incomplete Whole System Patient Flow Improvement Programme sub- QuEST Quality, Efficiency, Value
Whole System Patient Flow Improvement Programme 2020 Vision and the Quality Strategy The Scottish Government s 2020 Vision is that by 2020 everyone is able to live longer, healthier lives at home, or in a homely setting, and that we will have a healthcare system where: We have integrated health and social care. There is a focus on prevention, anticipation and supported self-management. If hospital treatment is required, and cannot be provided in a community setting, then day care treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission. The 2020 Vision provides the strategic narrative and context for taking forward the implementation of the Quality Strategy to deliver safe, person-centred and effective health care, and the required actions to improve efficiency and achieve financial sustainability. 2
incomplete Whole System Patient Flow Improvement Programme The Whole System Patient Flow Improvement Programme is one of the workstreams within the Scottish Government s Quality and Efficiency Support Team (QuEST). The team applies Quality Improvement Science to Performance Challenges. The Quality and Efficiency Support Team Performance Support Efficiency and Productivity Portfolio Office Outpatients, Primary and Community Care Facilities Shared Services Cancer Performance Support QuEST HR Shared Services Mental Health Procurement Whole System Patient Flow Prescribing 3 sub-
Whole System Patient Flow Improvement Programme Right care, right time, right place, right team, every time The Whole System Patient Flow Improvement Programme will: Adopt 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. Work collaboratively with other programmes of work to identify overlap and reduce variation. Promote the bringing together of both elective and unscheduled work streams to support a whole system approach. Reduce artificial variation in health care. Aim to develop a culture of sharing and continuous improvement across NHSScotland. Support a person-centred approach for quality improvement. 4
incomplete incomplete What is Patient Flow? Good patient flow supports optimal care for patients needs and contributes to safe, person-centred and effective care. It also elimates or reduces inefficiencies. Right care, right time, right place, right team, every time sub- Poor patient flow means reduced quality which may result in patients: waiting for treatment; receiving sub-optimal care that may not be as effective or perhaps take longer; being ed once their treatment is complete. 5 sub-
Whole System Patient Flow Improvement Programme Our Principles Our principles are those of QuEST which recognise the priorities and pressures of service delivery. Our approach to improving the quality, efficiency are value of healthcare for the people of Scotland is based on 10 key principles: Reduce unwarranted variation in service provision, remove waste and eliminate harm Improve healthcare quality by increasing the safety, effectiveness, experience and responsiveness of services Use resources effectively reduce costs, improve productivity and release efficiencies to enable reinvestment in front line patient care Encourage innovative approaches to service redesign and use of technology Adopt a whole system approach to service redesign Collaborate and partner with NHS Boards, Local Authorities and the third sector Ensure clinical decision-making takes precedence over short term efficiency gains or achievement of targets Encourage a more productive and empowering workplace culture Use good quality benchmarking and performance data, together with insignt into service provision, to identify where productive opportunities lie Identify, spread and sustain good practice Reference http://www.qihub.scot.nhs.uk/quality-and-efficiency/2020-framework-forquality,-efficiency-and-value/introduction.aspx 6
incomplete Current Priorities We recognise all these programmes have a bearing on flow, however, those within the pyramid are specifically related to the Whole System Patient Flow Improvement Programme. Workforce: 7 Day Service Facilities Shared Service Programme HR Services ED Overcrowding Institute for Healthcare Improvement Mental Health Waiting Time Targets Influencing Patient Flow Reliable Implementation and Spread of: Same Day Surgery Enhanced Recovery Fracture Pathway Redesign Demand Capacity Activity Queue Bed Planning Tool Day of Care Survey Theatres Boarding NHS Lanarkshire Flow Programme Proof of Concept: Institute for Healthcare Optimisation Hospital At Home Scottish Patient Safety Programme Frail Elderly Quality Unit Acute Assessment Study New workstreams: Flowopoly visualising flow Criteria Led Discharge Hospital Safety, Prediction, Flow Briefs* Healthcare Improvement Programme Prescribing Programme Person-centred Collaborative *In collaboration with SPSP, Person-centred Collaborative, Unscheduled Care Action Plan Variation Performance Support Quality Standards Diagnostics Presenting and Understanding Data Microstrategy Discharge Planning Real-time Demand Capacity Cancer Performance Support Team Procurement Programme Health and Social Care Integration Professional to Professional Unscheduled Care Access Plans Access Support Team Primary Care Community Outpatients 7 sub-
1. Whole System Patient Flow Improvement Programme Right time? This brochure focuses on the work of the Whole System Patient Flow Improvement Programme (WSPFIP) but recognises the contribution and achievement of many other national and local initiatives to improve patient flow and the quality of care. WSPFIP is now well established. The three workstreams in their spread and sustainability phases are continuing to improve the quality of care in Scotland. The pilot work with four boards to test the Right Right place use of operational management techniques to improve patient flow is now well underway. Three new workstreams are under development and all three are already engaged with local NHS boards. WSPFIP Director Every time? 8
