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The Journey -

The Somerset Clinical Commissioning Group (SCCG) led the review and redesign of reablement services over the last two years to help improve outcomes for patients.  We worked with local authority colleagues to lead a joint programme to review existing services and implement a redesigned service model based on systems thinking methodology.  We also worked with a range of stakeholders from the NHS, adult social care providers, and independent and voluntary sector organisations.  The programme has been discussed and supported by the Somerset Health and Wellbeing Board. Compass Disability was commissioned to bring together focus groups and develop a questionnaire giving people the opportunity to feedback their experiences of reablement services.  We held extensive stakeholder events with representatives from NHS, adult social care providers, independent and voluntary sector organisations and undertook a ‘deep dive’ exercise to understand what was happening in existing systems. A pilot integrating health and social care teams at one GP surgery has been in place for 18 months.  It has been rolled out to 15 practices in the Taunton and Area GP Federation with plans to phase in the service across the whole of Somerset. A clear message from the service users was: “I want to maintain my independence:  help me to find the solutions to do the things that matter to me”.  The key difference with this model is that we are asking patients what they feel is important to them and what goals they want to achieve.  The teams have flexibility to find solutions centred on these goals.  This is a fundamental shift from the ‘one size fits all’ approach often seen in existing services.  

Outcomes

Improved patient experience and quality of life as care delivered in a more appropriate setting; 1{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} reduction in emergency admissions 7{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} reduction in readmissions   Annual value of savings made 2012/13           £311,000 (Gross) Recurrent 2013/14           £1,659,000 (Gross) Recurrent  

Patient setting

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

 

Clinical area

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

Information, tools and techniques used 

Project Management Board jointly with Local Authority with Project Manager  

Geography

County wide Somerset Project being rolled out Somerset wide.  Population 550,000  

Timescale

2008 and ongoing April 2012 to March 2013  

Contact details and further information

Ann Anderson Director for Clinical Commissioning Development Ann.anderson@somersetccg.nhs.uk 01935 384190 [post_title] => Reablement - Contract Monitoring QIPP [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => reablement-contract-monitoring-qipp [to_ping] => [pinged] => [post_modified] => 2015-03-24 13:27:31 [post_modified_gmt] => 2015-03-24 13:27:31 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.tvhkt.org.uk/?post_type=improvement-science&p=3711 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 3432 [post_author] => 8 [post_date] => 2013-01-16 16:45:42 [post_date_gmt] => 2013-01-16 16:45:42 [post_content] =>

The journey -

This very successful project aimed to reduce time from A&E to theatre and improve pain control for hip fracture patients. It reviewed and revised the patient pathway through the system from paramedic through A&E, radiology, theatre, ward and discharge, including social care.  

Outcomes

There have been a number of significant improvements including extremely positive patient feedback.  The team has recorded impressive reductions in, for example, pain score on movement from severe (2.75) to mild (0.5); median time to theatre (48 hours to 19 hours) and an increase in the percentage of patients treated on the day of injury (3{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} to 33{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b}).  Although cost reduction was not a primary aim, the programme has led to a reduction of 1,800 bed days per year, saving an estimated £326,000.  There is also some evidence of reduced post-discharge dependency and therefore a reduced social care cost. Other intended and unintended benefits have included improvements in staff morale; theatre and ward productivity; a reduced backlog on trauma board; and the development of a screening tool for malnutrition.  However, the programme team believe that the most significant change is cultural and behavioural.  

Patient setting

In-patient   X 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 Mental health Long-term conditions End of life
 

Information, tools and techniques used

A small multidisciplinary team of anaesthetists, nurses, surgeons, and a clinical systems engineer worked together, with other professionals drawn in as required to help.  The project applied Lean Thinking and Enhanced Recovery principles, involving all professional groups and patients in the redesign. The team developed an innovative technique of clinical process simulation during which the process of care was simulated by the professionals involved from injury (with a paramedic) to ward. This technique has been used for another Trust’s team and could be offered to others who are interested.  

Geography

This programme involves South Devon Health Services (primary and acute care) and social care. Interest from many other health systems has generated visits from clinical teams across the UK  

Timescale

Approximately a year was spent defining and analysing the problem with testing of ideas for change and building the will for change. The change in process occurred in November 2010 and is sustained with regular team review of success and issues to fix; they are proud of what has been achieved and striving to improve still further.  

