using the model hospital to improve productivity · [email protected] using the model...
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https://model.nhs.uk
Using the Model Hospital to Improve Productivity
Thursday 6 September 2018
Dr David Ashby
Director of Model Hospital and Analytics
Dan Cariad
Policy and Strategy Lead, Model Hospital
Laura Langsford
Model Hospital and GIRFT Programme Manager,
University Hospitals Plymouth NHS Trust
@ExpoNHS #Expo18NHS
https://[email protected]
@model_hospital #modelhospital
Visit the following link on your phone to feedback
and ask questions
glsr.it/modelhospital
Model Hospital is a strategic data and information tool to
support improvement
Identify your opportunities to
improve
Understand the drivers of your opportunities
Identify areas for action
Understand detail and develop a plan
Case studies and best practice to
support improvement
Tracking and monitoring of delivery
We’re redesigning to focus more on opportunities and
where you can find them
We’re redesigning to focus more on opportunities and
where you can find them
We’re redesigning to focus more on opportunities and
where you can find them
We’re redesigning to focus more on opportunities and
where you can find them
We’re redesigning the metric pages to make them clear
and comprehensive
We’re making the Model Hospital more responsive
Mobile and tablet
friendly designDesktop Homepage
We are incorporating more best practice information,
guidance and case studies…
…and expanding to cover more sectors and give a more
holistic view of a system
Plymouth have put the Model Hospital at the centre of their
Carter Programme
• Lord Carter’s Feb 2016 report identified wide variation in acute hospital productivity and efficiency, with
unwarranted variation as well as warranted variation.
• It made a set of recommendations to make efficiencies over the next few years, of which the Model
Hospital was one of them.
NHS Efficiency Challenge
• £55.6bn spend annually by Acute Hospitals
• Reduce unwarranted variation
• Save £5bn (nearly 10%)
Selecting the right peers is critical
• How can Peers be used well?• What does Peer median tell us?• What makes a good Peer Selection?• When to use STP, and CQC Outstanding Peer Groups/
Consider the factors driving variation
ConsiderationsUse of contracted services? Vacancy position? Outsourcing Costs? Overheads for Income Generation? Community service provision? Directly commissioned services?
Deep Dive into priority areas in detail
Pay• Track back to the metric• Use ESR data – Obtain visibility• Engage with Stakeholders• What costs to move to an improved quartile?• So, what would we need to do differently?
Supporting Tools:• Example: Medical Staff Cost per WAU?
• % Direct Clinical Care time • % SPA time • Consultant Costs• WLI Costs• WTE to Staff Ratios
Non-pay requires a different approach
Non Pay• Use Trust accounts as the reference source• Align it in the Model Hospital methodology • Review separate categories• Model Hospital Supporting tools?
• Individual Dashboards for each element• Procurement (PPIB Performance unit costs)• Drugs (Top 10 Savings Performance)• Estates and Facilities (Unit Costs)
Procurement – Savings Target
Top 10 Medicines – Savings Target
Care settings are critical to understanding Clinical
Service Line Productivity
Getting Trust OversightGetting visibility – By setting?What are you biggest challenges?Delivering a Response Plan?
