Getting the best ‘value for money’ from your

Emergency Dept – What should we aspire to deliver!?

Dr Taj Hassan

Twitter : @RCEMpresident

OBJECTIVES

Where we are?

Where we need to be?

How to get there ?

Elephants in the room!

Demand Complexity Staffing …. Money! Shared values

Collaboration Culture System leadership

Emergency care system performance

May 2017 Priorities for the next government

X X Understanding what it means to work in an ED with <80%

System performance

97.70% 97.00%

94.70% 94.80% 95.60% 95.90%

94.50% 93.70%

94.90% 95.40%

93.50%

91.10%

93.40% 94.40%

93.50% 92.70% 92.60% 92.50%

88.90%

87.50%

91.10% 91.40%

87.40%

81.80%

85.40% 85.90%

81.90% 81.40%

75%

80%

85%

90%

95%

100%

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

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2010-11- - -2011-12- - -2012-13- - -2013-14- - -2014-15- - -2015-16- - -2016-17- -

Type 1 Attendances, Admissions and Four Hour Standard Quarterly Performance 2010 - 11 to 2016-17

Type 1 Departments - Major A&E Emergency Admissions via Type 1 A&E

Percentage in 4 hours or less (type 1)

STAFFING A paradigm change in EM

ED Staffing levels Senior Decision makers (SDMs) in ED – what do

they do? • Command & Control

• Team Leader Resus Room

• Senior sign off /supervise juniors

• RAT function

• CDU/ Ambulatory care

• ‘Queue bust’ ( balancing risk)

FY1/2

SAS

EM CT1-3

Phy Associates

Adv Care Practitioners

Clin Devpm Fellows MTI

CESR

ST4-6

Consultant EM with“depth & breadth”

delivery models of 1-4 Cons on shift - depending upon

demand

EM workforce planning

ENPs

ATTRACT RECRUIT RETAIN

GP CT1-3s

Senior Decision Maker Junior Clinical Workforce

Specialty Doctor

MTC or equivalent

Mid sized system

Small / Remote & Rural

Sustainable & tailored workforce planning for ED

Understanding the terminology

Career burnout

Compassion fatigue

Wellbeing

Resilience

Sustainability & satisfaction in workplace

• RCEM strategy

• DH / NHSI / NHSE

• BMA

• HEE

Systems • Front end design

• Virtual & physical co-location

• Resourced ‘streaming’

• Optimal gatekeeping with AEC & CDUs

Complex & confusing nomenclature / signage for patients!

System Quality Indicators Redirection, Hubs & Co-location, wider system resilience

Tailored cost effective solutions Eg primary care streaming for 10-15% of patients at ED

6. System resilience

• Supporting funding for wider system ( social care) – Kings Fund data on GDP

• More acute care bed base ( OECD on beds)

• Strategy for elderly & frail

• Will address exit block & crowding

Making STPs work!!!

• Focus on quality care for patients • Involve the clinical experts • Get economists in to help • Supporting networked solutions • Remote & Rural strategy

• LEARN THE LESSONS OF HISTORY!!!

Elephants in the room!

Shared values

Collaboration

Culture

System leadership

Influencing politicians & policy makers!

Building bridges & alliances

• Social care funding • Acute care beds • Staffing – short term • & MEDIUM TERM SOLUTIONS :

RCEMVision2020

System leadership

“ Management is about

coping with complexity.

Leadership is about coping

with change….”

John Kotter

Valuing training

The future ( present!)

Artificial Intelligence & decision support IT & Big data Education and training using AR / VR tech

Getting the best ‘value for money’ from your

Emergency Dept – What should we aspire to deliver!?