Capacity Planning Masterclass

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Capacity Planning Masterclass

Presented by:

Unscheduled Care Collaborative &

Planned Care Improvement Programmes

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MASTERCLASS LECTURES PRESENTED IN EDINBURGH BY:

• Elizabeth Bradbury, Clinical Systems Specialist, Bolton PCT and Bolton Hospital NHS Trust • Mark Jennings, Priority Programme Director, NHS Institute for Innovation & Improvement • Alan Cumming, Associate Director Elective Services, National Leadership & Innovation Agency

for Health

• David Dawson, Deputy Director of Service Transformation, Kings College Hospital NHS Foundation Trust, London

DVD User Guide

HOW TO USE THIS GUIDE

This guide is an accompaniment to the DVD of the Capacity Planning Masterclass event held on 5 June 2007 in Edinburgh.

The DVD is a recording of presentations from both the main plenaries (Introduction and Close of the day) as well as the 2 large breakout sessions held in the main room. The main points of each

chapter are outlined within this guide to ensure it is user-friendly and topic specific.

All the presentations from the day are available within the DVD. Speaker biographies are included to give you their professional background and the expert context they are presenting from. This is found using your CD ROM on Windows Explorer.

The purpose of the information is to give some structure to the lecture so that it can be watched in full or in part and can be used as a teaching resource. Other improvement and redesign material can be accessed at:

http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/Delivery-Improvement

Using the ‘view chapters’ selection on the main menu, you can choose which sections to watch.

N.B. This DVD can only play on a computer with compatible DVD software (such as CyberLink PowerDVD) or a DVD player. It will NOT play on Windows Media Player.

A N N IN G MA S TE RCL A S S

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DISK ONE

FIRST PLENARY

Please choose: Individual Chapters or “Play All” for the full session

Nicki McNaney, Head of Improvement Programmes, Improvement & Support Team (IST)

“Introduction to the Day”

(11 minutes)

1. Introduction to the Day

Elizabeth Bradbury, Clinical Systems Specialist, Bolton Hospitals NHS Trust

“Patient Flow Improvement Toolkit”

(50 minutes)

1. Introduction to Capacity Management 2. What is the Current State?

3. Four Steps to improve Patient Flow in your system 4. Wait for Bed Delays

5. What makes the difference?

6. Short-term Improvements (Quick Wins)

7. Integrating Elective & Emergency Capacity Management: The Future? 8. Communication across the System

9. High Volume Pathways

10. Summary(with closing by Nicki McNaney)

FINAL PLENARY

David Dawson, Deputy Director of Service Transformation, Kings College Hospital

NHS Foundation Trust, London

“Kings First Choice Programme”

(40 minutes)

1. Key Messages & Next Steps –Introduction by Nicki McNaney

2. The Future? Life Post-Programme Kings Fund

3. The Facts

4. What we did do? Suite of Transformation 5. Kings Philosophy

6. System Linking: Where can we be better? 7. Change Leaders’ Team (and their tools) 8. General Medicine reframing the argument 9. Balance and Strategy

10. First Choice: Service Transformation & Conclusions

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DISK TWO

MAIN BREAKOUTS

Mark Jennings, Priority Programme Director, NHS Institute for Innovation &

Improvement

“Managing Length of Stay”

(1 hour 4 minutes)

1. Outline and Introduction

2. NHS Institute for Innovation & Improvement 3. NHS Institute: Priorities and Challenges 4. Managing Length of Stay

5. Variation in Length of Stay

6. Group Work and Feedback (Interactive) Length of Stay: The New Drivers

7. System Level Drivers

8. Better Care, Better Value Indicators

9. NHS Indicator Explorer

10. Case Study: Barnsley Hospital

11. Process Level Drivers 12. Care Pathway Level Drivers 13. Questions & Discussion

Allan Cumming, Associate Director, Elective Services, National Leadership and

Innovation Agency for Healthcare

“Strategic Capacity and Demand Overview”

(1 hour 5 minutes)

1. Overview: Are we nibbling around the edges?

2. NHS Wales: What have we done?

3. Quick Facts: Modernisation Assessment Process 4. What have we learnt?

5. What do we know? 6. What do we need to do? Integrated Care Pathways 7. ICPs: Introduction

8. The Dunedin Experience

9. Approach to ICPs

10. What about Chronic Conditions? 11. Improving & Monitoring

12. Conclusions 13. Questions A N N IN G MA S TE RCL A S S

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RESOURCES

LEAN WEBLINKS AND REFERENCES

The NHS Improvement Network East Midlands

http://www.tin.nhs.uk/index.asp?pgid=1357

A useful site for improvement tools and techniques.

