Action On ENT Audiology and Balance

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Action On ENT Audiology and Balance
Phil James National Audiology and Balance
Programme Lead Previous life Head of Hearing
Services, Sunderland
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Have I Got News For You!

• Thirtyish minutes to tell you
• How we identified a need and why we developed the
  bid
• What it was like to be a site
• What we learnt
• What one should think about re change
• Whats been happening in Action On land

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Our bid why?

• We knew that there was a need for
  change/improvement because
• Qualified staff were leaving
• Recruitment issues
• Waiting lists and waiting times on the up
• Had just become 1st wave MHAS

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Before improvements/changes could be made, we
needed to understand what was happening in our
own back yard!

• Half the time, we dont know whats going on in
  our own departments
• so, if we didnt understand, why, how, should
  we expect others too!

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The Need to Understand the Process Communicate

• The patient is the focus dont forget it!
• The patient is different to different people
• When communication is poor, the patient suffers
• When communication is poor, queues bottlenecks
  will occur

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Process mapping
Illustrates the part(s) of the process that are
vulnerable it exposes the
WEAKEST LINK!
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Redesign

• See things through patients eyes
• Find a better way of doing things
• Look at the whole picture
• Give front line staff time, tools and techniques
  to tackle problems
• Take small steps as well as large leaps

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PDSA cycles
Plan Do Study Act
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PLAN
ACT
DO
STUDY
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Redesign
Innovate Innovators Think out the box!
Field test, evaluate learn
Pass on To build capability in healthcare
does it work PDSA cycles
New ideas
Spread
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viewed the Service as a whole
So we.

• Process mapped the patient journey
• Acted on the results
• Audiologists doing non audiologist things
• Need for an assistant role
• Need for increased clerical
• Areas of work could be done by an audiologist
  that was being done by a medic

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cunning plan
Action On ENT (to the rescue)
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Audiology Assistant Practitioner Project

• Questions we asked ourselves
• Is it possible
• Is it innovative and creative
• Can it be evaluated and how
• If successful, would it be threatening to others
• Could it be spread
• Could it be sustained after the comfort of the
  project
• How much dosh should we ask for

• WILL THEY BUY IT!!

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When we developed our Action On bid, did we think
about
Getting it in on time
Evaluation
Service improvements
The Patient
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All of the above!

• But more so, we geared the bid towards
• being closely aligned with achievement of NHS
  Plan targets
• benefiting the patient
• reducing waiting times and improving access to
  the service we provided
• ensuring that the service remains focused on the
  needs of individual patients Best Value
• the ability to eventually sharing good
  organisational practice throughout the specialty

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Being a pilot site what it was like!

• Part of the Action On team being able to share
  best practice
• Creating change in a non threatening,
  supportive environment
• Trailblazer
• Being innovative, and being funded tboot

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What we learnt

• Communication is the key regular meetings with
  key stakeholders
• Tools techs invaluable
• Teamwork rules
• Listen to patients views
• Understand what is to be evaluated from the start
• Plan how it is going to be evaluated

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If you always do what you always have done,

• you will always get what you always have got

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Creative thinking

• Dont be stuck in the past move forward

• Be innovative

• Try new ideas

• Think out of the box

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What have others done/doing?
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Target areas.

• Booked appointments
• Capacity and Demand analysis
• Extending the role of the Audiologist
• - Audiology led grommet follow ups
• - Wax management
• - Changing referral patterns
• The role of the Assistant
• Hearing aid group instruction

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Examples of change ideas redesign developed
from process mapping

• Standard Referral forms for all referring
  agencies - Faxed in (Kettering)
• Arranging for staff to remove wax (Leicester)
• Triage GP letters pre ENT for audiograms
  (Newcastle/Sunderland)

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Leicester Audiology

• Mapping the Process direct referrals
• 86 steps were identified
• 18 steps gave patient value
• Outcomes
• Non compliant referrals into ENT
• Identified that theres a need for Audiologists
  to remove wax
• Need for an electronic management system

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Blackburn Audiology

• Audiology led grommet follow ups
• Significant benefits
• Friendly times for appointments
• Less waiting in hospital
• Estimated that 450 ENT slots have been released
• ..much better system, no waiting around and so
  children dont get irritable. Congratulations
• Parent attending audiology

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Crewe/Gloucester Audiology

• Group hearing aid instruction

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National Survey

• Survey sent to 257 audiology depts
• 152 responded

• Asked the patients subjected to this heathen
  approach!

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Staff survey comment
Patient results
There is not enough space to see people in
groups
Very true - need to think of alternative venues
Confidentiality will be compromised
Patients were given the choice to be seen in a
group
98 of patients said they were able to ask
questions
Patients wont be able to ask questions in a
group
Patients cant hear in a group situation
100 of patients said they could hear in the
group
NO patients said they were uncomfortable in a
group
Patients dont like being seen in groups
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Some of Audiologists comments
accommodation is a problem
not responding to patients needs
patients have a rights to privacy dignity
what a retrograde step this would be
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Some patients comments
I felt I was not alone with my hearing problem
the atmosphere was really relaxed
it's a pity that all the NHS isn't this good
an excellent idea, keep it up
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More patients comments
I enjoyed the company
being in a group saves the embarassment - I
enjoyed it very much
a most rewarding experience
I was very comfortable and at ease
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What about the staff...

• Focus groups at Crewe and Cheltenham

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and from pilot sites
....I'm a total convert
I feel that patients really benefit
I was giving more - more of myself
The atmosphere is good - you notice when you take
the tea in
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Preliminary Findings/Impacts

• Shorter waits
• Improved access
• Patient satisfaction
• Less daunting

Patients
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Preliminary Findings/Impacts

• More appropriate use of time
• Relieves pressure on clinics
• Greater job satisfaction
• Opportunity to try new ideas

Audiologists
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Lessons Learned

• Strong commitment from Head of Service and
  Business Managers is needed to develop roles and
  redesign services
• It is important to work out early the resources
  required and make the necessary business case

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Lessons Learned

• There is rarely a quick fix
• Good communication is often the key to success
• We need to develop close working relationships
  between the various projects in audiology
• Share and share alike

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Throughout the pilots weve concentrated on

• M anagement
• O verview
• D evelopment
• E valuation
• R espect
• N HS plan
• I nvest/Involvement
• S haring
• A ction
• T eamwork
• I nspiration/Information
• O ptimism
• N egotiate

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www.modern.nhs.uk/action-on/ENT