HEREFORD HOSPITALS NHS TRUST Transformation Programme Highlight Report PURPOSE: To update the Board on the progress of the Transformation Programme during Quarter 1. IMPLICATIONS: Financial Legality Implications Considered HR Healthcare/ National Policy Efforts to reduce waste and increase efficiency will reduce costs and increase income. None Significant role redesign a likely outcome of some projects. Other RECOMMENDATIONS: programme. The Board is asked to note the progress of the DIRECTOR: Alan Dawson, Associate Director of Operations PRESENTED BY: Alan Dawson, Associate Director of Operations AUTHOR: Alan Dawson, Associate Director of Operations DATE: July 2008 Page 1
Transformation Programme Highlight Report Quarter 1 2008 Introduction This report highlights programme and project status for the Transformation Programme during Quarter 1 2008. The information provides a brief summary of progress within the period and some key performance indicators (). are being agreed as projects progress and many have a new data collection requirement. These new will be available in future iterations of this report. Project Portfolio The Programme currently comprises the following projects and work streams, prioritised by the Transformation Board: Emergency work stream o Discharge planning o Complex / delayed discharge o Productive ward Supply chain project Elective work stream (admitted pathways) o Pre-operative assessment o Theatre productivity o High volume pathway redesign Out-patient work stream (Non-admitted pathways) o Clinic productivity Specialty based projects Diagnostic test coordination Discharge Planning Project Estimated dates for discharge (EDD) now set on each admission & displayed on ward status boards (reviewed daily) Electronic staff handover sheets piloted on 2 wards with shared folder - remote access for Clinical Site Management team now planned Nurse led discharge policy re-launched across the Trust Consultant ward round piloting sequencing of patients on ward rounds in relation to discharge time (medicine) New weekend discharge procedure piloted in medicine from May 2008 New discharge planning checklist developed Commenced late in day discharges data collection and analysis Key Performance Indicators () Page 2
% Bed occupancy (daily information to be reported in future) (information below from performance report) Bed Occupancy (midnight) 100% 95% 90% 85% 80% 75% Apr-08 May-08 Jun-08 Productive Ward Ward in place on each ward to enable staff, patient and visitors to check the progress on each ward New patient status boards piloted on Frome Ward to reduce handover time Labelling of stock standardised across Trust (inc. cost per item, stock levels) Electronic handover sheets piloted on Arrow and Teme Wards Arrow and Wye completed 5S (Sort, Set-in-order, Standardise, Shine, Sustain) layout Page 3
Stock review during 5S linking to supply chain project Increase in direct patient contact time from 46% to 50% on Teme Ward, reduction in time taken for handover, medicine management, managing patient flow and admin. 12 hour activity observation 60 50 40 30 20 10 0 Motion Admin Handovers Medicines managem Discussion Personal hygiene Patient Flow Other Direct Care % of total post % total Other indicators such as unplanned absence showing improvements. Supplies Chain project (Productive Ward) Value stream mapping event in May 2008- mapped current and improved process with PFI partners (portering and distribution staff) Stock take on Teme and Arrow Wards completed large amount of waste identified Pilot of twice weekly delivery on Arrow and Teme Wards Currently engaging lean logistics experts to advise project team on setting stock levels, replenishment cycles, top up levels and optimal process Housekeeper role to take on stock management on wards (releasing nursing time) Exploring changes to NHS Logistics cage delivery (grouping and labelling of cages) Credit for returned / non delivered stock now identified on monthly ward budget statements New policy being developed for introduction of new products, running down existing stock and measuring waste Reduction in inventory and associated costs e.g. 520 stock returned to pharmacy from one cupboard (currently being measured) Page 4
Pre-Operative Assessment (POA) Agreed in principle to conduct POA screening at initial Outpatient Appointment - large proportion of patients will not need further full assessment thereby reducing visits and demand on POAC Agreed to pilot new process in Orthopaedics (clinical director support) from September Developed pre-op screening form to be piloted in POAC for all Orthopaedic patients except joints/ revisions JD developed for anaesthetic locum to provide 2 sessions for POA (awaiting reports from Info dept) % patients seen by POA prior to surgery Cancellations on day of surgery due to failed pre-op process Theatre Start time project Mapping event to agree key issues and actions Agreed definition of start time (anaesthetic start) & measurement (additional info on knife-to-skin) Agreed call times for patients to theatres Surgical Assessment Unit (SAU) & Day Case Unit (DCU) reception processes reviewed and changed Status boards introduced in DCU and SAU Live theatre lists now accessed in wards/ SAU reception Clarified procedure for list changes/ late additions Patient letters reviewed Monitoring and management of causes of delays ongoing % start on time (anaesthetic) (NB Data quality for June not verified as first report from Ormis new Theatre admin system) Page 5
100% All Theatres: Booked Sessions Start and Finish On Time 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar % start on time % finish on time National target start on time Theatre productivity New Ormis system reporting explored e.g. utilisation, down time, delays Service Improvement Team completed observation exercise in theatres Daily wash-up meetings by Band 7 staff review performance of day & identify issues to be resolved in future (to be reported by information department) % Theatre Utilisation (NB Data quality for June not verified as first report from Ormis) 1000 900 800 700 600 500 400 300 200 100 0 All Theatres: no of Patients & % Utilisation Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% No of patients % Patient Utilisation Page 6
Out-patient Workstream (non-admitted pathways) Staff Lean training commenced & communication board commenced Observation of patient, information and notes flow within clinics Waste identification completed Storage areas reviewed Nurse skill mix reviewed New patient & staff survey Immediate priority T & O: analysis by specialty of waiting times, DNA rates (and clinic utilisation) focus efforts to be in T&O next quarter. % utilisation (awaiting report from Info dept) Activity - in performance report % DNA rates (new and follow-up) Diagnostics Access Demand and capacity training workshop in June & support for diagnostic leads Reviews of booking, demand and capacity, reporting : o CT o Endoscopy o Lung function o Neurophysiology o MRI waiting times reduced from 11 weeks to 3/ 4 weeks since last report Myoview capacity plan developed (to meet increased demand) Business Improvement/ Lean Training programme for Staff Initial exploration with Worcester Business School regarding the development of a business improvement (Lean) training package for Trust staff. Chief Executive exploring future work with the Manufacturing Institute based on the experience of Virginia Mason Hospital in Seattle Key issues for Quarter 2 Ensuring that are completed and reported for all projects Continue to prioritise work in Theatres and on inpatient discharges Begin to plan next priority stream of work around the referral/booking/scheduling and administration value stream. Page 7