Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Meeting the Targets! The Crosshouse Journey

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Outline Who are we? Brief History Interim Measures Changes in work practice! How are we doing? The Future – is it bright?

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Who are we? Larger of 2 DGHs 527 beds (570) Area Beds: –Paeds –Gyn –Nephrology –Dermatology –ENT –Maxfac 1 MRI scanner – age 7 1 CT scanner – age 3 MRI GA service

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Introducing the Targets: August 2007 ‘ Diagnostic 4 week target will take effect from December 2010 – there should be additional resources’ (GR) In preparation AAHB Radiology - 6 weeks from now!

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Brief History August 2007: –CT: 5wks; MRI: 9wks ~7,000CT; 3,700MRI 9am – 5pm, Monday – Friday, 9am – 12pm Saturday (Stroke Service) (39 hour CT week; 36 hour MRI week) 4.75 WTE radiographers(6 staff); 2 WTE helpers 5 departmental porters

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Interim Measures Capacity and Demand Audit 111% MRI; 110% CT Process Mapping Forget lunch! Canvas staff Voluntary overtime – loyal! Clear the backload! Outsource reporting for MRI Extra session reporting (2 qualified Cranial CT Reporting Radiographers still not supported to practice) Patients scanned and reported at GJH and CG

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock The More You do………………. January 2009 (16 months down the line) –CT: 8wks; MRI: 9wks ~9,600CT (37% ); 4,600MRI (24% ); 9am – 5pm, Monday – Friday, 9am – 12pm Saturday (Stroke Service) Minimum of 5 OT sessions per week ( hour CT week; hour MRI week)

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock It’s not ALL about targets! After a year of OT –De-motivated – lack of solutions –Tired –Crabbit –Stress –Clinical risk –Recalls THEN - “4 weeks by March” NO APPARENT END

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock SO……. Overtime ended till there was a ‘PLAN’ Waiting lists not maintained

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Sustainable solutions - Ideal Service? Formalise the 12 hour days –Rota(s) proposed –Staff involved Requirements: –4 additional WTE staff –1 additional WTE assistant Funding was put in place for the Radiographer posts!

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Balance restored! 4 posts to advert closing date May OT supported again 12 hour days commenced October 2009

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock 12 hour shifts! MonTueWedThurFridSat SUN Penny9am - 5pm Jillian 9am - 5pm Sandra9am - 5pm Jacqui9am - 2pm 9am - 5pm Fiona7.45am pm Leigh 7.45am pm John 7.45am pm Marion7.45am pm Mhari-Clare/Angela7.45am pm Kim 7.45am pm 4.15pm pm7.45am pm8.45am-5.15pm

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock 12 hour shifts! 25th JanMonTueWedThurFri Sat Joan8am - 8pm Anna 8am - 8pm Linda8am - 8pm Mary 9am - 5pm

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock One year down the line: 8.8 WTE Radiographers (11 staff) 3 WTE Assistants (1 still not fully funded) 4 Departmental Porters CT: 8am - 8pm Monday – Thursday 9am – 5pm Friday and Saturday MRI: 8am – 8pm Monday – Friday (64 hour CT week; 60 hour MRI week)

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Benefits of 12 hour days:

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Benefits of 12 hour days:

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Patient Benefits of 12 hour days: Reduced waiting times - Reduced anxiety Increased flexibility Increased access Faster turnaround in Department with still more time to talk! Increased in-patient capacity – no more ‘bed- blocking’! Happy patients – even on a Saturday!!

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Staff Benefits of 12 hour days Improved Radiographer involvement Improved morale/job satisfaction Decreased external pressure Improved development/training opportunities Great flexibility Less pressure on the sessions Decreased recall rate – no more ! Happy Radiologists? No need to be on site!

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Service Benefits Better utilisation of the equipment Reliable Service Improved quality of Service Improved relations with referrers “Great service” Itamar Felsenstein

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Where we stand now - 6months later (Figures as of 5 th March) CT: 10,500 CT (9%); 9 day wait to appointment 99.2% completed in target MRI: 5,100 MRI (11%); 22 day wait to appointment (patient type) 93% completed in target 5 Departmental Porters –Jan % CT exams IP, 13% MRI exams –Jan % CT exams IP, 15% MRI exams

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock However: Frustrated Service Development –CT Colonography –GI MRI –Stroke MRI –Cardiac CT/MRI “CT Coronary Angiography should be developed as a decentralised service” WoS RPG Shortage of Permanent Radiologists –5 WTE Consultants –Total annual throughput 105,500 exams per annum –2 ‘permanent’ Locum Consultants (2 qualified Cranial CT Reporting Radiographers still not supported to practice)

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Are we there yet? NO! –MRI –Limited reporting time –Still ‘breachers’ –Protocol –Inject/Vet

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Acknowledgements: Clinicians Radiologists Theresa Holliman WLC But most of all: My Team Fiona, Jacqui, Penny, Sandra, Leigh, Mhari-Clare, Angela, Marion, John, Kim and Jillian, Joan, Linda and Anna Craig and Eleanor

Shona S Wilson, Superintendent Radiographer, Crosshouse Hospital, Kilmarnock Any: Comments? Questions? Concerns? Solutions??