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Results, Impact and Outcomes
Essential to the work of the programme was the need to ensure effective engagement with NHSScotland staff, without which no progress would be made. For many individuals and teams there was an eagerness and desire to work with the programme and attempt to improve service provision to patients and carers affected by cancer.
For many staff, process mapping and the subsequent methodology used by the team to help initiate change was a new concept. Because it was a new concept there was a reluctance to participate and a lot of ground work had to be undertaken with clinical leads to explain the purpose of the programme and the benefits to staff, patients and their carers. It was vital to achieve 'quick wins' to show the potential impact and achievable service improvement, in this way engaging staff in continued and sustainable improvement.
Key to the successful involvement with clinical teams and the resultant service improvement was the essential buy-in to the whole process of senior clinicians and managers.
Year 1
- Engage staff involved in delivering cancer services and forge positive relationships with networks, clinical leads and cancer teams working in lung, colorectal and gynaecology
- Explore the status quo and challenge traditional ways of working with a series of national process mapping events
- Identify areas of improvement to reduce waiting times and improve patients' and carers' experience
- Encourage innovative thinking
- Provide support to clinical teams while implementing changes
Year 2
- Host a National Conference to showcase and share early improvement work and impact across Scotland
- Review and consolidate improvement work
- Demonstrate impact of changes and present solutions in tackling delays for each stage of the pathway
- Identify where delays in implementation exist and agree with the networks the action to be taken
- Need to rapidly share successes and share with other networks as networks have a key role to play
- Extend support to urology, head and neck, upper GI and breast cancer
- Share improvements achieved and encourage spread regionally and nationally
There was a need to review how the team worked during year 2 due to staff changes. This allowed the team to reflect and refocus on maximising the team resource to achieve the programme objective.
Year 3
- Development of Top 20 Actions for Change guideline illustrating high impact changes
- Support clinical staff working within the three cancer networks to adopt the high impact changes highlighted in the Top 20 guide.
- Top 20 Actions for Change Guide adopted within the National Delivery Plan for Cancer Waiting Times
- Review and consolidate improvement work
- Host national Spread and Share Conference to encourage the spread of good work throughout Scotland.
- Extend support to chemotherapy, radiotherapy and endoscopy where requested
Demonstrating successful change to encourage more staff to participate in service improvement has been key. The programme adopted a variety of different formats to help communicate involvement, information and ways to achieve success. These were all circulated widely across the NHS in Scotland encouraging staff to engage and adopt change within their own service.
"The regional facilitators have been a very welcome addition to our network. They are working in close partnership with the Chairs and members of our regional tumour-specific groups, and have been really helpful in focusing their energies on redesign of their services. Persuading busy clinicians to give up time to map services is difficult, but it's worth it if it results in agreeing and implementing practical changes which make things better for patients. It's fair to say that some colleagues were sceptical at first, but a sure sign of progress is that several other groups are now keen to get involved."
Former Scan Network Manager
NATIONAL CONFERENCE "Making It Happen"
The conference took place on 5 November 2004 at the Corn Exchange Edinburgh with 250 delegates attending.
The focus of the conference was to showcase the programme's early work and its future plans. It was an opportunity for NHS Staff to demonstrate the changes they had made and share with others how they "Made it Happen".
Delegates heard about innovation good practice and presentations on:
- Achieving the Waiting Times target
- Improving communication
- Promoting multidisciplinary team working
The structure of the day was a combination of workshops, plenary sessions and guest speakers including the Minister for Health and Community Care, Mr Andy Kerr, Dr Eddie Obeng, Director of Pentacle The Virtual Business School and Dr M. Rashad Massoud, Senior Vice President, Institute of Health Care Improvement ( IHI).
Evaluation/Feedback was very positive and interest in the work of the programme escalated as a result. Some opinions of delegates who attended the event:
"Good to hear of systems working well - must share this and roll out across the board"
"very refreshing, wonderful presentation: thanks for being honest"
"Stimulating and one of the most optimistic for the future of cancer care and health service (despite all the reorganisations)"
"the energy for change is really encouraging"
Outcomes
- Increased awareness
- Engagement of NHS staff
- Showcasing well respected clinicians who had undertaken successful Improvements
Main speakers Dr M. Rashad Massoud, Minister for Health and Community Care, Mr Andy Kerr with Dr Anna Gregor
Top 20 Actions for Change
The experience of 25,000 patients diagnosed with cancer per year in Scotland could be improved if each and every cancer team implemented these changes.
