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Yorkshire and Humber Wheelchair ServicesYorkshire and Humber Wheelchair ServicesYorkshire and Humber Wheelchair ServicesYorkshire and Humber Wheelchair Services

“Time to Provision of a Wheelchair”

Measure Development Workshop Report

10th June 2014

“Right assessment, “Right assessment, “Right assessment, “Right assessment,

Right equipment, Right equipment, Right equipment, Right equipment,

Right first Right first Right first Right first timetimetimetime””””

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FINAL Report Workshop 10 06 14 v3.3.docx

For further information please contact:

Angela Green – Improvement Programme Manager

E mail: [email protected]

Improvement Academy

Office 16

Bradford Institute for Health Research

Temple Bank House

Bradford Royal Infirmary

Duckworth Lane

Bradford

BD9 6RJ

Office Telephone: 01274 383926

Visit our Website: http://www.yhahsn.org.uk/improvement-academy/

Report produced by : Angela Green (Improvement Programme Manager)

Michael Rooney (Senior Information Analyst)

July 2014

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Table of Contents

page

Executive Summary ……………………………………………………………………………………….. 3

1. Background …………………………………………………………………………………………………… 4

2. Baseline data for Improvement measure development ………………………………… 4

2.1 Initial proposed development measures…………………………………………….. 4

2.2 Baseline data field descriptions requested

(April 2013 to end March 2014)……………………………………………………………

5

2.3 Baseline data provided from the 11 provider organisations ………………. 6

3. Purpose of the workshop event …………………………………………………………………….. 6

4. Workshop attendees ……………………………………………………………………………………… 7

5. Evaluation of the event ………………………………………………………………………………….. 7

6. Workshop content and structure ………………………………………………………………….. 7

7. Summary of worksheet content and discussion sessions ……………………………….. 8

7.1 Worksheet 1 – Thoughts on services baseline data measures service

thoughts and comments on initial measures………………………………………

8

7.2 Worksheet 2 – Baseline Data Collection …………………………………………….. 10

7.3 Worksheet 3 – Baseline Data Definitions ……………………………………………. 11

7.4 Worksheet 4 – The Patient Voice ……………………………………………………….. 11

8. Agreed Next Steps – (July – Sept 2014)..……………………………………………………….. 12

9. Acknowledgements ………………………………………………………………………………………. 12

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Executive Summary

The Improvement Academy (part of the Y&H Academic Health Science Network) is working collaboratively

with the Y&H wheelchair services on the Responsive Wheelchair Programme. At a previous improvement

event (Dec 2013) wheelchair services agreed to work towards developing an improvement measure on

“Time to Provision of a Wheelchair” linked to working on local improvement priorities using this measure.

This report details progress on this and reports discussions from the “Time to Provision of a Wheelchair”

Measure Development Workshop held on June 10th 2014.

The purpose of the workshop was to seek further progress and agree future plans on the “Time to

provision” improvement measure development specifically:

• To review progress on service baseline data sharing

• To agree and define the future “time to provision measure” with services

• Agree a plan on how we will add the user/carer voice to this measure development

• To agree future data provision and next steps

Prior to the workshop all services were asked for an initial baseline dataset for 2013/14. This data request

included dates of referrals, dates of first contact, dates of provision and equipment provided. A list of data

field descriptions was provided to services to facilitate this process. Wheelchair service managers asked and

were provided with signed permission for data sharing from each of their trust CEO’s. Ten of the 11 trusts

were able to produce some initial baseline data to inform the draft development of their service

improvement measures which were then discussed at the event.

The workshop was attended by 15 managers and MDT members from 9 of 11 trusts wheelchair services.

The content of the workshop included a presentation on “Introduction to Statistical Process Control (SPC)

charts” and progress on development of their team initial baseline measures.

