Business planning for Clinical Librarian

Services

Jacqui LeMay Head of Knowledge Services

University Hospitals of Coventry and Warwickshire NHS Trust

SHINE Study Day

Aberdeen

21st March 2013

“Never in any hospital that I have worked in,

has somebody worked so hard to come up with

the best available evidence.”

Doing your homework

• Know your audience

• Know the process

• Scope and learn the drivers

• Do your background research – what IS the evidence?

• Network for example BCs

• Pilot interest, find your champions, use them.

• Be prepared for a fight!

Approval ProcessStage 1:

This will consist of a brief submission with input from appropriate clinicians and managers from within the Division/Core Department … approved by the appropriate Executive Director, normally the Chief Operating Officer, and copied to the Head of Business Planning for including on the business case log

Briefing paper: BACKGROUND

• Current arrangements• Drivers for change

SWOTBRIEF DESCRIPTION OF PROPOSED CHANGEBENEFITSANTICIPATED IMPACTLEVEL OF DISCUSSION AND SUPPORTANTICIPATED COSTS

Stage 2: Following approval - a more detailed business case. SERVICE TO BE PROVIDED THE CASE FOR CHANGE

• Current Provision• Strategic Context• Drivers for Change – Gap between current position and strategic

need • Option Appraisal

DESCRIPTION OF PROPOSED CHANGE• Non Clinical Impact• Objectives/Benefits• Stakeholder Impact

RESOURCE CONSEQUENCES ( Costs, Pay, Non pay and Capital)• Funding of Start Up Costs• Sources and Value of Funding/Income• Costs v Funding

IMPLEMENTATION PLAN RISK ANALYSIS / CONTINGENCY PLAN FOR PREFERRED OPTION MONITORING/EVALUATION EXIT STRATEGY

Speaking the right language?

Q1What strategic drivers would you use to IMPACT the need for your Trust to approve your business case?

Q1:Drivers – themes to document evidence• Demonstrates the use of evidence based practice• Supports quality patient safety agenda• Facilitates education• Promotes a reflective organisational culture dedicated to

improvement and shared learning• Empowers patient choice• Provides a systematic and comprehensive model in achieving

quality patient care.• Contribution to achievement of national healthcare standards and

performance indicators• Contribution to the achievement of Trust Foundation status• Demonstrates compliance with National quality drivers

Q1:Drivers: make it visual

Political Factors

Economic Factors

Technological Factors

Sociocultural Factors

REPORTS: DARZI, HILL, TOOKE STANDARDS: NSF QUALITY IMPROVEMENT, NHS QUALITY ASSURANCE ASSESSMENTS.VISION: NHS CONSTITUTION, FOUNDATION STATUS, INNOVATION, EVIDENCE BASED PRODUCTIVITY

Healthcare Commission Assessment Based Indicators*Foundation statusHospital length of stay and outpatient waiting timesLitigation against TrustNegative publicity/bad reputation/loss of income from Patient ChoiceProduct marketability

Patient satisfactionJoint working for common goalLifelong Learning Evidence based and reflective organisational culture

System development

Q2

• How much would it cost? Provide a breakdown of set up and recurrent cost implications for the Trust.

Q2: Cost:• Revenue – recurrent: Pay

• Capital – one off: Non-pay

• Other considerations

• Increased costs:

– ILLs

– Administration time

– Administration resources

– Resource expectation

• Increased income

– Departmental accounts

Clinical Query: Outcome Cost saving

Does the use of local anaesthesia in vitreoretinal surgery compromise the patient?

There was no evidence of compromise to surgical outcome or patient safety. Change from 80% GA to 80% LA procedures.

£140,000 p.a.

Do patients with anaemia treated with Desferrioxamine require routine medical retina follow-up?

Evidence review found no value in routine follow up of these patients. 

Saving 50 outpatients appointments p.a.£5,500

Patient (2) specific queries relating to challenging viral retinitis and fungal endophthalmitis

Rapid review of patient management, therapy and discharge saving on lengthy inpatient stays.

£6, 356 (based on 2 weeks stay only)

Is it necessary for patients to withdraw aspirin use prior to oculoplastic surgical procedures?

Evidence highlighted that it was not detrimental to patients to continue their aspirin therapy for a range of oculoplastic surgical procedures.

Reduction in surgical waiting times.Facilitated use of short notice surgical cancellations.Shortened length of pre-operative assessments.

Is it safe for patients with intraocular gas tamponades to travel by air following vitreoretinal surgery?

Evidence showed that it was not safe for patients to undertake any activities at high altitude or to receive nitrous oxide anaesthesia

Work with the VR Evidence in Practice Group resulted in patients leaving theatre with a warning wristband. The wristband is now provided by BOC on the purchase of intraocular gas internationally and the team achieved a National Award for Evidence in Practice.

Q3

How does your business proposal stand up against other

options for the implementation of evidence based practice?

– Option appraisal

– See handouts

Q4

What outcome measures would you use to demonstrate the clinical and non-clinical impact your service would bring to your Trust?

Outcome measures• Changed intended practice

– choice of diagnostic test

– choice of therapy

– choice of procedure

• Confirmed meeting best practice

• Confirmed lack of evidence

• Changed prognosis

• Avoided unnecessary

– referral

– outpatient appointment

• Shortened

– hospital length of stay

– waiting time to treatment

• Prevention– Risk– Complaint– Morbidity– Mortality

• Corporate– Change in service delivery– Cost saving– Change in Care Pathway– Guideline development– Audit– Research– Legal investigation– Knowledge base

Do not give in or give up• First attempt 2005

• Second attempt

– BC document stage 1 approval process (June 2009)

– BC document stage 2 – Trust Board (December 2009)

– Seeking Divisional Funding (December 2009 – April 2010)

– Recruitment process (May – October 2010)

– BC Evaluation Meeting (July 2011)

– CEBIS System (December 2009 – February 2013)

Any Questions?

Thank you

Jacqui LeMay

Tel: 02476 968838

E-mail: jacqui.lemay@uhcw.nhs.uk