Q Exchange
Regional Integration and collaboration for daily improvement in Ophthalmology services
- Shortlisted idea
- 2023
Meet the team
Also:
- Prof David Keegan, Clinical Lead NERIECS
- Dr Úna Cunningham Head of Transformation| Executive Lead, Strategic Projects
- Michelle Forde, General Manager Community HealthCare Organisation 9
- Caroline Piggott, Change Project Realisation Manager
- Mark Jeffrey, Programme Manager, Service Integration and Redesign
- Aaron Mullaniff, Chief Services Officer, NCBI
What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?
Ophthalmology in the Republic of Ireland has one of the longest waiting lists with 43,537 people waiting for a first visit outpatient appointment. In the Northeast region, it is estimated that 15-17,000 people are currently waiting. The North-Eastern Region Integrated Eye Care Service (NERIECS) was established in 2021 to improve patient care and access to services. We are clearly connected to the 2023 Q exchange theme of reducing delays in access to care, as we are working to develop a system-level integration of eye-care services. Our focus is to achieve the Sláintecare objectives of equality of access for patients, reduced patient waiting times for treatment, and provision of safe care. Work on ophthalmology patient care pathways (2021 to date) has already evidenced a 52 % decrease in adult ophthalmology waiting lists and a reduction of 50% in wait time for surgery.
What does your project aim to achieve?
NERIECS is a collaboration between three hospital groups and three Community Healthcare Organisations, patients, and voluntary and academic partners. We aim to continue enabling teams to move away from a single project improvement focus, to a whole system approach that builds a continuous improvement culture. We have implemented a system-level Daily Management System (DMS) in one of our acute hospital sites and two of our community sites, facilitating a fundamental shift in mindset, enabling systems thinking, enhanced communication, collective problem solving and testing of solutions. The DMS has facilitated the delivery of right-first-time quality care and improved access to care where issues were identified. We now aim to deploy the DMS to all other participating NERIECS sites, as based on our experience, work and results to date, we hypothesise that the DMS will be able to effectively address access to care issues as they arise locally.
How will the project be delivered?
The participating NERIECS sites (14) supported by the NERIECS transformation team will be coached, trained (revisited if in the 3 existing DMS sites) and mentored onsite locally in techniques including visual management and daily huddles to standardise, manage and improve their work. Our use of the DMS to date has facilitated 4 enablers for improvement:
1. Situational awareness: staff review safety, work methods, equipment, and supplies, and identify and resolve issues that impede access to care.
2. Problem-Solving: staff co-design potential improvement activities using a tested person-centred Lean Six Sigma model to identify root causes and build relevant local solutions.
3. Metrics that matter: co-designing and monitoring the lagging and leading indicators of success in access, quality, cost and people.
4. Daily Huddle: staff undertake short stand-up team reviews to monitor points 1-3 above, agree on actions and prioritise issues for escalation
Onsite local support to staff will enable issues of access to service to be addressed locally.
How is your project going to share learning?
We emphasise person-centred approaches to measurement in our working DMS in the 3 sites currently undertaking them. We focus not only on ‘hard metrics’ but understand that patients’ and staffs’ intentions, values, ideas and activity, shape their response to the ophthalmology service. We will share learning through:
- The NERIECS network of 14 sites – an ideal platform to share learning locally.
- Through our many stakeholders, including patients, voluntary and academic partners.
- Presentation nationally and internationally. We have presented our work to date as a Keynote lecture at the Lean Healthcare Transformation Summit Europe, Geneva, (2022), and as an invited plenary at the 7th Lean Healthcare Academic Conference at Stanford University (2022) with excellent feedback and collegial learning.
- The formation of NERIECS and our values and vision is currently in publication in a peer-reviewed academic journal releasing April 2023. We will likewise publish the results of our ongoing DMS work in a peer-reviewed academic journal.
How you can contribute
- Expert: Have you expertise in multi-site DMS? We would love your thoughts on what works well/what doesn’t work.
- Critical friend: Have you or your family members accessed ophthalmology services in the North East of Ireland? If so, and you are not as yet aware of the NERIECS we would very much welcome your input and thoughts and reflections on your experiences.
- Collaborator: Would you be interested in working with our team as a visiting Q member – carrying out GEMBA or attending some of our RIE? You are most welcome.
- Networker: Are there opportunities for cross-collaboration with your own service? We would love to hear from you.
- Disseminator: Is there an opportunity to present our work to date to your team to avail of frank discussion and feedback? There is an opportunity to learn from each other's work to date. Please reach out if this is something that might interest you.
