Ideas from UK modernisation: The Improvement Partnership for Hospitals

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Ideas from UK modernisation The Improvement
Partnership for Hospitals
Ideas from UK modernisation

• Penny Pereira

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Ideas from the UK Improvement Partnership for
Hospitals

• Presentation content
• Overview of the IPH approach
• Case study from an IPH site
• Key learning points

overview
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Background

• There was already
• Lots of existing projects and activity
• Work on many services / pathways
• Staff with skills in each organisation

• But
• Not always having an overall impact
• Not looking across the whole hospital
• Some put off by too many initiatives

The IPH approach - background
IPH was set up to help hospitals create an
integrated approach to improvement
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Background

• Designed to help meet demanding national targets
• 4 hour maximum wait in emergency department
• Max wait for outpatients 13 weeks and falling
• Max wait for inpatients 9 months and falling
• Hospitals got 180k matched funding and support
  from a national team
• c.150 hospitals participating since Jan 2003

The IPH approach - background
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The IPH approach
The IPH approach - clinical systems improvement

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Understand the variation

• The root cause of delays for patients in the care
  system is not volume, it is variation
• The greater the variation, the more capacity we
  need to meet demand
• We create the variation through the way we
  organise our systems
• If we reduce variation, we can make much better
  use of capacity

The IPH approach - clinical systems improvement
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Variation in demand for beds(admissions)
The IPH approach - clinical systems improvement
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Variation in bed capacity (discharges)
Number
The IPH approach - clinical systems improvement
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Variation in length of stay
The IPH approach - clinical systems improvement
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The IPH approach
The IPH approach - organisational development

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OD self-assessment

• Strategic capacity
• Leadership direction
• Policy planning
• Patient centred approaches
• Partnership working

• Resources
• processes
• Human resource management
• Clinical systems processes for quality
  improvement
• Financial management

• Results
• Patient experience clinical outcomes
• Staff experience outcomes
• Key performance targets
• Value for money productivity

The IPH approach - organisational development

• Intelligent information
• Use of information about patient experience,
  outcomes, resources processes
• Staff knowledge, skills experience
• Information systems use of technology

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The IPH approach
The IPH approach - whole systems alignment

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OD whole systems alignment

• 1. Strong visible leadership for improvement
• 2. Ambitious improvement goals agreed by all
• 3. Capacity in improvement skills at all levels
• 4. Networks to share learning across system
• 5. Headroom for improvement, with shared
  risk-taking
• 6. Investment based on analysis of demand
  capacity
• 7. Approach to payment driven by clear,
  patient-centred principles to avoid perverse
  incentives
• 8. Working in partnership to unblock whole system
  constraints

The IPH approach - OD whole systems alignment
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Case study

• Nottingham City NHS Trust
• One of four early pilots for IPH

IPH case study Nottingham City
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Nottingham took a whole system approach
Discharge
Diagnostics
EMERGENCY PATHWAY Referral Assessment
Treat Transfer of care
CHD NSF
Cancer NSF
ELECTIVE PATHWAY Referral Admission
Transfer of care
IPH case study Nottingham City
AMBULATORY CARE Referral Treat
Transfer of care
Infection Control
Older People NSF
Designed around the patient
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Overview of improvements to the Emergency Pathway

• Specific changes following months of diagnosis
• Each ward to discharge one patient before 10am
• GP /AE streaming patients in primary care
• Reconfigure beds to create ESSU/EAU
• Two acute physicians appointed (9am-6pm)
• Changed bed co-ordinators role
• No batching of bloods
• Order sets instigated by Registered Nurse

IPH case study Nottingham City
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Borders Sept 2002 August 2004
85 reduction in daily mean, 50 reduction in
variation
IPH case study Nottingham City
Designed around the patient
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Cancelled Operations April 2002 August 2004
50 reduction in weekly mean, 50 reduction in
variation
IPH case study Nottingham City
Designed around the patient
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Elective Inpatient Activity April 2002 August
2004
Elective surgical inpatient admissions increased
by 8 Feb-Jan 2004 compared to previous 12
months
30 reduction in weekly variation
IPH case study Nottingham City
Designed around the patient
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Additional benefits

• The number of patients that are discharged within
  24 hours has doubled from an average of 15 to
  34
• Recruitment and retention of staff has improved.
  Sickness has reduced from 17 to less than 6
• Waits and delays in Emergency Areas are reduced.
  Baseline data showed that on average patients
  would spend 5 hours 17 minutes on the admissions
  unit this has been reduced to 2 hours 59 minutes

IPH case study Nottingham City
Designed around the patient
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Staff satisfaction

• It is clear that the changes you and all your
  colleagues have made in acute medical admissions
  have had a major impact of reducing last minute
  cancellations of surgical beds
• Consultant Anaesthetist
• It is a pleasure to work at the City Hospital
  once again, as things are running smoothly with
  my operating lists and I have not experienced any
  cancellations recently for which I am very
  grateful
• Consultant Orthopaedic Surgeon

IPH case study Nottingham City
Designed around the patient
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What we learnt

• Overall messages from our work in the UK
• Anything here that might be relevant for you?

Key learning points
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What we learnt

• Look across the whole system in order to
  understand the real constraints
• Create an integrated approach to improvement
• Articulate a clear overall strategy
• Join up improvement activities
• Build improvement into mainstream business
• Engage Executives, clinicians and staff at all
  levels and give them practical tools

Key learning points
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What we learnt

• Every organisation is different Understand your
  system
• Make time for in depth diagnosis
• Invest in analysis and aim for real time data
• Understand the small changes that will have a
  significant impact
• Develop your organisation to have the strategy,
  skills and culture for really ambitious
  improvement

Key learning points
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• This is what we learnt.
• Does this fit with your PFC work?
• www.modern.nhs.uk/iph

Questions?