Manufacturing Advisory Service

This website is great for understanding Lean Thinking. Go to

http://www.swmas.co.uk/Lean_Tools/5S.php. Select Lean tools from the menu, then 5S. As well as theory and case studies there is a video example of 5S (Workplace Organisation) in a manufacturing context. Click on the picture of the video, enter your email address, then your area, and then hit the play button. You will need to have sound on your PC.

IHI 5 Million Lives Campaign

http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm?TabId=2

The 5 Million Lives Campaign aims to enlist thousands of hospitals across the country in a commitment to implement changes in care that have been proven to prevent morbidity and mortality.

NHS Institute for Innovation and Improvement

http://www.institute.nhs.uk/ServiceTransformation/Lean+Thinking/ The NHS Institute’s online guide to Lean.

Lean Blog

http://kanban.blogspot.com/

An online forum for anyone interested in Lean Scottish Executive Health Department.

Lean UK

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SCOTTISH EXECUTIVE PUBLICATIONS

All SEHD Publications can be found on this website: http://www.scotland.gov.uk/Publications

PROGRAMME DOCUMENTS:

Planned Care Improvement Programme

Planned Care Improvement Programme – Launch Document Day Surgery In Scotland

Referral Facilitation

Booking and Access Guidance

Unscheduled Care Collaborative Programme

Unscheduled Care Collaborative Programme – Launch Document Building the Foundations – Year 1 Report

A Guide to Hospital Transport Patient Flow Improvement Toolkit

NHS Institute for Innovation and Improvement:

All Institute Publications can be found on this website: www.institute.nhs.uk

NHS Institute for Innovation and Improvement, (2004),10 High Impact Changes for Service Improvement and Delivery

Better Care, Better Value Indicators:www.productivity.nhs.uk

1. NHS Indicator Explorer: The NHS Institute has developed a cost-effective, highly usable, web-based tool that will help organisations to benchmark their performance, prioritise areas for improvement and track progress.

2. Focus on: High Volume Care

• Executive summary

• 8 individual care area documents

The NHS Institute for Innovation and Improvement report(July 2006), Making the Shift: a review of NHS experience A N N IN G MA S TE RCL A S S

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AUDIT SCOTLAND:

All Audit Scotland Publications can be found on this website: http://www.audit-scotland.gov.uk

Accounts Commission for Scotland (1998),Better by the day – update

Audit Scotland (2004),Day surgery in Scotland – reviewing progress

Audit Scotland,Tackling Waiting Times in the NHS in Scotland

SURGERY:

Association of Anaesthetists of Great Britain and Ireland (2005),Day Surgery, (Revised edition)

http://www.aagbi.org

British Association of Day Surgery (2005-06),Directory of Procedures

Delivering for Health and Effectively deliver the simple change number 2, improving referral and diagnostic pathways

Department of Health (2002),Day Surgery: Operation guide – Waiting, booking and choice

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_40 05487

Heath Service Journal (09, 2005),Remains of the day

Healthcare Commission (2005),Acute hospital portfolio review – Day Surgery

http://www.healthcarecommission.org.uk

NHS England National Endoscopy Team, (2006), Improving Endoscopy Services: Meeting the Challenges http://www.18weeks.nhs.uk

NHS Education for Scotland, (2006),Role Development for Radiographers, & Radiology Support Staff within Scotland – Final Project Reporthttp://www.nes.scot.nhs.uk

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NHS MODERNISATION AGENCY:

http://www.wise.nhs.uk

Making Best Use of Beds:

http://www.wise.nhs.uk/cmsWISE/Cross+Cutting+Themes/makingbestuseofbeds/introduction.htm NHS Modernisation Agency, (2003),Modernising Endoscopy services, a practical guide to Redesignwww.endoscopy.nhs.uk

NHS Modernisation Agency (2004),Endoscopy challenges and top tips: www.modern.nhs.uk/endoscopy

NHS Modernisation Agency, (2005),Modernising Radiology Services – A Practical Guide to Redesign

UTILIZATION MANAGEMENT:

Department of Health, (December 2006) (CRU),Utilization Management: ‘Care & Resource Utilisation: Ensuring Appropriateness of Care’

Department of Health, (2007),Utilization Management – The Commissioning Framework

http://www.dh.gov.uk/assetRoot/04/13/72/30/04137230.pdf

NATIONAL LEADERSHIP AND INNOVATION AGENCY FOR HEALTHCARE WEBSITE:

www.nliah.wales.nhs.uk

National Leadership and Innovation Agency for Healthcare (2006),Day Surgery Programme, Final Report

THE INSTITUTE OF HEALTHCARE AND INNOVATION:

www.ihi.org

Nolan, T. (2007),Executing System Level Results: Part 1, 2, 3, & 4 (Final Plenary reference – ‘Will, Idea, Execution’)

http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/ImprovementStories/Executingfor SystemLevelResultsPart1.htm