The initial baseline improvement measures developed as SPC charts included:

• Weekly proportion of wheelchairs provided within 18 weeks

• Weekly provided median number of weeks from referral to Provision

• Weekly proportion of wheelchair referrals with 1st contact/assessment within 4 weeks

• Weekly median number of weeks from referral to 1st contact/assessment

Summary of learning and discussions from the workshop

Services highlighted issues of data quality, understanding local definitions and processes of data entry

which they agreed needed further attention within their teams. They also explained the challenges they

had extracting data from IT systems. In many cases different systems are used for clinical (e.g. System 1)

and equipment stock control (e.g. ELMS, OPAS) which are unable to link data. Those few services that

accessed data management support and specialist systems such as BEST had been most successful in

finding baseline data. The majority of services agreed the principles of these wide metrics but felt further

breakdown into provider site or wheelchair specific measures would be useful.

Agreed next steps (July – Sept 2014)

• Wheelchair services will continue work on local data quality and definitions. Progress to be discussed

at next Y&H wheelchair managers meeting (early Sept)

• The Improvement Academy will begin working with those services ready to further develop their local

improvement measures and plan and test some changes for improvement

• Services will be asked to agree and implement a plan on user engagement on measurement

• IA will support initial discussions around developing agreed metrics valid for all Y&H wheelchairs to

enable some benchmarking

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1. Background

The Improvement Academy (part of the Y&H Academic Health Science Network) has been working

collaboratively with the Y&H wheelchair services in planning and delivering the outcomes for the

Responsive Wheelchair Programme since Jan 2014.

Further information can be found at http://www.yhahsn.org.uk/improvement-academy/current-

improvement-projects/responsive-wheelchair-services/

At a previous improvement event (Dec 2013) wheelchair services agreed to work with the

Improvement Academy on the following areas:

1. Working with service staff volunteers to develop improvement measures.

2. Directly supporting wheelchair services to measure and improve in priority areas.

3. Supporting improvement in engaging with service users.

A full event report is available on the website link above.

The purpose of this report is to detail progress on development of the improvement measure and

reports discussions from the “Time to Provision” Measure Development Workshop held in Leeds

wheelchair service at Seacroft Hospital on 10th June 2014.

In March 2014 the Y&H wheelchair service managers requested signed permission from their trusts

to authorise the sharing of key data for the development of an improvement measure with the

Improvement Academy. This was processed through the AHSN and each of the eleven trusts CE’s

provided a signed document to their wheelchair service managers in April granting service

permission to share data and develop improvement measure.

2. Baseline data for Improvement Measure Development

In April, all the wheelchair services were asked to share some baseline 2013/2014 wheelchair

provision data and, where possible, this data was turned into some initial proposed metrics as SPC

(Statistical Process Control) charts, and sent back to service managers and their other team

attendees for review prior to the workshop event.

Services were provided with a list of requested data definitions and were asked to provide details of

any current local variance of these definitions in their service.

The table on page 5 (2.2) explains the initial baseline data fields requested for period April 2013 to

end March 2014.

2.1 Initial proposed improvement measures

Where data was provided by services, the following was mapped onto SPC charts for services

to review prior to the workshop event.

• Weekly proportion of wheelchairs provided within 18 weeks

• Weekly provided median number of weeks from referral to Provision

• Weekly proportion of wheelchair referrals with 1st contact/assessment within 4 weeks

• Weekly median number of weeks from referral to 1st contact/assessment

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2.2 Baseline Data field descriptions requested (April 2013 to end March 2014)

Data Field Data Field Description

Urgent Referral or Non Urgent Referral or

routine

Any categorisation of the referral e.g. Urgent or

Non-urgent or Routine, etc.

New Referral

A new referral for a wheelchair where patient

either not previously known to the service or has

been re-referred back into service (self or other)

after a previous episode of care

Previous episode of care

Yes or No?

Previously had episode of care with service for

wheelchair or not?

