setting the scene derek bell
Post on 25-Feb-2016
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Setting the sceneDerek Bell
Doing the simple hard wellas
Opposed to intellectual easyother wise known as navel gazing
How do we approach unscheduled care
• Demand – Is it increasing
• Patients older but ……….• Systems we design
• Access to care – Confusion between single point of access– Streaming of care
• Variation in care – Not patient driven – System driven
• Weekend outcomes • August outcomes• Xmas and Easter ?
– Poor performing systems respond poorly under pressure
The approach to demand• It’s a surprise• The patients are different
– It’s the weather– It’s the flu – It must be something
• Scotland is different
• While in this paradigm we will not move forward and worse may move backwards
• Need to – Continually improve our systems to improve patient flow– Monitor capacity and demand
Demand and capacity Predictableincrease in demand
Issue is matchedCapacity
Matched response ?
?
The approach to capacity
• We need – More staff– More facilities e.g. beds– More money
• Have we aligned our systems– Services compete for limited resources – Little evidence of joined up action– Do we plan staffing to meet demand - NO
Overall admissions
We need to sort out scheduled care ?
We need to sort out medical scheduled as well !
Scheduled and unscheduled care are NOT competitive
4hr access target
• 4 hr target is a barometer of the ‘whole system’ response to unscheduled care– No better measure at present– Not a quality measure
• Poor systems are variable by day and month– Will exhibit 12 hour breaches
How
• High volume changes designed to improve care for the majority– Collaborative but ….• Organisational memory
– Who now is still doing this job?
• Projectitis– Look at bespoke projects
Community
Hospital
The patient journey ?All parts need to work
04/22/2023 DBell Acute Medicine
Better Acute Care in Lothian
PrimaryCare
SecondaryCare
Summary• Need to develop an action plan which is
– Practical– Agreed and delivered by all agencies– Does simple hard– Starts with high volume quick wins– Develops a medium term strategy– Avoids projectitis
• incurable disease– Scotland is a small country
• Delivered so far but …….. • Still has reserve capacity if used well• Now aim for added value and quality
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