"Applying Quality Improvement Science to Performance Challenges".
Introduction
18 Weeks Referral to Treatment Standard
The Scottish Government has set out the vision for a stronger NHS which will make better use of NHS capacity to deliver a better deal for patients. A major element in achieving this vision will be a new national waiting time guarantee:
"a whole journey waiting time target of 18 weeks from general practitioner referral to treatment … by December 2011"
- Cabinet Secretary for Health and Wellbeing,
Scottish Parliament - Official Report, 28 June 2007.
Improvement and Support Team (IST)
IST will support NHS Boards deliver and sustain the standard through a 3 year national improvement programme which began in April 2008. A national programme team has been formed to lead improvement work centrally and local NHS Board improvement programmes are being established to lead improvement work locally. Programme planning guidance CEL 12 (2008) has been issued.
The 18 Weeks Service Redesign and Transformation Programme will build on knowledge and experience of the application of tools and techniques to improve clinical systems and processes. This experience of improving management of demand and capacity, improving patient flow by reducing bottlenecks and using small scale rapid cycles of change to make incremental and sustainable improvement, will provide a solid basis to move forward. The programme will also build in the appropriate approaches to behavioural change management that will be required to deliver service transformation of the scope and scale required.
The programme will be supported by the implementation of key high impact changes:
1. Treat day surgery (rather than inpatient surgery) as the norm for planned procedures.
2. Improve referral and diagnostic pathways.
3. Actively manage admissions to hospital.
4. Actively manage discharge and length of stay.
5. Actively manage follow-up.
The programme has a number of objectives: to support the attainment of access and waiting times targets, increase day case rates, reduce length of stay rates, reduce patient journey time and increase whole system capacity. By implementing these objectives, the programme aims to achieve the following goals:
- Improve the patient experience by the delivery of care at the right time in the right place by the right person.
- Promote a culture of improvement based on rigorous data analysis and common principles that empower clinical teams to transform the way they deliver their services from existing resources.
- Lead a whole system change in how care is provided by the identification, spread and adoption of good practice in planned care.
- Promote data management to support innovation and performance improvement.
- Promotion of sound system and process design, making sure that variation from non-standardised processes is eliminated.
- Develop robust and streamlined patient booking and referral management systems to improve access and confidence to patients and GPs by improving flow of information between clinicians and patients, primary, secondary and tertiary care, and within clinical teams.
The programme will bring together learning from the Unscheduled Care, Diagnostics Collaborative, Planned Care and Eye Care Redesign Programmes. The programme is based upon three key work streams (Inpatient capacity, Diagnostics and referral management, Day case and pre assessment) which will have specific learning needs and project focuses, however, IST promotes a fully integrated approach both nationally and locally. IST will support the spread of High Impact Changes and the use of improvement tools and techniques across NHSScotland to provide a systematic and sustainable approach to improvement.
NHS Lothian partnership
The IST improvement programme will be developed in partnership with NHS Lothian. This partnership allows IST to better develop the programme to meet the needs of the NHS. NHS Lothian brings also their knowledge of working with Lean improvement as a methodology for improvement which the programme will use and promote. Other NHS Boards will be involved in test bed and innovation work through the life of the programme.
Clinical and managerial engagement
Central to the improvement programme will be effective clinical and managerial engagement in order to deliver the vision through to implementation and embedding the improvements. IST will promote within the NHS Boards the need to align clinical support with managerial objectives in order to action plan for the implementation of improvement work.
Further information
For further, specialist information concerning the programme, please contact the following National Programme Manager:
Helen Maitland - Inpatient capacity
Tracey Williams - Diagnostics and referral management
Laura Jones - Day case and pre assessment
Links/Publications
The following are key links to the associated websites and documents: