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© Copyright NHS Institute for Innovation and Improvement 2009
The Productive Series
© Copyright NHS Institute for Innovation and Improvement 2009
Cost effective
care
Team performance and leadership
Safe and reliable care
Patient’s Patient’s experience experience & outcomes& outcomes
Principles of The Productive Series
© Copyright NHS Institute for Innovation and Improvement 2009
Critical factors for success with any Productive
Leadership at Executive level √
Aligned with strategic direction √
Governance of the programme √
Continuous improvement √
Capability and knowledge √
Right people in place √
Source: NHS London Review May 2009
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
The perfect operating list……..every list, every day, every patient
Effortless for everyone
Great team communication
Quiet & smooth
Fast but not rushed
No glitches
Safe, reliable care
Finish on time……………
Building teams for safer care
© Copyright NHS Institute for Innovation and Improvement 2009
Efficiency data
0
1
2
3
4
5
6
7
1 2 3 4 5 6 7 8
week
nu
mb
er o
f se
ssio
ns 22 unused,
cancelledsessions
32 extra sessions
Over 8 weeks:
Cost of cancelled, unused sessions £31,746
Cost of extra sessions£81,664
© Copyright NHS Institute for Innovation and Improvement 2009
% Session Utilisation
86
88
90
92
94
96
98
100
Apr
May Ju
n
Jul
Aug
Sep Oct
Nov
Dec Ja
n
Feb
Mar
Apr
May Ju
n
Jul
Aug
Sep
Mean – 90%
Mean – 99%
© Copyright NHS Institute for Innovation and Improvement 2009
Number of waiting list initiatives
0
2
4
6
8
10
12 TPOT meeting
reviews data
© Copyright NHS Institute for Innovation and Improvement 2009
Start, turnaround and finish times
August 2008
June 2009
© Copyright NHS Institute for Innovation and Improvement 2009
Well organised theatre
Overstock in main store room (4 theatres) resulted in financial reimbursement of £27, 500
Out of date stock in main store room (twin suite) valued at £9,385
Overstock in prep and anaesthetic rooms (2 theatres) valued at £10,400
Potential financial benefit for a twin theatre suite
to make a ‘one-off’ saving of £24,150
© Copyright NHS Institute for Innovation and Improvement 2009
% compliance with team brief
% of lists performing team brief
0102030405060708090
100
site 1 (2theatres)
site 2 (8theatres)
site 3 (2theatres)
site 4 (4theatres)
before TPOT
associate site - 6 monthsafter TPOT
field test site - 12 monthsafter TPOT
© Copyright NHS Institute for Innovation and Improvement 2009
Problems avoided by Team Brief
Week 4 - June 2009
0 1 2 3 4 5 6 7
No extended recovery / HDU bed
extra patient added to list
lack of staff
further investigation needed
awaiting bloods
operation not listed correctly
no junior doctor to assist
issue on ward causing delay
problem with, or no equipment
list order changed
Week 4 - Sept 2009
0 1 2 3 4 5 6 7
No extended recovery / HDU bed
extra patient added to list
lack of staff
further investigation needed
awaiting bloods
operation not listed correctly
no junior doctor to assist
issue on ward causing delay
problem with, or no equipment
list order changed
© Copyright NHS Institute for Innovation and Improvement 2009
Impact on staff
Mean Score from SAQ before and after introduction of briefing and debriefing
0
10
20
30
40
50
60
70
80
Team workClimate
SafetyClimate
JobSatisfaction
Perceptionsof
Management
WorkingConditions
StressRecognition
before
after
p<0.05
© Copyright NHS Institute for Innovation and Improvement 2009
Improvement drivers for key aims Value and efficiency 1 – main driver modules
Reduced cancellations– Scheduling & patient prep– Operational status at a glance
Improved utilisation and Reduced over-runs– Scheduling– Start-up, patient prep, turnaround, handover– Operational status at a glance
Avoiding cost of defects– Team-working– Handover– Recovery
Materials management– Well Organised Theatres– Consumables and equipment
Value & efficiency
Team performance &
leadership
Safety & reliability of
care
Patient’s experience &
outcomes
© Copyright NHS Institute for Innovation and Improvement 2009
Value and efficiency 2 – benefit estimates (per annum)
174 trusts in the NHS
Total of 2,871 operating theatres,
Average 16.5 theatres per trust
Per theatre Per DGH
Reduced cancellations £ 23k £ 388k
Improved utilisation & reduced over-runs
£ 120k £1,980k
Avoiding cost of defects £ 30.5k £503k
Materials management £6k+£6k one-off
£100k+£100k one-off
Total £179.5+£6k one-off
£2,971k+£100k one-off
© Copyright NHS Institute for Innovation and Improvement 2009