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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] => 3709 [post_author] => 8 [post_date] => 2013-03-27 14:57:03 [post_date_gmt] => 2013-03-27 14:57:03 [post_content] =>

The Journey -

NHS Somerset holds contracts with 74 Primary Care Dental Practices, with an annual contract value of £27 million. Through an annual contract review process the Primary Care Team developed key performance indicators that allowed activity to be analysed down to individual performer/patient level.  Comparisons were made by Clinician and Practice across the county and best practice encouraged in terms of patient recall intervals and dealing with repeat attending patients.  

Outcomes

Patients with high needs are now being managed more effectively (fewer claims per patient) and recall intervals have improved to exceed national average indicators.  Annual Saving: £700,000 recurring  

Annual value of savings made

Year: 2008 and ongoing         Amount: £700,000       Recurrent  

Patient setting

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

 

 Clinical area

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

Information, tools and techniques used 

N/A  

Geography

County wide Somerset  

Timescale

2008 and ongoing  

Contact details and further information

Richard Wood -Associate Director for Primary Care Development 01935 384122 Richard.Wood@somerset.nhs.uk [post_title] => Primary Care Dentistry – Contract Monitoring QIPP [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => primary-care-dentistry-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=3709 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => 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 ) [3] => 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.

[post_title] => Collaborative Commissioning events [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => collaborative-commissioning-events [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=3429 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 3427 [post_author] => 8 [post_date] => 2013-01-16 16:17:40 [post_date_gmt] => 2013-01-16 16:17:40 [post_content] =>

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 ) ) [post_count] => 5 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 3711 [post_author] => 8 [post_date] => 2013-03-27 15:11:05 [post_date_gmt] => 2013-03-27 15:11:05 [post_content] =>

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] => 20 [max_num_pages] => 4 [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] => 2c471f89cd476d0c31ca7e08e8ccadf8 [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: South West

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

Primary Care Dentistry – Contract Monitoring QIPP

The Journey – NHS Somerset holds contracts with 74 Primary Care Dental Practices, with an annual contract value of £27 million. Through an annual contract review process the Primary Care Team developed key performance indicators that allowed activity to be analysed down to individual performer/patient level.  Comparisons were made by Clinician and Practice across the […]

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

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