1. A&C Role Development Yorkhill’s MRI Service Lorraine Peebles, SIM, Diagnostics, NHSGGC 31 Mar 10

2. Once Upon a Time…… Concern about MRI department’s ability to transform its resources effectively to reduce waiting times for patients MRI PATIENT JOURNEY MRI REFERRAL PATHWAY

3. The Way We Were! Roles and responsibilities within MRI department blurred – Radiographers doing A&C tasks (booking beds, theatre time, Anaesthetists/OP appts and cancelling appts) Imaging Assistant duties inappropriate (mostly clerical) MRI reception area not staffed and Telephones on answering machine Cancelled Appointments not being re-used – capacity being wasted (GA appts) Referral demand not being managed – eg, no emergency slots identified Patient clinical and safety information from Referrers often inadequate No agreed Appointment templates Data and information being captured in two separate IT systems Theatre staff, Ward staff and Imaging staff unsure of their responsibilities in relation to input of data No joined up working between MRI, Anaesthetics and Day Care Prospective anaesthetic rotas sometimes unavailable

4. 1.Seamless, high quality MRI patient journey for inpatients, day cases and outpatients 2.Increased throughput and utilization of GA MRI sessions by managing the referral pathway and associated data effectively Over-arching Objectives

5. Tool used : RIE Rapid Improvement Events are part of the Lean 'toolkit' and provide a mechanism for making radical changes to current processes and activities (patient pathways) within very short timescales. "The power of RIEs comes from the combined talents of cross functional teams being focused on achieving specific goals in relation to bottom line, operational improvements" - Andrew Scotchmar, Data Analyst, East Lancashire Health Economy

6. Selling the RIE Tool! Why we needed to change What did we need to change Baseline of the current performance and trajectory of where we think this new model would take us – 4 weeks! High profile executive leadership and management buy-in Key Stakeholder buy-in Champions within the MRI team to drive the transformation

7. NHS Institute for Innovation and Improvement “Optimising roles along an agreed pathway of care leads to significant improvements for staff and patients in key areas”:

8. Role Development/Design Reducing delays in patient journey Reduction in waiting times Improve patient services Tackle staff shortages Increase job satisfaction by developing and amending roles Benefit entire Health Care Team – Support Workers to Medical Workforce Improve quality and flow of patient journey To attract and retain an effective workforce

9. Referral Access Managing Demand Acquisition Reporting/ Verification Report to Specialty Referrer Key Components which together make up the Integrated Patient Journey Specialty Referral Approach to RIE SEAMLESS Increased throughput and utilisation of MRI Sessions

10. Areas for Improvement Referral access Vetting Acquisition Reporting Data management MRI REFERRAL COORDINATOR to provide continuity & work closely with Supt Radiographer

11. A&C No MRI A&C input MRI A&C duties distributed over main officeHCSW Appting patients on PC and in duplicate paper diary Phoning patients Posting letters and sending out checklists Logging of referrals Patient demographics inadequately checked and IT system not updated Reception duties Answering phone GA Nurse Phoning Wards for patients Portering duties Dealing with anxious parents and less time with patient Reception duties Answering telephone with appt changes Ordering suppliesRadiographer Arranging manual diary – managing waiting list Bed/Theatre Booking Chasing up referrers re complex cases/additional info Supplies Ordering Monitoring vetting Safety Checklists Reception duties Answering phone Scanning patientsRadiologist Vetting being done on an ad-hoc basis Constant interruptions CURRENT SPLIT OF DUTIES RELATING TO THE REFERRAL PATHWAY AND PATIENT JOURNEY

12. REFERRAL COORDINATOR Managing waiting list Cancelling / reappointing Monitoring vetting Chasing Referrers re complex cases/additional info Bed/Theatre Booking Answering/filtering phone calls Phoning Wards for patients Logging & appointing patients on PC Appointing patients on PC Phoning patients with appointment and carrying out Safety Checklist Checking patient demographics Posting letters and sending out checklists Reception duties HCSW More time with patients and carers Assisting with transport of patients Ordering of supplies Assisting Phoning Wards for patients GA Nurse Dealing with Anxious parents/ patients Administering contrast Available during scanning Radiographer Scanning patients Radiologist Vetting (monitored by Referral Coordinator) Telephone calls filtered by Referral Coordinator PROPOSED SPLIT OF DUTIES RELATING TO THE REFERRAL PATHWAY AND PATIENT JOURNEY

13. Action List Business Case for Referral Coordinator Business Case for additional GA Nurse Developed new referral form Developed new referral access criteria Developed new referral management process Developed new inpatient journey from ward to MRI Worked with stakeholders to promote data input

14. Current Landscape – Where are we now? Safe, sustainable, seamless patient journey to MRI and back Maximise MRI scanner utilisation 4 week wait from referral to report 48 hours max wait for all urgent IP referrals Reduce DNA rates to < 4% and short notice cancellations Improve MRI staff morale and job satisfaction Improve on current high quality of service to Referrers Clear process & responsibilities for Managing referral pathway Appropriate allocation of MRI duties & responsibilities Joined-up working between key stakeholders in patient journey Clear process & responsibilities defined for data management Referral Coordinator

15. A&C Role Development Yorkhill’s MRI Service Lorraine Peebles, SIM, Diagnostics, NHSGGC 31 Mar 10