Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance

Transcription

1 Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance A Whole System Approach to Patient Flow for Scotland Our Quality Improvement Approach Jane Murkin Programme Director Nov 2013

2 Session Aims Strategic context and background Current state in relation to patient flow Scotland Future state Whole system patient flow Share our improvement approach Opportunity for collaboration and networking

3

4 The Healthcare Quality Strategy for Scotland Person-Centred - Mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision making. Effective - The most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. Safe - There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.

5 20:20 Vision We need to make sure people are admitted to hospital only when it is not possible or appropriate to treat them in the community and where someone does have to go to hospital, it should be as a day case where possible. We need to recognise and welcome that doing all of these things will result in changes in the pattern of acute care. Caring for more older people in the community or doing more procedures as day cases does result in a shift from acute to community based care, and as long as it is appropriate and as a result of the kind of service change we want to see, this will be a positive improvement in the quality of our healthcare services.

6

7 So, how is our business changing? Demography 25 % increase over 75 ( nxt 10yrs) Finance Falling public expenditure Technology Inequality Epidemiology/ Morbidity- Shift long term care and complex needs Expectations growing / Quality Mutuality

8 The Hospital Overcrowded Unsafe Poor experience Long waits Unsustainable

9 Jul 07 Aug 07 Sep 07 Oct 07 Nov 07 Dec 07 Jan 08 Feb 08 Mar 08 Apr 08 May 08 Jun 08 Jul 08 Aug 08 Sep 08 Oct 08 Nov 08 Dec 08 Jan 09 Feb 09 Mar 09 Apr 09 May 09 Jun 09 Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10 Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 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 Sep 12 4 hr emergency care standard compliance Avg daily ED* attendance Why In-patient Capacity and Flow? 100% NHS SCOTLAND ED* attendance, 4 hr emergency care standard compliance, 12 hr ED* LoS breaches Monthly compliance with 4 hr emergency access standard, %; average daily ED* attendance, n; ED LoS > 12 hr, n Sources: ISD validated A&E2 datamart extract and ISD management information reports covering unscheduled activity for core ED sites Jul 2007 to Sep 2012 Notes: (i) ED* refers to EDs, MIUs and trolleyed assessment areas; (ii) NHS Lanarkshire data for Mar 2011 are incomplete due to recent PMS issues; (iii) control limits are unadjusted XMR based control limits; (iv) results are intended for management information only and are subject to change 5,000 99% 4,288 4,516 98% 4,000 97% 96% 3,000 95% 94.9% 94% 93.6% 2,000 93% 92% , % % 0 Avg daily ED* attendance (Sep 2012): 4, hr ED* LoS breaches (Sep 2012): 62 4 hr ED* LoS compliance (Sep 2012): 94.9% Avg 4 hr ED* LoS compliance: 96.7% Lower/Natural process limit** HS6 national standard: 98.0%

10 Challenges Recent Media Headings: Shortage of hospital beds putting lives of patients at serious risk No more hospital bed cuts, signals minister (Thursday 25 April 2013) Health Secretary Alex Neil has signalled hospital beds will no longer be cut in Scotland. (Herald & Scotsman)

11 How we traditionally consider flow Access targets and standards (point improvements) Evolved from point improvements to pathway management (unscheduled care / 18 weeks RTT/ cancer/mental health) Chunking up strategies and goals for the system (i.e. elective and unscheduled) Focus on improving constraints (delayed discharge) Strategies having competing impacts (patient boarding) Insufficient emphasis on individual patient experience? Insufficient recognition of workforce design on flow and of improvement and workforce relationship?

12 Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance The workforce of the health service is arguably its most valuable asset. The health and wellbeing of this asset is likely to influence its ability to deliver person centred care in practice. Staff under pressure produce inferior care. Duncan (2011)

13 Principles Flow is a safety issue Flow is a clinical problem Flow is a multi-disciplinary problem Flow is a continuous problem Improvement science is the only solution From What s the matter? to What matters to you?

14 Part of the process of change is the capacity to imagine a possible and better future Aim high, stand out, be bold

15 Our Vision The programme will adopt: Vision : vision Right care Right time Right place Right team Every time A whole systems approach to patient flow designed to ensure patients receive the right care, at the right time, in the right place, by the right team. Will promote the bringing together of both elective and unscheduled work streams to support a whole system approach. Reduce the variation in healthcare experienced currently around Scotland Aim to develop a culture of sharing and continuous improvement across NHS Scotland.

16 Quality Improvement Approach Method Building capacity and capability in quality improvement Testing internationally recognised innovative approaches to improving whole system patient flow: Proof of concept Optimizing flow Macflow Improvement approach to ensure a focus on reducing variation achieving reliable implementation and ensuring spread: Same day surgery Enhanced recovery Non-operative fracture redesign

17 Tested methodology Separate planned and unscheduled flow Eliminate artificial variability in planned flow Determining and allocating resources using tools such as queuing, critical path and simulation models E Litvak, 2010

18 Our approach Collaborative & partnership working Supporting NHS Scotland to develop leaders in improvement Testing new and innovative ways of working Multidisciplinary working Shared vision Building the will Ways of working Sharing the learning & networking Support NHS Scotland as a learning organisation Embedding the use of real time data to drive continuous quality improvement

19 Islands of Excellence

20 Since Mar-11 NHS Scotland have successfully achieved and sustained the 80% Same Day Surgery HEAT Target but

21 there still remains significant variation and opportunity to make further improvement if all BADS Targets are achieved 82,000 Bed Days could be released

22 Glasgow Virtual Fracture Pathway 75% of all fractures are stable injuries Previously 100% of patients went to an outpatient appointment Now 62% discharged via either A&E or the virtual clinic The remaining 37% are reviewed at the right clinic by the appropriate specialist Percentage of Patients Patients Attending Fracture Clinic Appointments Traditional Fracture Clinic 7, Re-designed Fracture Clinic System Nationally ~ 100,000 Pts present with similar Fractures per annum Adapting this model may reduce ~ 53,000 outpatient attendeces 0 Consultant Led Fracture Clinic Consultant Led Sub-specialty Fracture Clinic 545 Nurse Led Fracture Clinic

23 Non operative Fracture redesign National Picture Current spread of fracture redesign Spreading across the UK National Clinical and Quality Improvement support Principles of redesign now moving into elective pathways (upper limb, foot & ankle) Also showing a benefit to reduce A&E waiting times There are approx. 3 million review outpatient appointments per annum in Scotland. (ISD Scotland) How can we use these principles of redesign to improve patient journeys?

24 Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance Every day the choice is in ourr hands What path will you choose?

25 Whew!