Innovation Series (2003),Optimising Patient Flow

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REFERENCES:

Alberti, Professor, Sir George (2004),Transforming Emergency Care in England, A report by DH, England

Dinsdale, P. (2006),Meet you at the door: feature article (Liz Lees and EAA) Nursing Standard, Vol.,20 No 38, pp 24 – 26. www.nursing-standard.co.uk

Fraser, S. (2002),Accelerating the Spread of Good Practice, Kingsham Press

Fraser, S. (2002),The Patient’s Journey. Mapping, Analysing and Improving healthcare Processes

Howard, K. (2003),How Faster A&E has helped 10 million people, British Journal of Health Care Management Vol. 9, No. 11

Lees, L. (2006),Emergency Care Briefing Paper: Modernising discharge from Hospital, updated version January 2006; National Electronic Library for Health.

http://libraries.nelh.nhs.uk/emergency

Lees, L (2007) Editor of:Nurse Facilitated Hospital Discharge(ISBN: 1-905539-12-6)

www.mkupdate.co.uk

Lees, L. (2004),Improving the quality of patient discharge from emergency settings, British Journal of Nursing, Vol. 13, No 7, 345-432, 8th_{April 2004. Pp – 412-421}

Lees, L. (2004),The 3008 service: GP referrals in Emergency Assessment Area at Birmingham Heartlands and Solihull NHS Trust, GP News Magazine, Feb 2004, p 2.

NHS Quality Improvement Scotland, (2004) Emergency Medical Admissions Scoping Group www.nhsqis.org

O’Brien, D. Lees, L. (2005),How a Clinical Coordinator improved emergency care. Nursing Times Vol. 101, No 15. pp 34 – 36 www.nursingtimes.net

Øvretveit, J. Bate, P. Cleary, P. Cretin, S. Gustafson, D. McInnes, K. McLeod, H. Molfenter, T. Plsek, P. Robert, G. Shortell, S. Wilson, T. (2002),Quality Collaboratives: Lessons from research. Quality and Safety in Healthcare,Chapter 11: 345–351 www.qualityhealthcare.com

Sandipan, P. Lees, L. Dyer, P. (2007),Compliance with administering stat medication doses: An audit within emergency care,Society of Acute Medicine, Spring Conference Abstracts 2007, page 15. http://www.acutemedicine.org.uk/

Walley, P. Silvester, K. & Mountford, S. (2006),Healthcare Process Improvement Decisions – A systems perspective, International Journal of Healthcare Quality Management, UK

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APPENDIX 1 BIOGRAPHIES

Elizabeth Bradbury

Clinical Systems Specialists, Bolton PCT and Bolton Hospitals NHS Trust

Elizabeth currently works as Clinical Systems Specialist across the Bolton health economy, with the remit of implementing widespread improvements using Lean Thinking. She also works for NHS Scotland’s Unscheduled Care Collaborative Programme principally advising on patient flow and the interface between primary and secondary care.

She has recent experience as PCT Commissioner for Urgent Care with the remit of developing community alternatives to A&E and secondary care admission. She joined the Department of Health Emergency Services Team in 2002 and was involved in the creation of the NHS Modernisation Agency’s Emergency Services Collaborative where she became national lead for emergency inpatient capacity management.

She trained as a nurse and worked principally in various UK emergency and high dependency services. She worked in Health Authorities as Intermediate Care and Emergency Care Lead.

Gill Cooper

Assistant Director, Utilisation Management, East Lancs PCT

Gill is currently employed by East Lancs PCT but co-ordinates the North West Utilisation

Management Review Programme (UM) across the North West. The work is aligned to NHS northwest and links primarily with ‘strategic pathway reform’.

Her remit includes, assisting with interpretation of data, feedback and action planning for participating trusts. She has worked in UM for the past five years and has been instrumental in refining and developing the process within the North West. She has contributed to creating the links with Department of Health and to publications in which UM has relevance, for example the ‘Care & Resource Utilisation’ (CRU) document released in December 2006.

With a background in both Emergency and Primary Care nursing (GP Practice) she is keen to promote the importance of robust clinical data which supports patient focussed change; i.e. intelligence which is acceptable to clinicians but can be confidently supported by managers.

Anna Crispe

Associate Director for Planned Care, Essex Rivers Healthcare NHS Trust

Anna Crispe has just taken up a post as Associate Director for Planned Care in Colchester, and was previously the General Manager for Surgery and Critical Care at King’s College Hospital NHS Foundation Trust.

She has worked in NHS management in London for the last nine years, having initially completed the NHS Graduate Management Training Scheme. Prior to joining the NHS she worked for McKinsey and Company, management consultants, in London and across Europe. She holds an MSc in Health

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Services Management from the London School of Hygiene and Tropical Medicine, University of London, where she was awarded the Linda Hoon Fellowship for comparative systems research, and a BA in Philosophy, Politics and Economics from Oxford University.

