Now we know what we didn’t know about accessing our Echo service

Richard Cannon, Diagnostics Services Manager

Mags Baird, 18 wks Project Manager

NHS Borders

Improving the Diagnostic Service

• What we now know:– Staffing and recruitment issues

– Where log jams are

– Data to manage:• Demand• Performance

– Evidence to justify investment

What did we do?

• Utilised the Primary Care Access model & Lean methodology

• DCAQ, TVA/COW, Stakeholder interviews, staff action matrix

• Initial findings: pressure in the system caused by capacity, demand, flawed systems & processes

Daily Demand Analysis

23.321.3 22.3

18.0

13.0

0

5

10

15

20

25

30

35

Mon Tues Wed Thurs Fri

Wk 1 15/02/2010

Wk 2 22/02/2010

Wk 3 01/03/10

Mean Demand

Capacity and Demand Trends Over Time

0

500

1000

1500

2000

Wee

k 1

Wee

k 2

Wee

k 3

Wee

k 4

Wee

k 5

Wee

k 6

Wee

k 7

Wee

k 8

Wee

k 9

Wee

k 10

Wee

k 11

Wee

k 12

Cum

ulati

ve A

vaila

ble

Appo

intm

ents

30 minuteappointments -capaci ty25 minuteappointments -capaci ty20 minuteappointments -capaci tyMean Demand plusbacklog

Next steps

• Dedicated porter trial for 4 weeks – various duties

• Lean training for senior technician

• Snr tech involvement in reviewing cardiology pathway (OPD redesign)

• Investment for clinical locum cover

• Investment for admin support

Lessons Learned

• Introduce process changes gradually

• Dedicated time & mindful of BAU

• Buy in & commitment

• Invest time – to determine team / leadership readiness; collecting evidence / data

• Sense of humour / support

• Think Titanic!

Expect the unexpected

Always…