10 High Impact Changes

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10 High Impact Changes

• For Service Improvement
• and Delivery
• NHS Modernisation Agency, September 2004

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United Kingdom(England, Scotland, Wales,
Northern Ireland)

• Population 59.6 million (2003)
• Public expenditure on Health
• England 80 Wales 6
• Scotland 11 Northern Ireland 3
• Department of Health
• Sets overall policies on health issues
• Is responsible for managing the NHS

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NHS in England
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NHS Modernisation Agency

• Comprised of 8 teams of individuals
• Goal To help clinicians and managers across the
  NHS to improve the quality of their services
• Three Guiding Principals for Change
• Patient-centered service
• Evidence-based management
• Systems view

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2 KEY QUESTIONS

• Which service redesign improvements will make the
  biggest difference?
• What (quantifiable) benefits can potentially be
  achieved through modernisation?
• The PCT Guide to Applying the 10 High Impact
  Changes

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10 High Impact Changesfor Service Improvement
and Delivery (2004)

• MA worked with thousands of clinical teams to
  identify needed changes to improve the delivery
  of health care service
• Identified and audited best practice advice from
  clinical teams over a 3 year period
• Aimed at Senior NHS leaders
• How to use the 10 High Impact Changes?

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www.modern.nhs.uk/highimpactchanges

• Other pages in this section
• Feedback form
• Related Links
• Links to resources
•  Case studies
•  Toolkits or Guides
•  Reports
•  Assumptions
• Download Document

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Typical Performance Improvement Strategy

• Design the system to prevent failure
• Create awareness of targets and performance
  requirements
• Seek to improve performance of various parts of
  the system
• Work harder
• Implement measurement systems to monitor
  compliance with the required performance

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Potential Performance Improvement Strategy

• Design the system to continuously improve
• Take a process view of patient flow
• Work smarter
• Focus on bottlenecks in patient flow
• Manage and reduce causes of variation in flow
• Segment patients according to specific needs
• Implement measurement systems that measure true
  performance in the system and the impact of
  changes

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Change No. 1

• Treat day surgery
• (rather than
• inpatient surgery)
• as the norm for
• elective surgery

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Change No. 2

• Improve
• patient flow
• across the whole
• NHS system
• by improving
• access to
• key diagnostic tests

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Change No. 3

• Manage variation in
• patient discharge
• thereby reducing
• length of stay

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Change No. 4

• Manage variation
• in the
• patient admission
• process

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Change No. 5

• Avoid unnecessary
• follow-ups
• for patients
• and provide
• necessary
• follow-ups in the
• right care setting

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Change No. 6

• Increase the reliability
• of performing
• therapeutic
• interventions
• through a
• Care Bundle approach

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Change No. 7

• Apply a
• systematic approach
• to care for people
• with long-term
• conditions

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Change No. 8

• Improve
• patient access
• by reducing
• the number of
• queues

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Change No. 9

• Optimise patient
• flow through
• service bottlenecks
• using
• process templates

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Change No. 10

• Redesign and
• extend roles
• in line with
• efficient
• patient pathways
• to attract and retain
• an effective workforce

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Potential Implementation Framework
Strategic Aims
Measurable Goals
Stay in Business Goals
10 High Impact Changes
Assess Service Improvement