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Listen
Tools and Techniques
To understand the patient journey and to identify areas for improvement, it was necessary to process map with each clinical team and apply small change cycles to make changes happen.
It's not rocket science but nevertheless it's very important to improving patient services. The CCI work has brought all the people who provide a service together (sometimes for the first time) and got them to think about how they can improve the service. It is often this process that helps colleagues realise that simple changes can improve life for everybody but especially the patients.
Dr John A Dewar, Clinical Lead, Tayside Cancer Network
Process Mapping
Working closely with regional clinical leads, process mapping events were organised for each of the cancer teams. A range of staff from all levels involved in delivery of cancer care were invited to participate in mapping the patient journey from GP referral through to diagnosis, treatment and follow up.
Process mapping is a simple exercise.
It is one of the most powerful ways of illustrating to teams the complexity of the journey from the patients' perspective, providing an understanding of the real problems/issues faced and identifying opportunities for service improvement.
The process mapping events provided an opportunity for staff to come together, in some instances for the first time, to share information on the service they provide. Staff gave a detailed step by step breakdown of the service. This resulted in a visual "map" which reminded staff that their work was part of a wider process and helped them understand how their work had an impact on others.
The visual "map" demonstrated bottlenecks, duplicated tasks and delays in the process and allowed staff to see where improvements could be made.
The second part of the process mapping event was dedicated to the introduction of the Improvement Tool, PDSA, and generation of change ideas.
Staff were encouraged to think differently and create improvement ideas to be tested out when they returned to their workplace and use PDSA cycles to record and monitor their changes.
"This is fantastic, I see that man 2 - 3 times a week and he has never told me any of that (transferring images electronically)" - Physician and Radiologist who closely work together but had never discussed the patient pathway.
PDSA Improvement Tool - Plan, Do, Study, Act
A PDSA (Change Idea) cycle involves testing the improvement ideas on a small scale before introducing the change. By building on the learning from the test cycles in a structured and incremental way, a new idea can be implemented with greater chance of success. It is very important to capture information to show improvement is measured. One PDSA invariably leads to another. Because they are so small, they reduce the anxiety about change. In this way any member of a team can be involved and take ownership of the changes being implemented, leading to more sustainable improvements.
"So simple why didn't we do it 10 years ago" (Surgeon)
For further information on PDSA methodology, refer to "A Guide to Service Improvement" ( www.cci.scot.nhs.uk ).
Pdsa Cycle example
Cancer Facilitator | | Cancer Lead Clinician | |
|---|
Cancer Type | | Region | |
|---|
National Target | Cancer in Scotland :
Action for Change -
2 month target from urgent referral to treatment. | Hospital | |
| | PDSA No | 001 |
Local Objective: A minimum of 90% of patients to see a Respiratory Physician within 2 weeks of referral. |
| Plan | Do | Study | Act |
|---|
1 | Pdsa Start Date: For highly suspicious chest x-rays - direct referral to Respiratory Clinic from Radiology. Radiology report sent to GP with date of appointment detailed | Pilot commenced Radiology Clerical Assistant contacting chest clinic to arrange appointment for patient on advice of Radiologist report. Appointment being made and sent out to patient on the same day. X-Ray report sent to GP confirming result of X-Ray and future appointment with Respiratory Physician. | Meeting held to review pilot and ongoing implementation Redesigned Process has 6 less steps than previous and initial review of audit data shows a move from: Chest X-Ray to referral (11 days) then referral to seen by Physician (12 days) total 23 days Chest X-Ray to seen by Physician, 12.5 days Review identified that GPs were no longer submitting detailed referral to Chest Clinic as appointment already made. Respiratory Physician's feel this is a valuable source of information and therefore radiology agreed to add a sentence to the X-Ray report after appointment details to request continued submission of referral form. Improvement model implemented for referrals. | X-Ray report amended to include request for GP to continue to fax in detailed referral to ensure provision of valuable background patient information. Appointment dates given are allowing GPs time to contact patient should they wish to do so. Next stage is to progress with potential implementation of model. December Audit data shows Chest X-Ray to seen by Physician as median 10 days January audit data - Chest X-Ray to seen by Physician median 8 days Physician undertaking retrospective review of referrals to establish whether similar system is needed elsewhere. February audit data - median 10 days, current system to be maintained. Now looking to see if this fast track system could work elsewhere - further discussion at meeting on 25 June. March audit data - median 11 days. |
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