incomplete care? An alternative fracture clinic model has been developed in NHS Greater Glasgow and Clyde which shows improved patient experience and quality of care. The new model streamlines the patient journey and removes the need for non-value adding patient attendances in hospital. 2. Fracture Pathway Redesign Would have been a waste of everyone s time (mine included) to go to clinic. Patient comment Thank you. It was a 5-star quality service. The removable boot meant that I could walk right away, it was generous to supply crutches, too, as my balance is poor. Patient feedback? 3. Hospital Right Huddle: Hospital, team Safety, Prediction, Flow Briefs In Scotland, we recognise that Patient Flow has consequences for Patient Safety and vice versa and therefore suggest that neither Safety nor Flow should be seen in isolation. Organisations have identified Hospital Huddles as an opportunity for Flow and Safety to be part of the same conversation, to learn and emulate best practice. It s my favourite 20 mins of the day as we get a good clear picture of flow, pressure points and any other issues which are relevant to share. Senior Nurse/ Operational Manager Child Health & Gynaecology Huddles identifies morning discharge and the ADT Criteria supports patient discharges. Crosshouse Hospital Flow is a real thing. principally and number one a safety problem. Professor Jason Leitch (presenting at WSPFIP Event, 2013) 9 sub-
4. Enhanced Recovery Enhanced Recovery provides a way of managing care and rehabilitation that improves patient outcomes and speeds up a patient s recovery after surgery, enabling them to return to normal activities more quickly. National Workstream Lead Right time? Next steps include: Supporting ER pilot in obstetrics for planned Caesarean section procedures Providing support for the National Enhanced Recovery Analysis Toolkit Right Launch of ER LearnPro elearning module Right place Continue to engage with local teams and understand further opportunities for spread. 5. Same Day Surgery Building on achievements within day and short-stay surgery performance, this workstream aims to support NHSScotland reduce the variation that exists in care pathways, ensuring patients receive the right care, at the right time, in the right place, by the right team, every time. When I was ready to go home it was a joint decision with the hospital staff and myself. Day surgery patient, NHS Lanarkshire The most important thing was that I was going to get home that evening. Day surgery patient, NHS Lanarkshire Every time? 10
incomplete care? 6. Criteria Led Discharge Launched in 2014 Criteria Led Discharge prevents unnecessary s in patient flow, through promoting delegated decision making by members of the multi-disciplinary team thus ensuring discharge from an acute hospital at the optimum time and day for patients. This process promotes proactive decision planning with the aim to improve quality and safety of patient care, by limiting s in decision making. National lead for Criteria Led Discharge? 7. Proof of Right Concept team The aim of this work is to successfully test, implement and spread an operations management approach from the Institute of Healthcare Optimisation (IHO) that will optimise patient flow across the whole system and improve the experience for patients, carers and staff. Right Patient, Right Place, Right Time everyone wanted to achieve this but didn t know how. Projects in isolation had failed in the past. IHO was seen as the catalyst to make it happen throughout the whole health board. Consultant, Anaesthesia & Critical Care, NHS Forth Valley 11 sub-
Right 8. NHS Lanarkshire Flow Programme Monklands Hospital Right The programme aims to improve time? emergency flow in Monklands Hospital by using the principles and tools from clinical systems improvement which draws on concepts and principles from two key manufacturing methodologies lean and the theory of constraints. Although we knew it before, it s becoming clearer and clearer that in order to truly improve patient flow all stakeholders need to be engaged, motivated and working together as a team. (Staff comment) Right place Staff feel happier. Appears a calmer environment. We have more time to provide good patient care. (Nursing Staff feedback on Emergency Flow Pilot) Much Quicker than Last time. The new system seems a vast improvement. (Patient feedback on Emergency Flow Pilot) 9. Flowopoly Flowopoly is a table-top exercise that provides boards with the opportunity to visualise real hospital data to help understand the problems and complexities of patient flow. This helicopter view demonstrates the journey patients make through the system including blockages and pressure points they encounter. Every I thought we were busy! time? Flowopoly is a great exercise that helped me to see the bigger picture and not just what was happening in my department. Staff nurse 12
incomplete care? Whole System Patient Flow Improvement Programme The National Team The team is drawn from across the NHS in Scotland and currently includes: Martin Hopkins Programme Director Martin.Hopkins@scotland.gsi.gov.uk Katie Cuthbertson Programme Manager Katie.Cuthbertson@scotland.gsi.gov.uk Laurence Keenan Service Improvement Laurence.Keenan@scotland.gsi.gov.uk Manager Michelle McNulty Service Improvement Michelle.McNulty@scotland.gsi.gov.uk Manager Julie Main Service Improvement Julie.Main@scotland.gsi.gov.uk Manager? Right team David McDonald Service Improvement David.McDonald@scotland.gsi.gov.uk Manager Lynne Mann Service Improvement Lynne.Mann@scotland.gsi.gov.uk Manager Kathryn Neill Information Advisor Kathryn.Neill@scotland.gsi.gov.uk Clare Adams Project Manager clareadams1@nhs.net Lynne Jarvis Information Analyst Lynne.Jarvis@scotland.gsi.gov.uk Esme Wilson Project Support Officer Esme.Wilson@scotland.gsi.gov.uk Whole System Patient Flow Improvement Programme website: http://www.qihub.scot.nhs.uk/quality-and-efficiency/whole-systemspatient-flow.aspx 13 sub-
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Our website: Revision, October 2014 APS Group Scotland DPPAS29679 (10/14)