Clinical Pathway Redesign The Route to a Solution

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Clinical Pathway RedesignThe Route to a Solution
The Wakefield Kirklees Health Community
Approach Helen Barker Mid Yorkshire Hospitals
NHS Trust Jim Barwick Kirklees PCT Linda
Driver Wakefield District PCT
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What was our approach?

• In partnership with our 2 main commissioners,
  launched 18 weeks to clinical teams across the
  Local health Community
• Developed a rapid change process for the delivery
  of 18weeks The Route to a Solution
• Worked as a Local Health Community from day 1
  with a clear, agreed programme structure.

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January February March April
May June July August
September October November December
2007
Local initiatives

• Programme structure
• Programme delivery plan agreed

Public and patient involvement
Presentation of Cohort 1 outputs
18 week clinical partnership meeting
18 week clinical partnership meeting
Steering group
Steering group
Steering group
Steering group
Steering group
Steering group
Steering group
Steering group
Steering group
Steering group
Steering group
Cohort 1
Pathway redesign
Cohort 2
Pathway Governance
Cohort 1
Cohort 2
Project support
Project support
Pathway implementation
Cohort 1
Benefit realisation
Cohort 1
System redesign
System redesign
National requirements and initiatives
Tailored support offered to challenged health
economies
Model contract released

• Waiting time standard
• OP, 11 weeks
• Diagnostics, 13 weeks
• IP, 20 weeks

10 care model care pathways release
27 care model care pathways due to be release
Information requirements and performance
management
18 week performance management regime starts
Pioneer sites RTT measurement and service change
Connecting for health strategic solution 1.
Commence reporting on admitted patients RTT
Commence reporting on non admitted patients RTT
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Why?

• Only way to deliver this standard is with
  clinical involvement and ownership
• Standard, for the first time, measures waiting
  times across organisations therefore changes to
  pathways are essential but requires clinical
  expertise
• 18weeks is about improving patients experience
  and not simply achieving a target this is an
  opportunity to put clinical redesign at the
  centre of change and target delivery

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18weeks Delivery Programme
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18weeks Delivery Programme
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What is the Route to a Solution?

• A rapid change programme focussing on clinical
  pathways supported by system change
• Brings together clinicians and managers from
  primary secondary care looking forward not back
  
• 3 meetings - maximum 2hrs each in length over a
  6week period
• 3 cohorts of meetings all specialities covered in
  each cohort over 18months (13programmes of 1 5
  pathways)
• High level pathways 8020 rule applied
• All supported by a LHC governance structure that
  tests benefit sustainability
• Clear feedback loop into further LHC events

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Route to a solution
Meeting one Agree clinical managerial leads
lead organisation What is the objective what
would success look like Describe key elements of
preferred pathway What is appropriate
approach Review current pathway identifying
stages that dont add patient value
Meeting two Describe preferred pathway
Identify location workforce considerations Iden
tify potential bottlenecks
Meeting three Finalise pathway Identify system
change requirements Agree clinical consultation
requirements Prepare presentation to Corporate
Stakeholder Teams
Complete Process 6weeks
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What Happened in Practice

• Route to a Solution

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Issues

• Finding a best fit time
• Getting the message across
• Choosing venues
• Encouraging representation
• Delegate attendance
• Administrative support
• Cynicism

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Positives

• Provides focus
• Primary Secondary Care talking
• Ability to review large no. of pathways
• Focus on the future state
• Raised awareness of 18/52 clock rules
• Momentum

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The Outputs - where are we now?

• 95 cohort 1 commenced
• Over 150 people involved in the RTS meetings from
  all organisations and disciplines over 50 GPs
  Consultants
• Lead manager lead clinician in place for each
  specialty (some combined i.e. Primary care
  manager with secondary care clinician)
• 30 high level pathways under review
• 2nd LHC event scheduled and attendees notified

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The Orthopaedic Specific Outputs Knee Pain

• Developed a shared understanding of the current
  pathway
• Acceptance of importance of MSK services
• Increased use of non medical practitioners
• Increased primary care access to diagnostics
• Recognised of need for triage in primary care
• Recognised the need for information to plan but
  didnt use in first phase of RTS as could have
  limited pathway development
• Principles within outputs transferable across
  majority of Orthopaedics

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Next Steps

• Route to a Solution

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Next steps why?

• To ensure that the positive work with clinicians
  and others is maintained and channelled.
• To ensure that the changes that we can make do
  contribute to achieving and sustaining the 18
  week standard.

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Next steps

• However to get maximum benefit, the outputs need
  to be channelled and progressed in a structured
  way.

• There is a process of assessment against a
  criteria, in no particular order, this is

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Next steps

• Acceptability
• Demonstrable robust governance
• Demonstrate economic viability
• Supports collaborative working
• Promote innovation

• Person focused
• Improves quality outcomes
• Promotes public health
• Contributes to achieving and sustaining 18 weeks

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Next steps

• Create a time limited health economy wide panel
  that reviews the proposed new pathways and
  relevant changes
• Finance
• Planning
• 18 week leads
• HR (re workforce planning)
• IMT

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Next steps

• Review the proposals and appropriates against
  criteria
• At this time the proposal has a sense check in
  order for the panel to agree that the proposal is
  sensible
• Individual organisations would be given the
  opportunity to review initial proposals to agree
  that they fit with strategic the direction of
  that organisation. This would be a quick, simple
  and timely process.

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Next steps

• RTS teams and 18 week leads would ensure that
  business cases where completed to allow proposals
  to be progressed.
• Business cases would then be ratified by each
  organisation
• Business case would then be implemented. A
  performance monitoring process would be
  established to ensure that benefit are realised.
  Changes would also be required to be built into
  SLA.

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Conclusion

• Uses clinical time wisely
• An empowering process for clinical staff
• Identified system redesign issues within the
  process
• Many pathways transferable
• Needs to be supported by a programme structure
• Ensures operational ownership
• High input but high output

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Contact details

• Helen Barker Mid Yorkshire NHS Trust
• helen.barker2_at_midyorks.nhs.uk
• Jim Barwick Kirklees PCT
• jim.barwick_at_kirkleespct.nhs.uk
• Linda Driver Wakefield District PCT
• linda.driver_at_wpct.nhs.uk