Date of referral Date the referral was received into the

service/dept (DAY/MONTH/YEAR)

Date of 1st Contact

(DAY/MONTH/YEAR)

First contact can be: face to face assessment

(APPOINTMENT), telephone contact, or date of

letter to patient (re: voucher option decision)

Type of 1st Contact as per definition

Type of 1st Contact e.g. face to face assessment

(APPOINTMENT) telephone, date of letter to

patient (re: voucher option decision)

Date of APPOINTMENT (if after 1st

contact)

Date of APPOINTMENT that is NOT the 1st Contact

e.g. where appointment made after a first contact

letter sent (DAY/MONTH/YEAR)

Date of Provision of wheelchair

Date the equipment is handed over to the patient

(any setting) by either Therapist or approved

repairer/manufacturer (DAY/MONTH/YEAR)

Who provided the Wheelchair?

Description of role of person who handed over the

wheelchair equipment. E.g. Therapist or Approved

Repairer or manufacturer

Description of the wheelchair

provided/categories of equipment

provided

Please indicate from broad categories type of

wheelchair provided as follows:

• Manual wheelchair

• powered wheelchair

• complex seating system

• Bariatric wheelchair

• Buggy

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2.3 Baseline data provided from the 11 provider organisations

The following table indicates which data fields were provided (green Y), not provided (pink N)

or partially provided (yellow ~) by each of the trusts to the Improvement Academy between

May and June 2014.

Air

ed

ale

Ca

ld &

Hu

ds

NLA

G

Do

nca

ste

r

Sh

eff

ield

No

rth

Yo

rksh

ire

Lee

ds

Bra

dfo

rd

Wa

ke

fie

ld *

Ro

the

rha

m

Hu

ll &

Ea

st R

idin

g

Categorisation of the referral N Y Y Y Y Y N N Y N N

New / follow-up referral N Y Y N ~ Y Y N Y N N

Previous episode of care N N Y N Y Y Y N N N N

Date Ref Received Y Y Y Y Y Y Y Y Y Y Y

Date of first contact N Y Y Y Y ~ N ~ Y Y Y

Type of first contact N Y Y N ~ ~ N N Y N N

Date of appointment (not first) N N Y ~ Y ~ N N ~ N N

Date equipment received N Y N Y Y Y Y Y Y N Y

Description of role N N N N N N N Y Y N N

Category type N N N Y Y Y Y Y Y N N

3. Purpose of the workshop event

To seek further progress and agree future plans on the “Time to provision” improvement measure

development specifically:

• To review progress on service baseline data sharing

• To agree and define the future “time to provision measure” with services

• Agree a plan on how we will add the user/carer voice to this measure development

• To agree future data provision and next steps

* Wakefield shared data definitions only i.e. no baseline raw data provided

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4. Workshop attendees

A total of nine of the eleven provider organisations with wheelchair services were represented.

Wakefield and Airedale services were unable to attend due to unforeseen circumstances. There

were 15 delegates at the event, consisting of 9 managers with 6 other service MDT members. The

event was supported by 3 Improvement Academy staff (Programme Manager, Information analyst

and Implementation Manager).

5. Evaluation of the event

Summary of the 8 completed evaluation forms as follows:

Question 1 2 3 4 5

Please rate your overall satisfaction with this workshop

1 = totally dissatisfied, 5 = completely satisfied 2 5 1

How relevant was this event in helping you work towards

measuring for improvement

1= not at all, 5 = highly relevant 4 2 2

I have a greater understanding of measure development for

improvement

1 = no, not at all, 5 = yes definitely

1 6 1

Attendees were asked to circle at least 3 words which best represented overall experience of the

workshop event. The following wordle was created with largest words representing those circled

most frequently.

6. Workshop content and structure

• Slide presentation on: -baseline data, purpose, introduction to Statistical Process Control (SPC)

charts

• Table activities: Worksheet 1 – Thoughts on services baseline data measures

• Table activities: Worksheet 2 – Learning from baseline data collection

Facilitated room discussions

• Table activities: Worksheet 3 – Your data definitions

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• Table activities: Worksheet 4 – How do we bring the patient voice into this?