Plan timeline
| 5 Jun 2023 | Rapid Realist Review of DMS to further inform thinking |
|---|---|
| 4 Sep 2023 | Team coaching in DMS: Delivered in the 14 sites Sept-Nov |
| 4 Sep 2023 | Values and Vision workshops: Delivered in the 14 sites Sept-Nov |
| 8 Jan 2024 | Development & operationalisation (consolidation in 3) of DMS at NERIECS sites (Jan-April) |
| 6 May 2024 | Measuring success: pre & post DMS metrics, patient & staff feedback (May-June) |
| 10 Jun 2024 | Realist evaluation: what aspects of NERIECS DMS worked/didn't work & why |
| 16 Sep 2024 | 'Good change' week: system wide PDSA, consolidate findings, next actions. |
| 30 Sep 2024 | Commence results papers (Cataract, Glaucoma, AMD, Paed amblyopia, Eye Emergency) |
| 15 Dec 2024 | Submit results papers to peer reviewed journals for publication |
Comments
Dave Jones-lofting 5 Jun 2023
Having support and helped develop the NERIECS approach as a virtual accountable care organisation I glad to see that you are progressing this to the next steps. Implementing a DMS across the NERIECS will definitely enable you to drive further improvement.
Sean Paul Teeling 5 Jun 2023
Thanks, David, I think the constituent NERIECS members across all grades and professions have really given 110% to them. We're hopeful that the combined DMS and Values and Visions workshops will further support staff in enabling change and coming up with further innovative ideas to facilitate patient access to care. Thanks again for all of your guidance!
Mirza Aun Muhammad Baig 3 Jun 2023
Congratulations, Fairplay to you. Definitely need more ideas like this from ROI.
Best wishes.
Sean Paul Teeling 4 Jun 2023
Thanks so much, we really appreciate that. The Neriecs team with Anne Marie and Richard, had a full improvement event with Children's Health Ireland last week to get the ophthalmic paeds pathways underway, so the work continues. We'd be delighted if we were lucky enough to receive Q exchange support, but we will keep going regardless, to quote Yoda (from Star Wars) 'There is no try, do, or do not'.
Sean Paul Teeling 24 May 2023
We're delighted that a paper detailing the person-centred preparatory work of the North East Regional Integrated Eye Care Service (NERIECS) to develop teams for the system wide improvement, has now been published.
https://www.fons.org/library/journal/volume13-issue1/article6
Libby McGrane 23 May 2023
Congratulations on this project. It was great to hear about the impact it will have for patients and the benefits of new ways of working for all partners at the recent Q-Ireland Tea-Time catch up. Wishing the team the very best of luck.
Sean Paul Teeling 23 May 2023
Thanks so much, Libby. It was fantastic that the Q-Ireland team gave Anne Marie and myself the opportunity to present and discuss the foundational work of NERIECS on behalf of the wider team. Thanks again.
Siobhan McCarthy 23 May 2023
Congratulations on this project. Looks like it brings together well QI and implementation science principles throughout. Best of luck with it.
Sean Paul Teeling 23 May 2023
Thank you so much, Siobhan, on behalf of the team, very much appreciated. We're using a combination of methodological approaches to get the best possible results, so you are spot on. Thanks again.
Eleanor Campbell 22 May 2023
The best of luck to you all!!! 🇮🇪
Eleanor
Sean Paul Teeling 22 May 2023
Thank you so much, Eleanor, that is very generous of you! We would be delighted to collaborate as we move into the next phase. We'll contact you directly and you can decide how you would like to collaborate as best suits you. Thanks again!
Olivia Wall 17 May 2023
Congratulations to you and the team on this project. Best wishes for the next steps. It was great to hear all about this integrated project on the Q-Ireland Tea Time catch up this evening.
Olivia
Sean Paul Teeling 17 May 2023
Thank you so much Olivia, very much appreciated.
Maureen Flynn 11 May 2023
Congratulations Sean Paul and Anne Marie, really delighted to see your project shortlisted ... the very best of luck in the next stage.
Best wishes
Maureen and QPS Connect team
Sean Paul Teeling 11 May 2023
Thank you, Maureen, the support of yourself and the QPS team for quality improvement healthcare teams in Ireland is invaluable, and very much appreciated!
Sean Paul Teeling 11 May 2023
Thank you so much for those pointers Emma, we have joined the groups we hadn't subscribed to as per your advice. We would be delighted to network with you on the development of the service in the North East, across as you say the multiple providers. I am sure we can learn a lot from you, and from our own sharing of what worked well for us, and what didn't work quite so well. Honest reflection. Thanks again on behalf of the team.
Emma Adams 11 May 2023
Hi. Over here in England we're learning more and more about daily/quality management systems. We'd love to hear some of your learning, especially about how you have worked across multiple providers, so I hope your proposal is successful.
There are three Specialist Interest groups that may be interested in this - Quality Management Systems, Complexity approaches to improvement and the Lean group. Might be worth joining and posting a link to these.
Good luck, Emma
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