Allan Cumming

Associate Director, National Leadership and Innovation Agency for Healthcare

Allan Cumming is an Associate Director with the National Leadership and Innovation Agency for Healthcare, the NHS improvement organisation for Wales. Allan currently heads the NLIAH

“skills4change” programme, an innovative project-based change training programme for NHS staff; the national Integrated Care Pathways programme for management of chronic conditions; and the national critical care programme.

Previously Allan ran the “Implementing the Guide to Good Practice Programme”, a £3 million programme running over two years to bring improvements to elective services across secondary care in Wales. This programme, which ended in March 2006, delivered in excess of £3 million per

annum savings. He is also the author of “The Guide to Good Practice: Elective Services”, which has set the policy framework for elective services in Wales.

Before moving to Wales in 2001, Allan worked in Northern England for two years, and for 20 years in Dunedin New Zealand, where he was a senior operational manager at Dunedin Hospital. He has facilitated change workshops in New Zealand, England, Scotland and Northern Ireland as well as Wales.

David Dawson

Deputy Director of Service Transformation, King’s College Hospital NHS Foundation

Trust, London

David Dawson is Head of the Change Leaders Team at King’s College Hospital London. With 25 years’ experience in the acute NHS he has experience at many levels – including porter, hospital and general management, contracting and planning.

Growing out of the responsibility to deliver significantly reduced inpatient and outpatient waiting times in a very challenging provider, he led various improvement initiatives – including Action On, etc. – and developed an interest in Lean Principles as an underpinning means to secure systemic change.

In 2003 he joined King’s College Hospital change team and led the Emergency Services

Collaborative work to successfully achieve the 4-hour target and a successful project to significantly increase day surgery work. In 2005 he became Programme Manager for the First Choice King’s project – a multi-year programme to improve service quality, patient experience of services, financial and operational efficiency. The small Change Leaders Team provides expertise and project support to the Trust and are building a community of staff who have the skills and tools, structure and information and organisationally endorsed opportunity to lead change day-to-day at the frontline of service delivery.

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Mark Jennings (MBA. BSc. CEng.)

NHS Institute for Innovation and Improvement

Originally qualified as a Charted Engineer, Mark has been an NHS Manager in the United Kingdom for over 25 years with experience at National, Health Authority and Trust levels including Director of a major acute hospital.

Subsequently he held the role of National Lead for Clinical Systems Improvement with the NHS Modernisation Agency where he led the development of guidance and systems to help the NHS improve patient flow. This work was initially focused on the patient journey through the emergency care system where Mark was a member of the Department of Health project team responsible for delivering the maximum 4-hour Accident & Emergency wait. As part of this work he was also

responsible for leading the development and delivery of the Making best use of beds programme for NHS Trusts which has made a significant contribution to the improvement of patent flow and the achievement of access targets. Later work focused on applying industrial and commercial process and flow methodologies ( such as lean management and six sigma) to help the NHS achieve the 18-week maximum total patient journey time from referral treatment for all elective care.

In 2005 Mark joined the new NHS Institute for Innovation and Improvement based at the University of Warwick and is now leading work focused on helping the NHS improve the quality, productivity and efficiency of care.

Liz Lees

(Dip N, Dip HSM, BSc (Hons), MSc)

Consultant Nurse, Acute medicine, Heart of England Foundation Trust RGN

Liz’s current post as Consultant Nurse for acute medicine at the Heart of England Foundation Trust is extremely diverse, such that it has kept her challenged since January 2002. The scope is continually evolving through collaborative development of new services with the local PCT. Liz contributes to a number of different interfacing agendas, namely; Nursing Homes, out of hours services, chronic disease management, Primary and Intermediate Care Services (including development of IV therapy at home).

She is a visiting Lecturer at the University of Central England, which involves proactive development of new educational modules (discharge planning, assessment skills and intermediate care). On a national level, she contributed to work for the Department of Health, most recently (2006)

“modernising nursing careers”, previous years, emergency care, ‘skills for health’ and ‘Assisting Timely Discharge Toolkit’ (2004). Complimentary activities to her professional role include; mentorship of students undergoing a Masters programme, writing for publication, peer review of articles for Nursing Times, Nursing Standard and Nursing Management. Liz enjoys sharing ‘work in development’ and research projects at national / international conferences.

During 2006, she designed, compiled and edited her book with M&K publishers called,Nurse Facilitated Hospital Discharge, available now 2007 from www.mkupdate.co.uk. She is a Graduate of the Kings Fund International Nurses Leadership Programme. Her greatest attribute is perhaps her enthusiasm to reinvest her skills/knowledge to inspire, motivate and lead staff, promoting genuinely improve services for patients.