Theatre Transformation Programme. Programme Brief

Transcription

1 Theatre Transformation Programme Programme Brief Document Status: Version 1 Date: 30 th June 2011 Authors: A Bennett Head of Transformation Patsy Spence Head of Operational Performance Senior Reporting Officer: Lynn hill Director of Operations and Service Transformation 1

2 Review Reviewed by Version Organisation Date Programme Board members Draft 1 RNOH 23 rd May 2011 External review Draft 2 27 th June 2011 Approval Approved by Name Organisation Date I Bayley and team 8 th July 2011 Document History Version Summary of Changes Document Status Date published Draft amendments to Draft 2 Initial document incorporate additional 30 th June 2011 modules and quick wins V1 All amendments incorporated and agreed with Singed off by external external team review 8 th July 2

3 Contents 1 Introduction Background Aim/Vision Outcomes Benefits Scope Objectives, Outputs and Targets Programme Success Criteria Key Assumptions Constraints External Factors Projects / Work Strands and Priorities Interdependencies and Interfaces Timescales / Key Milestone Dates Risks Key Issues Structure (i.e. Governance & Accountabilities) Resources Stakeholders Communications Quality Current Status of Programme and Plans

4 1 Introduction The RNOH s vision is to develop as a world class centre of excellence for specialist musculo-neurlgcal conditions. The Trust is committed to the delivery of high quality care which is a consistent part of everyone s experience within the Trust. Services need to evolve to reflect the changes in healthcare and the Market place. Whilst the RNOH has an excellent clinical reputation for the development of complex orthopaedic treatment this is not supported by the current infrastructure. The communication along the patient admitted pathway is inconsistent and fragmented. The business at present works in silos, which is the cause of many of the constraints that affect service delivery. 2 Background The current theatre review was completed in May 2011 by Ian Bayley and colleagues. A number of recommendations have been made. None of the recommendations were a particular surprise to the executive team and many of the clinical team are cynical about real change actually coming to fruition, despite the number of people being interviewed, all sharing similar views and frustrations. There are a number of recommendations that if implemented will achieve the objectives outlined in the introduction, which fundamentally are to produce more activity whilst reducing cost. A full representation is contained in the pack produced by Ian Bayley. This programme of work is being set up to shape and re-design the way theatre services are delivered at the RNOH. The objective is to increase productivity to create additional income and reduce costs whilst enhancing both the patient and staff experience, underpinning the excellent clinical reputation that is already enjoyed within the organisation. In order to accomplish our strategic goals for the RNOHT we need to reconfigure and transform the theatre services within the Trust, to enable to us to compete in both the NHS and private market places. This can only be achieved by changing the way we work culturally, organisationally and through financial ownership. This will require significant stakeholder engagement across the Trust from everyone who is employed both directly and indirectly by the organisation. 3 Aim/Vision The aim of the project is to reconfigure the way we work in theatres. This will be done by creating a number of work streams to shape a seamless process for the patient pathway, from the point the patient is listed for surgery to the point they are returned to the ward after their procedure is completed and then discharged. 4

5 4 Outcomes 4.1 Infrastructure 4.11 Leadership to be lead by the CEO Ensure that there are governance arrangements in place To ensure that there is executive management engagement and support To ensure clinical engagement To escalate issues to the Trust Board Communication trust wide to ensure there is a clear and consistent message 4.12 Finance To effect regular demand and capacity modelling To understand and disseminate relationships between throughput (volume), reduction in unit costs and generation of income/surplus To provide costs/benefits analysis support to the Programme 4.13 Information management and IT To establish organisation of data collection and information sharing Implementation of structure for embedding information-sharing across the organisation To integrate consultants (information analysts) into service level working Communication To develop a communications strategy and plan which is congruent with the workstreams and informs progress Interface with 18 weeks To ensure the overall programme links in with the delivery of the 18 week access and performance targets Quality To ensure that quality is integral to all work within the programme with a robust audit and monitoring structure is in place Clinical outcomes to ensure that clinical outcomes are forefront of the work and are both maintained and improved Sustainability to ensure that all improvements are maintained and monitored through audit. Staff empowerment and training and becomes business as usual Improved staff experience Improved patient experience Substantiality to undertake the sustainability questionnaire and analysis at 5 months post implementation To complete and best cost/benefits analysis 6 months post implementation 4.17 Training To ensure that staff are trained in change management and running projects/workstreams To support staff throughout the programme and ensure that communication is upheld and issues with implementing change and running projects are identified and resolved. 5

