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The journey -

From 2008 to 2009, two acute trusts in NHS South West took part in the Orthopaedic Rapid Improvement Programme led by the NHS Institute. Interest in the programme was much more widespread than this: another 15 acute trusts in the region applied to the programme but were not selected as pilot sites. As a result, the SHA decided to work with the NHS Institute to spread the learning from the Orthopaedic Rapid Improvement Programme, in particular from the two pilots in the region, and build on the desire for improvement. For these reasons, the SHA and NHS Institute designed a programme of three events focused on good practice in the commissioning and delivery of orthopaedic surgery. They brought together commissioners, nurses, managers, physiotherapists, surgeons and anaesthetists to build relationships and common understanding of best practice, and foster a more collaborative culture.  

Outcomes

The Collaborative Commissioning events were seen to create more conversation, networking and collaboration across organisational and professional boundaries – for example, service providers started working with their commissioners to solve issues; and teams from local trusts worked alongside independent sector treatment centres. Following the events, improvements were also seen in about a third of the elements of the pathways. The divergence between the best and worst providers initially increased, suggesting that the better ones responded faster to put learning from the events into practice, but performance has since converged. The region is now estimated to be saving about 250 to 280 beds a year for orthopaedic pathways, compared to a national average of about 50.  

Patient setting

In-patient   X Out-patient Community based
Mental health Chronic illness Cross-systems
 

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care X
Planned care  X Mental health Long-term conditions End of life
 

Information, tools and techniques used

In designing the programme of events, the SHA was aware (not least from the Darzi white paper) that a particular challenge to address was a lack of collaboration and common understanding in the commissioning process. The events were themselves developed collaboratively. They were workshop based and open to the 14 PCTs and all providers of fractured neck of femur and hip and knee surgery (including the independent sector) in the south west.  

Geography

Across the south west of England  

Timescale

Over a period of six months from spring 2009.  

Contact details and further information

Sasha Karakusevic sasha.karakusevic@nhs.net led the design of the events; Deborah Thompson deborah.thompson@institute.nhs.uk headed the orthopaedic Rapid Improvement Programme team.

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The journey -

This programme’s purpose was to replace a hospital’s complex and inconsistent system for outpatient bookings with a call centre, usinga single telephone number for all outpatient bookings. A review found that bookings were being made by over 300 staff with over 70 phone numbers in use across the trust. In some departments, it was only possible to book an appointment between certain times and on occasion there was nobody was available to cover bookings during annual leave. The lack of consistency across the trust meant that the patient experience was confusing and navigating between specialties was difficult. The team worked with stakeholders to interpret the review findings and to co-design a more streamlined booking system.  A new bookings process was then introduced alongside call centre technology and, after a trial period, all booking staff moved into one building.  The service has since been gradually refined to enable staff to work across specialities.

Outcomes

Outpatient bookings are now handled by 30 full time employees.  Patient experience is much improved and savings of £1.2 million have been achieved.

Patient setting

In-patient Out-patient        X Community based
Mental health Chronic illness Cross-systems
 

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care
Planned care   X Mental health Long-term conditions End of life
 

Information, tools and techniques used

The creation of a Patient Access Centre was a Process Redesign in Administrative and Managerial services project (PRAM).  The project team drew on principles from a number of change tools, using a lean systems approach and being guided by principles from the DEMAIC (Define, Enthuse, Measure, Analyse, Improve, Control) model of change. To govern the overall project management, the team drew on principles from PRINCE 2. To embed the change, the team drew on Kurt Lewin’s ‘unfreeze, change and refreeze’ thinking.  The principles of Kubler Ross’ change curve were also instrumental in the team’s approach.  

Geography

The change took place within one acute hospital in Torbay, Devon.

Timescale

The project started in January 2010 and took approximately 18 months to complete.

Contact details and further information

Nick Debney, Torbay Hospital. Email: nick.debney@nhs.net [post_title] => Patient Access Centre [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => patient-access-centre-2 [to_ping] => [pinged] => [post_modified] => 2015-03-24 13:27:32 [post_modified_gmt] => 2015-03-24 13:27:32 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3427 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 3425 [post_author] => 8 [post_date] => 2013-01-16 16:10:47 [post_date_gmt] => 2013-01-16 16:10:47 [post_content] =>

The journey -

The Orthopaedic Rapid Improvement Programme was set up to rapidly improve patient pathways for fractured neck of femur and hip and knee surgery. It was a national programme designed to embed best practice pathways and, in so doing, to make major improvements in patient experience, beds saved and clinical outcomes.   Nationally, the Rapid Improvement Programme was commissioned by the Department of Health and led by the NHS Institute for Innovation and Improvement. Each trust was supported by a clinical facilitator to embed the pathways. In NHS South West, the SHA built on the Rapid Improvement Programme pilots with a series of events to help spread the learning (see: Collaborative Commissioning events).  

