1. Improving Quality and Reducing Cost The Role of Measurement Carrie Marr Associate Director Change & Innovation Tayside Centre for Organisational Effectiveness

2. Integrating Finance and Quality Context FinancialWaste DemographicHarm Safety & QualityVariation

3. 9% 24% 41% 61% 84% NHS Tayside +148 beds 2016 +517 beds 2031 Healthcare demand is growing A new Ninewells Hospital by 2031!

4. Evidence of Waste in Healthcare Systems

5. 27% of New Outpatient appointments are being wasted! Question 1 – Are there significant Outpatient Capacity losses? Increase Capacity of Outpatient Clinics? Opportunity? 0.0 5.0 10.0 15.0 20.0 25.0 DischargedAWAITING TEST RESULT REFD OTHER CLIN/HOSP DNA-TotalCould Not Wait - FAREFER TO OTHER HOSP % New Return

6. »There are approx 430,000 District Nurse Visits in a year (56% of District Nurse time was non-patient facing) District Nursing

7. Evidence of Clinical Variation in Healthcare Systems

8. Cost per Head by GP Practice 2006/07 (incl. GMS)

9. Examples of Variation in Clinical Practice Poly pharmacy Rates of admissions in over 65 years Lengths of stay in over 65 years Referral patterns into acute specialist care

10. Achieving Quality Improvement and cost reduction

11. Improving Quality and Reducing Costs Our Choice Surviving – the 5% Thrive – the 95%

12. TACTICALSTRATEGIC DEALING WITH THE 5% SPENDING THE 95% BETTER PRODUCTIVITY & EFFICIENCY CRES SERVICE OPTIMISATION TRANSFORMATION 2009 - 2011

13. 2010 - 2013 TACTICALSTRATEGIC DEALING WITH THE 5% SPENDING THE 95% BETTER PRODUCTIVITY & EFFICIENCY CRES SERVICE OPTIMISATION TRANSFORMATION

14. Steps to Better Healthcare Mental Health Out Patients Theatre Capacity / Planned Care WorkforceOlder people Shifting the Balance of Care Optimisation of Health Facilities across Tayside Prescribing and Medicines Finance Support Workforce Support Scenario Planning, Financial Baselines, Benefits Tracking, Business Cases Workforce Modelling, Engagement & Communications with staff Comms Support Communications with public and staff Other OE Support Organisational Effectiveness support Labs Maternity

16. How I engage with the centre: Technology Enabling Health Improvement Academy Improvement & Development Support Real time information resource to support quality improvement of clinical services Enhance spread and share of good practice through use of technology ie web portal Develop a innovative education and training resource to assist in our quality improvement needs through improvement science and optimising e health resources. To develop trained experts in quality improvement organisational development and leadership to support improvement work prioritised by our joint clinical boards. The focus of this expertise will be mobilised to support front line staff and clinicians to build capability in improvement methodology and support key improvement programmes

17. Business Support Real time information and measurement systems

18. NHS Tayside Clinical Portal:

19. CHKS Annual and Bi annual reports which will take a high level organisational perspective Specific reports designed to address issues identified within the organisational reports or at the request of the organisation when internal review may have identified issues which need further clarification Continuous review of data quality and feed back to the organisation to support audit and development

20. Average Length of Stay : General Surgery Approaching length of stay either at specialty level as part of other indicators or specifically length of stay within the hierarchy by specialty 3.3 days (peer 2.6 )

21. Consultant Level Average Length of Stay (GS) The table identifies the consultants involved in the management of cases in General Surgery Most individuals have a greater average length of stay than the peer Bed day opportunity is derived from average length of stay and volume of activity Some individuals have very small volumes of cases

22. Length of Stay by Condition (HRG) The table above illustrates the 8 HRGs with the greatest potential for bed day improvement based on volume and comparative length of stay to peer average. Off note is the number of cases with no associated procedure for some of these condition groupings

23. Outpatients The outpatient indicators concentrate on new to review ratios and DNA rates At organisational level new to review – 1 to 0.5 (peer 1 to 2.1) At organisational level DNA rates 8.2% (peer 7.9%)

24. Business Support Hub Collect once use for many purposes Collect from a wide range of sources NHS, Local government, Public health High Data Quality Standards applied Systems to support business requirements Training & education Predictive modelling

25. Clinical Quality Organisational Effectiveness Financial Planning

26. Development of 2 tiers: Production – automating regular reports as much as possible using IT solutions eg. BO and VBA Health Intelligence / Innovation  Waiting list reporting  Full patient tracking  Weekly position summary  Bed statistics / utilisation  A&E submissions  others...  Unique Patient Tracking  Clinical Dashboards + Quality Metrics  Statistical Process Control + Variation reporting  Strategic improvement data analysis (variation and waste Data) + Service Improvement  Patient Pathways  Predictive Risk Score Modelling To build capability within the Business Support Unit

27. Clinical Dashboards – Pilot Metrics Real-time Bed Management, e.g. available / occupied beds Service / Resource Utilisation, e.g. boarding patients, same day surgery rate, outpatient dna rates Waiting Times & Access, e.g. 18 weeks RTT, inpatient / daycase / new outpatient Infection Control, e.g. hospital acquired infection, handwashing, cleanliness Patient Safety, e.g. anti-biotic policy, early warning scores, compliance with central line insertion, daily safety briefings compliance

28. 28 Patient Safety

29. 29 Click to view trend line

30. 30 Hover over data point for detail Click for more details Data Table

31. Data for discussion, not judgement supports a shift in culture Education programmes that build capacity and capability in data and analysis Supporting staff to build confidence in handling data and align to real time delivery of services real-time information and measurement systems that connect whole systems – clinical and non- clinical Prospective capacity management Dashboards for clinical quality, business information and governance The Current Challenge facing NHS Tayside