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Making it Better at Weston Park Collaborative Quality Improvement

Ian Scott, Programme Director Jackie Martin, Consultant Clinical Oncologist Milly Finch, Leadership Fellow, Pharmacy Anne Hilton, Project Manager David Nicholls, Project Manager June 2018

Delivering People Centred Cancer Care

Ian Scott, Programme Director June 2018

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• Transformation Strategy

• Service Improvement Lead

– MCA WPH Collaborative

– Clinical Lead Service Improvement Projects

• Leadership Fellow-Pharmacy

• Estates Project Lead

• Workforce Project Lead

Overview

Rising National and Local Demand

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Planning for Immunotherapy

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• New attendances show a steady but small increase over time • FU activity shows stable increase in use in Melanoma until April

2016 • Rate escalated significantly since due to early impact of

immunotherapy primarily in Lung

Radiotherapy 6% vacancy rate

Nursing 10% vacancy rate

Oncologists 4% attrition 1% growth

9% increase in consultants is needed

nationally to stand still

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The Workforce

Patient and Staff Experience

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Patient

• “I ask about treatment but am told I’ll have to wait to see

the Consultant….but then I have to wait until next clinic

to see them”

• The experience within clinics and outpatients is chaotic

and as a patient I felt my needs were not put

first…waiting 2 hours plus for chemotherapy and

pharmacy”

• Patients get a great service from individual staff

members although it feels like we do so in spite of

systems and environment”

• “The brachytherapy suite is more akin to a prison cell”

• “There’s a shortage of space for patients waiting to be

seen “

• “I get anxious about coming to work – OPD is chaotic

with poor patient flow”

• “Parking is key for patients. Some of us have to be here

very early in the morning and if our work isn’t done, no

patients can be treated”

• Not just an outpatients refurbishment again please”

Staff

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Our vision is to be a nationally recognised leader in the provision of Precision Oncology & People Centred Cancer Care with plans to provide a calm and therapeutic environment in which we deliver services wrapped around the needs of the patients and their families, while meeting the needs of our staff. 9

Transforming Our Network

• Delivering more chemotherapy options closer to the patient

• Maximise research potential and reduce inequity of access to trials

• Modernising and enhancing the workforce model to meet changing patient needs

• Extending the Weston Park brand across the wider region

• Improved access to Radiotherapy services in Sheffield, enabling access to cutting edge therapies and better treatment decisions

People Centred Cancer Care sets out an ambitious vision for the future of

Weston Park Cancer Centre and the South Yorkshire, Bassetlaw and

North Derbyshire network. We will improve where we work, how we work

and we’ll transform our services for our patients.

Here’s what we’re planning to deliver together:

✓ New

Inpatient

wards

✓ New

Outpatients

Department

A modern

Walkway

to RHH

New,

bigger

Pharmacy

Aseptic

Suite

An

expanded

Day Case

Modern

Brachytherapy

unit

Bigger

Car

Park

More

Office

Space

Transforming

our Hospital

Delivering

World Class

Innovation

Appoint

Education

Centre Manager

Expanded

Early Phase

Trials

Cutting Edge

Radiotherapy

Research

Nationally

Recognised

Education

Centre

✓ ✓

Investing in

our People

New

Staff

Areas

✓ Advanced

Practitioners

Right

Person,

Right Place,

Right Time

More Career

Opportunities

Investing in

Cultural

Development

Proud to

work

@Weston

Park ✓ ✓ ✓

Focus to fill

Vacancies

in the Right

Places

Co-

production

with

patients

Serv

ice

Im

pro

vem

en

t P

rog

ram

me

Equitable

Chemotherapy

Delivery

Improved

Access to

Cutting Edge

Radiotherapy

Easier

Access to

Treatments

More

Research

Undertaken

Improved

Outcomes for

Patients

Delivering the

Best for Our

Patients

✓ ✓ ✓ ✓

✓ ✓

✓ ✓

✓ ✓

The Good The Bad The Ugly

The Good The Bad The Ugly

Making it Better at Weston Park Collaborative Quality Improvement

Personal Perspective from the Clinical Service Improvement Lead

Dr Jackie Martin, Consultant Clinical Oncologist

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Strategic ambitions for the SI work stream

• Leadership for change

• Build internal capability for a sustainable SI culture change

• Patient centred SI changes

• Improve team working, patient experience & flow, increase capacity for increasing demand

• Create a sustainable SI approach using data to support decision making

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Day Case Services

Unit (DCSU)

Pharmacy Radiotherapy (RT)

Outpatients (OPD)

In Patients Wards

WAU (assessment

unit)

CCTC

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Pharmacy Radiotherapy (RT)

In Patients Wards

WAU (assessment

unit)

CCTC

Joint Group Established in 2014 with MCA coaching

support

Outpatients (OPD)

Day Case Services

Unit (DCSU)

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Pharmacy Radiotherapy (RT)

Outpatients (OPD)

In Patients Wards

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU)

Team Working

Chemo coordinator

DCSU communication

sheets

Staff rotation between OPD

and DCSU

Community Blood form

Team Working

Team nursing rolled out across department… Positive feedback from both staff and patients!