Elective, and Day Case Cost per WAU Variances: Overlay with Theatre Utilisation Performance
Service Activity
Reported 16/17
Reference Costs
16/17 Variance to
National Average (£)
Q1 Q2 Q3 Q4Job
Planning% DCC
Theatres% UtilisationPre-Persist
17/18
Theatres % UtilisationJuly 2018
Orthopaedic *& Spinal Elective £13,875,298 £2,120,627 X75.09% 79% 80%
Orthopaedic* & Spinal Surgery £3,085,309 £212,544 X
Neurosurgery Elective £7,761,956 £899,507 X 79.34% 81% 72%
Ophthalmology* Day Case £4,523,600 £736,738 X 75.65% 93% 94%
Urology* Elective £3,468,871 £418,744 X 77.04% 67% 76%Plastics* Elective £2,087,740 £403,248 X
75.22% 70% 73%Plastics* Day Case £4,305,273 £405,813 X
General Surgery* Elective £9,602,292 £320,238 X 75.39% 67% 67%
Breast Surgery* Elective £1,404,608 £252,904 X 85.25% 78% 72%
Vascular* Elective £1,814,738 £153,063 X 79.77% 73% 78%
Obs and Gynae* Elective £3,038,370 £130,531 X 75.13% 85% 80%
Dentistry Day Case £311,412 £119,431 XENT * Day Case £2,287,547 £81,962 X
76.22% 69% 73%ENT* Elective £1,652,857 £60,112 X
Paediatrics Elective £254,501 £32,214 X 73.75% 44% N/ADermatology Day Case £715,372 £347,224 X
76.21% 51% 50%Dermatology Elective £61,309 £23,941 X
Overlaying variance (£) with response plan Is improvement being achieved?
Model Hospital: Outpatient Cost per WAU Variances:
Overlay with Outpatient Programme Utilisation Performance (last Quarter)
Service
Reported 16/17
Reference Costs
16/17 Variance to
National Average (£)
Q1 Q2 Q3 Q4
OP Clinic Utilisation
Pre Start of OP Project
(Aug- Sep 17)
OP Clinic Utilisation
Latest Quarter(Apr - Jun 18)
% Change?
Respiratory £3,856,209 £1,135,598 X 86.5 88.8 2.3Obs and Gynae £8,835,833 £584,091 X 71.4/88.3 64.3/90.7 -7.1/2.4Urology £2,695,219 £551,072 X 86 83.7 -2.3Breast Surgery £1,665,444 £399,028 X 91.8 90.9 -0.9Cardiology £2,253,439 £130,989 X 89.4 90.7 1.3Neurology £2,149,496 £316,161 X 86.5 85.2 -1.3ENT £2,664,268 £243,632 X 87.4 90 2.6Paediatrics £4,535,013 £192,513 X 79.3 82.5 3.2Dentistry £1,471,573 £191,667 X 81.1 80.7 -0.4Diabetes and Endo £1,746,893 £59,432 X 80/58 80.6/73.6 0.6/15.6
Rheumatology £2,198,109 £16,598 X 87.8 88.8 1
Overlaying variance (£) with response plan Is improvement being achieved?
Model Hospital: Outpatient Cost per WAU Variance Outpatient: Largest Variance: Respiratory
Next Steps?
• Job Plan % Direct clinical care?• Job Planned time v Clinic delivered time?• Clinic utilisation?• Consultant led/Nurse led clinics?• DNA rate?• Clinics/Procedures with highest variation (£)?• Is all activity being recorded – Tel Clinics?• Procedure steps – Are we under recording
activity that is being delivered?• Benchmarking with One Stop clinics?• Complexity of procedure by setting; Are we
delivering higher complex work in an OP setting?
Variance (£) What % is it of the total costs of
delivery by setting?
Now starting to look at productivity across an STP…
Is this ok?Do we understand this?Why are we all in different quartiles?
Is this ok?Do we understand this?Why is 1 Trust in Q1 (Green)Why are 3 Trusts in Q4 (Red)
What can we learn from each other in driving improvement?
Model Hospital Trust Ambassador Programme
• Benefit from exclusive previews and learning opportunities within the
Model Hospital;
• Help shape and influence the Model Hospital as a trusted local expert
for your organisation, with knowledge of local context and practices;
• Champion the Model Hospital within your trust. Acting as a key contact
for your organisation, sharing the latest developments and supporting
colleagues to actively use the tool;
• Network nationally with other trust ambassadors sharing ideas, best
practice and learning between trusts.
Question?
• Register at https://model.nhs.uk
• Feedback at http://feedback.model.nhs.uk or at [email protected]
• View our Animations: ‘Introduction to the Model Hospital’ and ‘What is a WAU?’,
• Watch our series of Masterclass webinars available on demand
• Become a Model Hospital Trust Ambassador: [email protected]