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Rivers Building TallaghtOctober 23rd•October 28th•October 29th•
Kilkenny and Cork
October 27th
Limerick and Galway
November 2nd
Mullingar
November 19th
Donegal
November 27th
Kells
December 4th
National Ambulance Service
Strategic Plan
Vision 2020
Staff Focus Group Meetings 2015
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Facilitators: Damien McCallion Martin Dunne Vincent Cronly
Introduction – Damien •
Presentation Vision 2020 Strategic Plan – Vincent •
Discussion Session – Martin •
Session Close – Martin •
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Background
Enables clarity for staff, patients and general public on •direction of ambulance services
Framework for the next 5 Years• - Process running over 12 months – workshops, international literature review - External input sought from >10 key partners including National Patient Forum - Consolidate all reviews and feedback into one single coherent plan
Vision 2020 Steering Group•Acute Hospitals, Primary Care, Quality Improvement, Health & Wellbeing and other key HSE Divisions
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Context for our Strategic Plan•
Our Goals and Objectives•
Draft Implementation Plan•
Vision 2020 Presentation Overview
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Internal HSE Review
Completed mid 2014•Commissioned as a result of •concerns from HIQA to provide assuranceReview team comprised of •senior HSE mgmt outside of NAS
HIQAReview
Completed Dec 2014• Key findings focused on •improving operational performance, effective leadership and mgmt, alternative models of care, DFB relationship and better ownership.
Capacity Review
Completion October 2015• Focused on improving NAS •operational performanceKey will be technology, •dynamic deployment, additional resources and community response.
HR and OD Development
Strategy
Commenced April 2015• Target Q4 2015• Focused on developing a •clear people and organisation strategy
Review ofServices in
Dublin
Target Q4 2015• Jointly commissioned between •HSE & DCCTOR to identify optimal •approach for Dublin
CarndonaghInvestigation
Completed Oct 2014• Initiated as a result of a •tragic death in LGHAmbulance turnaround •framework developed as a consequenceImplementation Group in •place
Fleet & Equipment
Strategy
Commenced May 2015• Target Q4 2015•Focused on ensuring an •appropriate and cohesive fleet plan, systems and structure to 2020
Quality and Patient
Safety Plan
Commenced Q4 2014•
QIP developed to improve •quality and safety of services
Service Reviews and Plans
Key Challenges
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Improve quality and patient safety systems, such as clinical audit•
Improve performance through dynamic deployment, single dispatch •centre, and focus on patient outcomes
Improve service in Dublin with Dublin Fire Brigade•
Develop and implement new models of care•
Ensure organisation is modern and fit for purpose•
Address manpower challenges to increase staffing in key areas•
Integrate ICT Systems•
Modernise fleet, infrastructure & control systems•
Improve our approach to patient engagement•
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SWOT Analysis – NAS Vision 2020
Strengths
Statutory service provider Patient centred services Professional, skilled and motivated workforce External accreditation of staff and systems competencies Experiencedconsultant teams utilisedfor key specialists subjects Enthusiastic workforce c ommitted to improving patient centred services High vehicles, equipment and technologyinvestment Financial balance consistentl ydelivered Good relationships with stakeholder organisations Innovativeand dynamic in our drive for continuous improvement Increasing community involvement
Weaknesses
Patient, public and stakeholder engagement Variations in service delivery Inconsistentresponse targets Often over-stretched resources Need to continue to find recurring cost savings year on year Limited clinical audit
Opportunities
Improvingnational fiscal position Development of national integrated care programmes Improved governance, management and leadership arrangements Increased capacitybased on review recommendations Involvement of staff, public, patients and stakeholders in service development An open learni ng environment Increasing pace of change in clinical practice Promotion of innovation, research and education Staff development through implementation of new systems and processes New systems to provide a more efficient and effective service to patients Improved busi ness continuity / resilience
Threats
Strategy dependent on additional funding Funding not keepi ng pace with demand Workforce/recruitment constraints – competition from other providers Lack of resources may inhi bit future service delivery/growth Stakeholder resistance to change Setting of unattainable targets Individual workload Unpredictableservice demandsmay impact on implementation timescales Future politicalchanges may significantly influence delivery priorities Non implementation of review recommendations (HIQA, PHECC, Lightfoot)
Emerging and International Trends in Pre-Hospital Emergency Care
Increasing demand at 3-5% per annum.•
Developing alternative Models of Care:•Hear and treat call in Emergency Operation Centre – “low acuity”–Alternative destinations for patients other than ED – minor treatment centres–Treat and discharge patients where hospitalisation not required–Care Bundles for specific groups of patients–
Integrating within the broader health care system; Emergency •and Urgent Care with hospitals and primary care
Infrastructure investment and development – technology driven •performance improvements in response times
Leadership & workforce development (inc. paramedic shortfalls)•
Moving from single target focus on time based targets to broader •set of measures focusing on outcomes
Use of dynamic deployment to improve response times•
Use of Community First Responder Schemes in rural areas•
