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Endoscopy – the next two years and beyond

Endoscopy – the next two years and beyond. Debbie Johnston National Endoscopy Implementation Manager – 18 weeks. NKBH - November 2006. Development in endoscopy. 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009. pilot work. spread 28 SHAs. training programme.

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Endoscopy – the next two years and beyond

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  1. Endoscopy – the next two years and beyond Debbie Johnston National Endoscopy Implementation Manager – 18 weeks NKBH - November 2006

  2. Development in endoscopy 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 pilot work spread 28 SHAs training programme ‘62 days’ ‘18 weeks’ BC screening

  3. Department of Health: 18 weeks team National endoscopy Project 10 Screening Clinical Leads 10 Regional Clinical Leads Endoscopy unit staff Community hospitals endoscopy training centres Professional bodies Regulatory bodies Private sector

  4. Aligning agendas Cancer – 62 day TARGET Screening GOAL QUALITY Best deal for the patient ….. JAG - training ENDOSCOPISTS ..…. and the workforce DH - 18 weeks MILESTONES Professions WORKFORCE

  5. Aligning agendas Commissioners VALUE FOR MONEY Choice GOAL COMPETITION Best deal for the patient ….. Academia RESEARCH ..…. and the workforce Private sector MARKET SHARE Community hospitals SURVIVAL

  6. Leadership Tools and techniques Standards

  7. Timeline of change first awareness established practice contemplation maintenance preparation awareness action persuasion support Effective Health Care 1999;5(1)

  8. pre-JAG visits contemplation maintenance preparation awareness action support Effective Health Care 1999;5(1)

  9. exit strategy contemplation maintenance preparation awareness action support Effective Health Care 1999;5(1)

  10. Challenge of 18 Week Wait

  11. The challenge of 18 Weeks 18 Weeks GP OP D OP IP GP Visit 1st OutpatientAppointment Decision to treat Treatment This step is clinical pathways and diagnostics

  12. 9000 Endoscopy 8000 7000 6000 Audiometry 5000 Number of 13+ wk waiters Non-obstetrics Ultrasound MRI 4000 3000 Echocardiography 2000 Peripheral Neurophysiology CT Diagnostic cardiac 1000 catheters/angiography Sleep studies Nurse & GPSI led endoscopy Electrophysiology GI Physiology - manometry 0 0 5 10 15 20 25 30 Clearance time (weeks) Most significant challenge to reducing diagnostic waits to below 13 weeks Diagnostic clearance times Total sample size = 100,000 waiters Source: Pilot site data

  13. Bowel Cancer Screening

  14. SC SC SC SC SC Programme Hub: (FOBT) SC SC SC SC SC Bowel cancer screening programme Colonoscopy site Screening centre treatment Persons aged 60-69 Colonoscopy site

  15. Projected endoscopic activity 2003 - 2008 (with FOB screening) % of population per year = screening colonoscopy for FOBT Symptomatic Patients must not be compromised…

  16. Quality Assurance Agreement, achievement and demonstration of standards

  17. Quality assurance - what and who? GRS + JAG visit organisations individuals accreditation process

  18. Quality assurance - what and who? GRS + JAG visit organisations individuals accreditation process

  19. What would matter to you if you were having an endoscopy?

  20. Patient-centred standards Quality Patient Exp • equality • timeliness • choose and book • privacy and dignity • aftercare • ability to provide feedback to the service • Quality and safety • appropriateness • information/consent • safety • comfort • quality • timely results endoscopy global rating scale www.grs.nhs.uk

  21. GRS - Levels for Safety item Level D • Adverse events reviewed Level C • Level D & events are acted upon Level B • Level C & action is monitored for effectiveness Level A • Level B and prospective monitoring of 5+ known adverse events

  22. GRS Homepage

  23. GRS supporting 18 weeks • 4 items specifically support the delivery of the 18 weeks target: • Timeliness • Appropriateness • Choose & Book • Communicating results Supported by Quality and Patient Exp Items

  24. GRS – National results Acute Trust completion: 85% 94% 100% % scoring A or B

  25. Relationship between low waits and clinical validation of waiting lists. Clinical validation is a process that determines whether there is a clinical need for a procedure. It is particularly important for recall or surveillance procedures.

  26. GRS – National results Acute Trust completion: % scoring A or B 85% 94% 100%

  27. So how are we supporting the service with all this?

  28. Supporting the service • SHA Clinical Leads • Peer review visit programme - New • GRS Knowledge Management System • Networks – formal and informal • New Domains and Tools • Workforce Domain • Training Domain • Productivity Tool

  29. SHA Leads – What do they do?

  30. Roles and Responsibilities • To support the implementation of the 18 weeks • Provide SHAswith strategic clinical support for endoscopy • Identify and Support local endoscopy units that are at risk of not achieving key waiting time milestones and might need more intensive external support • Create/support local endoscopy networks • Providea local point of contact for all issues related to endoscopy performed in endoscopy unit • Feedbackinformation and concerns to the National Clinical lead, SHAs and DH – including providing examples of good practice • Ensure completion of the GRS by local endoscopy units and ensure progress in the next 9 months on waiting times • Support implementation and integration of the 2nd waveIndependent Sector Procurement of endoscopy

  31. Pre-JAG Visits

  32. Pre-JAG visits - purpose • Support units and help them prepare for • 18 week RTT target • accreditation of BCS/JAG • Improve engagement • Trust management • PCTs

  33. Pre-JAG visits - process • Preparation • Documentation, GRS, productivity tool etc • Visit • Identifying good practice and gaps • Providing solutions • Committing the unit to action plans • Agreeing a provisional date for formal visit • Report • Follow up • Monitoring of action plans • Support

  34. Quality improvement – how to do it • The GRS provides a framework on which to prioritise tasks • A web-based knowledge management system links solutions directly to problems How to do it – sharing best practice

  35. New updated KMS System

  36. Maximised view of Knowledge Base be adept: adopt and adapt • Getting Started • Policy and guidelines • Audit Tools • Useful Links • Patient Information • Sample Questionnaires • Presentations • Case Studies • General Folder New!

  37. The London Hospital – 2004/05 • routine waits > 1 year • >500 waiting • fire fighting • no extra resource

  38. London Hospital Timeline of change 2004 - first awareness 2006 - established practice • Pooled & back filled lists vetted all referrals improved list utilisation reduced DNAs • collected data • routine waits now< 4 weeks

  39. Looking After The Workforce

  40. We need the right person for the right job who is: trained assessed developed cared for listened to The endoscopy workforce • Endoscopist • Nursing • Clerical • Technical • Management If all the above is done well then recruitment and retention will not be an issue

  41. Supporting the Workforce • Items of workforce domain: • Skill mix review and recruitment – “right person” • Orientation and training – “trained” • Assessment and appraisal • – “assessed & developed” • Staff are cared for - “cared for” • Staff are listened to – “listened to”

  42. Productivity

  43. Productivity of your Service • Efficiency • utilisation of capacity • waiting list management • Input • staff • equipment • opportunity costs • Output • activity • impact on other services

  44. Activity per procedure room - units per year

  45. Activity per procedure room - units units per list for 40 week year 6 6 8 8 8 11 Hospitals

  46. Summary of Endoscopist Utilisation performance 26/06/06 – 29/09/06

  47. Aligning the Agendas? Commissioning in 2009

  48. Commissioning Endoscopy in 2009 Sophisticated commissioning via the GRS • Quality and safety • Customer care • Workforce • Training • Timeliness • Bowel cancer screening For Traditional NHS and ISPs

  49. Challenge for 2009 To be the quality choice for the Commissioners

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