Contact details and further information

Andrew Fordyce: andrew.fordyce@nhs.net [post_title] => Improving hip fracture pathways [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => improving-hip-fracture-pathways [to_ping] => [pinged] => [post_modified] => 2015-03-24 13:27:31 [post_modified_gmt] => 2015-03-24 13:27:31 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3432 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 3430 [post_author] => 8 [post_date] => 2013-01-16 16:37:16 [post_date_gmt] => 2013-01-16 16:37:16 [post_content] =>

The journey -

The purpose of the programme is to improve patient flows, making emergency pathways more efficient and reducing length of stay and number of beds whilst also making care safe, effective and a good experience for patients and staff. By better matching capacity to demand the trust aimed to make sure that patients who didn’t need to be admitted to the hospital could be managed on an ambulatory pathway or a short stay pathway; and that inpatients were swiftly signposted to the right specialty with a clinical management plan and pathway of care that would facilitate an appropriate length of stay.

Outcomes

Key achievements of the Programme include: Rapid Assessment in place in A&E where feasible; average length of stay reduced by 0.6 days; a 28 per cent decrease in length of stay over 14 days; 5 pathways embedded in ambulatory and short stay with another 7 at various stages of roll out; 45 patients case managed at home through a ‘virtual ward’ at any one time; a 3 per cent increase in discharges taking place before 2pm; and monthly levels of patients being seen and treated within four hours at 97 per cent.

Patient setting

In-patient           X 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 Mental health Long-term conditions End of life
 

Information, tools and techniques used

Several change management tools and models have been used, most notably some principles of PRINCE2 methodology and a Sarah Fraser model for sustainability.  Lean methodology has also informed the programme and a performance dashboard was developed according to IST specifications. The Emergency Care Programme has also benefited from clear communication strategies within divisions and large-scale direct engagement with staff.

 

Geography

This programme took place in the three main acute sites of East Kent Hospitals University NHS Foundation Trust: Kent and Canterbury Hospital (Canterbury); William Harvey Hospital (Ashford); and the Queen Elizabeth the Queen Mother Hospital (Margate).  

Timescale

The programme started in June 2010.  For the first 18 months, the programme focused primarily on developing the right systems and processes, identifying clinical leaders to facilitate the change and engaging staff.  It is now being refreshed to recognise current achievements and look ahead at the challenges that remain. With systems and processes in place, greater focus is being placed on the cultural aspects of embedding change in the organisation.  

Contact details and further information

Karen Miles, Associate Director of Operations, East Kent Hospitals University Hospitals NHS Foundation Trust: kmiles1@nhs.net [post_title] => Emergency Care Quality Improvement Programme [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => emergency-care-quality-improvement-programme [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=3430 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => 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’s purpose was to create inter-operability between a range of clinical systems that capture patient records.  These include GP, out-of-hours, A&E, social care, minor injuries units and mental health services.  It was recognised that similar clinical systems existed in a number of these organisations (replacing paper patient records) and the opportunity was identified to extend their inter-connectivity to improve point of delivery care. The programme aimed to create a summary view of patient records, safely accessible to a range of health and social care professionals. Although at its heart is an IT solution, the change is less about technology and more about a range of organisations agreeing and working towards a shared vision, which involves learning to work in different ways.  Behavioural and cultural change are seen as essential components in its successful delivery.  

Outcomes

Outcomes to date include closer integration and working relationships on all aspects of IT delivery and cross-professional co-operation; for example between clinicians and IT.  There has been significant learning about cross-functional collaboration, including creating a shared vision and influencing multiple partners.  

Patient setting

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

Clinical area

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

Information, tools and techniques used

No information available.  

Geography

Avon Information Management and Technology Consortium (AIMTC) is a shared service over NHS Bristol, North Somerset and South Gloucestershire (BNSSG).   Other participants in the programme include Bristol City Council (social care), North Bristol NHS Trust, Weston Area Heath Trust and University Hospitals Bristol.  Also involved are a number of voluntary community organisations and social enterprises.  

