Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity &...
Transcript of Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity &...
![Page 1: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/1.jpg)
Endoscopy
Capacity & Productivity
Service Improvement Review
Fiona Thow
Scientific Advisor to the CSO
![Page 2: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/2.jpg)
Review approach – site selection
• Identified 12 sites from reviewing DM01
returns & profiling the waiting lists over the last
year – some with rising waits / some not
• Cross referenced to GRS returns (via JAG)
• Used local & national intelligence e.g. cancer
networks, IST, screening leads
• Not an exact science, but confident we had a
range of sites
• 12 visits in 3 weeks – one day on site
![Page 3: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/3.jpg)
Review approach - method
• Service improvement opportunities
• Short-term & longer term capacity
• Process issues (admin, clinical, decontamination)
• Leadership assessment ( nurse leadership, ops
management, clinical engagement & leadership)
• Trust infrastructure – level of priority, escalation &
integration into service delivery
• Service improvement – understanding & capability
(including information & data)
![Page 4: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/4.jpg)
High level findings – Clinical process
• Delays to start times of lists
• Delays in the middle of lists, but in addition waiting for scopes, interpreters, bleeps & interruptions
• High DNA rates – due to complex admin processes +/- no pre-assessment (then not utilised due to inflexibility of working between rooms)
• Cancellations on the day – anti-coagulation issues, co-morbidity drug issues
• Lack of monitoring or feed back mechanism of the above / shared ownership of issues/ action plan to address (or ‘publishing as KPI’s)
![Page 5: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/5.jpg)
Delayed start times – “List nibbles”
• Examples of data
• Good examples of recording sheets, with codes that are fed into management meetings – pro-actively used
• Endoscopists didn’t like it and nothing really happened with the information, no information to support need for more scopes
![Page 6: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/6.jpg)
Day Date Room
No
List start
time
Doctor arrival
time List Start time
List finish
time
Monday 3-Oct-11 AM 1 08.30 09:05 09:35 12:10
2 08.30 08:55 09:10 13:00
3 08.30 09:05 09:18 11:35
PM 1 13.30 13:35 14:05 16:10
2 13.30 14:00 14:00 15:30
3 NO LIST
Tuesday 4-Oct-11 AM 1 08.30 09:10 09:10 12:00
2 08.30 09:15 09:30 10:45
3 08.30 09:05 09:30 13:20
PM 1 13.30 14:10 14:20 18:05
2 13.30 NO LIST
3 13.30 14:15 14:20 16:25
Wednesday 5-Oct-11 AM 1 08.30 08:55 09:00 13:20
2 08.30 09:20 09:30 13:30
3 08.30 09:05 09:20 13:05
PM 1 13.30 14:00 14:14 17:40
2 13.30 14:05 14:30 18:15
3 13.30 13:40 14:30 17:30
![Page 7: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/7.jpg)
Thursday 6-Oct-11 AM 1 08.30 08:50 08:53 12:10
2 08.30 09:00 09:15 12:25
3 08.30 09:20 09:20 11:45
PM 1 13.30 14:15 14:20 18:00
2 13.30 15:00 15:05 15:55
3 NO LIST
Friday 7-Oct-11 AM 1 NO LIST
2 08.30 09:00 09:15 12:45
3 08.30 09:10 09:20 11:45
PM 1 NO LIST
2 13.30 14:10 14:20 17:00
3 13.30 14:00 14:05 17:35
14Hrs 35mins 6 Hrs 45mins
Total in 1 week = 21hrs 20 mins
![Page 8: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/8.jpg)
DNA’s & cancellations
• High DNA rates – reported at 10%, or 1-2 per day (one site 16%)
• High numbers of cancellations on the day – particularly OGD
• Sites who pre-assess colons have fewer cancellations as have sorted anti-coagulation issues or co-morbidities & appropriate prep
• OGD – health questionnaire & telephone pre-assessment, plus reminder service
• One site rings all patients who DNA to find out why?
![Page 9: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/9.jpg)
DNA’s &
cancellations
![Page 10: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/10.jpg)
![Page 11: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/11.jpg)
Admin reasons for DNA & Cancellations
• Under pressure no choice given – next available slot sent out
• 2nd class post – significant delays
• Telephones often unmanned
• Huge amount of rework (25%)
• Patients query – often anti-coagulation or co-morbidities (clinical queries)
• See direct booking as too difficult !(often last minute list cover problems or no clear or adhered to leave policies)
![Page 12: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/12.jpg)
Insert Admin map - current
![Page 13: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/13.jpg)
Insert Future state direct booking map
![Page 14: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/14.jpg)
Uncovered / “dropped sessions”
• Annual leave policies not adhered to (could be a Trust wide problem)
• No agreement to cover leave routinely
• Some gained extra sessional payments
• Sometimes nursing cover but no endoscopist….whole team WLI on a Saturday!
