improving quality and reducing cost the role of measurement carrie marr associate director change...
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Improving Quality and Reducing Cost The Role of Measurement
Carrie MarrAssociate Director Change &
InnovationTayside Centre for Organisational
Effectiveness
Demographic change for population aged 65+ ScotlandPotential impact on emergency bed numbers 2007-2031
0
2000
4000
6000
8000
10000
12000
14000
16000
Y/E Mar 2007 Projected2011
Projected2016
Projected2021
Projected2026
Projected2031
Year
Be
ds
9%24%
41%61%
84%
NHS Tayside+148 beds 2016+517 beds 2031
Healthcare demand is growing
A new NinewellsHospital by 2031!
• 27% of New Outpatient appointments are being wasted!
Question 1 – Are there significant Outpatient Capacity losses?
Increase Capacity of Outpatient Clinics?
Opportunity?
0.0
5.0
10.0
15.0
20.0
25.0
Discharged AWAITING TESTRESULT
REFD OTHERCLIN/HOSP
DNA-Total Could Not Wait - FA REFER TO OTHERHOSP
%
New
Return
» There are approx 430,000 District Nurse Visits in a year (56% of District Nurse time was non-patient facing)
District NursingDistrict Nursing
Comparison of band 6 and band 5 activity
0%5%
10%15%20%25%30%35%40%45%50%
Band 6
Band 5
Examples of Variation in Clinical Practice
• Poly pharmacy• Rates of admissions in over 65 years• Lengths of stay in over 65 years• Referral patterns into acute specialist care
Achieving Quality Improvement and cost reductionDeveloping and Improving Services
QUALITY INITIATIVES COST REDUCTION PROGRAMMESNEW DEVELOPMENTS EFFICIENCY SAVINGS
1 2 3 4 5
Costs more Cost neutral Improves quality Quality neutral Reduces & reduces costs quality
TACTICAL STRATEGIC
DEALING WITH THE 5%
SPENDING THE 95% BETTER
PRODUCTIVITY & EFFICIENCY
CRES
SERVICE OPTIMISATION
TRANSFORMATION
2009 - 2011
2010 - 2013
TACTICAL STRATEGIC
DEALING WITH THE 5%
SPENDING THE 95% BETTER
PRODUCTIVITY & EFFICIENCY
CRES
SERVICE OPTIMISATION
TRANSFORMATION
Steps to Better Healthcare
Mental Health
OutPatients
Theatre Capacity / Planned
Care
Workforce Older people
Shifting the
Balance of Care
Optimisation of Health Facilities across Tayside
Prescribing and
Medicines
Finance Support
Workforce Support
Scenario Planning, Financial Baselines, Benefits Tracking, Business Cases
Workforce Modelling, Engagement & Communications with staff
Comms SupportCommunications with public and staff
Other
OE SupportOrganisational Effectiveness support
Labs
Maternity
How I engage with the centre:
Technology Enabling Health
ImprovementAcademy
Improvement &
Development Support
Real time information resource to
support quality improvement of
clinical services
Enhance spread and share of
good practice through use of technology
ie web portal Develop a innovative education
and training resource to assist in
our quality improvement needs
through improvement science
and optimising e health resources.
To develop trained experts in quality
improvement organisational development
and leadership to support improvement
work prioritised by our joint clinical boards.
The focus of this expertise will be mobilised
to support front line staff and clinicians to
build capability in improvement methodology
and support key improvement programmes
CHKS
• Annual and Bi annual reports which will take a high level organisational perspective
• Specific reports designed to address issues identified within the organisational reports or at the request of the organisation when internal review may have identified issues which need further clarification
• Continuous review of data quality and feed back to the organisation to support audit and development
Average Length of Stay : General Surgery
Approaching length of stay either at specialty level as part of other indicatorsor specifically length of stay within the hierarchy by specialty 3.3 days (peer 2.6 )
Consultant Level Average Length of Stay (GS)
• The table identifies the consultants involved in the management of cases in General Surgery
• Most individuals have a greater average length of stay than the peer
• Bed day opportunity is derived from average length of stay and volume of activity
• Some individuals have very small volumes of cases
Length of Stay by Condition (HRG)
• The table above illustrates the 8 HRGs with the greatest potential for bed day improvement based on volume and comparative length of stay to peer average.
• Off note is the number of cases with no associated procedure for some of these condition groupings
Outpatients
• The outpatient indicators concentrate on new to review ratios and DNA rates
• At organisational level new to review – 1 to 0.5 (peer 1 to 2.1)
• At organisational level DNA rates 8.2% (peer 7.9%)
Business Support Hub• Collect once use for many purposes• Collect from a wide range of
sources NHS, Local government, Public health
• High Data Quality Standards applied
• Systems to support business requirements
• Training & education• Predictive modelling
Development of 2 tiers:
Production – automating regular reports as much as possible using IT solutions eg. BO and VBA
Health Intelligence / Innovation
Waiting list reporting Full patient tracking Weekly position summary Bed statistics / utilisation A&E submissions others...
Unique Patient Tracking Clinical Dashboards+ Quality Metrics Statistical Process Control + Variation reporting Strategic improvement data
analysis (variation and waste Data)+ Service Improvement Patient Pathways Predictive Risk Score Modelling
To build capability within the Business Support Unit
Clinical Dashboards – Pilot Metrics
• Real-time Bed Management, e.g. available / occupied beds
• Service / Resource Utilisation, e.g. boarding patients, same day surgery rate, outpatient dna rates
• Waiting Times & Access, e.g. 18 weeks RTT, inpatient / daycase / new outpatient • Infection Control, e.g. hospital acquired infection, handwashing, cleanliness
• Patient Safety, e.g. anti-biotic policy, early warning scores,
compliance with central line insertion,
daily safety briefings compliance
• Data for discussion, not judgement supports a shift in culture
• Education programmes that build capacity and capability in data and analysis
• Supporting staff to build confidence in handling data and align to real time delivery of services
• real-time information and measurement systems that connect whole systems – clinical and non-clinical
• Prospective capacity management• Dashboards for clinical quality, business
information and governance
The Current Challenge facingNHS Tayside