the osprey programme - training clinical systems engineers

Training Clinical Systems Engineers

The Osprey Programme

Kate Silvester BSc MBA FRCOphth

Lean Healthcare Summit June 2007

K. Silvester 170607Global Summit Ospreys

Agenda:

• Why Osprey?• What is a clinical systems engineer?• How are we getting on?

– Dr Steve Allder, Osprey Plymouth• Where next?

– Advice please!


The National Health Service• 1947: free healthcare at the point of access

– Emergency room (A&E)– General Practitioner (GP)

• Paid for out of taxation– £98 Billion budget – £860 / annum / UK citizen

• 1,000,000 employees• Administered centrally

– Department of Health through the NHS Executive• England, Scotland, Wales and Northern Ireland.

– Local services now commissioned by Primary Care Trusts


The NHS’ Symptoms

• Long delays:– NHS is famous for ‘waiting lists’

• ‘Long waits because demand > capacity’– Increase in resource from £47B to £98 Billion

• Output only increased by 3% (Economist 2004)– Patients will still wait 18 weeks by Dec 2008

• Wrong diagnosis !


NHS has run out of excuses

• We need to understand:– the system.– the pathology of the system– how to put it right – convince others of what to do

• lead by example• Peer to Peer • with statistical kosher evidence


Traditional NHS ManagementUnit Cost

Clinic

Radiology

Laboratories

Theatres

Adm

in

Wards

Unit cost

Clinic

Unit cost

Activitycost

Activitycost

Activitycost

Activitycost

Activitycost

Activitycost

Activitycost


Flows in a Healthcare System

A&E&

EAUGP

Radiology Pathology

‘Tests’

Pharmacy or elsewhere

Home

Follow up

Long term care

Social services

NHS dir

Specialist clinicSpecialist clinic

Specialist clinicSpecialist clinic

rehab > 3 / 52

theatre

1 to 10 days

Day case unit(inc Endoscopy)

Pre op

assess

Discharges Deaths

Quick

Sick: specialist ward

theatre ITU


Primary Care Trust’s Spendby flow through Hospital

PCT expenditure on Flow

0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

Elective Non elective New OP FU OP

Patient Flow

£s

This is failure demand from the ‘green’ process


Grouping of diagnostic codes for top 50% of emergencies

What is the process for these patients?

Groupings Cumulative Total Cumlative %IHD/chest pain 758 22.14%Respiratory infection / disease 1236 36.10%Abdo pain/appendix 1703 49.74%Atrial Fibrilation and flutter 1873 54.70%Poisoning 2029 59.26%Localised swelling, mass, lump lower limb (DVT)2163 63.17%# Neck of Femur 2292 66.94%Syncope & collapse 2420 70.68%Urinary Tract Infection site unspecified 2544 74.30%CVA Cerebral Vascular ‘Attack’ 2660 77.69%Cellulitis of other parts of limb -axilla, hip, shoulder2774 81.02%Chole/pancreatitis 2881 84.14%Inf or Cx procedure 2988 87.27%Miscarriage 3094 90.36%Heart failure 3188 93.11%Asthma unspecified 3263 95.30%Head Injury 3326 97.14%Senility – ‘off legs’ old age 3375 98.57%# other parts lower leg - ankle 3424 100.00%


Pareto Analysis

50

6

0

1000

2000

3000

4000

5000

W42

.1

T42.

3

J43.

9

G45

.9

Q18

.1

Z42.

1

W41

.3

P22

.1

Z94.

1

H36

.9

N26

.2

T46.

2

W74

.1

Z44.

9

Patient Type (elective surgical procedure)

Cum

ulat

ive

Dem

and

Cumulative Demand: Pareto

50

5

20

80


Value Stream ManagementUnit Cost

Clinic

Radiology

Laboratories

Theatres

Adm

in

Wards

Unit cost

Clinic

Unit cost

Activitycost

Activitycost

Activitycost

Activitycost

Activitycost

Activitycost

Activitycost

RONA

RONARONARONA

RONA


What is a Clinical Systems Engineer?

• Responsible for ‘healthcare production line’– from presentation – to discharge & prevention (death)

• Meets demand• Timeliness, cost and quality

• Chief Engineer?


