ( some 15) 6 4hrs Hrs / 3.5Hrs Hrs 10 8 (A) 4 Hrs 11 Competency (B) 4 hrs Uses own points system (C) 4 Hrs 13 Competency (D) 4 hrs 12
18 No of Points Date 12 3-Oct Oct Oct Oct Oct Oct Oct Oct-11 4-Oct Oct-11 4-Oct Oct Oct Oct Oct Oct Oct Oct-11 Actual Points (11 point list) Oct Oct Oct Oct Oct-11 6-Oct-11 7-Oct Oct Oct-11 7-Oct Oct Oct Oct Oct Oct Oct Oct Oct-11
19 Things that help Sequencing of lists to be site appropriate dedicated in patient lists, 8.30am bleeder (for scopes) Demand management self vetting referral forms (BSG guidance & one type) Same day pre-assessment Direct booking Clear list start & stop times Leave & list cover agreed (job plans) Data to support service delivery (Demand, capacity, not just activity)
20 Things that help A pull system that works to increase productivity Understanding new service demands & building effective business cases for expansion (EUS, Halo ablation, EMR) Visual display of KPI s Collaborative working across clusters An escalation policy to maintain capacity & stop rising waits Planning for the expected pressures with commissioner support
21 Endoscopy: Summary There is potential capacity & productivity gains that could be achieved through process redesign (6 areas of focus) Effective operational management Data collection & planning Understanding & appropriate demand management Ensuring capacity is optimised Review of variation to highlight potential Positive patient experience
22 These modules create the Productive Endoscopy Unit
23 - design - -
24 - design - - Measures
25 Productive Endoscopy
26 Productive Endoscopy
27 100,000 Genomes Programme 13 Genomic Medicine Centres (GMCs) 3 London North Thames (GOSH) West London (Imperial) South London(Guy s & St.Thomas s) Collect samples of blood & tumours to undergo Whole Genome Sequencing To gather information about tumours to better target treatments
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