Benefits of Endoscopy Service Improvement

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Benefits of Endoscopy Service Improvement

• Liz Allan
• National Endoscopy Manager

Wakefield 04/03/05
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What would a modern endoscopy service look
like?

• a service that you or your relatives would be
  happy to access

a patient-centred service
a service that staff enjoy working in and
functions efficiently
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Modernisation background
2000 2001 2002 2003 2004 2005
Preliminary work
1st wave sites (8)
Bolton Winchester
(6)
2nd wave sites (26)
Experience from other MA projects Industry
Endoscopy Toolkit
Independent sites (?)
SHA clinical leads (28)
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Modernising Endoscopy Services Endoscopy toolkit
- a practical guide to redesign

• Challenge 1
• Identify Strategic and Clinical Leadership
• Challenge 2
• Understand the current service
• Challenge 3
• See the service through patients eyes
• Challenge 4
• Be clear about actual capacity

Clinical lead Trust board and operational
support
Map processes
Information Access consent
Data
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Modernising Endoscopy Services Endoscopy toolkit
- a practical guide to redesign

• Challenge 5
• Understand existing backlog
• Challenge 6
• Be clear about actual demand
• Challenge 7
• Use activity to identify trends
• Challenge 8
• Promote new ways of working

Data
Data
Even more data
Skill mix Role redesign
www.modern.nhs.uk/endoscopy
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Patients experience of endoscopy

• The staff are fantastic!
• But..
• Long waits
• Poor /badly written information
• Grotty surroundings
• Lack of privacy dignity

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Staff experience of endoscopy

• Low morale
• Under funded
• Inefficient

• Stressful
• Understaffed
• Disorganised
• Can't see the wood for the trees

Endoscopy feels bottom of the pile in terms of
trust priorities
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Examples Of Patient Identified Changesfrom
Endoscopy pilot Sites

• Privacy and dignity- redesigned theatre gowns,
  curtains installed and quiet room created
• Patient information Either created or
• re-written in plain English
• Reducing waits in unit by staggering patient
  appointments instead of block booking

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Privacy and dignity

• Monthly essence of care meetings
• admit/discharge in separate office
• patient undressed just prior to procedure
• patient asked about observers
• staff in and out of room minimised
• relatives discouraged from recovery area

EN Herts, second wave pilot
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Using Scheduling to reduce waits
Longest wait 1 hr 05 minutes
Longest wait 55 minutes
Hinchingbrooke Health Care
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Effect of IP liaison nurse visits on completion
of IP colonoscopy
Mayday, second wave pilot
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• The single most important thing is good data.
• data turns into a credible argument.
• a credible argument turns into change

clinical lead, second wave pilot site
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Improving patient experience by tackling
capacity and demand
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2nd wave pilot sites - outcomes
Active Waiting List aggregate data
27 reduction in Active waiting lists
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Active and planned waiting lists Percentage
change between Sept-02 Dec-03
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York Tackling waiting lists
80 of patients waiting
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St James Hospital Leeds
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Tackling DNAs - Mayday
Phone system introduced
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Cancellations
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Cancellations
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Effective use of capacity
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Which strategies were most helpful?

• Involvement of the department itself and the
  clinical lead who has taken a very active role in
  the project

Darent Valley Project feedback
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Patients view of endoscopy

• The staff are still fantastic!
• And ..
• Waits have been reduced
• Information has been rewritten
• Infrastructure improved
• Privacy dignity enhanced

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Staff view of endoscopy

• there are problems but they can be resolved

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The National Endoscopy Team

• Web site www.modern.nhs.uk/endoscopy
• Enquiries endoscopy.enquiries_at_modern.nhs.uk