Transcript The Change challenge - University of Portsmouth

Modernisation Agency
The Change Challenge
Combining service redesign and IT
to transform the NHS
Mark Outhwaite
Director Technologies in Health Group
NHS Modernisation Agency
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Modernisation Agency
Where do we get the benefits?
High
Degree of business
transformation
5. Business scope redefinition
Low
4. Business network redesign
3. Business process redesign
Revolution
In NHS 80% of benefits derived
from process re-engineering
Evolution
2. Internal integration
1. Localised exploitation
Low
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Range of potential benefits
High
Modernisation Agency
www.modern.nhs.uk
SIHI 1 October 2004
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1
Change No1: Treating day surgery (rather than inpatient
surgery) as the norm for elective surgery could release
nearly half a million inpatient bed days each year.
2
Change No2: Improving patient flow across the NHS by
improving access to key diagnostic tests could save 25
million weeks of unnecessary patient waiting time.
3
Change No3: Managing variation in patient discharge,
thereby reducing length of stay, could release 10% of total
bed days for other activity.
4
Change No4: Managing variation in the patient admission
process could cut the 70,000 operations cancelled each year
for non-clinical reasons by 40%.
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5
Change No5: Avoiding unnecessary follow-ups for patients
and providing necessary follow-ups in the right care setting
could save half a million appointments in just Orthopaedics,
ENT, Ophthalmology and Dermatology.
6
Change No6: Increasing the reliability of performing
therapeutic interventions through a Care Bundle approach in
critical care alone could release approximately 14,000 bed
days by reducing length of stay.
7
Change No7: Applying a systematic approach to care for
people with long-term conditions could prevent a quarter of a
million emergency admissions to hospital.
8
Change No8: Improving patient access by reducing the
number of queues could reduce the number of additional
FFCEs required to hit elective access targets by 165,000.
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9
Change No9: Optimising patient flow through service
bottlenecks using process templates could free up to 15-20%
of current capacity to address waiting times.
10
Change No10: Redesigning and extending roles in line with
efficient patient pathways to attract and retain an effective
workforce could free up more than 1,500 WTEs of
GP/consultant time, creating 80,000 extra patient interactions
per week.
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What is the potential?
• enhance the experience of millions of people
who use NHS services
• save millions of:
– hours of clinician time
– appointments in primary and secondary care
– hospital bed days
•
•
•
•
virtually eliminate waiting lists
tangibly improve clinical quality
create enjoyment and pride at work
help NHS organisations achieve local and
national goals and financial balance
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• “Trying harder will not work.
changing systems of care will.”
(Institute of Medicine; 2001)
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The Improvement Dividend Framework
IMPACT ON SERVICE DELIVERY
 faster delivery of care
 unnecessary admissions avoided
 shorter length of stay
 fewer cancellations
 more effective use of existing resources
IMPACT ON PATIENTS
• personalised service
 more control over care
 more co-ordination of care
 better experience
 waiting time reduced
 less anxiety
IMPACT ON OUTCOMES
 fewer readmissions
 reduction in complications and deaths
 speedier recovery
 impact on chronic conditions
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IMPACT ON STAFF
less turnover
 more attractive to potential recruits
 impact on skill mix
 employee satisfaction
 reduce ‘firefighting’
 professional development

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But what about the benefits from IT?
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US evidence on e-prescribing
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A UK Adverse Drug Reactions Study
• ADRs continue to represent a considerable burden
on the NHS, accounting for 1 in 16 hospital
admissions and 4% of the hospital bed capacity
• Most ADRs were predictable from the known
pharmacology of the drugs and many represented
known interactions and are therefore likely to be
preventable.
• Over 2% of patients admitted with an adverse drug
reaction died, suggesting that adverse effects may be
responsible for the death of 0.15% of all patients
admitted
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Adverse drug reactions as cause of admission to hospital: prospective analysis of
18,820 patients. Munir Pirmohamed, Sally James, Shaun Meakin, Chris Green,
Andrew K Scott, Thomas J Walley, Keith Farrar, B Kevin Park, Alasdair M
Breckenridge BMJ VOLUME 329 3 JULY 2004
Modernisation Agency
And that adds up to:
• at any one time the equivalent of up to seven 800
bed hospitals may be occupied by patients admitted
with ADRs
• ADRs causing hospital admission are responsible for
the death of 5700 patients (3800 to 7600) every year.
The true rate of death taking into account all ADRs
(those causing admission, and those occurring while
patients are in hospital) may therefore turn out to be
greater than 10,000 a year
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Results from US research on CPOE
• 53% - 83% reduction in serious medication errors
• The use of decision support for clinical decisions
can also result in major reductions in the rate of
complications associated with antibiotics,and can
decrease costs and the rate of nosocomial
infections.
• Information technology can substantially improve
the safety of medical care by structuring
actions,catching errors, and bringing evidencebased,patient-centered decision support to the
point of care to allow necessary customization.
• But in US Computerised Physician Order Entry
is fully implemented and being actively used in
between only 0.8% and 1.3% of the nation’s
Improving Safety with Information Technology, David W.Bates,M.D.,and Atul
hospitals
A.Gawande,M.D.,M.P.H. N Engl J Med 2003;348:2526-34.
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The Receptive Context
So what are the characteristics of
organisations that get the most out of
IT investment?
Evidence from industry
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Market value
The synergy between investment in
organisational capability and in IT
tal
gi
Di
Or
g.
IT Capital
Erik Brynjolfsson Centre for ebusiness@MIT http://ebusiness.mit.edu
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Seven Practices of
Effective Digital Organisations
• Move from analogue to real-time digital
business processes
– embed standard procedures in technology and
– use IT to manage the enterprise with ‘live’
information
•
•
•
•
•
•
Distribute decision-rights (delegation)
Foster open information flow and access
Link incentives to performance
Maintain and communicate goals
Hire the best people
Continually invest in human capital
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Typical current NHS performance
improvement strategy
• design system to prevent performance failure
• create awareness of targets and performance
requirements
– raise leadership intent to deliver them
• seek to improve the performance of specific
departments, specialties or parts of the system
• work harder
• implement measurement systems to monitor
compliance with the required performance
Source:
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2004
Helen Bevan/Richard Lendon/Institute for Healthcare Improvement 2004
Potential future NHS performance
improvement strategy
Modernisation Agency
• design the system to continuously improve
• take a process view of patient flow across
departmental & organisational boundaries
• focus on bottlenecks that prevent smooth patient
flow
• work smarter by
– segmenting & scheduling patients according to their
specific needs
– managing and reducing causes of variation in patient
flow
• implement measurement systems for improvement
that reveal the true performance of the system and
the impact of any changes made in real time
Source:
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1 OctoberKate
2004
Silvester/Helen Bevan/Richard Lendon/Institute for Healthcare Improvement 2004
Modernisation Agency
Where do we get the benefits?
High
Degree of business
transformation
5. Business
80% of benefits
derived scope
from redefinition
exploitation of IT technology driven change
Low
4. Business network redesign
3. Business process redesign
Evolution
2. Internal integration
1. Localised exploitation
Low
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Revolution
Range of potential benefits
High
Modernisation Agency
Medical informatics is as much about
computers as cardiology is about
stethoscopes… Any attempt to use
information technology will fail dramatically
when the motivation is the application of
technology for its own sake rather than the
solution of clinical problems.
Enrico Coiera (1995)
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