Throughout the first two years of the Programme, the Regional Facilitators were consistently asked by teams which change ideas would have the biggest impact on the service. In response to these requests, the team developed a simple-step guide Top 20 Actions for Change "Making it Happen" in March 2005. The guide aims to illustrate high impact changes which, if implemented, can significantly reduce delays in the whole system of cancer service care achieving benefits for patients, their families and staff.
The Top 20 Actions for Change is widely available to the NHS to support a faster pace of change across Scotland by encouraging teams to adopt successful improvements rather than reinvent the wheel.
NATIONAL SPREAD AND SHARE CONFERENCE
This event was held in Dundee on 24 May 2005. Approximately 150 delegates attended who had the opportunity to network with other colleagues from across Scotland.
The event was organised to share improvements and encourage the spread of good work throughout Scotland. It's Aim was also to promote discussion, networking and learning. The Top 20 Actions for Change guide was publicly launched at this conference to raise awareness and encourage the implementation of the changes. Many successful improvements achieved by staff across cancer services in Scotland were highlighted.
The main speaker of the day was Sir John Oldham, Head of the National Primary Care Development Team, who hosted a question and answer session after his presentation.
The poster displays provided an opportunity for delegates to communicate with staff who had been involved in changes and improvements. The conference was also attended by patients who participated in all aspects of the event throughout the day.
Outcomes:
- Increased awareness of the CSIP work and encouraged staff to adopt any of the Top 20 Actions for Change.
- Highlighted that CSIP regional facilitators were available for support if requested
- Encouraged sharing of good practice
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Networking | Sir John Oldham Delivers Presentation |
"It was informative day, particularly for the patients who gained an insight into the NHS"
"Well run, very interesting speakers, thought provoking"
"Made me think more about how to improve things in my own department"
Illustrating "how to" implement the Top 20 Actions for Change
A further publication "Illustrating 'How to' implement the Top 20 Actions for Change" was launched to support the successful uptake of Top 20 change ideas. A practical guide containing examples of sustained changes that have benefited cancer patients across Scotland. Changes are illustrated across the four key parts of the cancer patients' pathway: Referral, Consultation/ Investigation/Diagnosis ( CID), Multidisciplinary Team Meeting ( MDT), and Treatment.
The examples contained in the booklet are only a snapshot of the improvements achieved throughout Scotland. It illustrates changes at key stages of the care pathway.
It has given clinical staff the opportunity to share their improvements and encourage spread across the cancer networks both at regional and national level. The booklet contains contact details for staff involved in making the changes happen.
Contact details for the local member of staff involved in the change are available at the bottom of every example to allow contact with the appropriate staff member, once CSIP ends.
Newsletters and Website
CSIP newsletters have been produced quarterly and copies are available on the CCI website; www.cci.scot.nhs.uk. The newsletters were widely circulated throughout the NHS and the 3 regional cancer networks providing an update of recent progress from each region, with a focus on a particular area, i.e. referral as well as providing staff with information on new publications, forthcoming events and useful weblinks.
The Cancer Service Improvement Programme website is located under the National Programme section of the Centre for Change and Innovation website www.cci.scot.nhs.uk. It provides valuable resources collated from the past three years' experience. The website also includes parallel session presentations and video clips of plenary speakers for the "Making It Happen" Conference in November 2004, links to all publications and full detail on improvements and changes.
NHSScotland feedback
Working with the CCI, Dumfries and Galloway teams played a significant role in helping to develop the Top 20 Actions for Change, a key CCI publication highlighting those changes that we know, if implemented, impact positively on services.
This was achieved by redesigning services and considering, with the CCI and colleagues from around the region, which changes brought about the biggest impact in terms of delivering improvements for patients.
We are grateful to the CCI for providing us with an excellent start but we realise that there is still much work to be done. We must ensure that this focus on improving cancer services is sustained and that the Top 20 actions and other identified elements of good practice are rolled out and implemented throughout cancer services.
John Ross, CBE, Chairman,
NHS Dumfries and Galloway
John Burns, Chief Executive,
NHS Dumfries and Galloway
The Cancer Service Improvement Programme has undoubtedly assisted us to achieve some of these improved patient pathways and has energised and focussed our clinical leaders and front line clinical staff on the possibilities of further improvements…
As ever, effectiveness of any service is dependent upon staff involved and that is equally true in this case. We are also, however, very appreciative of the involvement the CSIP team in achieving these excellent results.
Ian M Mullen, OBE, DL
Chairman of NHS Forth Valley
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