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Scheduling - Elaine Kemp National Improvement Lead NHSIQ Domain 3 Presentation from the Productive Endoscopy Workshop, Tuesday 15th October 2013 at Ambassadors Bloomsbury , London, WC1H 0HX This meeting brought together teams from around the country, and embarked on creating and testing the productive endoscopy toolkit. The aim of the day is to allow time with your team for sharing of experiences and exchange of good practice, learn how to apply lean techniques and hear the impact of successfully implemented case studies.
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Scheduling
Elaine Kemp
National Improvement Lead
NHSIQ Domain 3
Scheduling module looks at -
• Improving the flow of information and patients• Reducing errors/delays• Eliminating unnecessary duplication
…… for the patient as well as for ourselves
Today we will take a high level look at –
• The scheduling game – reminder of how scheduling effects flow
• Demand and Capacity – the balancing act
• Utilisation – why it’s important
• Procedure Times – what do we measure and why
• Rework – removing the waste
Does it sometimes feel like this?
The scheduling game
Goal – reminder of the impact scheduling has on patient
flow, individuals within the process and the opportunity to
review current ways of working to reduce waste
• Groups of 5 people on each of the 4 tables
• Each person choose a role/perspective – Patient,
Nurse, Endoscopist, Clerical Staff, Trust Manager
• Read the scenario and create your 1st schedule –
Discussion
• Create your 2nd schedule – Discussion
• Feedback
What is the ideal scheduling process?
• Demand and Capacity
• Utilisation
• Procedure Times
• Rework – removing the waste
What is the ideal scheduling team?
• Multi skilled
• Defined roles
• Trained
• Valued
Demand and Capacity so what? Demand is due to increase DH
Modelling showed 10-15% year on year lower GI increase over 5 years, by 2016
could mean 75%
If you don’t match the amount of work coming in with the actual ability to do the
work what happens?
Demand is not the measure of how much work you do – it’s the measure of how
much work you are being asked to do
Capacity – is this the amount of work you could do, plan to do, schedule or
deliver?
How many points should we schedule?
How many of each procedure should be scheduled?
161
0
329
383
357
372
387
342
397
333
0
171
0
375 378
345
394
377
313
394
340
0
17
0
34
416
32
10 13
32
50
277
0
253
292
264
299290
229
291
277
0
0
50
100
150
200
250
300
350
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450
Baseline
2011/12
Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Ho
urs
Example Trust
Endoscopy Project
Capacity
Demand Actual Capacity Extra Capacity Activity Theoretical Capacity
Demand and Capacity
Top Tips
• Keep it simple to start and keep it consistent• Meaningful, real time, used and displayed• Count it all – inpatients and surveillance• Use your PTL – add a column for points• Policy and procedure - SOP• Predict the predictable – holidays, winter• If your demand is above your capacity be careful of
asking for more resources without checking utilisation• Remember you could reduce demand • Developmental creep – new services• Training and development• Be careful using data – process not people, inclusive,
no surprises
Utilisation
What is the optimum utilisation 80%, 90%, 100%?What do we mean by utilisation?
181
141
94
49
47
42
38
38
35
2624
20 17
5 4
Sessions affected by delaysOn day DNA/CNC
Endoscopist late
Patient unprepared
Slow admission process
Changes to session
Over runs
Cannualtion
Other commitments
Patient information
Courses/Teaching
Waiting for scopes
Sscheduling error
Lack of nursing or BCS
Private activity
Portering delays
Out of 847 sessions - lost 862 hours due to under running and 80 over running
Process Times – What do we measure and why?
