How to optimise systems & processes to deliver a cost effective service that works for both patients & staff alike, whilst achieving 'must do' targets.

1. Presented By: Katy
Gordon

2. Outline of Presentation
BackgroundBackground
RequirementsRequirements
Our ApproachOur Approach
Advantages
of Working
with Co-
Creating
Balance
Advantages
of Working
with Co-
Creating
Balance
SummarySummary

3. Background:
NHS Plan [DoH 2000]
1. Our aim is to redesign the system
around the patient
1. Our aim is to redesign the system
around the patient
2. This involves:
 Looking at services from the way
the patient receives them
 Planning the pathway that a
patient takes from start to finish
 Best, modern clinical practice is
identified & decisions made about
which professional should best
carry out which function
2. This involves:
 Looking at services from the way
the patient receives them
 Planning the pathway that a
patient takes from start to finish
 Best, modern clinical practice is
identified & decisions made about
which professional should best
carry out which function

4. Care Pathways
People and perfect processes make a
quality health service – a poor
quality service results from a
badly designed and operated
process, not from lazy or
incompetent health care workers”
John Ovretviet, Health Service
Quality, 1992
People and perfect processes make a
quality health service – a poor
quality service results from a
badly designed and operated
process, not from lazy or
incompetent health care workers”
John Ovretviet, Health Service
Quality, 1992

5. ICPs – what are they?
1. A tool & a concept that embed
guidelines, protocols & locally
agreed, evidence-based, patient
centred, best practice, into
everyday use for the individual
patient
1. A tool & a concept that embed
guidelines, protocols & locally
agreed, evidence-based, patient
centred, best practice, into
everyday use for the individual
patient
2. ICPs record deviations from
planned care in the form of
variance
2. ICPs record deviations from
planned care in the form of
variance

6. ICPs aim to have:
the right peoplethe right people
doing the right thingsdoing the right things
in the right orderin the right order
At the right timeAt the right time
In the right placeIn the right place
With the right outcomeWith the right outcome
All with attention to the patient experienceAll with attention to the patient experience

7. Bolt on to Current Services

8. Bolt on to Current Services

9. Bolt on to Current Services

10. Background: Each Area
2. Visit G.P2. Visit G.P
3. Local
Hospital
3. Local
Hospital
5. Rehabilitation Team5. Rehabilitation Team
4. Regional
Hospital
4. Regional
Hospital
6. Community
Team
6. Community
Team
1. Patient1. Patient
7. Specialist
Team
7. Specialist
Team
1. Patient1. Patient
7. Specialist
Team
7. Specialist
Team
Each area is completely
concentrating on their
own roles and targets
Each area is completely
concentrating on their
own roles and targets
Are they managing an
integrated patient
pathway?
Are they managing an
integrated patient
pathway?

11. Bolt on to Current Services

12. Requirements
1. Visit G.P1. Visit G.P
2. Local
Hospital
2. Local
Hospital
3. Regional
Hospital
3. Regional
Hospital 4. Community
Team
4. Community
Team
5. Specialist
Team
5. Specialist
Team
6. Rehabilitation Team6. Rehabilitation Team

13. Requirements
3. Regional
Hospital
3. Regional
Hospital 4. Community
Team
4. Community
Team
6. Rehabilitation Team6. Rehabilitation Team
1. Visit G.P1. Visit G.P
2. Local
Hospital
2. Local
Hospital
5. Specialist
Team
5. Specialist
Team

14. Create a Strong Base
Implement Change
Our Approach
Overview of
problem

15. Our Approach
Implement
Change

16. Bolt on to Current Services

17. Current Pathway for
Specialist Respiratory Services
Tuesday, 16 Feb 2010
4 weeks4 weeks 5-6 weeks5-6 weeks 3-4 weeks3-4 weeks
2 weeks2 weeks 3
months
3
months
3
mths
3
mths
3
mths
3
mths
6
mths
6
mths
6 months6 months
6-8 weeks6-8 weeks
S&S snoringS&S snoring Obstructive sleep apnoeaObstructive sleep apnoea
About 10-20%
require home visits
for which there is
no provision at
present
About 10-20%
require home visits
for which there is
no provision at
present
Signs & symptoms
Obese?
Sleepy?
Apnoea?
Snoring?
Signs & symptoms
Obese?
Sleepy?
Apnoea?
Snoring?
Tests
BMi
ESS
ABG
Book SS
Tests
BMi
ESS
ABG
Book SS
Equipment
dispensed at
this appt
Equipment
dispensed at
this appt
Ongoing care by
physios via
telephone (helpline
and/or face to face
Ongoing care by
physios via
telephone (helpline
and/or face to face
Phone/see
Physio plan
Phone/see
Physio plan
Annual
replacement
consumables
Annual
replacement
consumables
Annual engineers
CPAP service
Annual engineers
CPAP service
20% of patients
25% of patients
75% of
patients
EntEnt
Referral
to Ent
Referral
to Ent
DischargeDischarge
CPAPCPAP
Discharge
from medical
follow
up
Discharge
from medical
follow
up
PCT 1° care
appointment
PCT 1° care
appointment
Referral via
choose & book
Referral via
choose & book 1st
OPA1st
OPA Home sleep
study (SS)
Home sleep
study (SS) 2nd
OPA2nd
OPA
CPAPCPAP
UrgentUrgent
RoutineRoutine
3rd
OPA3rd
OPA IssuesIssues OPAOPA
No issuesNo issues
OPAOPA
80% of
patients

18. One Stop Clinic
Dr & Physio
multidisciplinary
Dr & Physio
multidisciplinary
This could be face to
face or via
telemedicine
This could be face to
face or via
telemedicine
Issues to be
addressed
Referred
Proforma
Choose & book
process
Backlog on
CPAP
Space for
equipment
storage
SS admin
Any other
resources
Issues to be
addressed
Referred
Proforma
Choose & book
process
Backlog on
CPAP
Space for
equipment
storage
SS admin
Any other
resources
11 22
• How many
physios
required for
this?
• How many
engineers
required?
• How many
physios
required for
this?
• How many
engineers
required?
33
1 wk1 wk 1 wk1 wk
SSSS 1st
OPA1st
OPA
Physio
contact
ongoing as
required
Physio
contact
ongoing as
required
Annual Physio
consumables and
also engineers
review
Annual Physio
consumables and
also engineers
review
EntEnt DischargeDischarge
Dr OPADr OPA
Physio
Helpline
75% of
patients
25% of
patients
ENTENT
GPGP
CPAPCPAP

19. Summary
You have a
need to
improve …….
You have a
need to
improve …….
We have shown
how our
methodology
will help
We have shown
how our
methodology
will help
We provide a
cost effective
solution
We provide a
cost effective
solution

20. Thank You