What we need to doHierarchies• People are problem• Parent to child• Fire-fighting • Short term

Functional view• Focus is organisation• Waiting list = asset• Utilisation• Unit cost• Quality costs money

Comparative methods based on averages

(Audit Commission, Monitor, Dr Foster,)

Batch production

Push systems

Teams• System is problem• Adult to adult• Persistent, consistent, • Long term

Process view• Focus is Patient• Waiting list = liability• Waste• Return on Net Assets• Quality saves time,

money and lives

Variation in one system in real time

Flow

Pull systems

Human dimensions of change

Systems dynamicsSteady state & dynamic state

Theory of ConstraintsShort term optimising of bottlenecks

Statistical Process Control

LeanUnderstand Human Body Processes required to ‘fix’ it Value streamsUnderstand demandImprove flowEliminate waste

Leading by exampleK. Silvester 170607Global Summit Ospreys

Who are we?

• Sponsored by 6 Strategic Health Authorities – ‘Clone Kate’

• 1st batch: 2004 - 06– 9 doctors:

• General Practice (Primary Care), • Hospital care (Secondary care)• Mental Health

• 2nd batch : 2006 - 08– Mixture of healthcare professionals with clinical

background


Osprey Plan

6 months

12 months

May 06

Nov06

March08

0

May 07

Nov 07

Improved PerformanceImproved PerformanceKate

Curriculum

Practice & experience

Ospreys

Local Projectteams

Senior Managers

Senior Clinicians

data Senior Managers

Senior Clinicians

knowledge

confidence

feedbackfeedback

feedback

May 08

2 years18 months


Queen Mary’s Sidcup Patients discharge from Hospital

Weekly medical Length Of Stay 80%

3

4

5

6

7

8

3-Ma

y-04

17-M

ay-0

431

-May

-04

14-Ju

n-04

28-Ju

n-04

12-Ju

l-04

26-Ju

l-04

9-Au

g-04

23-A

ug-0

4

6-Se

p-04

20-S

ep-0

4

4-Oc

t-04

18-O

ct-04

1-No

v-04

15-N

ov-0

429

-Nov

-04

13-D

ec-0

4

27-D

ec-0

410

-Jan-

05

24-Ja

n-05

7-Fe

b-05

21-F

eb-0

5

Weekly readmissions within 28 days of discharge

20

40

60

80

100

120

3-Ma

y-04

17-M

ay-0

431

-May

-04

14-Ju

n-04

28-Ju

n-04

12-Ju

l-04

26-Ju

l-04

9-Au

g-04

23-A

ug-0

46-

Sep-

0420

-Sep

-04

4-Oc

t-04

18-O

ct-04

1-No

v-04

15-N

ov-0

429

-Nov

-04

13-D

ec-0

427

-Dec

-04

10-Ja

n-05

24-Ja

n-05

7-Fe

b-05

21-F

eb-0

5

Quality: better ? No increase in readmissions

Saving: £1,368,750 p.a. (based on 30 discharges per day and hotel costs £125/day)

Time: average LOS for 80% of medical patients reduced by >1 day


55

60

65

70

75

80

85

90

95

09-Ju

l-05

16-Ju

l-05

23-Ju

l-05

30-Ju

l-05

06-A

ug-0

5

23-O

ct-05

30-O

ct-05

Indi

vidu

al V

alue

Crisis team of nurses(trying to block admissions)

* Consultant Psychiatristsin front line seeing1 or 2 emergencies / day

Time: 3 day wait to same day assessment

Crisis Team cost ++ * Savings: some agency nurse costs, + Saved £2M on out of district placements

Quality: no increasein suicide rate. Patients DelightedStaff ‘Thrilled’

Mental Health: bed occupancyBed Occupancy %


Osprey Plan

KateSenior Managers

Senior Clinicians

Curriculum

Practice & experience

6 months

12 months

Improved PerformanceImproved Performance

data Senior ManagersOspreys

Senior Clinicians

knowledge

confidence

May 06

Nov06

March08

0

May 07

Nov 07

Local Projectteams

feedbackfeedback

feedback

May 08

2 years18 months


Sorting the System

• Over to Dr. Steve Allder!– Osprey for Derriford Hospital, Plymouth


Summary: What is an Osprey?

Systems Understanding:

Complexity& Variation

High

Low

NHS (Project) Manager

University Lecturer Clinical Systems Engineer

Improvement Advisor: e.g. Lean / 6 Sigma

‘I’ve hit the target so what is the problem?’

‘I have never had to deal with such complexity

before!’

‘Its all very well in theory –but putting into practice is another matter!’

I understand the system + target improvement

interventionsMeasure time, cost & quality

Few tools Lots of toolsApplication of ImprovementTools and Techniques


Batch 2008 -2010?

• University of Warwick Medical School– Osprey as post graduate programme– Lots of doctors interested but funding required– 5 NHS Organisations interested currently

• Advice please!


the osprey programme - training clinical systems engineers

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