Releasing time for care Workshop 4 Development Advisors Jayne - - PowerPoint PPT Presentation

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Development Advisors Jayne Beasley and Rachel Duffy

25th May 2017

Releasing time for care Workshop 4

#Gpforwardview

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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

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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

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• 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

Previously …….

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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?

The Model for Improvement

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• 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

In between session we suggested you might

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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?

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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

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Variation in Demand and Capacity

20 40 60 80 100 120 140 Mon Tues Wed Thurs Fri Mon Tues Wed Thurs Fri Mon Tue Wed Thurs Fri Appointments

No of Appointments Needed & No of Appointments Available - 3 Weeks

Demand Capacity

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So is the answer to simply increase capacity to match demand???

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What Causes Variation?

Demand

• Reduced weekend working
• Seasonal
• Government initiative

Capacity

• Holidays
• Statutory training
• Professional development
• Sickness
• Bank Holidays
• External meeting
• Internal meetings
• Re work

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Why Do Queues or waits form?

• Because demand exceeds capacity?
• Mismatch between demand & capacity?

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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?

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Moment of truth

Even if: Average demand = Average capacity, Variation in demand + Variation in capacity

= QUEUE!

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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

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Carve Out

• An obvious or “known” solution
• But is it making things worse ?

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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

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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

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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
• actual consequences are not seen at point of bottleneck
• flow rates compromised • few needs met

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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 ……..

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Model for Improvement

Set AIMS that are measurable, time- specific, and apply to a defined population Establish MEASURES to determine if a specific change leads to improvement Select INTERVENTIONS most likely to result in 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?

Test the change

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If you could measure 6 things in your practice easily

• n a daily basis what do you or could you measure?

Why would you choose these areas to measure?

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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!

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Making change happen : ingredients

• f success

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Large scale change usually fails

Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey of company executives

70% 25%

5%

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Change Model for Health and Social Care

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Change Model for Health and Social Care

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Our shared purpose

• So what is our shared purpose for this group?
• What matters to us? What is our why?
• 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?

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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?

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Action Planning

Overall Owner: What Actions ? By Whom ? How? In what way ? By When ?

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Jayne Beasley jayne.beasley@nhs.net Rachel Duffy rachel.duffy2@nhs.net

Contact details