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Non- team nursing pingtime average

Pilot team nursing pingtime average

Established team nursingping time average

Series1

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Pharmacy Radiotherapy (RT)

Outpatients (OPD)

In Patients Wards

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU)

Team Working Group 1st

course chemo counselling

Outcome forms Chemo

coordinator DCSU

communication sheets

Staff rotation between OPD

and DCSU

Community Blood form

Patient Pagers

Patients reported they felt:

Safe

Supported

Comfortable

Reassured

Arrived early as this

was 1st treatment and

waiting room opened

up for us to sit in - very

nice

So Easy

No patients reported they felt:

Worried

Uncertain

Unhappy

Unwelcome

Was good, most helpful,

the information was

explained in detail

Very well

presented

At Ease

Very

Informative

1st Course Group Counselling

Patients reported they felt:

Safe

Supported

Comfortable

Reassured

Arrived early as this

was 1st treatment and

waiting room opened

up for us to sit in - very

nice

So Easy

No patients reported they felt:

Worried

Uncertain

Unhappy

Unwelcome

Was good, most helpful,

the information was

explained in detail

Very well

presented

At Ease

Very

Informative

1st Course Group Counselling

~ 8 NP per day (1 hr/pt = ~ 40 hrs of

nursing time saved per week)

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Pharmacy Radiotherapy (RT)

In Patients Wards

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU)

Outpatients (OPD)

Reduce Waiting times Clinic Rescheduling

OPD Tidy up

Clinic Prep

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Pharmacy Radiotherapy (RT)

In Patients Wards

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU)

OPD Sub-cut SACT injection

pathway

Outpatients (OPD)

Reduce Waiting times Clinic Rescheduling

Coffee Club

Outcome forms

OPD Tidy up

Re-stock of patient info

OPD TV

Nursing Clinic Coordinator

Patient Info

Folders (CSC)

Clinic Prep

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Pharmacy

Outpatients (OPD)

In Patients Wards

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU) Healthier eating Mould Room –

Calls to patients pre-1st visit

Shoulder stabilising armholes

Radiotherapy (RT)

Breast Treatment on-set process

Test Patient Pagers

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Pharmacy Radiotherapy (RT)

Outpatients (OPD)

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU)

E-Whiteboard

In Patients Wards

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Radiotherapy (RT)

Outpatients (OPD)

In Patients Wards

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU)

Pharmacy

Specific time given to staff during shift to update the board

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Pharmacy Radiotherapy (RT)

Outpatients (OPD)

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU)

Board-Rounds

E-Whiteboard

In Patients Wards

MDT Referrals Discharge planning Bed Management

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Radiotherapy (RT)

Outpatients (OPD)

In Patients Wards

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU)

Pharmacy

Newsletters

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Radiotherapy (RT)

Outpatients (OPD)

In Patients Wards

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU)

Patient info re pharmacy

process Pre-dispensing

chemo pre-meds

Pharmacy

Vial sharing

Newsletters

Pagers

Brain oral chemo

pathway

Vial Sharing

• Pembrolizumab therapy for lung and melanoma

• Pharmacy identified the potential to use one vial of expensive drug between two patients

• Short expiry of drug

• Moving patient appointments close together so that vial sharing is practical

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Radiotherapy (RT)

Outpatients (OPD)

In Patients Wards

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU)

Patient info re pharmacy

process Pre-dispensing

chemo pre-meds

Pharmacy

Vial sharing

Oral chemo 1st course counselling

Newsletters

Pagers

Pharmacy tracking IV chemo

Brain oral chemo

pathway

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Pharmacy Radiotherapy (RT)

Outpatients (OPD)

In Patients Wards

WAU (assessment

unit)

Day Case Services

Unit (DCSU)

CCTC

Trial set-up re-design

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Pharmacy Radiotherapy (RT)

Outpatients (OPD)

In Patients Wards

CCTC

Day Case Services

Unit (DCSU)

WAU (assessment

unit)

Communication to ED in network

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Pharmacy Radiotherapy (RT)

Outpatients (OPD)

In Patients Wards

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU) Learning MCA

methodology

Celebrate success

Weston Park Service

Improvement EXPO

March 2017

OUTPATIENTS

IN PATIENTS

PHARMACY

NEWSLETTERS

Loved hearing about all the success – we need this

positivity

Sharing ideas - what other areas are doing

As new staff member great overview of all the projects

Our clinical lead

Chance for people to ‘show off and shine’

I thoroughly enjoyed it, very proud to work at WPH

Presentations were fantastic

Great celebration – thanks everyone

Opportunity to be honest about successes and failures

Interesting variation in improvement stories

5- teams together, Empowered , Enthusiastic staff

Newsletters

Opportunity to understand each other’s pressures

Let’s make it bigger next time

More people to attend to see the excellent work

More representation but difficult due to work

pressures

Lack of clinician in each team

Patient involvement not easy

Staff Capability to interpret data

Slow process at times

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Pharmacy Radiotherapy (RT)

Outpatients (OPD)

In Patients Wards

WAU (assessment

unit)

CCTC

Day Case Services

Unit (DCSU) Learning MCA

methodology

Celebrate success

Overcome challenges

BARRIERS

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Poor morale

No engagement / buy-in of key stakeholders

Belief that others should change first

Lack of opportunity / lack of time to attend meetings and work on projects

Complexity of service / Making changes that may affect other departments.

