Scottish Ambulance Service. Quality Improvement and Efficiency Programme. Heather Kenney Director of Strategic Planning and Quality Improvement

Transcription

1 Scottish Ambulance Service Quality Improvement and Efficiency Programme Heather Kenney Director of Strategic Planning and Quality Improvement

2 Our Quality and Efficiency Programme Philosophy of Learn and Improve Bottom up A range of efficiency priorities Back office support services Administration Operation Workforce and Resource Planning Our Ambulance Control Centres Our Scheduled (PTS) Care Service

3 SAS QI Collaborative 65 staff from across the country engaged Foundation level QI training Improvement based on small tests of change Falls and Frailty Pathway developments COPD pathway developments The role of our paramedic practitioners SEPSIS PVC Bundles Mental Health

4 Scheduled Care Our Approach Challenging hypotheses proof of concept Learn and Improve 8 Week Intense Service Review Detailed Diagnostic Key stakeholder engagement Several Critical Issues Workshops Lanarkshire Pilot Working towards a national framework Mobile Data Solution

5 NHS Scotland Mainland Health Boards = 14 Population: 30 June 2011 = 5,254,800 No of PTS Journeys per year = 1,272,590 No of Hospital sites = 350 No of miles covered = 11.8m

6 Our Assumptions Capacity & demand issues Day to day service delivery issues Differing perspectives nationally & locally Variance in practice and perceived quality SAS Health Board tensions High levels of waste Organisationally under-valued Lack of technology and communication infrastructure

7 1) Hospital (circle): Elgin Borders Edinburgh General Forth Valley Stobhill 2) Distance travelled Less than 2 miles 2-5 miles 5-10 miles Over 10 miles 3) Age Under Over 80 4) Have you used PTS in the past? Yes (more than 6x/yr) No (less than 6x/yr) 5) For what reason do you use the service? Clinical Geographical Social Mobility 6) If PTS wasn t available, how would you get here? (tick) Relative/friend Couldn t Volunteer transport Taxis Own car (M) Public transport Approach Step 1: understanding PTS Step 2: engaging with stakeholders Understanding the process: stakeholder interviews, process walks and crew shadowing Critical Issue Workshops (CIWs) with PTS, Health board and patient stakeholders across 3 regions Stage 4: what are our outcomes? Stage 3: creating the baseline Scottish Ambulance Service - Patient transport service Learn and improve Patient survey General information Your PTS experience An outcomes map was produced to illustrate the quick wins and longer term benefits the team can deliver. This was driven by data collection and engaging with stakeholders Data sourced from CLERIC, other departments (Fleet, MIS, mgt accounts etc), ASO survey and patient engagement A structured and fact based approach to ensure the team put forward the best recommendations for improvement

8 Stakeholder engagement Patient satisfaction surveys Service lacks clinical focus Evidencing Variation in Practice Identifying waste and low levels of efficiency and productivity Exploring technology capability Understanding the expectations of partners and stakeholders The Lanarkshire test of change establishing proof of The Lothian Hub concept Building the case for change

9 Principles of New Model Clinically focussed service SAS ownership of pre-appointment information Direct patient access Consistent application of patient needs assessment Removal of prioritisation Standardisation of systems/processes/procedures Improve service responsiveness, flexibility & efficiency Improve the use of technology e.g. Journey planning, resource management etc. Improve links to other transport providers Maintain local knowledge & liaison

10 Area Service Office (system) Configuration In simple terms we went from this...

11 To this... PTS Regional Centre North Co-located Inverness EMDC PTS Regional Centre West Co-located Cardonald EMDC PTS Central Server Systems With DR System and controlled access PTS Regional Centre East Co-located Norseman EMDC

12 With a bit of this Sophisticated cab based technology for journey planning In vehicle satellite route navigation and tracking Electronic patient record Access to back office systems ( , shift rostering, risk and averse incident reporting Airwave communication systems to support

13 And a lot of this Shift timings do not match demand patterns Patient Cancellation Hotline - does it still get used? Lack of technology to support Increased efficiency and productivity Use of service i.e. if a request was made for a C2 pt and the requester was told Quota full then the caller would change the mobility to suit any transport available. Stakeholders Engagement various issues Lack of communication between ASO and crews Too many people are allowed to book patients Some areas do not use eligibility so inequity and NHS staff abuse of transport is a problem A lot of patients do not need transport, but get it and it is the Patients that do require it that suffer or get cancelled with no resources.

14 We are not quite there yet! What will success look like? A better patient experience Improved Productivity more with less Improved service delivery, streamlined processes, consistent models, reduced variation Better use of finite resources Stronger partnerships, greater collaboration A paradigm shift in the culture of the service

15 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 PTS Journeys Managing Demand Total Monthly Activity (All Scotland) by Mobility 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 A&E C C1 C2 Stretcher

16 22/04/ /05/ /06/ /07/ /08/ /09/ /10/ /11/ /12/ /01/ /02/ /03/ /04/ /05/ /06/ /07/ /08/2013 Improving Direct Access Call Performance % North West East

17 Benefits Logic Opportunity Areas Stop fax booking & Phase out paper National registration centre Better apply eligibility 80% bookings made by phone Benefit Drivers Patient Experience Clinical Quality Benefit Areas Patient Improvements 30 max block booking, eligibility validity & booking Inappropriate use form National cancelation line Better enforce eligibility criteria Appeals process Pre-appointment form 2.9m - 5.7m Less in-eligible patients 0.6m Staff Experience Staff morale Cost reduction (non-cashable) Staff Improvements PTS Service Improvements Share Health board information Reduction AVCS Plan inbound journeys only PTS crew reduced cleaning 0.8m 0.6m Reduction in aborted journeys Reduced private amb. * Reduced waiting time at Hosp. 0.65m Cost reduction (cashable) Capacity increase Post code zoning Reduced journey times

18 CRES STRUCTURED APPROACH TOTAL CRES DELIVERED OVER 3 YEARS M PTS CRES - 2.5M (14/15) BUT A BIG HEALTH WARNING HERE AROUND PACE AND SUSTAINING QUALITY