Allocate a colour to each step
Process TIME (mins)
Patient booked into Admissions 5
Patient registers in Poplar
Patient gets changed/Toilet 5
Consent 5
Patient taken to ENDOS Suite
OBS checked 5
Procedure undertaken (flexi-sig)** 15
OBS checked 5
Report Completed 5
Scope cleaned & Documented 30
Patient returned to Poplar ward 5
Patient in Recovery(OBS checked etc) 30
Future Mgt and Discharge 5
STAFF MEMBER
Admission Staff
Poplar Nurse
Poplar Nurse
Endoscopy Nurse
Doctor or Nurse specialist
Endoscopy Nurse
Doctor or Nurse specialist
Endoscopy Nurse
Endoscopy Nurse
Endoscopy Nurse
Endoscopy Nurse
Poplar Nurse
Poplar Nurse
Doctor or Nurse specialist
Add a staff member
Red
Yellow
Green
Blue
Green
Blue
Blue
Blue
Blue
Yellow
Green
ID Thurs pm Lists (actual in + out times)1.25 PM 5
1:30 PM 5 Scheduled Time
1:35 PM 5 Waiting in unit
1:40 PM 5 5 Admission Staff
1:45 PM 5 5 Poplar
1:50 PM 20 30 Doctor or Nurse Specialist
1:55 PM Endoscopy Nurse
2:00 PM
2:05 PM 5
2:10 PM 5 5 5
2:15 PM 5 40 5
2:20 PM 5 5 65
2:25 PM 30 30 5 5
2:30 PM 20 5
2:35 PM 100
2:40 PM 5
2:45 PM 5
2:50 PM 5 110
2:55 PM 5 5 5
3:00 PM 5 5
3:05 PM 30 30 20
3:10 PM
3:15 PM
3:20 PM
3:25 PM 5
3:30 PM 5 5
3:35 PM 5 5 5
3:40 PM 30 30 20
3:45 PM
3:50 PM
3:55 PM
4:00 PM 5
4:05 PM 5
4:10 PM 5 5
4:15 PM 30 30 5
4:20 PM 5
4:25 PM 20
4:30 PM
4:35 PM
4:40 PM 5
4:45 PM 5 5 5
4:50 PM 5 20
4:55 PM 5
5:00 PM 30 30
5:05 PM
5:10 PM 5
5:15 PM 5
16/01/2003
Thurs afternoon list- Actual
times ‘in’ & ‘out’ of
Endoscopy room showing wait
times for procedure on unit-
NB this is not procedure time but times
the patient enters and leaves the
procedure room
Removing Waste – rework caused by rescheduling, DNA’s, CNC, rebooking
Do you know what your rework rate is?
A simple calculation how many of the above as a percentage of your activity
Case Study from a Trust - Rework rate of 25%
Identified causes using 5 Why’s
• Patients rescheduling – patients advised by letter of a date, no choice
(particularly the surveillance patients), wrong procedure, redo, abandoned
• DNA’s – patient didn’t understand, incomplete prep, got cold feet, letter not
received in time
• CNC – too short notice, procedure not required, staff or information unavailable
• Schedule – endoscopists alerting the schedule, no notice period enforcement,
other commitments irregular and took priority, adjusting case mix last minute
because of waiting list pressure
• Waiting list initiatives – last minute, clinically staffed no extra admin, not enough
notice for patients, no advantages.
• Urgent demand – rearrange work to allow for 2WW and inpatients
Top Tips
• Review your rework rate occasionally, know your waste rate daily/weekly
• Measure, share, display and act on the information
• Optimum lead in time – 4 weeks
• Access - allow patients choice and ensure opportunity to ask questions
• Phone log/glitch log – who is giving answers about what?
• Regular review of patient information – BY PATIENTS
• Adherence to notice periods and consequence – escalation policy – shared data
• Pooling of lists
• Nurse endoscopists – Consultant endoscopist
• Remove fire fighting – plan 6 weeks ahead recurring
• Use technology – text reminders
• Dig deep for root cause in persistent problems
• Solutions – from other services in your trust or other local endoscopy units
http://www.improvement.nhs.uk
NHS IQ website
NHS Improvement website
If you have a great example let us know …
What scheduling systems are you using and linked to
which unit systems and trust hospital systems?
Link to our website to read the rapid review document :
http://www.improvement.nhs.uk/documents/endoscopyreview.pdf
http://www.nhsiq.nhs.uk/
More Resources
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