How to achieve improvement with digital tools and new applications
What is the challenge your project is going to address and how does it connect to the theme?
Timely emergency services have always been the jewel of the NHS crown, but for staff or patients, this is often not the case. Facing rising urgent care demand, 4-hour targets are missed by most organisations most of the time. Delays increase mortality (4,519 patients died as a result of crowding in 2020-2021, Royal College of Emergency Medicine review). Staff frustration leads to burnout and rota gaps lead to a vicious cycle of even poorer quality care.
The digital revolution should have reversed this, but the experience of front-line staff is that innovations such as Electronic Patient Records add barriers and bureaucracy. This leads to less efficient, less effective and no safer care. Industry experts recognise that this missed opportunity is because digital interventions are often rolled out to mimic current processes, rather than redesigning them. To overcome this missed opportunity will take a mindset shift driven by new insights.
What does your project aim to achieve?
Following an in-depth analysis of the MBA dissertation in which he outlines recommendations for the Emergency Department (ED) in Scarborough:
The overall goal of this project is the analysis of the most critical processes identified through the dissertation (with particular focus on patient triaging and onwards referral activities) and the benchmarking with OUH to generate specific recommendations for improvement in Scarborough and Oxford.
Data visualisation will play an important part of our solutions and recommendations.
· Definition of comparison metrics and peer groups (at Scarborough and OUH) for benchmarking and application of proven risk and reliability adjustments for benchmarking
· Benchmarking, the generation of scale for measuring the level of innovation (and innovative/efficient performance) of ED departments.
· Assessment of applicability of recommendations generated through the dissertation (in both environments?)
· Roadmap (guidance) for improvement in ED in Scarborough (baked by comparison with OUH) and other hospitals with same ED innovation rating.
How will the project be delivered?
Collaborating across two departments of very different digital maturity (in Oxford and Scarborough), we have a unique opportunity to test solutions from one organisation in the other. This application both ways will keep us grounded in digital as an enabler.
The quality improvement and digital teams will ground this in a sound methodology (the Model for Improvement) and support staff and organisational learning through the improvement journey.
1. To create a map of processes in ED to include IT systems, communication channels and patient flows.
2. Recruit clinical staff and patients to measure key processes in detail.
3. To redesign these including customer service, immersed in co-design.
4. Test out the solutions with iterative refinements in both participating organisations
We will work with the 162 members of the Urgent and Emergency Care SIG by inviting them to help mapping, for which their time will be rewarded with Hexitime credits. Five other SIGs have been approached.
How is your project going to share learning?
We will share our learning and progress during the duration of the project on a Hexitime campaign page, which will also enable engagement with the improvement community. We will also use a shared team space on Hexitime and several Q SIGs to host Action Learning Sets to include clinical and non clinical staff and patients.
As the setting for the project will be York and Scarborough Teaching Hospital and Oxford University Hospitals NHS Foundation Trusts. This will also allow us to produce generic conclusions and recommendations at the end of the project that could be used in every ED setting. This will be published in peer reviewed journals such as BMJ Open Quality.
As OUH is part of the Shelford Group of 10 university trusts, this gives the opportunity to share learning through an extensive and influential network
We will share all diagrams and process maps via Q SIGs and Blogs.
How you can contribute
- Please add comments on this idea and include issues facing your A&E so we can share findings with you directly. Here are some of the issues identified:
- ED as a gatekeeper to hospital services, ensure consistent practices and communication, reduce unnecessary admissions, peripheral areas (SAU, EAU, CAU, should match availability of ED, signposting of patients to services outside the hospital, and transfer of patients to specialist areas.
- Offer to run some of our ALSs to help us to understand the challenges in different settings and clinical areas. Please comment.
- Inform us of any previous activity/research in this area.
- Share any ED process documentation you have.
- Help identify key ED processes.
- Share any detail of digital information boards that you use. This type of information board could play a part in our project.
- Respond to our posts in the Q SIGs that we are members of.
- Join our Action Learning Sets.
|1 Jun 2022||Visualise various aspect of Scarborough ED e.g. interfaces & patient flow.|
|1 Jul 2022||Obtain relevant documents e.g. SOPs, transfer and discharge criteria.- review.|
|1 Aug 2022||Compile list and start mapping key processes (work as done).|
|1 Oct 2022||Instigate improvement projects/focus groups to identify process improvements - QI tools|
|1 Dec 2022||Prepare interim report and Blogs on project progress. BMJ papers.|
|1 Feb 2023||Design ALSs for delivery locally and remotely in collaborating SIGs.|
|1 Sep 2023||Feedback from ALSs for PDCA cycles to identify process improvements.|
|3 Jan 2024||Publish process maps on WWW to share learning across EDs.|
|1 May 2024||Draft final report for feedback and recommendations for digital applications.|