Modernisation Agency

SIHI 1 October 2004

The Change Challenge Combining service redesign and IT

to transform the NHS

Mark Outhwaite

Director Technologies in Health Group

NHS Modernisation Agency

Modernisation Agency

SIHI 1 October 2004

Where do we get the benefits?

High

Low

HighLow Range of potential benefits

Deg

ree

of

bu

sin

ess

tran

sfo

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ion

1. Localised exploitation1. Localised exploitation1. Localised exploitation1. Localised exploitation

2. Internal integration2. Internal integration2. Internal integration2. Internal integration

3. Business process redesign3. Business process redesign3. Business process redesign3. Business process redesign

4. Business network redesign4. Business network redesign4. Business network redesign4. Business network redesign

5. Business scope redefinition5. Business scope redefinition5. Business scope redefinition5. Business scope redefinition

RevolutionRevolution

EvolutionEvolution

In NHS 80% of benefits derived from process re-

engineering

Modernisation Agency

SIHI 1 October 2004

www.modern.nhs.uk

Modernisation Agency

SIHI 1 October 2004

Change NChange Noo11: : Treating day surgery (rather than inpatient surgery) as the norm for elective surgery could release nearly half a million inpatient bed days each year.

1

Change NChange Noo22: : Improving patient flow across the NHS by improving access to key diagnostic tests could save 25 million weeks of unnecessary patient waiting time.

2

Change NChange Noo33: : Managing variation in patient discharge, thereby reducing length of stay, could release 10% of totalbed days for other activity..

3

Change NChange Noo44: : Managing variation in the patient admission process could cut the 70,000 operations cancelled each yearfor non-clinical reasons by 40%.

4

Modernisation Agency

SIHI 1 October 2004

Change NChange Noo55: : Avoiding unnecessary follow-ups for patients and providing necessary follow-ups in the right care setting could save half a million appointments in just Orthopaedics, ENT, Ophthalmology and Dermatology..

5

Change NChange Noo66: : Increasing the reliability of performing therapeutic interventions through a Care Bundle approach in critical care alone could release approximately 14,000 bed days by reducing length of stay.

6

Change NChange Noo77: : Applying a systematic approach to care for people with long-term conditions could prevent a quarter of a million emergency admissions to hospital.

7

Change NChange Noo88: : Improving patient access by reducing the number of queues could reduce the number of additional FFCEs required to hit elective access targets by 165,000.

8

Modernisation Agency

SIHI 1 October 2004

Change NChange Noo99: : Optimising patient flow through service bottlenecks using process templates could free up to 15-20% of current capacity to address waiting times.

9

Change NChange Noo1010: : Redesigning and extending roles in line with efficient patient pathways to attract and retain an effective workforce could free up more than 1,500 WTEs of GP/consultant time, creating 80,000 extra patient interactions per week.

10

Modernisation Agency

SIHI 1 October 2004

What is the potential?

• enhance the experience of millions of people who use NHS services

• save millions of:– hours of clinician time– appointments in primary and secondary care – hospital bed days

• virtually eliminate waiting lists• tangibly improve clinical quality• create enjoyment and pride at work• help NHS organisations achieve local and national

goals and financial balance

Modernisation Agency

SIHI 1 October 2004

• “Trying harder will not work. changing systems of care will.”

(Institute of Medicine; 2001)

Modernisation Agency

SIHI 1 October 2004

IMPACT ON SERVICE DELIVERY

faster delivery of care unnecessary admissions avoided shorter length of stay fewer cancellations more effective use of existing resources

IMPACT ON PATIENTS

• personalised service more control over care more co-ordination of care better experience waiting time reduced less anxiety

IMPACT ON OUTCOMES

fewer readmissions reduction in complications and deaths speedier recovery impact on chronic conditions

IMPACT ON STAFF

less turnover more attractive to potential recruits impact on skill mix employee satisfaction reduce ‘firefighting’ professional development

The Improvement Dividend Framework

Modernisation Agency

SIHI 1 October 2004

But what about the benefits from IT?

Modernisation Agency

SIHI 1 October 2004

US evidence on e-prescribing

Modernisation Agency

SIHI 1 October 2004

A UK Adverse Drug Reactions Study

• ADRs continue to represent a considerable burden on the NHS, accounting for 1 in 16 hospital admissions and 4% of the hospital bed capacity

• Most ADRs were predictable from the known pharmacology of the drugs and many represented known interactions and are therefore likely to be preventable.