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Sets out the HSE goals to improve the health service which are incorporated within the National Services Planning process
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Our Strategic Goals
What we will do
Play an active role in improving population health needsEngage with Health and Wellbeing community promotion programmes•Participate in the delivery of community based educational/ training •programmesDevelop and implement a public information campaign – appropriate use of •112/999 and use of alternative care pathways
Ensure a prevention focused approach to staff health and wellbeingImplement the Health Ireland Framework within the NAS•Review NAS policies, procedures and practices to maintain staff safety and •welfareImprove occupational health support to NAS•
Our Goals, Objectives and Projects
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Goal 1Promote Health & Wellbeing as part of everything we do so that
our patients and staff will be healthier
What we will do
Improve quality of care and patient safetyImplement an electronic patient care record (ePCR)•Introduce additional clinical performance measures•Develop and implement clinical support capacity•
Develop alternative models of careImplementation of Hear and Treat in NEOC•Establish and agree basis for handling routine activity•Implement paramedic treat and discharge protocols•
Seamless, responsive and safe service in Dublin regionImplement recommendations of the review group•
Improve operational performanceImplement real-time performance and quality dashboard•Improve ambulance turnaround performance•Implement additional capacity•Optimise the location of ambulance resources•Expand national linked Community First Responder schemes •Expand retrieval services •
Goal 2Provide fair, equitable and timely access to quality, safe
emergency services that people need
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Our Goals, Objectives and Projects
What we will do
Improve our engagement with patients and service usersDevelop and implement a Patient and Service User Engagement Strategy•Implement a NAS patient forum•
Become more transparent and open with our patients, the public and staffContinue implementation of the HSE Open Disclosure National Policy – near & adverse advents•Continue implementation of the National Standards for Safer Better Healthcare•Implement the National Incident Management System and Complaints & Compliments •Management SystemCarry out an annual staff survey & implement an annual action plan on feedback•Strengthen leadership capacity to manage change – facilitative management style•
Goal 3Foster a culture that is honest, compassionate, transparent
and accountable
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Our Goals, Objectives and Projects
What we will do
Engage with and involve our staff in the provision of serviceImplementation of the ‘Public Health Services People Strategy’•Develop an annual communications plan that includes focus on staff•Provide clinical services ‘web’ and email access to NAS staff•
Strengthen NAS leadership, workforce and governance structuresImplementation of NAS Human Resources and Organisational Development Strategy•Embed formal staff and managers performance management system•Implement recommendations of the Management Structure Review•Implement a management training and development programme•
Provide a high quality, competent workforce to meet our model of patient careImplement a comprehensive workforce plan•Increase staff numbers to meet international norms•Implementation of a comprehensive education and competency assurance plan •3rd level educational programme for paramedics•Regular review of staff development needs•
Goal 4Engage, develop and value our workforce to deliver the best possible emergency care and services to the people who depend on them
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Our Goals, Objectives and Projects
What we will do
Ensure that NAS fleet and equipment is appropriate for useImplement recommendations of the NAS fleet and equipment strategy•
Ensure that NAS has effective infrastructure Review NAS deployment points•Carry out a fit-for-purpose review of current and future NAS estate requirements•Commence estate upgrade and new build programme•
Improve our service efficiencies and effectiveness through the use of technology enabled solutions
Develop NAS eHealth strategy•Continue the development of the NAS CAD system•Continue the introduction of mobile data terminals and navigation tool•Implement a single national rostering/time (CORE) system•Implement NAS payroll system•
Goal 5Manage resources in a way that delivers best health outcomes,
improves people’s experience of using our services and demonstrates value for money
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Our Goals, Objectives and Projects
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Implementation Plan
Implementation is subject to:
Completion of Reviews, Strategies and Plans•
Service Planning and Funding Dependent across the lifetime •of the strategic plan
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Sample Implementation PlanGoal Objective Project Start Finish Lead National Standards for Safer
Better Healthcare
Goal 2
Provide fair, equitable and timely access to quality, safe emergency pre-hospital services that people need
2.1 Enhance clinical competencies and governance arrangements to improve quality of care and patient safety
2.1.1 Implement an Electronic Patient Care Record (ePCR) Q1 2016 Q4 2017
N ASMedical Director
2.1.2 Introduce additional Clinical Performance Measures Q1 2017 Q4 20202.6
2.1.3 Develop and implement a clinical support capacity Q1 2017 Q4 2018
2.2 Develop alternative models of care to ensure that patients are directed to or taken to the appropriate location for treatment
2.2.1 Develop and implement Alternative Care Pathways :- Implement Hear and Treat by setting up a clinical support
desk in the NAS National Emergency Operations Centre Q1 2016 Q4 2016 Care is provided through a model of service designed
to deliver high quality, safe and r eliable healthcare.