• Poor communication resulted in lost opportunities to flex job plans & training lists
• Sites with experienced nurse endoscopists could manage list cover effectively
• Some nurse endoscopists under utilised due to job plans
![Page 15: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/15.jpg)
Monday
05/12/2011
Tuesday
06/12/2011
Wednesday
07/12/2011
Thursday
08/12/2011
Friday
09/12/2011
AM PM AM PM AM PM AM PM AM PM
Room 1 Dr. H Dr. J Dr. B Dr. E Dr. E Dr. B
Room 2 Dr. J Dr. G Dr. G Dr. D Dr. A Dr. D Dr. H Dr. I
Monday
12/12/2011
Tuesday13/12/
2011
Wednesday
14/12/2011
Thursday
15/12/2011
Friday
16/12/2011
AM PM AM PM AM PM AM PM AM PM
Room 1 Dr. H Dr. B Dr. F Dr. E Dr. B Dr. F
Room 2 Dr. J Dr. D Dr. A Dr. H Dr. B Dr. I
Week 2
Week 1
Session Used Session Lost Unbooked
![Page 16: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/16.jpg)
Variability of points system
• Points system used as a guide (but also a barrier) – long history
• Roughly reflects process time
• Doesn’t account for turnaround time
• Do NOT want to squeeze procedure time (risk of compromising on quality gains)
• There are opportunities for productivity gains in turnaround times (“ Pull system”)
• Saw a “pod system” on one site
![Page 17: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/17.jpg)
Points System
Site Session length No. of points Training
No.of points
1 4 Hrs 10 (11) 8
2 4 Hrs 10 8
3 4hrs 12 (am) 10 ( pm)
(some do 15 some do 8)
8
4 4hrs 12(am) 10(pm)
5 3.5 hrs 12(am) 10(pm)
( some 15)
6 4hrs 10
7 4 Hrs / 3.5Hrs 10 7
8 3.5 Hrs 10 8
(A) 4 Hrs 11 Competency
(B) 4 hrs Uses own points system
(C) 4 Hrs 13 Competency
(D) 4 hrs 12
![Page 18: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/18.jpg)
No of Points Date
12 3-Oct-11
9 3-Oct-11
7 3-Oct-11
6 3-Oct-11
4 3-Oct-11
8 3-Oct-11
12 4-Oct-11
2 4-Oct-11
4-Oct-11
9 4-Oct-11
4-Oct-11
7 4-Oct-11
9 5-Oct-11
10 5-Oct-11
8 5-Oct-11
10 5-Oct-11
7 5-Oct-11
9 5-Oct-11
11.5 6-Oct-11
8 6-Oct-11
5 6-Oct-11
11.5 6-Oct-11
6 6-Oct-11
6-Oct-11
7-Oct-11
6 7-Oct-11
5 7-Oct-11
7-Oct-11
6 7-Oct-11
10 7-Oct-11
6 10-Oct-11
7 10-Oct-11
7 10-Oct-11
10-Oct-11
7 10-Oct-11
7 10-Oct-11
Actual Points
(11 point list)
![Page 19: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/19.jpg)
Things that help
• Sequencing of lists to be site appropriate – dedicated in patient lists, 8.30am “bleeder” (for scopes)
• Demand management – “self vetting” referral forms (BSG guidance & one type)
• Same day pre-assessment
• Direct booking
• Clear list “start” & “stop” times
• Leave & list cover agreed (job plans)
• Data to support service delivery (Demand, capacity, not just activity)
![Page 20: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/20.jpg)
Things that help
• A “pull system” that works to increase productivity
• Understanding new service demands & building effective business cases for expansion (EUS, Halo ablation, EMR)
• Visual display of KPI’s
• Collaborative working across clusters
• An escalation policy to maintain capacity & stop rising waits
• Planning for the expected pressures with commissioner support
![Page 21: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/21.jpg)
Endoscopy: Summary
There is potential capacity & productivity gains that could be achieved through process redesign (6 areas of focus) – Effective operational management
– Data collection & planning
– Understanding & appropriate demand management
– Ensuring capacity is optimised
– Review of variation – to highlight potential
– Positive patient experience
![Page 22: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/22.jpg)
These modules create the
Productive Endoscopy Unit
![Page 23: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/23.jpg)
-
- design
-
![Page 24: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/24.jpg)
Measures
-
- design
-
![Page 25: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/25.jpg)
Productive Endoscopy
![Page 27: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/27.jpg)
100,000 Genomes Programme
• 13 Genomic Medicine Centres
(GMCs)
• 3 London
– North Thames (GOSH)
– West London (Imperial)
– South London(Guy’s &
St.Thomas’s)
• Collect samples of blood &
tumours to undergo Whole
Genome Sequencing
• To gather information about
tumours to better target
treatments https://www.genomicsengland.co.uk
![Page 28: Endoscopy Capacity & Productivity Service Improvement Review Thow... · Endoscopy Capacity & Productivity Service Improvement Review Fiona Thow Scientific Advisor to the CSO](https://reader031.fdocuments.us/reader031/viewer/2022031002/5b8383007f8b9adc698d3963/html5/thumbnails/28.jpg)
• To allow for molecular pathology in future cancer pathways (infrastructure for genomic testing) – WGS or panel testing (improved panels with fresh frozen samples)
• Opens up more treatment options for patients – understanding more specifics on how tumours behave
• Identifies cancer predisposition genes
• Identifies familial links – e.g. Lynch Syndrome
• Opens up pharmaco genetics – targeted drugs, chemo
• “Future proofs” the system to put in the infrastructure to build the evidence as new techniques and knowledge develops
Why cancer?