• Over 2% of patients admitted with an adverse drug reaction died, suggesting that adverse effects may be responsible for the death of 0.15% of all patients admitted

Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients. Munir Pirmohamed, Sally James, Shaun Meakin, Chris Green, Andrew K Scott, Thomas J Walley, Keith Farrar, B Kevin Park, Alasdair M Breckenridge BMJ VOLUME 329 3 JULY 2004

Modernisation Agency

SIHI 1 October 2004

And that adds up to:

• at any one time the equivalent of up to seven 800 bed hospitals may be occupied by patients admitted with ADRs

• ADRs causing hospital admission are responsible for the death of 5700 patients (3800 to 7600) every year. The true rate of death taking into account all ADRs (those causing admission, and those occurring while patients are in hospital) may therefore turn out to be greater than 10,000 a year

Modernisation Agency

SIHI 1 October 2004

Results from US research on CPOE• 53% - 83% reduction in serious medication errors

• The use of decision support for clinical decisions can also result in major reductions in the rate of complications associated with antibiotics,and can decrease costs and the rate of nosocomial infections.

• Information technology can substantially improve the safety of medical care by structuring actions,catching errors, and bringing evidence-based,patient-centered decision support to the point of care to allow necessary customization.

• But in US Computerised Physician Order Entry is But in US Computerised Physician Order Entry is fully implemented and being actively used in fully implemented and being actively used in between only 0.8% and 1.3% of the nation’s between only 0.8% and 1.3% of the nation’s hospitalshospitals

Improving Safety with Information Technology, David W.Bates,M.D.,and Atul A.Gawande,M.D.,M.P.H. N Engl J Med 2003;348:2526-34.

Modernisation Agency

SIHI 1 October 2004

The Receptive Context

So what are the characteristics of organisations that get the most out of

IT investment?

Evidence from industry

Modernisation Agency

SIHI 1 October 2004

The synergy between investment in organisational capability and in IT

IT Capital

Erik Brynjolfsson Centre for ebusiness@MIT http://ebusiness.mit.edu

Modernisation Agency

SIHI 1 October 2004

Seven Practices of Effective Digital Organisations

• Move from analogue to real-time digital business processes – embed standard procedures in technology and

– use IT to manage the enterprise with ‘live’ information

• Distribute decision-rights (delegation)• Foster open information flow and access• Link incentives to performance• Maintain and communicate goals• Hire the best people• Continually invest in human capital

Erik Brynjolfsson Centre for ebusiness@MIT http://ebusiness.mit.edu

Modernisation Agency

SIHI 1 October 2004

Typical current NHS performance improvement strategy

• design system to prevent performance failure• create awareness of targets and performance

requirements– raise leadership intent to deliver them

• seek to improve the performance of specific departments, specialties or parts of the system

• work harder• implement measurement systems to monitor

compliance with the required performance

Source: Helen Bevan/Richard Lendon/Institute for Healthcare Improvement 2004

Modernisation Agency

SIHI 1 October 2004

• design the system to continuously improve• take a process view of patient flow across departmental &

organisational boundaries• focus on bottlenecks that prevent smooth patient flow• work smarter by

– segmenting & scheduling patients according to their specific needs

– managing and reducing causes of variation in patient flow

• implement measurement systems for improvement that reveal the true performance of the system and the impact of any changes made in real time

Source: Kate Silvester/Helen Bevan/Richard Lendon/Institute for Healthcare Improvement 2004

Potential future NHS performance improvement strategy

Modernisation Agency

SIHI 1 October 2004

Where do we get the benefits?

High

Low

HighLow Range of potential benefits

Deg

ree

of

bu

sin

ess

tran

sfo

rmat

ion

1. Localised exploitation1. Localised exploitation1. Localised exploitation1. Localised exploitation

2. Internal integration2. Internal integration2. Internal integration2. Internal integration

3. Business process redesign3. Business process redesign3. Business process redesign3. Business process redesign

4. Business network redesign4. Business network redesign4. Business network redesign4. Business network redesign

5. Business scope redefinition5. Business scope redefinition5. Business scope redefinition5. Business scope redefinition

RevolutionRevolution

EvolutionEvolution

80% of benefits derived from exploitation of IT -

technology driven changetechnology driven change

Modernisation Agency

SIHI 1 October 2004

Medical informatics is as much about computers as cardiology is about stethoscopes… Any attempt to use information technology will fail dramatically when the motivation is the application of technology for its own sake rather than the solution of clinical problems. Enrico Coiera (1995)