6 4.2 Pre-admission (decision to admit to date to come in) Electronic TCI in place Full audit trail of the pre-admission process Pre-screening and pre-operative assessment in place Pre-admission documentation completed before admission All patients to have a decision to admit (DTA) by week 9 of the 18 week pathway All patients to be validated three and one week before procedure. 4.3 Admission (day of admission to transfer to Theatres) Patient admitted on the day of surgery (where appropriate) Eliminate cancellations for avoidable reasons First on the list defined 48 hours before list Standardisation of patient notes Accurate patient data input Patient is delivered to theatre for allotted time slot (90% of the time) Improved patient experience by benchmarking data before changes to the admission process and then a continuous audit cycle through real time patient surveys, interviews and post-evaluation questionnaires (quarterly). 4.4 Theatre Planning Robust theatre list construction to enable transparency of utilisation Visual session/slot utilisation. 4.5 Theatres readiness A theatre management system well defined operating list, appropriate slot allocation (70% session and slot utilisation and working towards 85%) Implementation of a stock control system Policy and protocol for the procurement of prostheses that will reduce costs by (X %) Loan kit management system to reduce cancelled operations through lack of or incorrect equipment (by X) and costs Tailored flexible workforce to meet the needs of the department measured by 70% utilisation and elimination of cancellations due to staffing issues Enhanced staff experience - measured by reduction in staff turnover (<10%), achievement of Trust sickness levels (2.75%) and reduced usage of agency staff (<10%). Improved outcome from staff survey (check benchmark) Well run operating list by introduction of team brief and de-brief (possibly measured by check list). 4.6 Discharged from theatre and return to ward All patients to be returned to ward within 10 minutes of Recovery discharge criteria being met - measured by delayed discharge against recovery discharge criteria Discharge planning all patients to have an expected date of discharge prior to admission measured by delayed discharge audits Improved patient outcomes all patients to be pain free on return to ward measured by monitoring pain scores 6

7 Reduction in length of stay (LoS) to include enhanced recovery pathways. 4.7 Quick wins (next Tuesday) New admission process to reduce delayed starts and bring knife to skin to 08:30 (pilot) Prostheses costs identify current usage (numbers, type and frequency) per unit by speciality and rationalise the shelf stock Walking all patients to theatre Loan kits indentify current usage (numbers, type and frequency) per unit by speciality and rationalise the shelf stock. Establish tracking system Develop and implement a data pack for units and individuals (visibility of session/slot utilisation, delayed starts etc). 5 Benefits High quality services that demonstrate an improvement for all surgical patients at the RNOH Increased productivity through robust demand and capacity planning across whole pathway Increased efficiency through reduction in delayed starts and hospital cancellations Improved theatre stock control and purchasing Reduction in costs due to excess stock and wastage Rationalisation of prostheses Services that support the delivery of the overall Trust Development Plan Services that support national targets such as 18 weeks Improved clinical outcomes and patient related outcome measures (PROMS) Improved staff experience. 6 Scope The Programme Board members have been agreed and project leads and teams are to be identified once programme approval is obtained. Stage 1: Define what we want the service to look like by (to be) Creating a patient flow process from the point of decision to admit and completion of etci to patient discharge taking a modular approach; however these modules will run in tandem. Each module will include a Communication plan, data set and input by Information Management and IT, a risk/issues register and programme outcomes log with financials attached (income and expenditure) key milestone indicators and a reporting progress mechanism. The modules are as follows: - Pre-admission decision to admit (etci) to admission date being agreed - Admission (day of admission to transfer to Theatres) - Theatre readiness - Discharge from theatre and return to ward. 7

