Implementing the National Action Plan The Wheelchair & Seating Services Approach John Colvin

Introduction & Background Moving Forward – March 2006 Scottish Executive Response to Moving Forward – January 2007 Funding announced following National Spending Review – November 2007 Business Case Submission – September 2008 National Action Plan – February 2009

What have the Centres done to implement the Action Plan? Implementing our specific actions on the National Action Plan Implementing our local business cases Participating in national work streams National Performance Indicators We are currently half way through a 2 year planned, funded project

How have we done this? Project Management –Governance –Planning –Risk Management –Responsibility Charting Kaizen/Rapid Improvement Events Continuous Improvement Change Management A ridiculous amount of meetings

User Satisfaction Survey

WoS WSS RTT High Level Pathway Referral To Provision

User’s and Carer’s Forum Established Steering group established Forum established (60 members) Inaugural meeting held October st newsletter issued (Feb 2010) 1 st Open day planned for May 2010 Identified as a priority group by NHS Tayside

Project Managers

Risk Management

In April 2009, as part of NHS Highland “shifting the balance” strategy the Wheelchair and Seating Service began a pilot scheme working with a local “not for profit” organisation called ILM Highland. ILM offer a repair and delivery service to wheelchair users living in Ross-Shire, Sutherland and Caithness who in the past would have received their equipment via a courier. They have carried out over 400 visits since the beginning of the pilot in April 2009 Operatives are trained to set up the chair correctly and are able to identify patients that have postural and pressure issues that may require a follow up visit by one of our occupational therapist and rehabilitation teams. WORKING WITH ILM HIGHLAND HIGHLAND WHEELCHAIR & SEATING SERVICE

NHS Lanarkshire WSS Centre - Floor Layout Stores Workshop Wheel chair Skills Area Clinic Rooms Office Area Reception Goods In Staff Toilets, Changing, Showers Break Area

Southeast Mobility and Rehabilitation Technology (SMART) Services Fife Satellite Clinic Lynebank Hospital, Dunfermline Service Users involved in Design Large Clinic Room with overhead hoist Workshop for minor repairs and adjustments ‘Wheelchair Shop’ – storage for selection of chairs and equipment Looking at developing a similar clinic in NHS Borders

Root Cause Analysis

1. PROBLEM STATEMENT  Most of the patient referrals to Westmarc WSS require at least one follow up appointment before the patient is equipped with ‘a safe and useable device’  This results in: - discomfort and frustration for the patient due to (potentially unnecessary) delays in receiving the prescribed device. - secondary appointments being necessitated for ‘fitting and fixing’. - an exacerbation of the waiting-list back-log - ‘double-handling’ by Clinicians, Workshop & Admin Staff. 4. GAP ANALYSIS7. IMPLEMENTATION PLANS 2. THE PRESENT STATE October 2009) Jan01-Dec31, 2009 Data: Clinical Appointments held at Westmarc= 1202 Assessments at WestMARC clinics = 100 per month Current One-Stop-Shop Appointments= 0 5. SOLUTION APPROACHES8. THE CONFIRMED STATE At 31 March 2010: To date, >60 OSS Clinics were successfully held This comprises an average of 15 OSS Clinics/Month A ramp up of >3x is required to achieve the Target State Ramp-up Measures: The capacity for OSS clinics was increased by opening the scope to ALL clinicians in March (was only 2 x OTs for 3 months) Data collection measures being introduced for reasons for NON OSS clinics 3. THE TARGET CONDITION6. PROVING TRIALS9. LESSONS LEARNT Don’t assume – check, quantify and check again. Involve the staff who are essential to the process, to gain their ‘buy-in’. Don’t be afraid to experiment (in a controlled environment). Don’t rush in – Do the homework and preparation. Choose the correct tools/techniques for the task. Westmarc Lean Programme: ONE-STOP-SHOP Start Date: 2 October 2009 Last Update: 7 April 2010 Team Members: S.Gold, R.Fiskin, A.Oliver, E.Beattie, A.Love, W.Forsyth, K.Lees, P.Greene, D.Devlin, I.Mackay, H.Collin Review Team: Westmarc Senior Management Team Process Owner: Bill Forsyth A3 Compiler: Henry Collin Decision by Review Team : GO Target OSS Appointments = 50% of total appts within, say, 6 mths = 50 Appts/month Decision by Review Team : GO Decision by Review Team : WIP Decision by Review Team : G0 Decision by Review Team : GO However, for many clinical appointments, the patients needs can be satisfied - within a single appointment - with a ONE-STOP-SHOP service, - with minimal or no extension to the allotted appointment times, - by a planned approach to ‘at-hand’ inventory holdings, - and by an orchestrated interaction between the different staff groups involved in the Patient Journey (Clinicians, Technicians, Stores and Admin). This method of data collection will continue, while establishing the robustness of the OSS process and system requirements, prior to agreeing a bespoke ReTIS report which can track the progress towards achieving the One-Stop- Shop targets. A ‘Clinician Request to Workshop’ form ‘A’ was created which also enables data collection. This data is currently, manually entered into a register ‘B’ in order to permit the metics on OSS thro’put and inventory usage. A B

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