Timescale

Active work on the programme has been underway since 2010. It is now in its procurement phase, during which clinical partners were involved in assessing a shortlist of suppliers.  

Contact details and further information

Andy Kinnear, Head of Avon IM&T Consortiums: andy.kinnear@aimtc.nhs.uk

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The Journey -

The Somerset Clinical Commissioning Group (SCCG) led the review and redesign of reablement services over the last two years to help improve outcomes for patients.  We worked with local authority colleagues to lead a joint programme to review existing services and implement a redesigned service model based on systems thinking methodology.  We also worked with a range of stakeholders from the NHS, adult social care providers, and independent and voluntary sector organisations.  The programme has been discussed and supported by the Somerset Health and Wellbeing Board. Compass Disability was commissioned to bring together focus groups and develop a questionnaire giving people the opportunity to feedback their experiences of reablement services.  We held extensive stakeholder events with representatives from NHS, adult social care providers, independent and voluntary sector organisations and undertook a ‘deep dive’ exercise to understand what was happening in existing systems. A pilot integrating health and social care teams at one GP surgery has been in place for 18 months.  It has been rolled out to 15 practices in the Taunton and Area GP Federation with plans to phase in the service across the whole of Somerset. A clear message from the service users was: “I want to maintain my independence:  help me to find the solutions to do the things that matter to me”.  The key difference with this model is that we are asking patients what they feel is important to them and what goals they want to achieve.  The teams have flexibility to find solutions centred on these goals.  This is a fundamental shift from the ‘one size fits all’ approach often seen in existing services.  

Outcomes

Improved patient experience and quality of life as care delivered in a more appropriate setting; 1{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} reduction in emergency admissions 7{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} reduction in readmissions   Annual value of savings made 2012/13           £311,000 (Gross) Recurrent 2013/14           £1,659,000 (Gross) Recurrent  

Patient setting

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

 

Clinical area

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

Information, tools and techniques used 

Project Management Board jointly with Local Authority with Project Manager  

Geography

County wide Somerset Project being rolled out Somerset wide.  Population 550,000  

Timescale

2008 and ongoing April 2012 to March 2013  

Contact details and further information

Ann Anderson Director for Clinical Commissioning Development Ann.anderson@somersetccg.nhs.uk 01935 384190 [post_title] => Reablement - Contract Monitoring QIPP [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => reablement-contract-monitoring-qipp [to_ping] => [pinged] => [post_modified] => 2015-03-24 13:27:31 [post_modified_gmt] => 2015-03-24 13:27:31 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.tvhkt.org.uk/?post_type=improvement-science&p=3711 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 26 [max_num_pages] => 6 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => 1 [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => 1 [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => [is_privacy_policy] => [is_404] => [is_embed] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_favicon] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 91584b9f2b16c7a9f4b214688ea07c6f [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) ) [1] => derp )

Category: Cross systems

Reablement – Contract Monitoring QIPP

The Journey – The Somerset Clinical Commissioning Group (SCCG) led the review and redesign of reablement services over the last two years to help improve outcomes for patients.  We worked with local authority colleagues to lead a joint programme to review existing services and implement a redesigned service model based on systems thinking methodology.  We […]

Posted on Mar 27th Cat: , , , , , Comments: Comments are off for this post

Improving hip fracture pathways

The journey – This very successful project aimed to reduce time from A&E to theatre and improve pain control for hip fracture patients. It reviewed and revised the patient pathway through the system from paramedic through A&E, radiology, theatre, ward and discharge, including social care.   Outcomes There have been a number of significant improvements […]

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

Emergency Care Quality Improvement Programme

The journey – The purpose of the programme is to improve patient flows, making emergency pathways more efficient and reducing length of stay and number of beds whilst also making care safe, effective and a good experience for patients and staff. By better matching capacity to demand the trust aimed to make sure that patients […]

Posted on Jan 16th Cat: , , , Tags: 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

Avon Connecting Care

The journey – This programme’s purpose was to create inter-operability between a range of clinical systems that capture patient records.  These include GP, out-of-hours, A&E, social care, minor injuries units and mental health services.  It was recognised that similar clinical systems existed in a number of these organisations (replacing paper patient records) and the opportunity […]

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