Facilitated room discussions

• Summary of next steps - room discussion slide

• Summary of agreed actions - room discussion slide

7. Summary of worksheet content and discussion sessions

7.1 Worksheet 1 – Thoughts on services baseline data measures

Service thoughts and comments on initial measures:

• Variation in our measure is linked to when money ran out

• We have 4 different sites so difficult to understand variation when data is all together

• Concerns about data quality

• Our data appeared to be within average

• We would need data split for Hull and East Ridings

• Useful way to diagnose where improvement can be targeted

• Data quality?

• We need to understand our local definitions of referral, 1st contact, triage, face to face

etc.

• At present this work is not for benchmarking or comparison of different wheelchair

services. -we work in very different ways

• We would need separate data for our two sites for it to be useful

• Need to separate out data from our 2 services

• Very useful presentation of our data

• Issues of data quality and user error identified

• Need to breakdown further in order to understand where problems are

Do you have any current improvement plans?

• Improvement plans “in limbo” due to service out to tender

• No current improvement plans

• Working on System 1 data consistency and cleansing

• Working to reduce clinic options to 2 bases to improve efficiency, reduce travel

• Trying to recruit extra staff member

• Measure could be useful to identify any changes we make in prioritising referrals

• On-going service improvements e.g. reducing rework delays, introduction of electronic

referrals and ordering

• Beginning to implement a new service specification and induct new staff following a

business plan

• Improve data collection to fill any gaps

• Current planned changes to pathways for electric powered wheelchair provision

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Do you have any current targets for time to 1st contact and/or time to provision?

• Target of no more than 18 weeks to provision

• Targets 18 weeks standard, 12 weeks priority or 2 weeks for emergency

• Targets of 4 weeks to 1st contact and 18 weeks to provision

• Target of 18 weeks to provision (I think?)

• Target of 4 weeks to 1st contact and 6 weeks to provision

• Target of 4 weeks to 1st contact and no target as yet for provision

• Target for urgent assessment is 2 weeks and routine assessment is 6 weeks, referral to

provision target is 18 weeks

Service thoughts and comments on service/system factors that may influence

measures:

• Currently separate services with different commissioners but new service (out to tender)

may be one site and one service

• Would be useful to compare variation across our 4 different sites

• We use BEST system for clinical and equipment but still using paper recording as well

• Our service includes all aspects of wheelchair provision including postural and complex

seating

• We have two commissioners, one service but 4 clinical sites

• We can only provide assessment data because we assessment only service, Nottingham

Rehab services subcontracted by commissioners for provision of equipment

• We use two separate IT systems not linked system 1 (clinical) and IRIS (provision)

• We use BEST system

• May be useful to have separate data on some groups of interventions e.g. visits vs clinics?

• Our two sites record on same system one but provide different services

• We use system 1 for clinical notes and BEST for stock control, delivery, informatics do not

access BEST

• We do not currently differentiate between urgent or routine

• Triage and provision based upon information on referral is deemed as “admin” and not

included in the data

• Equipment store on a separate site and separate IT system

• Use system 1 and BEST but not connected

• Complex seating will skew figures

• May need to separate simple/complex/children measures

• Need breakdown of s/seating, special chairs, NP SP chair, NP AP chair, NP Chair cushions,

EPIC, EPIOC, buggy

• We provide all services complex and non-complex

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Summary of room discussion on initial service improvement measures

• Most services highlighted they had identified data quality issues

• Some trust data lumped together and would need a break down where more than one

service provided by that trust e.g. North Yorks

• Service agreed measures are useful for whole picture but all felt would need breakdown

on type of chair provided e.g. manual/transit, powerchair, specialist seating etc. in order

to understand where improvement can be made

• Services have different definitions of data fields

• Discussion on potential value of agreeing regional Y&H definitions for data fields, some

agreed this would be useful

• Some discussion that services are different and therefore can’t be compared

• However agreement that would be useful to understand which services are the positive

outliers or positive deviants in wheelchair provision to understand characteristics of these

services

7.2 Worksheet 2 – Baseline Data Collection

• We use BEST system and team leaders extracted data, our data required cleansing