- Work with partners to establish an agreed basis for handling routine activity with improved utilisation of ICV’s Q2 2016 Q4 2016
- Implement Alternative Patient Destinations Model Q3 2017 Q4 2019
- Treat and Discharge / See and TreatImplement paramedic treat and discharge protocols Q3 2017 Q4 2018
2.3 Ensure a seamless, responsive and safe emergency ambulance service in the Dublin region
2.3.1 Assume res ponsibility for the integrated call tak ing and dispatching ofall emergency ambulance in Dublin Q2 2016 Q4 2016 Director NAS
2.3.2 Implement recommendations of the review of services in Dublin Q1 2016 Q4 2016 National
Director NAS
2.4 Foster a culture of strong performance management to improve operational performance
2.4.1 Implement a real-time Performance and Quality Dashboard Q1 2016 Q2 2017
Director NAS2.4.2 Develop a balanced set of meas ure for emergency ambulance service between response times and patient outcome meas ures
Q1 2016 Q4 2016
2.4.3 Improve performance in the NAS NEOC through implementation of Capacity Review recommendations Q1 2016 Q4 2019
NAS HR Manager2.4.4 Improve response times in urban areas with the recruitment
of additional staff Q3 2016 Q4 2020
2.4.5 Improve performance for ambulance turnaround times with ac ute hospital division and ensure safe handov er of patients Q2 2016 Q4 2016
National Director NAS
2.4.6 Optimise the Location of Ambulance Resources
Director NAS
- Fixed Locations Q2 2016 Q4 2016- Implement recommended Dynamic Deployment Points to
both minor and major urban areas Q1 2017 Q4 2018
2.4.7 Ex pand the number of linked Community First Responder Sc hemes as recommended by the Capacity Review Q1 2016 Q4 2020
2.4.8 Ex pansion of the Paediatric Retriev al Service Q1 2016 Q4 2020
2.4.9 Ex pansion of Adult Retrieval Servic e Q1 2016 Q4 2020
2.4.10 Develop Aero Medical Services Q1 2016 Q4 2020
2.4.11 Assis ting in the delivery of dedicated children’s ambulance service for routine, urgent and end of life journeys
Q1 2016 Q4 2020
Survey
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Consultation Feedback To DateSurvey Suggested Areas of Improvement
Improve Staff Health and Wellbeing
Develop Rosters
Introduce Deployment Points
Introduce Alternative Care Pathways
Introduce Patient / Public Relations/Education
Improve Management / Staff Engagement
Improve Clinical Supervision / Audit
Improve Staff Training & Development
Improved Fleet and Equipment
Introduce Management 24Hr Cover
Increase Staffing Levels
Improve relationship between Control and Operations
Station Upgrade
Improve operations with Dublin Service (DFB)
Next Steps
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ReviewQuestionnaire Feedback
and
Feedback from External Stakeholders
Review of Services
in Dublin
Fleet & Equipment
Review
HR and OD Development
Plan
Capacity Review
Open Forum Discussion
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