assistive technology services: wheelchairs & seating ‘sharing the learning’ glasgow 2009...
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NHS Tayside. Assistive Technology Services: Wheelchairs & Seating ‘Sharing the Learning’ Glasgow 2009 Report on Rapid Improvement Event April 2008. Rapid Improvement Event April 2008. Background Scope / objectives Actions, results, improvements Future work / sustainability RIE - PowerPoint PPT PresentationTRANSCRIPT
Assistive Technology Services:Wheelchairs & Seating
‘Sharing the Learning’Glasgow 2009
Report on
Rapid Improvement EventApril 2008
NHS Tayside
Rapid Improvement Event April 2008
• Background• Scope / objectives• Actions, results, improvements• Future work / sustainability
–RIE–National Wheelchair Project
• Reflections on RIE / AT service• Thanks• Comments / questions
Background
• Waiting times out of control• Poor information to users• Service user complaints• Old wheelchairs• Staff morale low• Etc
End of CCSF fundsShort term SG waiting list fundsAgenda for change
Scope of the RIE
“All patients (adult and paediatric) to meet the
18 week target from referral to provision
of safe and usable equipment
within NHS Tayside”
Management – Team Goals
• 95% of new clients to achieve 18 week target by Dec 31st 2008 (Assessment to provision)
• Routine follow-up for Paediatrics• Information available for client / carer enquiries• Screening of referrals within 1 working day of
receipt• Weekly monitoring by project manager• Standard weekly reporting mechanism• Move towards ‘Moving Forwards’ priorities• Geographical equity of service• Improved service for clients / carers / users• Increased team morale
Action Plan – Key Improvements
5 key themes
• Pathways defined• Waiting list management• Communication• IT• Staffing issues• Stock / storage / technical
Waiting Lists
Clients > 18 weeks – assessment to provision of safe and usable equipment
(this includes all patient categories)
• May 2008 - 108
• May 2009 - 10
Reduction of Reduction of
9898Clients!Clients!
Patients waiting over 18 weeks (Assessment to provision)
100
60
40
10
80
20
0
July08
Jan09
JuneOct March
Number
Date
<98%N waiting
<98%N waiting
Assessment Waiting Times
Routine assessment – scheduled clinicsMay 2008 – 67 weeksJune 2009 – 10 weeks
Priority Assessment – unallocated listsMay 2008 – 25 weeksJune 2009 – 3 weeks
Redesign of services – How?
• Cleansing of waiting lists• Removal of ex-employee lists• Removal of team lists• Reduce number of waiting lists -
Unallocated + scheduled clinicsPackages in progress – individual
clinicians• Weekly monitoring by Project Manager• Reporting to Group Manager and
Clinical Director
Clinic Structure• TORT clinics
– May 2008 – 9 clients listed– June 2009 – 146 clients listed
• Administrative staff telephone client to confirm attendance• Patient focused booking system
• Satellite clinics – – Perth Royal Infirmary– Fairview School Perth– Upper Springlands Perth – February 2009
• Existing clinics– Kingspark School Dundee– ACDC Dundee– TORTC
Communication - general
• New referral documentation• New screening tool• Standardised letters• New client information leaflets• Information on waiting time now
available on enquiry with administrative staff
Communication - Staff
• Weekly meetings – agenda set and minutes recorded
• TRES meetings – bimonthly• Summary of improvements on
notice boards • Improved use of electronic diaries• Visible service by all via database• Individual meetings review client
lists / actions
Communication – staff cont’d
• New template for notes to ensure consistency of information
• Core team event – July 2008
• Strategy session – January 2009
• Skills maximisation team event – planned for August 2009
Staff
• Success in filling vacant positions• Temporary staff extended contracts• Trainee Clinical Scientist – May 2009
Technical staff• Long term sick backfill arrangements• Enhanced role consultations• Reviewed job descriptions• Agenda for change issues• PPM – man and a van
Proposed new staff – National Wheelchair Project
Information Technology (IT)
• Database upgraded – New Ways waiting times
• Staff trained – external staff training in progress
• New PCs – digital radiograph access for clinicians
• Stock management module• Van planning module• Website in development
Stock / Storage and Technical
• LEAN principles applied – culling of obsolete stock
• Mobile workbench• Delivery lists (Clinicians work)
• Redesign of client information – mobile technicians
• Existing minibus / van replaced with new leased vehicle
Stock /Storage &Technical cont’d
• New fleet of wheelchairs in progress• New stock of spare parts• Reorganisation of store – identified
locations• Storage issues – awaiting space in
technical store
RIE Way Forward
• Continue weekly monitoring• Aim for 100% -referral to
provision• Analyse DNA rates• Commence patient focused
booking (Repairs / ppm)• Reinstating user / carer group• Repeat service users satisfaction
surveys
National Wheelchair Project
National Wheelchair Project
Vision for future of NHS Tayside Wheelchair and Seating Service
Based on•RIE•Moving Forwards, •Better Health, Better Care •Local delivery Plan…….
Vision : Bid to Government
• Responsive, local, integrated– Communication, users, other agencies
• Efficient, rapid, quality service– Staff levels, skills, clinics,
• Safe, continuous, pro-active– Ppm, out of hours, clinical reviews
• Modern service– Wheelchair designs, telemedicine
• Meeting overall needs– Outdoor power
Target Standards (examples)
• Referral to provision (direct) : 80% < 14days
• 1st Assessment offered < 4 weeks
• Assessment to provision, – configurable stock wheelchair: 80% < 21 days– bespoke equipment : 80% < 60 days
• Repairs – Routine: 90% < 5 days– Urgent : 75% < 1day
Key Performance Indicators
Rehabilitation Technology Information Service (ReTIS)
–NHS Tayside development–Scottish implementation
Project Staffing
1 Clerical officer1 Trainee technician2 Mobile technicians ppm, (1.0)1.2 Technical Instructors (0.6)1 Stores person3 Technician upgrades1 Therapist
( ) = temp staff in post
Modern Wheelchairs & spares
Year 1 - £360,000Year 2 - £390,000
Scottish Government Funding?
• 08/09 £171,000 allocated
• 09/10 £600,000 approx• 10/11 as above
Note : 2 year commitment
Reflections on RIE
• Before RIE
• Significant improvements made.• Some improvements already planned• Nothing new, but not happening• RIE Catalyst for change
• Speed vs Quality ? - outcome measures Home visits, clinics
Reflections on RIE• Cost
– £ low for NHST (£0 revenue)– Staff time / stress
• Benefits – National project– Staff– Team cohesion
– Service users
Sustainability ?
• RIE • National project
–2 years–Afterwards (CCSF!)
• Workforce planning• Training / education
Future Vision
Assistive Technologypotential for development
• Electronic assistive technology• Pressure ulcer management (pain)• Seating / ergonomics• Vehicle mobility• Technology for daily living• Etc …..
Independence, Quality of life, Cost savings
Thank you• NHS Tayside• Scottish Government• Ross International• Users / associated staff• RIE Project manager (Margaret)
• Service staff
Comments, Questions ?
Poster report on
Rapid Improvement EventApril 2008
•Pathway identification•18 week Referral to
Provision
NHS TaysideAssistive Technology Services:
Wheelchairs & Seating
10<98%
Patients waiting longer than 18 weeks (Assessment to provision)