8 Stage 2: Obtain executive support for the module action plans to include leadership, IM&T, finance and communications. Stage 3: Implement the modules in a phased approach initially (two theatres) through the delivery of detailed action plans and project groups Develop and implement a progress reporting mechanism to include a theatres performance report for Trust, individual units, clinicians and staff Develop a roll out plan across all theatres as improvements are implemented. Roll out timescales will be dependant on scale of change. Stage 4: Review each action plan with the Programme Board and report regularly to the Executive Team Escalation of deviations to plan, delays in timelines and risk to Executive Team and Trust Board. 7 Objectives, Outputs and Targets Ensure that the programme outcomes deliver clinically safe and sustainable services that demonstrate an improvement for patients and staff Demand and capacity that is tailored to each unit s needs, factoring in the variation in demand, encompassing future capacity requirements. Finance a reduction in costs through reduced down time, overruns and wastage; less variation in monthly income due to appropriate throughput (volume) Engagement with patients, public, carers, commissioners and third sector organisations Recommendations to the Executive Team, Service Transformation Committee and Trust Board around theatre service improvement initiatives such as day case unit, direct admissions to theatre, etc, to be provided Deliver a service that offers high quality, value for money and achieves the Trust s development plans and access targets for commissioners. 8

9 8 Programme Success Criteria Criteria A clear and consistent vision of the Theatre Transformation Programme objectives Successful engagement and consultation with clinicians, administrative staff, management and other relevant stakeholders Ensure the outcome will deliver clinically safe and sustainable services Services that are an improvement for patients How measured This will be achieved through regular updates to all key stakeholders via current meeting forums, Team Brief, intranet, posters, update events This will be achieved through communication via face to face meetings, intranet, presentations at appropriate forums, use of clinical leads/champions and workshops. Regular Programme Board and work stream meetings (face to face/telephone conference calls will also be incorporated into the Programme timeline at every stage. A mode of consultation will be undertaken were appropriate. Staff survey/interviews Service improvements will be consistent with best practice guidance. All improvements will have clinical input and guidance and be assessed for risk. Audit and monitoring will be an integral component of the Programme to monitor effectiveness of change. Improved pre-admission process Improved admission process on the day where appropriate Improved communication and information Reduced starvation times Eliminate cancelled operations by the Trust Eliminate DNA s or patient cancellations on the day of surgery Improved pain scores to enhance early mobilisation and reduce length of stay Reduced length of stay Improved discharge planning Services that are an improvement for staff and the Trust These will be measured through audit and patient questionnaires/surveys/interviews Improved working environment Improved health and safety Improved staff recruitment and retention and reduction in agency usage Reduction in staff sickness Improved scheduling well planned lists, elimination of delayed starts due to avoidable reasons and overruns Increased utilisation by individuals and units Elimination of cancelled operations 9

10 Robust ongoing demand and capacity modeling to reflect growth and changes in service provision and allows for variation Improved financial stability due to demand and capacity planning, reduction in costs and wastage Improved communication and team working across departments Theatre services that meet the needs of the Trust and commissioners and ensure we are a provider of choice Theatre services that are affordable, cost effective and are in line with the Trusts financial plans Capable workforce to deliver services Services have been designed to meet the Trust s strategic objectives and financials. The service meets the needs of commissioners in terms of the QIPP agenda and access targets. Service quality and cost of delivery will be compared against baseline and the market. An evaluation criteria for assessing will be developed Assessment of individual performances through objective setting and appraisal 9 Key Assumptions Current theatre services are sub-optimal and can be delivered more effectively To achieve financial balance, the Trust will need to manage theatre demand and capacity and utilisation to reduce costs and wastage and ensure income generation Potential service improvements will require infrastructure changes IM&T support will be provided and IT solutions implemented Reconfiguration of stores, stock control and prostheses procurement is integral to the programme There is service user, carer, clinician and other key stakeholder engagement 10 Constraints Initial programme constraints include: The Trust s current financial position The current theatre infrastructure buildings etc Current commissioning environment Skill mix shortfall Lack of engagement from partners to provide service change Historical custom and practice 11 External Factors National policy guidelines and directives such as: Healthcare For London NHS reforms Commissioning challenges 10