Outcomes

The impact of the programme has varied between the trusts but overall it has been very successful. Common outcomes include greater numbers of patients being admitted on the day of surgery and reduced length of stay. Trusts developed a better understanding of their actual performance, which helped them improve and there were also cultural changes, such as traditional role demarcations being broadened to foster a ‘can do’ attitude and better quality teamwork.  

Patient setting

In-patient   X Out-patient   X Community based   X
Mental health Chronic illness Cross-systems    X
 

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care
Plannedcare X Mental health Long-term conditions End of life
 

Information, tools and techniques used

The programme drew upon regional benchmarking evidence to support best practice in orthopaedic pathways. It used an evidence-based rapid work process developed by the NHS Institute, which included a range of tools, such as the observation tool ‘Through the eyes of’.  

Geography

The programme was implemented in 20 acute trusts across England, two in NHS South West.  

Timescale

Each trust implemented the pathways in an intensive 12 week period. The programme as a whole ran for a year from 2008 to 2009. This included time to form direction, select trusts and work with these pilot sites.  

Contact details and further information

Deborah Thompson deborah.thompson@institute.nhs.uk headed the orthopaedic Rapid Improvement Programme team. Further information on the programme can be found at: http://www.institute.nhs.uk/quality_and_value/high_volume_care/rapid_improvement_programme.html

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The journey -

This programme was a review of administration and clerical support services within a large foundation trust.  Its aim was to reduce the overall pay bill for the trust’s two district general hospitals whilst delivering quality administrative support.  It followed an independent review by the professional services firm PwC, which identified higher numbers in this staff group than other comparable trusts. The programme aimed to reduce the number of staff and change structure, systems and processes in order to deliver efficiency savings. Between 100 and 150 staff roles were identified as in need of re-banding. This took place following an assessment process.  

Outcomes

The restructure designed by the programme went live in April 2012.  Whilst the anticipated outcome was a reduction in headcount, the actual outcome was a complex change in skill-mix across the trust with no reduction in headcount.  However, as a result of structural and behavioural change, savings of approximately £500K will be achieved.  Release of savings is dependent on ongoing reduction in numbers of staff on pay protection and marked time. The change required four clinical divisions to work together on a project for which there was little appetite.  A number of key learning points were identified, including communication to staff about the changes and senior management capability in leading and delivering complex organisational change.  

Patient setting

In-patient Out-patient Community based
Mental health Chronic illness Cross-systems   X
 

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care   X
Planned care   X Mental health Long-term conditions End of life
 

Information, tools and techniques used

This project was managed by the Trust’s Programme Management and Service Improvement team.  This team uses its own Project Management Toolkit, which provides consistency to project management across the Trust.  Staff assessments were developed and managed by the Human Resources Department.  

Geography

The programme involved the two district general hospitals of the Gloucestershire Hospitals NHS Foundation Trust.  This one of the largest hospital trusts in the country and provides acute elective and specialist care for a population of more than 800,000 people.  

Timescale

The programme started with an information gathering phase in July 2011.  It was implemented in April 2012.  

Contact details and further information

Gill Bridgland, Programme Manager Clinical Strategy: gill.bridgland@glos.nhs.uk [post_title] => Administration and clerical review [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => administration-and-clerical-review [to_ping] => [pinged] => [post_modified] => 2015-03-24 13:27:32 [post_modified_gmt] => 2015-03-24 13:27:32 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3422 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 3420 [post_author] => 8 [post_date] => 2013-01-16 15:57:01 [post_date_gmt] => 2013-01-16 15:57:01 [post_content] =>

The journey -

The aim of this project was to reduce hospital acquired pressure ulcers and falls, thereby having a significant impact on patient safety, patient experience and organisational productivity. It was undertaken as part of a Department of Health pilot, the Southampton University Hospitals NHS Trust chosen because of its previous success in rapid improvement projects.

Outcomes

Since the start of the project in 2010 there has been an overall reduction of 75 per cent in Grade 3 and 4 pressure ulcers.  The trust is currently on target to achieve a 62 per cent reduction in Grade 2 pressure ulcers during the current year. There has also been a reduction of 30 per cent in high harm falls since the start of the project, although this measurement has proved more complex, and has been amended to produce valid data. Productivity through length of stay since the project began equates to £900k for pressure ulcers and £300k for falls. Staff have also noted a reduction in call bells and greater patient satisfaction, and patients are experiencing less avoidable harm as a result of the project.  

Patient setting

In-patient     X Out-patient Community based
Mental health Chronic illness Cross-systems

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care X
Planned care  X Mental health Long-term conditions End of life

Information, tools and techniques used

The project used Rapid Spread methodology, designed by the Department of Health to introduce evidence-based High Impact Actions (HIAs) in specific aspects of patient care.Rapid Spread is a ‘whole system’ approach and is launched Trust-wide as opposed to phased Plan Do Study Act (PDSA cycle) implementation. It consists of a systematic, week-by-week guide and workbook with supporting tools and coaching to equip staff without previous change expertise to bring about improvements.

