09.10.11
There’s still time!
Even with 18 weeks looming, it’s not too late to apply service transformation approaches to the challenge
So, two months into the year, how is your New Year’s resolution holding up? Was its something you’ve been meaning to do for ages? Did it start well? Is it still going well?
For the NHS, the 18 week wait isn’t new for this year. We’ve known about it since June 2004, back when December 2008 seemed a long way off. But now it is less than a year away and the urgency is definitely with us. But when we do make it, how good are we going to be at sustaining it?
Because of its proximity, it may well feel that it’s too late to approach the issue as one of service transformation and that, instead, the next few months are going to be full of waiting list initiatives, pushing patients through the system and fighting against breaches. However, getting the necessary quick wins and being pragmatic about timescales is not necessarily incompatible with the longer view of redesigning pathways to ease the flow of patients.
For example, South Devon Healthcare NHS Foundation Trust, an 18 week early achiever site and No Delays Ambassador Trust, have made capacity available for service improvement and redesign work in their gynaecology service even in the face of the pressing timescale. They used the No Delays Achiever to understand where to target their service improvement activity, specifically the need to reduce delays experienced by patients between decision to treat and first definitive treatment. Service improvements that have paralleled increased activity include introducing flexible sessions for consultants, training GPs to manage some patients in primary care, performing more procedures as day cases and in outpatient settings and setting up one-stop clinics for continence. In all, their gynaecology pathway was cut almost in half over six months.
Whatever stage staff are at with a particular service transformation effort, it’s never too late to apply some simple golden rules that can ease flow and performance without necessarily requiring extra resources. It could be pooling similar work and sharing staff resources, planning ahead to reduce the number of different journeys a patient has to come to the hospital for different tests or by reducing the batching of administrative tasks. The last one can sometimes seem counter-intuitive to our traditional ways of working, but batching causes variation and variation is the enemy of smooth patient flow. You can learn about these and other principles in Seven Ways to No Delays available soon from the NHS Institute.
For commissioners, the world beyond 18 weeks is one that will enable them to move from purchasing activity and stages of treatment to shaping the whole patient journey. The ability to perceive and intervene across the whole patient pathway is one of the bedrock capabilities demanded by world class commissioning and increasingly significant in a world of multiple providers and patient choice. How, for example, does a commissioner balance the needs of planning for the best pathway, managing a semi-competitive market and giving patients what they want, when and where they choose it? The answers aren’t easy ones, but tools from the NHS Institute including Commissioning for Patient Pathways can help by creating a structured approach to commissioning planned care pathway with these and many other factors in mind. This year will also see the continued growing influence of practice based commissioning and from this month there will be a specific function on the No Delays Achiever that will allow GPs to select their PBC grouping and examining their patient data through the 18 week journey.
So, whatever you’re trying to achieve – get fit, stop smoking, or hit 18 weeks – 2008 is the year to do it. Just make sure you do it in a way you can sustain.
Julia R A Taylor is No Delays Priority Programme director at the NHS Institute for Innovation & Improvement
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