Lots of enthusiasm generating many ideas can make focussing on one area difficult

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Leadership for change

• Maintain visible leadership

• Recognise and celebrate success

• Communication to keep engagement high

• Change is very tiring and often requires extra time and effort

• Staff need to know their contribution is valuable

• Address peoples barriers to change to prevent a fast return to “the old ways”

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Lessons for Moving Forward

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Now for……..

…….. Leading by

example

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…….. Juggling!!!

Chemotherapy Capacity & Demand

Modelling

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Long patient waiting times

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Increasing Treatments

& Complexity

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WPH cyto unit daily IV chemo workloadMon 5th Sept to Fri 23rd Dec

In-house production

Pre-mades bought in

Capacity limit

Safe upper limit

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Absorbing work pressures from

DGH’s

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Multiple changes – complementing MCA work

Booking Rules & Staffing

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Clinic and prescribing patterns

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Results

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Development of Chemotherapy Capacity Modelling Tool

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Supervise Junior Doctors QIP’s

Supervise Junior Doctors QIP’s

…….I need a break from Juggling!

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Transforming Our Hospital

Anne Hilton, Project Manager June 2018

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Modernising the Centre of the Network

• Newly built Assessment Unit and modern Inpatient Wards

• Planned New OPD and Daycase Facilities

• Interconnecting walkway to acute specialties approved

Transforming Our Hospital

Take a look at how we are

Milly Finch Leadership Fellow - Pharmacy

Leadership fellow

• 50:50 funded post between Health Education England & Sheffield Teaching Hospitals

• A year out to work on a project, develop leadership skills and complete a PGCert in management & leadership

• Dose standardisation of chemotherapy CQUIN at Sheffield and associated DGHs

Dose standardisation of chemotherapy CQUIN

• NHSE developed a dose standardisation of chemotherapy CQUIN in 2016/17 to deliver quality improvements and drive transformational change within the NHS.

• Now going into the 3rd year of the CQUIN.

• 17 drugs targeted in year 1, additional 30 drugs in year 2.

Dose standardisation of chemotherapy CQUIN

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A graph to show how expenditure of the year 2 dose banded drugs related to number of doses prescribed

Total cost of year 2 drugs

Total number of year 2doses

Leadership fellow

• Usually expected to carry out projects alongside 9 to 5

• Overall cost savings of a reduction in expenditure of over £70,000 a month over the CQUIN

• By hitting CQUIN set targets STH have received £94,425 from NHS England to date

Investing in Our People:

Modernising and Developing the Workforce

David Nicholls, Project Manager June 2018

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• Organisational Development interventions for leaders, managers & staff to improve capability, capacity, teamworking & coaching:

8 x Events - Working Together As Leaders 8 x Events - Working Together as Multi- Professional Teams

• Next Steps will look at Workforce Performance & Development (Competency Framework / Appraisals / Succession Planning / Talent Management)

• Further leader, manager & staff development to improve personal & team capability

Right people, right place, at right time to deliver best

service possible

Improved Processes,

Patient Pathways to support new

ways of working

Staff being able to

perform at their best

more of the time

(see Appendix One)

• Detailed Process Maps of the whole Directorate

• Calderdale skills mix Identification on each part of the pathway / process

• Skills Mix Log (57 changes identified so far) and Workforce Modeller

• Workforce Plan

Workforce Skills Mix & Service Improvement

• Microsystems Empowering Staff to Develop Service Improvement Change to existing Pathways

• Re- modelling of new pathways across the network with workstream leads & key stakeholders (including patients & front line staff)

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Process Mapped the Directorate

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• The workforce skills mix events identify ‘who does what tasks now’ at each stage of the process and ‘who else could do the tasks in the future’

• It might be ‘bundles of activity’ that are moved to other staff or it could be a completely new role

• Calderdale Framework supports the change taking into account risk, safety and governance

Skills Mix Log

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• The skills mix change log and modeller allows users to explore the impact of proposed changes in workforce capacity

• The Workforce Modeller allows visual representation of workforce peer group comparison

Skills Mix Log and Workforce Modeller

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• Possible to identify the right service delivery person at each stage of the patient pathway

• You can change the skills mix safely with task analysis and mitigating actions

• This seems the best way to identify the best workforce model based on maximising capability and increasing capacity or reducing cost

• Key is a ‘holistic approach’ involving process mapping, workforce skills mix analysis, modelling & Organisation Development interventions to lead and support change.

• Requires sustaining and embedding through a mix of PDRM (Plan / Deliver / Review / Make Sense) & Performance Management & Development linked to PROUD values

Benefits • Accurate picture of workforce skills mix requirements for current activity and provides a

good base for future predictions in workforce needs

• Provides the qualitative and quantitative data for best business case for change

• Involving different levels of staff in the process you get high levels of support and motivation for change

What have we learnt so far?

Thank you

Any Questions ?