a practical example of dcaq
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DESCRIPTIONA PRACTICAL EXAMPLE OF DCAQ. Dr Gerry Beattie Clinical Lead, NHS Lothian 18 th November, 2009. DCAQ Gynaecology - background. Why is the out-patient waiting time 16-18 weeks ? What are the consultant staff doing ? Why are we losing capacity and how can we stop it ? - PowerPoint PPT Presentation
A PRACTICAL EXAMPLE OF DCAQDr Gerry BeattieClinical Lead, NHS Lothian18th November, 2009
DCAQ Gynaecology - backgroundWhy is the out-patient waiting time 16-18 weeks ?What are the consultant staff doing ?Why are we losing capacity and how can we stop it ?What are we going to do about the next round of job planning ?
DCAQ Gynaecology UNDELIVIERED ACTIVITY the waiting list, service entry points, primary care interface.
DELIVERED ACTIVITY productivity, rotas, inappropriate activity, templates.
LOST CAPACITY leave, compensatory rest, short notice cancellations
Two important points to remember Its just good housekeeping, its not rocket science !
Just because its aye been done this way doesnt mean there isnt a better way of doing it !
Demand the problemsUnclear as to what the demand was in terms of numbersNo idea as to the case mix out there6 entry points into the system NRIE, WGH, SJH, LCTC, Roodlands, Liberton.Little dialogue between primary care and the acute sector
Demand some solutionsCentralised Booking set up for Lothian bringing all referrals to one central point in the NRIE and now moving to e referral and e-triage
Outcoming from triage recorded to inform the size and location of service queues and what needs to be in place where
Exploring electronic GP helplines to prevent patients becoming referrals
Another important point -Demand is not a given, it can be influenced in your favour
The 3 Ds Driving Down Demand !
A thought -What if referrals were not referrals and simply requests for advice ?
Capacity the problemsDifficult to define
Difficult to measure
Reliant on Consultant job plans
What is capacity ?Templated capacity (52 weeks)
Adjusted capacity (42 weeks)
Delivered capacity (about 36 weeks)
What is capacity ?Capacity is a dynamic concept that is constantly changing
It is not a straight line or a box with rigid sides
Capacity ModellingReal time job plans can help measure capacityConvert weekly job plans into at least 4 weekly spreadsheets to overview capacity and identify peaks and troughsA real need for dynamic prospective capacity modelling
Capacity some solutionsCentralised booking has allowed capacity measurement across Lothian and respond to service pressuresReal time job plan mappingSanitisation of clinic templatesStandardisation of clinic templatesFlexibility of consultant workforce
Activity the problemsLots of it but not accurately recordedCoding issuesInappropriate activityClinic templates new/return ratiosOutreach clinicsConsultant productivityRole of senior trainees
Activity some solutionsAccurate recording and coding, with medical input into codingMinimum standards for clinic templatesNew/return ratios revised in the light of speciality developmentThe ring pessary challengeUtilisation of senior traineesKeep the mavericks in the building
Queues the problemsThere was a big one and lots of little ones
There was no idea of how wide the pathway had to be to accommodate the queues
Chaos reigned !
Queues some solutionsCentralised booking has streamlined, quantified and reduced the queues
Patients now seen by the most appropriate clinician at the most appropriate site
Waiting time across Lothian now 6 weeks and falling !
Question - DCAQ where did we start ?
Answer - Job planning
The 2004 Consultant ContractFull time commitment of 10 programmed activities (PAs) per week 4 hour sessionsDirect clinical care (DCC), Supporting professional activities (SPA), additional/external duties7.5 PAs DCC / 2.5 PAs SPA (Plans for 9+1)Flexibility depending on commitments eg Clinical Governance leads etcEPAs separate contract, no obligation
Job PlanningThe process is individual but collectively job plans must reflect the over all needs of the serviceProvides the capacity to meet the demand on the service
Job planning the issuesPlan the service to meet the demandConsultant productivity 42 wks if not, why not ?Notify, control, monitor and restrict leave and learn to say NO !Get service into PAs and use EPAs for reward eg cross cover / additional activity
Job planning the issuesRota management to reduce impact of compensatory rest lost capacityAllow flexibility in the job planning processPlay to individual strengthsNeed all consultants look the same ?
Consultant engagementProtected time gives recognition to the importance of the work
Sell the carrot, not the stick
Get one of their own doing the work
A disease analogySymptoms of reluctance to change, reluctance to engage and inefficiency
Syndrome of weve aye done it this way
The challenge - Physicians of the utmost fameWere called at once, but when they cameThey muttered as they took their feesThere is no cure for this disease
Any questions ?