North Lincolnshire and Goole NHS Foundation Trust

Report
Meeting the 7 Day Diagnostic
Access Challenge
Tracey Broom, General Manager
Diagnostics, Therapeutics & Central Operations
Improving health outcomes across England by providing improvement and change expertise
Diagnostics & Therapeutics
Group
Diana Princess of Wales
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General Radiology
CT/MR
Ultrasound + community locations
Mammography
Physiological Measurements (PM)
Audiology + community locations
Nuclear Medicine
Medical Engineering
Pharmacy
Endoscopy
Outpatients Nursing
Cancer Services
Specialist Practitioners –
Transfusion & Immunology
Scunthorpe General
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General Radiology
CT/MR
Ultrasound +
community locations
PM
Audiology + community
locations
Medical Engineering
Pharmacy
Endoscopy
Outpatients Nursing
Cancer Services
Specialist Practitioners Transfusion &
Immunology
Goole District General
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General Radiology
Audiology
Endoscopy
Outpatients Nursing
Cancer Services
611 staff
£30 million budget
Improving health outcomes across England by providing improvement and change expertise
Challenges –
Our Transitional Journey is Underway
Re-Shaping Diagnostics
2012-2017
- The Diagnostic Innovation & Improvement Plan
 Fit for the Future Implementation 2011 saw integration of Finance and HR
across Diagnostics bringing harmonisation and efficiencies into the then
Diagnostics, Therapeutics and Path Links Teams.
 Diagnostics had followed a continuous process of service reconfiguration/
modernisation for a number of years but were struggling to meet demand
from both the Acute and then Primary Care sector.
 Main aim for Re-Shaping Plans were to increase productivity levels at a
lower cost whilst maintaining quality, introducing a more responsive and
flexible service provision.
 Need to support 7-day working.
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Core Elements to Re-Shaping –
NHS Change Model
 Workforce Redesign – introduced
stronger clinical leadership. New posts
of Deputy Heads/Deputy Clinical
Leaders of Department created in
keeping with The Francis Report.
 Leadership - Service Management
Changes Merged SGH and Goole Xray.
 Process Redesign – 3 session day
moved away from reliance on overtime.
 Consistent Regulated Quality.
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Moving to 7-Day Diagnostics
was achieved by: Moving staff away from locally agreed on-call payments to an out of ours 3 session day
shift over 7 days.
 Offering a pay protection period to staff to ensure they receive protection of income loss.
 Rotation of staff from general radiography to CT/MR using competency based skill
packages for staff.
 Offering training and support of sonographers by offering secondments to local
radiographers to undertake training at local universities – with supported course fees.
 Ensuring contracts of staff include working across the 2 main sites both days and nights.
 Formal staff rotation through CT, MR and general radiology areas to support
maintenance of skills.
 Additional staff recruitment.
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Impact – patients
 Inpatients and outpatients now have access to CT, MR, General
Radiology and Ultrasound 7 days per week.
 Same day diagnostic for those attending Consultant outpatient
appointment, where possible in General Radiology, Ultrasound and CT
 Increased timeliness to access to diagnostics e.g. CT head scan for
Stroke patients achieved within Stoke Accreditation targets
 Where possible provision of same day diagnostics for Inpatients if the
patients preparation time allows.
 Wider choice of appointments for all outpatients.
 More timely access and diagnosis for cancer.
Improving health outcomes across England by providing improvement and change expertise
Overall
Redesign aided other clinical groups to support timely clinical
decision making leading to more effective discharge planning.
Wider access for outpatient services.
Initial investment required of an additional £533k to support
increased staffing levels. The widening of access brings in
more income to off set the expenditure against this.
Full extent of spend on additional recruitment and the savings
to be made from working shift systems as opposed to on call yet
to be finalised .
Improving health outcomes across England by providing improvement and change expertise
Challenges and solutions
 Formal 90 day consultation process.
 Staff invited to offer their preferred rotas within the consultation period.
 Robust contingency plan for report provision was locally complimented by
outsourcing to private providers.
 Trial of home reporting kit to compliment Radiologists reporting at home.
 Staff recruitment on-going key challenge. Locums are a large cost
pressure.
 Grow your own culture of Sonographers and CT/MR Radiographers in
place.
 Recruitment drive continuous, looking at bursary type scheme with HR .
Improving health outcomes across England by providing improvement and change expertise
Where we are now
 All Diagnostics Staff – 7 Day Contracts.
 7 Day Diagnostics - X-Ray, CT/MR, Ultrasound.
 3 session days in X-Ray, CT/MR over 7 days.
 Services appropriately supported with Portering, Nursing, Electronic Requesting,
Medical Engineering Service, Diagnostics IT.
 Diagnostic Reporting Standards embedded.
 Admin roles separated out from clinical roles.
 Flexible establishments across the sites.
 Harmonised patient information across sites.
 Achievement of KPIs – e.g. Stroke 1 hour and 24 hour targets.
 Rolling Capital Replacement Plan.
 Robust CIP Plans.
Improving health outcomes across England by providing improvement and change expertise
Challenges ahead
Recruitment
and Retention
of highly skilled
workforce
Financially viable
and efficient
services
Quality
services with
quick
turnaround
times, earlier
diagnosis with
improved
outcomes
Meeting the demand
– huge areas of
growth
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Emerging Themes & Principles
 Review numbers of staff required to deliver safe effective services.
 Undertake capacity and demand analysis to help understand how services could be
delivered to support waiting times and patient choice.
 Review skill mix of staff at all levels to ensure career opportunities.
Top Tips
 Ensure early engagement of staff in reviewing and developing staff shift systems.
 Produce a strategy document that maps the journey for staff. This ensures staff are kept
well informed and wanting to drive the changes themselves.
 Engage with other interdependencies e.g. Portering, Domestic Services and Diagnostic IT
services to ensure 7 day services run effectively.
Improving health outcomes across England by providing improvement and change expertise
Conclusion
 Corporate unparalleled changes on the horizon – Diagnostics &
Therapeutics need to continue with reconfigurations whilst
balancing cost against long term gains for the Trust.
 Our short term success in some cases is determined by skills of
workforce and ability to recruit.
 Concentrate on operational capacity and performance to deliver
effective services with robust CIP plans .
 Commitment from all staff and strong leadership from the clinician
leads and managers to support all clinical services taking a wider
strategic viewpoint across the Trust and health community
ensuring quality services.
Improving health outcomes across England by providing improvement and change expertise
Thank you for
listening.
Any questions?
Improving health outcomes across England by providing improvement and change expertise

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