Releasing time for care Workshop 4 Development Advisors Jayne Beasley and Rachel Duffy 25 th May 2017 #Gpforwardview www.england.nhs.uk
Agenda 12:30 Arrival and lunch 13:00 Welcome 13:10 Sharing progress, insights and learning from projects 14:15 Understanding variation and waiting times 15:00 Refreshment Break 15:15 Making change happen – ingredients of success 16.30 Actions and next steps 16.45 Evaluation and close www.england.nhs.uk
The aims of the workshop are: • To progress projects, sharing progress insights and learning • Knowing how we doing, what is practical and useful for you to know about how your practice is running? • To consider the key ingredients of making successful change • To identify and plan next steps and actions for your practice and for Herefordshire www.england.nhs.uk
Previously ……. • Shared our project aims and progress • Introduced to the model for improvement as a framework for implementing change & PDSA cycle • Undertook an activity involving a small test of change (coin game) and considered: measures, baseline, prediction, testing, small changes • Discussion on understanding demand and capacity www.england.nhs.uk
The Model for Improvement What are we trying to accomplish? How will we know that change is an improvement? What change can we make that will result in improvement? www.england.nhs.uk
In between session we suggested you might • Define your aim and measures • Progress next stages of your project in relation to planning and implementation • Reflect on capacity and demand in light of your project www.england.nhs.uk
Activity : Sharing progress What’s working well? What’s working not so well? \What challenges or questions do you have that you would like help with? www.england.nhs.uk
Last time we discussed demand and capacity we discussed that you • are good at matching capacity with demand where possible • do not know what your demand is but you have patterns which you can predict • most of the time you scheduled staff to match this www.england.nhs.uk
Variation in Demand and Capacity No of Appointments Needed & No of Appointments Available - 3 Weeks 140 120 100 Appointments 80 Demand Capacity 60 40 20 0 Mon Tues Wed Thurs Fri Mon Tues Wed Thurs Fri Mon Tue Wed Thurs Fri www.england.nhs.uk
So is the answer to simply increase capacity to match demand??? www.england.nhs.uk
What Causes Variation? Capacity Demand • Holidays • Reduced weekend working • Statutory training • Seasonal • Professional development • Government initiative • Sickness • Bank Holidays • External meeting • Internal meetings • Re work www.england.nhs.uk
Why Do Queues or waits form? • Because demand exceeds capacity? • Mismatch between demand & capacity? www.england.nhs.uk
Demand greater than capacity? • What will happen to our queues/waiting lists if demand really is greater than capacity? • Are our waiting lists getting longer & longer? www.england.nhs.uk
Moment of truth Even if: Average demand = Average capacity, Variation in demand + Variation in capacity = QUEUE! www.england.nhs.uk
Carve Out (Ring Fencing) Reserve slots/sessions/resources for selected groups • Fixed session working • Surgeries 9-12, 2-5 • Urgency • 2/52 wait • Urgent/soon/routine • On the day, pre-bookable, extra • Specialisation/condition • Diabetic, CHD, asthma clinics • Other www.england.nhs.uk
Carve Out • An obvious or “known” solution • But is it making things worse ? www.england.nhs.uk
Terms Carve-out When the flow of one group of patients is improved at one bottleneck at the expense of another group of patients Streaming or segmentation Separation of the process of care along the whole pathway for one group of patients to improve overall flow but not at the expense of other groups of patients The issue is not to eliminate all carve-out, but rather to eliminate unnecessary carve-out and reduce the impact of carve- out we can’t eliminate www.england.nhs.uk
Analogy of segmentation and flow: traffic flow on motorway Slow lane 50 mph Middle lane 70 mph Fast lane 90 mph All vehicles keep to same speed in allocated lane and all progress according to their need www.england.nhs.uk
What happens when lorry moves into middle lane at 55 mph? Slow lane 50 mph Middle lane 70 mph Fast lane 90 mph • backlog of traffic • flow rates compromised • few needs met • actual consequences are not seen at point of bottleneck www.england.nhs.uk
Variation and carve-out • Variation helps cause the waiting list • Carve out can reduce the flow of patients So what are we to do? Where are your biggest issues? What is your data telling you state the problem and measure it Then …….. www.england.nhs.uk
Model for Improvement Set AIMS that are measurable, time- specific, and apply to a defined What are we trying to accomplish? population Establish MEASURES to determine if How will we know that change is an improvement? a specific change leads to improvement Select INTERVENTIONS most likely to result in improvement What change can we make that will result in improvement? Test the change www.england.nhs.uk
If you could measure 6 things in your practice easily on a daily basis what do you or could you measure? Why would you choose these areas to measure? www.england.nhs.uk
Would this tell you from a data point of view how you where doing? Where would you look want to look in more detail? What out there to help us all, tally charts are a worry! www.england.nhs.uk
Making change happen : ingredients of success www.england.nhs.uk
Large scale change usually fails 5% 25% 70% Source: McKinsey Performance Transformation Survey , 3000 respondents to global, multi-industry survey of company executives www.england.nhs.uk
Change Model for Health and Social Care www.england.nhs.uk
Change Model for Health and Social Care www.england.nhs.uk
www.england.nhs.uk
Our shared purpose o So what is our shared purpose for this group? o What matters to us? What is our why? o What does it mean for the future of this group? What will it look like? Why should we do this? What would you offer what would you like to receive? Thinking now and next time? www.england.nhs.uk
Bringing it together Reflecting on: • The Change Model for Health and Care • What are the missing pieces for your project? Where are your strengths? Gaps? And what action do you need to take? • Sharing and insights of projects • The Model for Improvement • What stage are you at? Planning or testing? What do you need to do next? • Capacity and demand • What is the future sustainability of this change and improvement capability? What does this community look like for Hereford? How would it work/operate? www.england.nhs.uk
Action Planning Overall Owner: What Actions ? By Whom ? How? By When ? In what way ? www.england.nhs.uk
Contact details Jayne Beasley jayne.beasley@nhs.net Rachel Duffy rachel.duffy2@nhs.net www.england.nhs.uk
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