The Scottish Government

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Service Redesign

Throughput

As a result of the independent review of wheelchair and seating services in Scotland carried out in 2005/06, NHS wheelchair and seating centres are engaged in redesign activity to improve the efficiency and transparency of the processes that support their service delivery. Redesign in NHSS is patient centred and focuses on the patient pathway through their journey of care. Improving the patient experience of the services needs to be embedded in all changes and related improvement measured.

Adopting and implementing lean principles to managing the flow of activity through the centres will remove unnecessary activity and waste. Each centre shares similar patient pathways through the clinical and repairs and maintenance branches of the service and a high level national pathway should be developed and implemented in each centre.

Demand and Capacity

Understanding and managing demand and capacity is central to efficient delivery. Each WSS centre needs to actively manage the demand for their services to reduce waiting times for users and their carers and to utilise their capacity to best effect. The national referral to treatment target ( RTT) of 18 weeks is for the entire patient journey. WSS Centres may form part of this journey and need to ensure their contribution supports the objective of meeting the overall 18 week target.

In order to ensure the right person with the right level of skill is carrying out the appropriate activity, a task analysis must be undertaken of clinical and non clinical staff in the centres. This will provide the basis for more efficient use of resource and for enriching the skill mix by developing and extending roles which will improve the service delivered to users, their families and carers.

Sharing Learning

Redesign methodology has patients and service users at the centre and wheelchair and seating centres need to implement this, using the tools available. ⁶ They need to develop a culture of continuous quality improvement and the capability within the staff to achieve this. The improvement cycle contains many activities and promotes the implementation of evidence based practice. It seeks improvement in the six dimensions of quality ⁷ keeping patients at the centre. Using validated approaches and agreed methodology to redesign services ensures that this happens.

Meeting the learning needs of staff in using improvement tools is central to embedding continuous improvement in each centre and each will develop a local action plans to underpin this.

Sharing the learning between centres from improvement activity and sharing outcomes will support the spread of improvement across Scotland and will be supported by the WSS Project Manager. Information, knowledge and instances of best practice should be widely available to all staff.

Rehabilitation Technology Services

The NHS offers other rehabilitation services including Orthotics, Prosthetics, Electronic Assistive Technology Services ( EATS) and other equipment customisation that require clinical and technological expertise and knowledge. The prosthetics and orthotics services have a similar patient pathway to that of the wheelchair services and some patients may be treated by more than one of these services at the same time.

In addition, all these services utilize similar light engineering and fabrication workshops. The associated staff in these areas have common technical skills to deliver their services. This offers potential to maximise resources within rehabilitation technology services to optimise clinical services. All improvements should be supported by efficiency and productivity measures where productivity is measured in terms of time released to care and cash releasing savings.

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