11 12 Projects / Work Strands and Priorities The Projects/ work streams and Project Managers are defined as: Project/ work stream Project Lead/Clinical Manager Lead Infrastructure Rob Hurd Pre-admission decision to admit (etci) to admission date being agreed TBC TBC Admission (day of admission to transfer to Theatres) TBC TBC Theatre planning & readiness TBC TBC Discharge from theatre and return to ward TBC TBC Quick wins TBC TBC The priorities of each project are to: Review the theatre transformation report and recommendations conducted by Mr Ian Bayley and team Implement module action plans for each area/action within the overarching theatre transformation action plan and set milestones Map the current pathway & service delivery Review current best practice and evidence base Identify IM&T requirements and implement data analysis and reporting Activity analysis Financial analysis of activity demand Identify core service components Implement new pathway and processes Ensure continuous communication and engagement with clinicians, staff and other key stakeholders. See action plan in appendix 1 13 Interdependencies and Interfaces Estates Programme RNOH Redevelopment Plan Outpatient Programme to include pre-operative assessment Foundation Trust application Trust financial position North Central London Commissioning Agency NHS London ISS facilities management provider. 11

12 14 Timescales / Key Milestone Dates Timelines is in appendix 15 Risks Initial high level risks include: National political changes e.g. change of government, change in national policy etc. Alignment with strategic organisational plans, e.g. Foundation Trust status, redevelopment Delivery of financial recovery / turnaround plans Organisational capacity and ability to deliver the Programme Availability and skills of the workforce to deliver the new model of care National and local commissioning reconfiguration Improvement costs higher than assumed 16 Key Issues Lack of programme and project management resources and ability to deliver the Programme Lack of data analysts and administrator resources Potential duplication and lack of clarity of work going on in other areas of the Trust Competing priorities Requirement to utilise existing project groups that are already established and building on the work that has already been produced 17 Structure (i.e. Governance & Accountabilities) The Programme Board is responsible for overseeing and managing the Programme. The workstreams are responsible for the delivery of the action plans and reporting to the Programme Board 12

13 Chart 1: Programme Structure Theatre Transformation Programme Governance and Accountabilities Trust Board Clinical Governance & Data Quality Executive Management Team Theatre Transformation Programme Service Transformation Committee Work streams Infrastructure Pre-admission Admissions Theatre Readiness & Planning Discharge from theatre & return to ward Quick wins Quality 18 Resources Going forward the Programme will be funded by the Trust. Manpower resources will include: Programme leads will be provided by the Heads of Operational Performance and Service Transformation Project Managers Administrative support provided by Service Transformation Programme Finance IM&T dedicated resource to the Programme Communications and engagement Clinical input 19 Stakeholders A full stakeholder map will be developed as part of the Programme Brief, to include the stakeholders listed below: Consultants Allied health care professionals Nursing staff Administrative staff 13

14 IM&T Communications Commissioners Estates & Facilities PCTs GP s and Acute Trusts Patients and public Finance Human Resources External suppliers 20 Communications The launch and programme outline and progress will be included in both the service transformation and Trust strategy and plans. Communication will be via existing meetings, theatre notice boards, intranet, Trust screen saver, news letter, and other relevant forums within the Trust. 21 Quality The Programme will comply with Prince 2 methodology. 22 Current Status of Programme and Plans Programme Brief completed Set up of work streams and agreed Project Leads in progress Developing Programme and workstream Team TOR Developing Communication Plan Developing Finance TOR 14