NHS Tayside and the Atos Origin Alliance have developed a robust and successful culture of Continuous Improvement (CI) and change through a programme of organic development ‐ Steps to Better Healthcare ( StBH). This session will share experience from the StBH programme with particular focus on how we can learn from and accelerate positive Quality outcomes in a person‐centred and sustainable manner.

1. WHOLE SYSTEMS IMPROVEMENT

3. Medicine for the Elderly Demonstrator

4. Outpatients Efficiency DemonstratorThe Benefits

6. NHS Tayside’s principal health organisations comprise the NHS Tayside board, the single delivery unit and the Community Health Partnerships in Angus, Dundee and Perth & Kinross.

7. Meeting Scottish Government Efficiency & Productivity SR10 challenge, £27.4m in 2010, £30.0m in 2011/12following November’s budget.

8. Continuing to deliver against the Scottish Patient Safety Programme and meeting the demands of the recently announced NHS Scotland Quality Strategy

10. IMPROVING QUALITY REDUCING COSTS Our Choice Surviving – the 5% Thrive – the 95%

11. 2009-2011 – A TACTICAL JOURNEY TACTICAL STRATEGIC PRODUCTIVITY & EFFICIENCY SERVICE OPTIMISATION CRES TRANSFORMATION DEALING WITH THE 5% SPENDING THE 95% BETTER

12. 2010-2012 – A BLENDED APPROACH TACTICAL STRATEGIC PRODUCTIVITY & EFFICIENCY SERVICE OPTIMISATION TRANSFORMATION CRES CRES DEALING WITH THE 5% SPENDING THE 95% BETTER

13. 2010-2012 KEY OUTCOME AREAS TACTICAL STRATEGIC PREVENTION OF ADMISSION IMPROVED DAY CARE INTERMEDIATE CARE CARE HOME INTERFACE MEDICATION REVIEWS CASE MANAGEMENT IMPROVED PATHWAYS HOUSING / HOMECARE SUPPORT ENABLING TECHNOLOGY IMPROVED SERVICE LIASON AND DISCHARGE REDUCE LENGTH OF STAY AND BED DAYS INTEGRATED HEALTH AND SOCIAL CARE SERVICES VIRTUAL WARDS WORKFORCE REDESIGN SELF CARE AND ENABLEMENT COST MINIMISATION WORKFORCE EFFICIENCY TELEHEALTH / TELECARE NEW MODELS OF CARE- DEMENTIA, FALLS AND END OF LIFE WORKING WITH COMMUNITIES - COPRODUCTION

14. Identifying the areas for improvement.. WHOLE SYSTEMS ANALYSIS Assess the performance of the whole health system with respect to local and national targets Identify areas of existing & potential constraints within the whole system To consult with stakeholders across the whole system & recommend areas of priority Assessing the management information requirements to support better patient flow management

15. STEPS TO BETTER HEALTHCARE Tayside Centre for Organisational Effectiveness www.t-coe.org.uk IMPROVEMENT ACADEMY INNOVATION HUB & E HEALTH DEVELOPMENT&SUPPORT Mental Health Theatre Capacity Workforce Efficiency Integrated Care Older People Mental Health Optimising Facilities Prescribing Medicines Others Labs, Maternity Finance Support Scenario Planning, Financial Baselines, Benefits Tracking, Business Cases Workforce Support Workforce Modelling, Engagement & Communications with staff Comms Support Communications with public and staff OE Support Organisational Effectiveness support (includes eHealth)

16. NHS Tayside – first phase strategic improvement projects Elective Urgent & Emergency Community Care Services End to end pathway in Improve Flow in Medical Orthopaedics Wards Develop use of Community Nursing - Community Hospitals - patient contact Variation in referral improve use/flow Time /anticipatory care rates Reduce multiple admissions in over 75's AHP activity - Community Diagnostics Referral Mgt – Whole rebalance the activity - to support Community System Approach towards community Hospital model Improve efficiency In Outpatients Streaming access for U&E patients Deliver effective and Efficient Theatre and Surgery Enhance the Ambulatory i Care service offered in ward 15 Clinics Information provision and coding (e.g. The Gap) Prescribing Quality Discharge Communications Patients still on Medicines at Admission medicines they no Prescribing Practice (ADRs) longer need Atos, Atos and fish symbol, Atos Origin and fish symbol, Atos Consulting, and the fish symbol itself are registered trademark s o f Atos Origin SA. October 10 © 2006 Atos Consulting. Private for the client. This report or any part of it, may not be copied, circulated, quoted without pr io r written approval from Atos Consulting or the client. WHOLE SYSTEM ANALYSIS –PHASE 1

18. Challenge around Health Population Management (HPM)

19. Lack of effective collaboration between Health and Social Care

20. Alignment of e Health with key HEAT T6-T12 outcomes

21. Key improvement areas:Reduce over 65’s Emergency Beds More effective HPM Effective MDT working Reduction in Polypharmacy

