Theatre Safety and Efficiencies in Wales Lesley Law Planned Care Policy Lead Welsh Government
Welcome Who am I? I am Lesley Law - Policy Lead for planned care in Welsh Government Why am I here? March 2016 the Welsh Audit Office (WAO) produced a national report on operating theatres Within the report it made a series of recommendations for Welsh Government and the NHS to address I am here today to summarise what we have learnt, what we have done, and what we are doing to address this nationally.
Background The WAO national report concluded: Many theatres remain under-utilised and there are barriers to improvement along the entire patient pathway, not just within theatres. The focus on theatre efficiency and productivity has waned in Wales in recent years although positively there has been greater focus on surgical safety
What have we learned in Wales? While it was good to have confirmation from the WAO that good progress has been made in safety- we acknowledge that more work is needed We have a history in ensuring safety is a priority in theatres but as we know theatres involve humans and humans can make mistakes...
Safety How easy is it to get things wrong?
Past safety focus Previously published for Wales WHO surgical checklist http://www.who.int/patientsafety/safesurgery/ss_checklist/en/ 5 steps to Safer Surgery http://www.nrls.npsa.nhs.uk/resources/collections/10-for-2010/fivesteps-to-safer-surgery/
Next stage in patient safety (PSN034) 1. The introduction of national Safety Standards for invasive procedures 2. Publishing national newsletters- Sharing lessons, Improving Safety across wales based on real stories 3. Through Health Inspectorate Wales (HIW) the establishment of a surgical inspection framework looking at: Patient experience Safety & effectiveness Management & leadership
What has happened since the review? Learning form a national event Common areas of improvement All 7 HBs have service improvement programmes for planned care and each have a local project targeted at theatre safety and efficiencies. All HBs are collecting data, while there are common themes, such as late starts, early finishes, utilisation, cancelled operations, some have gone further with local dashboards exploring wider measures across the pathway All local groups have senior leadership a number are actually lead by clinicians
What has happened since the review? Learning form a national event Common barriers to delivery Bed availability- need for more dedicated day surgery beds, and day of admission of surgery units (DOSA) Need to engage wider than just theatres, and set measures across the whole theatre pathway, pre and post operation Need for cultural change- which can take time Staff, skill mix, recruitment and retention
Example of progress with clinical leadership and team work Utilisation averaging 79% (previously 75%) Performance during the winter maintained in previous years if fell down to 62% 500k of costs avoided to support RTT delivery in 2014/15
Measures need to be owned and add Traditional measures (to review) Cancelled operations Operations outside allocated time Maximum available capacity Planned time Allocated time Available used time Actual used time List start and finish times (planned and actual) Turnaround times Recovery value Possible new areas (local dashboard developments) Pre theatre, session scheduling accuracy In theatres Missed opportunities (lost time) Effectiveness of list scheduling on the day Post theatre Discharge from recovery, incidents PREMS Management/Staff Vacancy, sickness staff mix Staff moral Training and development
What have we agreed to do? To review our past key performance indicators (established 2011) for consistency and relevance (do they reflect current best practice?) They need to be useful to support local work and drive improvements, they need to be owned, therefore agreed jointly between Welsh Government and the NHS The national theatre managers group with Welsh Government representation will be responsible for implementing and developing the work nationally and continuing sharing lessons
Summary Local and national focus in theatres is needed- this was reinforced by the WAO report but also through internal findings While we can learn and implement now, some change will take longer Strong clinical leadership and partnership working is needed
Thank you for your time Any Questions? Lesley.Law@wales.gsi.gov.uk