understanding and demonstrating the benefits of improvement a work in progress!
TRANSCRIPT
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Understanding and Demonstrating the benefits of improvement
A work in progress!
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Where do you begin?
• Quality improvement for the service user
• Increase percentage of patients receiving this surgery as a day case from 22% to 50% by April 2010
• What difference does this make for patients?
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GP referral
Outpt apt
No test results
Adm
Adm night pre-surg
surgery
No surgery
Cancelled theatre
Ward stay
home
LOS
TTO variation
GP(sick note)
Sick noteDischarge info
Pain meds
Lap chole pathway for 97.9% Ninewells’ patients as inpatients
Waste to be removed:•Repeat outpatient apt•Admission pre-surgery•Cancelled operations•Post-surgery stay•Variation in TTOs•Variation in sick note/discharge info
Understanding and quantifying the waste in the current system
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Lap chole pathway for 50% post change for Ninewells’ patients as daycase surgery
GP referral
Outpt apt
surgery home
Apt for surgery made
Arrive on day TTOs
SicknoteDischarge letter
Waste removed:•Repeat outpatient apt•Admission pre-surgery•Cancelled operations•Post-surgery stay•Variation in TTOs•Variation in sick note/discharge info
Map the future state
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Collecting information from a patient’s notes to understand the waste
• Number of GP apts• When tests were done• Number of outpatient apts (grade of Dr they
saw)• Surgery cancelled or not • Length of stay• Any complications whilst in hospital• Discharge letter or not• TTOs – what drugs, length of time• Did they have any complications/re-admissions
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Understanding Cost
• Cost of GP apt
• Cost of outpatient apt
• Cost of medics time
• Cost of time in ward (overnight stay)
• Cost of drugs
• ?Admin costs
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Summarising the data into cost
• Is it possible to produce an estimated range of the cost of the waste in the current process?
• Clear time frame that you are quantifying this waste for: is it over 6months?
• Things to think about: – range in waste per patient – Variation in waste = variation in cost
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Understanding the cost of change
• Time for redesign– Cost of staffing time – how many people will
be involved in the redesign work?
• Parallel processes – Frequently, changing to a new model of
service delivery involves running parallel processes for a short period of time
• New technology implementation?
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Summary– the start of a framework:
• Understand the waste in the current pathway
• Map out pathway• Determine how much by when – what are
you aiming to achieve? By when?• Map out future state• Identify waste that you plan to remove
from the pathway from comparing the two pathways
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Summary– the start of a framework:
• Undertake an audit of a sample of patient notes to collect information about the frequency and variation of waste along the pathway
• Use this information to determine some ranges of cost in terms of:– Staff time– Financial Cost– Patient time/experience– Extrapolate your costs based on a specific time period
and level of activity, including taking into consideration the impact of the change; will it impact on all patients or a % of them?
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Summary– the start of a framework:
• Quantify the cost of undertaking the improvement work• Build a project plan• From the plan, estimate the time commitment for all staff
involved• Consider any possible costs of running the old and new
pathways at the same time: will this happen? How many patients will be going through the old process, how many through the new? For how long?
• Quantify the cost of any new equipment/IT developments/staff etc
• Compare the cost of undertaking the work with the cost of the waste in the current system
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What will be the impact?
• Quality improvement?• Direct cash releasing saving?• Increased productivity?• Cost avoidance?• Resource release, e.g staff time? – what
will you do with it?• Putting timelines around the savings made
through removing the waste, e.g. £x will be saved in y months, £z over £a years.