23. Followed up by local sessions in CHP areas…

24. NHS Tayside worked with partners to develop new HPM toolset – PEONY2

25. Test of Change Demonstrators set up in each CHP

26. Wider collaboration with Social Care, Voluntary Sector and Social Care

28. T6 Long Term Conditions admissions

29. Patient experience

30. Releasing Time for Community Care

32. ANGUS CHP – PATIENT PROFILE Virtual Wards focusing on Tier 4 , Innovative Step Down Services are key to success! Macro Integrator NHS Tayside and Angus Council LEVELS OF CARE 724 2% LTC Population North West 187 North East 191 South 346 LEVEL 4 INTENSE CASE MANAGEMENT VIRTUAL WARD ANTICIPATORY CARE PLANS PATIENT PASSPORTS CASE MANAGEMENT 10148 28% LTC Population LEVEL 3 CASE MANAGEMENT North West 2631 North East 2673 South 4844 PRO-ACTIVE CONTACT SUPPORTING SELF CARE 70% LTC Population LEVEL 2 SUPPORTED SELF CARE 25372 North West 6577 North East 6684 South 12111 PRO-ACTIVE CONTACT SUPPORTING SELF CARE LEVEL 1 HEALTHY COMMUNITIES 72487 66% Overall Population North West 18790 North East 19096 South 34601 LTC’s Asthma 6101 COPD 2056 Diabetes 4698 HBP 16423 CHD 5318 Obesity 11854 PREDICTED RISK PROFILE MICRO INTEGRATORS

33. ENSURE OUTCOMES ARE DELIVERED…. Project Definition Statement Benefits Statement Project Status Report Is used for: Stating your case for change Current state analysis Evidence / Data Envisaged Change Summarise benefits Is used for: Define benefits in detail Define appropriate measures Summarise enabling changes ( PP&T) Summarise milestone tracking Is used for: Report on delivery progress. Report on Benefits Realisation against plan. Escalate to Project Board or EMT for decision, support etc Multi- disciplinary Project Board, Clinical and Finance essential

34. RESHAPING CARE FOR OLDER PEOPLE – OUTCOMES 1

35. RESHAPING CARE FOR OLDER PEOPLE – OUTCOMES 2

36. User Device Access TECHNOLOGY ENABLING INTEGRATED CARE Applications Security Service Complex Case Management Collaboration Tools Glue Staff ID Virtual Database Case Management Clinical Portal RBAC Pro-active Contact PMS GP Community Health& Social TELEHEALTH PREDICTIVE RISK TELECARE BUSINESS ANALYTICS Prevention Integration Platform

38. Enabling technology being fully utilised

39. Aligning with local improvement initiatives eg CMR in Angus, Case Management and ACP’s across Tayside..

40. Envisaged benefits across Patient Access, Service Redesign and Patient Experience:Drive effective attendance at A&E Reduction in unscheduled bed days Effective discharge models Focus on the right patients Increase value multi-disciplinary team time Net CRES of £1.5-2.0m per annum.

42. Over 40% of all patient admissions are elderly, and will GROW!

43. Variation in LoS across MfE wards..

44. Average LoS higher that ‘best of breed’, around 28 days..

45. Discharge planning not always linked to EDD..

47. A collaboration of extensive healthcare experience and application of LEAN thinking…

48. Initial review highlighted large amounts of waste and variation

49. 7 key improvement areas identified:Admission Criteria Inpatient management Discharge planning Social work redesign Staffing profile Co-located wards Step up / Step down

51. Patient focus and removing waste has delivered a higher quality more cost effective service…

52. Key outcomes/benefits achieved:Reduced inappropriate admissions Reduced Length of Stay (28-18 days) Lower re-admissions Closure of 2 wards CRES in excess of £1.4m per annum.

54. 3990 clinics were cancelled across Tayside in Tayside in 2009…

55. 189 clinics were cancelled within 6 weeks notice in 2009…

56. 85,922 patient appointments were moved in Tayside in 2009, 50% by the hospital..

57. High percentage of patient appointment moves DNA on new appointment(50%)…

60. CAPACITY BUILDING IS… An approach to the development of sustainable skills, organisational structures, resources and commitment for healthcare improvement Hawe et al: 1999

62. Vision

63. Strategy

64. Culture

65. Measurement

67. TAYSIDE CENTRE FOR ORGANISATIONAL EFFECTIVENESSwww.t-coe.org.uk Mobilisation of trained experts in quality improvement organisational development and leadership to support improvement work. The focus of this expertise will be mobilised to support front line staff and clinicians to build capability in improvement methodology and support key improvement programmes Real time information and measurement resources to support quality improvement of clinical services. Enhance spread and share of good practice through use of technology e.g. Clinical Portal, Clinical Dashboards. Improvement & Development Support Technology Enabling Health Develop an innovative education and training resource to build further out capacity and capability in improvement science. A dynamic approach to knowledge transfer which supports our “All teach: All learn” philosophy in support of quality improvement. Knowledge Management Improvement Academy

68. MAKING BETTER PLACES,MAKING PLACES BETTER Our Stretch Challenge 2011-2015 “ those who are less able to coproduce and use public services as a resource in their lives, experience much more negative outcomes” This accounts for 40% of public sector expenditure in Scotland

69. Transformation Transformation Division Improvement Improvement >25% >25% Redesign Redesign Improvement Improvement Organisational scope 5 - 25% 5 - 25% Streamlining Streamlining Improvement Improvement ~5% ~5% Department Work processes Business processes Business objectives Work processes Business processes Business objectives Content scope Content scope THE TRANSFORMATION JOURNEY TO 2015… Whole System Analysis Improvement Action Weeks

71. Identify high impact projects and prioritise resource..

72. Leadership aligned with core personal objectives key..

73. Skills transfer critical to accelerate Continuous Improvement across whole system..

74. Quality improvement with associated CRES can be achieved..

75. Early engagement of whole system stakeholders essential..

76. Pro-active internal/external communication policy..

77. Build on best practice evidence and focus on reducing unwarranted variation…