• Data was extracted from System 1 by our performance department

• We are now working towards having a consistent approach to data entry

• Our data was extracted by information management from BEST

• Data was extracted from ELMS system by myself (service manager)

• We use two systems, System one for clinical and BEST for equipment data

• Our workshop manager uses his own stock control system which is more accurate than

BEST

• Our data was extracted by information department

• We have learnt that we need to improve our understanding of what and how we record

data

• The list of data fields provided by Improvement Academy helped us understand what data

we needed to look for

• We identified some gaps in our data collection and planning ways of improving recording

of data

• We use BEST system v12 but also record clinical activity on spreadsheet

• A difficulty is that we get charged for changing reports on the BEST system

• We have since implemented a new process for data entry

Summary of room discussion on initial baseline data collection

• All services agreed they had learnt from the process of finding this initial data set

• Some services already started addressing gaps and quality in data collection

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• Some services approached their information management departments for support and

found this helpful although some concerns expressed that this service may not necessarily

understand their service data

• Services discussed referral to 1st contact and wondered if this would be better to record

referral to prescription (assessment) completed because usually 1st contact telephone

triage was done quite timely anyway

7.3 Worksheet 3 – Baseline Data Definitions

• Our future data collection may change due to service out for tender

• Feel that data definitions need to be agreed across the region, data would then be

comparable

• Work has started and on-going on agreement of our data definitions

• We realised we all have different interpretation of urgent and routine

• We have no idea of what our 1st contact is

• We are unsure which date is recorded for referral

• We need to do more work on understanding our data definitions

• Not all the initial data fields requested are recorded by Bradford

• We need to understand our data definitions

• We feel it would be useful for our services to look at definitions across site

• Data fields we couldn’t provide we have now incorporated into new version of BEST

• We need further team discussion and training to clarify our definitions

Summary of room discussion on initial baseline data definitions

• All services had identified improvements to be made on clarifying definitions

• Some agreed it would be good to work towards regional agreed definitions

• Services had improved understanding of implications of poor data quality e.g. payment

• Services feel under supported by trusts as systems not supportive of good data collection

e.g. different systems which are not linked, old out-dated systems still in use

7.4 Worksheet 4 – The patient Voice

Suggestions on how we can engage patients with this measure development work

• User groups

• Survey Monkey

• Focus groups

• Newsletter

• Short user questionnaire about time to provision

• Identified the challenge of different patient expectations

We did not have enough time to discuss this more widely at the workshop but group agreed

would be useful to seek user and carer opinions about measuring time to provision of a

wheelchair.

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8. Agreed next steps (July – Sept)

1. Wheelchair services will discuss and agree local definitions of data collected with their teams

and service manager. Progress to be discussed at next Y&H wheelchair managers meeting

(early Sep).

2. The Improvement Academy will begin working with those services that are ready to further

develop their local improvement measures and plan and test some changes for improvement.

3. The Improvement Academy will work with these services above on the following progress

steps:

• Clarify and agree local service definitions of measures

• Discuss and test any appropriate breakdown of measure data e.g. sites, chair types

• Agree content and process for regular future data provision

• Discuss and agree a test of improvement in which measure can be used to track any

change

• Agree and implement a plan on user engagement on this improvement measure

• Support initial discussions around developing agreed metrics valid for all Y&H wheelchairs

to enable some benchmarking

9. Acknowledgements

Disclaimer statement

The views expressed in this report are those of the authors, wheelchair service teams and

Improvement Academy (part of the Y&H AHSN) who attended the workshop event on 10th June

and are not those of any other organisations including NHS England.

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