Geography

The project took place within Southampton University Hospitals NHS Trust. It was implemented in 44 wards (only paediatrics, theatre wards and critical care were excluded because of either short stay or intensity of care).

Timescale

The project was started in June 2010 and initially covered a twelve week period. This included four weeks preparation, four weeks immersion and training and four weeks implementation.

Contact details and further information

Gail Byrne, Deputy Director of Nursing and Head of Patient Safety, Southampton University Hospitals NHS Trust. gail.byrne@uhs.nhs.uk [post_title] => The Turnaround Project [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-turnaround-project [to_ping] => [pinged] => [post_modified] => 2015-03-24 13:27:32 [post_modified_gmt] => 2015-03-24 13:27:32 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3420 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 5 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 3429 [post_author] => 8 [post_date] => 2013-01-16 16:31:35 [post_date_gmt] => 2013-01-16 16:31:35 [post_content] =>

The journey -

From 2008 to 2009, two acute trusts in NHS South West took part in the Orthopaedic Rapid Improvement Programme led by the NHS Institute. Interest in the programme was much more widespread than this: another 15 acute trusts in the region applied to the programme but were not selected as pilot sites. As a result, the SHA decided to work with the NHS Institute to spread the learning from the Orthopaedic Rapid Improvement Programme, in particular from the two pilots in the region, and build on the desire for improvement. For these reasons, the SHA and NHS Institute designed a programme of three events focused on good practice in the commissioning and delivery of orthopaedic surgery. They brought together commissioners, nurses, managers, physiotherapists, surgeons and anaesthetists to build relationships and common understanding of best practice, and foster a more collaborative culture.  

Outcomes

The Collaborative Commissioning events were seen to create more conversation, networking and collaboration across organisational and professional boundaries – for example, service providers started working with their commissioners to solve issues; and teams from local trusts worked alongside independent sector treatment centres. Following the events, improvements were also seen in about a third of the elements of the pathways. The divergence between the best and worst providers initially increased, suggesting that the better ones responded faster to put learning from the events into practice, but performance has since converged. The region is now estimated to be saving about 250 to 280 beds a year for orthopaedic pathways, compared to a national average of about 50.  

Patient setting

In-patient   X Out-patient Community based
Mental health Chronic illness Cross-systems
 

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care X
Planned care  X Mental health Long-term conditions End of life
 

Information, tools and techniques used

In designing the programme of events, the SHA was aware (not least from the Darzi white paper) that a particular challenge to address was a lack of collaboration and common understanding in the commissioning process. The events were themselves developed collaboratively. They were workshop based and open to the 14 PCTs and all providers of fractured neck of femur and hip and knee surgery (including the independent sector) in the south west.  

Geography

Across the south west of England  

Timescale

Over a period of six months from spring 2009.  

Contact details and further information

Sasha Karakusevic sasha.karakusevic@nhs.net led the design of the events; Deborah Thompson deborah.thompson@institute.nhs.uk headed the orthopaedic Rapid Improvement Programme team.

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Category: Planned care

Collaborative Commissioning events

The journey – From 2008 to 2009, two acute trusts in NHS South West took part in the Orthopaedic Rapid Improvement Programme led by the NHS Institute. Interest in the programme was much more widespread than this: another 15 acute trusts in the region applied to the programme but were not selected as pilot sites. […]

Posted on Jan 16th Cat: , , , Tags: Comments: Comments are off for this post

Patient Access Centre

The journey – This programme’s purpose was to replace a hospital’s complex and inconsistent system for outpatient bookings with a call centre, usinga single telephone number for all outpatient bookings. A review found that bookings were being made by over 300 staff with over 70 phone numbers in use across the trust. In some departments, […]

Posted on Jan 16th Cat: , , Comments: Comments are off for this post

Orthopaedic Rapid Improvement Programme

The journey – The Orthopaedic Rapid Improvement Programme was set up to rapidly improve patient pathways for fractured neck of femur and hip and knee surgery. It was a national programme designed to embed best practice pathways and, in so doing, to make major improvements in patient experience, beds saved and clinical outcomes.   Nationally, […]

Posted on Jan 16th Cat: , , , , , Comments: Comments are off for this post

Administration and clerical review

The journey – This programme was a review of administration and clerical support services within a large foundation trust.  Its aim was to reduce the overall pay bill for the trust’s two district general hospitals whilst delivering quality administrative support.  It followed an independent review by the professional services firm PwC, which identified higher numbers […]

Posted on Jan 16th Cat: , , , Comments: Comments are off for this post

The Turnaround Project

The journey – The aim of this project was to reduce hospital acquired pressure ulcers and falls, thereby having a significant impact on patient safety, patient experience and organisational productivity. It was undertaken as part of a Department of Health pilot, the Southampton University Hospitals NHS Trust chosen because of its previous success in rapid […]

Posted on Jan 16th Cat: , , , Tags: , , Comments: Comments are off for this post