Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Meeting the Targets!
The Crosshouse Journey
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Outline
• Who are we?
• Brief History
• Interim Measures
• Changes in work practice!
• How are we doing?
• The Future – is it bright?
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Who are we?• Larger of 2 DGHs• 527 beds (570)• Area Beds:
– Paeds– Gyn– Nephrology– Dermatology– ENT– Maxfac
• 1 MRI scanner – age 7• 1 CT scanner – age 3
• MRI GA service
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Introducing the Targets:
• August 2007‘Diagnostic 4 week target will take effect from December 2010 –
there should be additional resources’ (GR)
• In preparation AAHB Radiology - 6 weeks from now!
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Brief History
• August 2007:– CT: 5wks; MRI: 9wks
• ~7,000CT; 3,700MRI• 9am – 5pm, Monday – Friday, 9am – 12pm
Saturday (Stroke Service)• (39 hour CT week; 36 hour MRI week)• 4.75 WTE radiographers(6 staff); 2 WTE helpers• 5 departmental porters
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Interim Measures
• Capacity and Demand Audit• 111% MRI; 110% CT
• Process Mapping• Forget lunch!• Canvas staff• Voluntary overtime – loyal! • Clear the backload!• Outsource reporting for MRI• Extra session reporting
• (2 qualified Cranial CT Reporting Radiographers still not supported to practice)
• Patients scanned and reported at GJH and CG
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
The More You do……………….
• January 2009 (16 months down the line)– CT: 8wks; MRI: 9wks
• ~9,600CT (37% ); 4,600MRI (24% ); • 9am – 5pm, Monday – Friday, 9am – 12pm
Saturday (Stroke Service)• Minimum of 5 OT sessions per week
• (47 - 51 hour CT week; 42 - 48 hour MRI week)
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
It’s not ALL about targets!
• After a year of OT– De-motivated – lack of solutions
– Tired
– Crabbit
– Stress
– Clinical risk
– Recalls
THEN - “4 weeks by March”
NO APPARENT END
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
SO…….
• Overtime ended till there was a ‘PLAN’
• Waiting lists not maintained
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Sustainable solutions -• Ideal Service?• Formalise the 12 hour days
– Rota(s) proposed– Staff involved
• Requirements:– 4 additional WTE staff– 1 additional WTE assistant
• Funding was put in place for the Radiographer posts!
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Balance restored!
• 4 posts to advert closing date May
• OT supported again
• 12 hour days commenced October 2009
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
12 hour shifts!
Mon Tue Wed Thur Frid Sat SUN
Penny 9am - 5pm 9am - 5pm 9am - 5pm 9am - 5pm
Jillian 9am - 5pm
Sandra 9am - 5pm 9am - 5pm 9am - 5pm 9am - 5pm 9am - 5pm
Jacqui 9am - 2pm 9am - 2pm 9am - 2pm 9am - 2pm 9am - 5pm
Fiona 7.45am - 8.15pm 7.45am - 8.15pm 7.45am - 8.15pm
Leigh 7.45am - 8.15pm 7.45am - 8.15pm 7.45am - 8.15pm
John 7.45am - 8.15pm 7.45am - 8.15pm 7.45am - 8.15pm
Marion 7.45am - 8.15pm 7.45am - 8.15pm 7.45am - 8.15pm
Mhari-Clare/Angela 7.45am - 8.15pm 7.45am - 8.15pm 7.45am - 8.15pm
Kim 7.45am - 8.15pm 4.15pm - 8.15pm 7.45am - 8.15pm 8.45am-5.15pm
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
12 hour shifts!
25th Jan Mon Tue Wed Thur Fri Sat
Joan 8am - 8pm 8am - 8pm 8am - 8pm
Anna 8am - 8pm 8am - 8pm 8am - 8pm
Linda 8am - 8pm 8am - 8pm 8am - 8pm
Mary 9am - 5pm
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
One year down the line:• 8.8 WTE Radiographers (11 staff)• 3 WTE Assistants (1 still not fully funded)
• 4 Departmental Porters
• CT:• 8am - 8pm Monday – Thursday• 9am – 5pm Friday and Saturday
• MRI:• 8am – 8pm Monday – Friday
(64 hour CT week; 60 hour MRI week)
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Benefits of 12 hour days:
CT Waiting Times
6 67
8
65
34
5 54
5 54
3
54 4 4
3 3 3 3
5
8
2
4
6
2 2
4
2
4
12 2 2 2
0123456789
Jan-
07 Feb
Mar
Apr
May
Jun Jul
Aug
Sep
Oct
Nov
Dec
Jan-
08 Feb
Mar
Apr
May
Jun Jul
Aug
Sept Oc
tNo
vDe
cJa
n-09 Fe
bMa
rAp
rMa
yJu
ne July
Aug
Sept Oc
tNo
vDe
cJa
n-10
Feb-
10
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Benefits of 12 hour days:MR Waiting times 2007-2010
9
4
6
7.5 78
78
9 9
6
89
11
67 7 7
8
6
8
65
89
8
5 54 4
34
34
7
43
7
0
2
4
6
8
10
12
Jan-
07 Feb
Mar
Apr
May
Jun Ju
lAu
gSe
pOc
tNo
vDe
cJa
n-08 Fe
bMa
rAp
rMa
yJu
n Jul
Aug
Sept Oc
tNo
vDe
cJa
n-09 Fe
bMa
rAp
rMa
yJu
ne July
Aug
Sept Oc
tNo
vDe
cJa
n-10
Feb-
10
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Patient Benefits of 12 hour days:
• Reduced waiting times - • Reduced anxiety• Increased flexibility• Increased access• Faster turnaround in Department with still more time
to talk!
• Increased in-patient capacity – no more ‘bed-blocking’!
• Happy patients – even on a Saturday!!
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Staff Benefits of 12 hour days• Improved Radiographer involvement
• Improved morale/job satisfaction• Decreased external pressure • Improved development/training opportunities• Great flexibility
• Less pressure on the sessions• Decreased recall rate – no more !
• Happy Radiologists?• No need to be on site!
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Service Benefits
• Better utilisation of the equipment • Reliable Service• Improved quality of Service• Improved relations with referrers
“Great service” Itamar Felsenstein
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Where we stand now - 6months later (Figures as of 5th March)
• CT:• 10,500 CT (9%); • 9 day wait to appointment• 99.2% completed in target
• MRI:• 5,100 MRI (11%); • 22 day wait to appointment (patient type)• 93% completed in target
5 Departmental Porters– Jan 2008 42% CT exams IP, 13% MRI exams– Jan 2010 47% CT exams IP, 15% MRI exams
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
However:
• Frustrated Service Development– CT Colonography– GI MRI– Stroke MRI– Cardiac CT/MRI
“CT Coronary Angiography should be developed as a decentralised service” WoS RPG
• Shortage of Permanent Radiologists– 5 WTE Consultants– Total annual throughput 105,500 exams per annum– 2 ‘permanent’ Locum Consultants
(2 qualified Cranial CT Reporting Radiographers still not supported to practice)
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Are we there yet?NO!
– MRI
– Limited reporting time
– Still ‘breachers’
– Protocol
– Inject/Vet
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Acknowledgements:• Clinicians
• Radiologists• Theresa Holliman WLC
But most of all:• My Team
Fiona, Jacqui, Penny, Sandra, Leigh, Mhari-Clare, Angela, Marion, John, Kim and Jillian,
Joan, Linda and Anna
Craig and Eleanor
Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock
Any:
Comments?
Questions?
Concerns?
Solutions??