Assistive Technology Services:Wheelchairs & Seating

‘Sharing the Learning’Glasgow 2009

Report on

Rapid Improvement EventApril 2008

NHS Tayside

Rapid Improvement Event April 2008

• Background• Scope / objectives• Actions, results, improvements• Future work / sustainability

–RIE–National Wheelchair Project

• Reflections on RIE / AT service• Thanks• Comments / questions

Background

• Waiting times out of control• Poor information to users• Service user complaints• Old wheelchairs• Staff morale low• Etc

End of CCSF fundsShort term SG waiting list fundsAgenda for change

Scope of the RIE

“All patients (adult and paediatric) to meet the

18 week target from referral to provision

of safe and usable equipment

within NHS Tayside”

Management – Team Goals

• 95% of new clients to achieve 18 week target by Dec 31st 2008 (Assessment to provision)

• Routine follow-up for Paediatrics• Information available for client / carer enquiries• Screening of referrals within 1 working day of

receipt• Weekly monitoring by project manager• Standard weekly reporting mechanism• Move towards ‘Moving Forwards’ priorities• Geographical equity of service• Improved service for clients / carers / users• Increased team morale

Action Plan – Key Improvements

5 key themes

• Pathways defined• Waiting list management• Communication• IT• Staffing issues• Stock / storage / technical

Waiting Lists

Clients > 18 weeks – assessment to provision of safe and usable equipment

(this includes all patient categories)

• May 2008 - 108

• May 2009 - 10

Reduction of Reduction of

9898Clients!Clients!

Patients waiting over 18 weeks (Assessment to provision)

100

60

40

10

80

20

0

July08

Jan09

JuneOct March

Number

Date

<98%N waiting

<98%N waiting

Assessment Waiting Times

Routine assessment – scheduled clinicsMay 2008 – 67 weeksJune 2009 – 10 weeks

Priority Assessment – unallocated listsMay 2008 – 25 weeksJune 2009 – 3 weeks

Redesign of services – How?

• Cleansing of waiting lists• Removal of ex-employee lists• Removal of team lists• Reduce number of waiting lists -

Unallocated + scheduled clinicsPackages in progress – individual

clinicians• Weekly monitoring by Project Manager• Reporting to Group Manager and

Clinical Director

Clinic Structure• TORT clinics

– May 2008 – 9 clients listed– June 2009 – 146 clients listed

• Administrative staff telephone client to confirm attendance• Patient focused booking system

• Satellite clinics – – Perth Royal Infirmary– Fairview School Perth– Upper Springlands Perth – February 2009

• Existing clinics– Kingspark School Dundee– ACDC Dundee– TORTC

Communication - general

• New referral documentation• New screening tool• Standardised letters• New client information leaflets• Information on waiting time now

available on enquiry with administrative staff

Communication - Staff

• Weekly meetings – agenda set and minutes recorded

• TRES meetings – bimonthly• Summary of improvements on

notice boards • Improved use of electronic diaries• Visible service by all via database• Individual meetings review client

lists / actions

Communication – staff cont’d

• New template for notes to ensure consistency of information

• Core team event – July 2008

• Strategy session – January 2009

• Skills maximisation team event – planned for August 2009

Staff

• Success in filling vacant positions• Temporary staff extended contracts• Trainee Clinical Scientist – May 2009

Technical staff• Long term sick backfill arrangements• Enhanced role consultations• Reviewed job descriptions• Agenda for change issues• PPM – man and a van

Proposed new staff – National Wheelchair Project

Information Technology (IT)

• Database upgraded – New Ways waiting times

• Staff trained – external staff training in progress

• New PCs – digital radiograph access for clinicians

• Stock management module• Van planning module• Website in development

Stock / Storage and Technical

• LEAN principles applied – culling of obsolete stock

• Mobile workbench• Delivery lists (Clinicians work)

• Redesign of client information – mobile technicians

• Existing minibus / van replaced with new leased vehicle

Stock /Storage &Technical cont’d

• New fleet of wheelchairs in progress• New stock of spare parts• Reorganisation of store – identified

locations• Storage issues – awaiting space in

technical store

RIE Way Forward

• Continue weekly monitoring• Aim for 100% -referral to

provision• Analyse DNA rates• Commence patient focused

booking (Repairs / ppm)• Reinstating user / carer group• Repeat service users satisfaction

surveys

National Wheelchair Project

National Wheelchair Project

Vision for future of NHS Tayside Wheelchair and Seating Service

Based on•RIE•Moving Forwards, •Better Health, Better Care •Local delivery Plan…….

Vision : Bid to Government

• Responsive, local, integrated– Communication, users, other agencies

• Efficient, rapid, quality service– Staff levels, skills, clinics,

• Safe, continuous, pro-active– Ppm, out of hours, clinical reviews

• Modern service– Wheelchair designs, telemedicine

• Meeting overall needs– Outdoor power

Target Standards (examples)

• Referral to provision (direct) : 80% < 14days

• 1st Assessment offered < 4 weeks

• Assessment to provision, – configurable stock wheelchair: 80% < 21 days– bespoke equipment : 80% < 60 days

• Repairs – Routine: 90% < 5 days– Urgent : 75% < 1day

Key Performance Indicators

Rehabilitation Technology Information Service (ReTIS)

–NHS Tayside development–Scottish implementation

Project Staffing

1 Clerical officer1 Trainee technician2 Mobile technicians ppm, (1.0)1.2 Technical Instructors (0.6)1 Stores person3 Technician upgrades1 Therapist

( ) = temp staff in post

Modern Wheelchairs & spares

Year 1 - £360,000Year 2 - £390,000

Scottish Government Funding?

• 08/09 £171,000 allocated

• 09/10 £600,000 approx• 10/11 as above

Note : 2 year commitment

Reflections on RIE

• Before RIE

• Significant improvements made.• Some improvements already planned• Nothing new, but not happening• RIE Catalyst for change

• Speed vs Quality ? - outcome measures Home visits, clinics

Reflections on RIE• Cost

– £ low for NHST (£0 revenue)– Staff time / stress

• Benefits – National project– Staff– Team cohesion

– Service users

Sustainability ?

• RIE • National project

–2 years–Afterwards (CCSF!)

• Workforce planning• Training / education

Future Vision

Assistive Technologypotential for development

• Electronic assistive technology• Pressure ulcer management (pain)• Seating / ergonomics• Vehicle mobility• Technology for daily living• Etc …..

Independence, Quality of life, Cost savings

Thank you• NHS Tayside• Scottish Government• Ross International• Users / associated staff• RIE Project manager (Margaret)

• Service staff

Comments, Questions ?

Poster report on

Rapid Improvement EventApril 2008

•Pathway identification•18 week Referral to

Provision

NHS TaysideAssistive Technology Services:

Wheelchairs & Seating

10<98%

Patients waiting longer than 18 weeks (Assessment to provision)