Comprehensive Healthcare Strategy for Sustainable Improvement
Recognizing year-round pressures, this healthcare strategy emphasizes Snr Leadership support, Decision to Admit system, Trust culture, and shared responsibility in breach analysis. It aims to enhance workforce sustainability, improve patient care pathways, and achieve efficiency through technology investment across multiple specialties.
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Recognition of All year round pressure and not just at peak times Snr Leadership Support & Mandate Empower Trust in Decision to Admit system Develop Culture of Trust Decision to Admit fully embedded in ECC 4 hr Access Standard becoming Responsibility of whole Hospital Specialties to account for breach analysis and feedback Shared ownership of Breach Analysis by downstream specialties Senior Decision Makers Led flow Allow Key strategic goals and vision for Division Wider links with IJB and Acute Agreed and Approved 1, 3 & 5 year workforce and service plan Emphasis on progressive skills and training opportunities Sustainable Workforce to meet the changing needs of the units Supernumerary Model for Doctors in Training & Consistencies of service Stable multi-disciplinary workforce More options other than current front door services ED/AMIA Discharge & Redirection with holistic care systems in community to reduce reattendance Reconfiguration of front-door services PULL from Front- door to Ambulatory Care Services Unscheduled Care Division Top 5 Priority Robust Logistic, Social & Primary care interface Surgical & Medical AEC expansion & Development Increased focus on AEC delivery Active PULL of AEC patients from ED early: minimise non-valued added time in the ED Senior Decision Makers Led flow Shared performance standard Explore options for a shared information platform USC Action Delivery Group: Task & Finish Group to improve outcomes IJB Shared Objectives Shared vision and Strategies with USC. Alternatives in Shire/City services integrated Hub/S&C Patients cared for closer to home Shared vision for delivery of quality of care Realignment of resources and budget Person centred approach to care delivered Financial balance Invest in relevant front door technology to gain financial balance Investment in technology to deliver better patient education & front door efficiencies & experiences
Divisional Priorities Expected Impact Priority Actions 19/20 Expected Outcomes Medicine Divisional High Level Plan Achieve 4 hour standard, and ensure the right patient is in the right place at the right time. Improve performance of 4 hour target at specialty level. Embed 6EA into daily service delivery. Create a footprint that enables delivery of agreed clinical pathways. Snr Leadership Support & Mandate Enable development of Decision to Admit system Shared ownership of Breach Analysis by downstream specialties Improved timely access for USC patients. 4 hr Access Standard becoming responsibility of whole Hospital Collaborating with specialties on agreed clinical pathways Specialties to account for breach analysis and feedback Senior Decision Makers Led flow Achieve 31/62 day Cancer pathway target. Improve Recruitment and Retention with focussed recruitment initiatives. Facilitate attendance at MDT via Job and Service planning. Attendance at Acute Sector Cancer Management Meeting Improved Multidisciplinary working across all complimentary specialties Emphasis on progressive skills and training opportunities Meeting Cancer Targets Sustainable Workforce to meet the needs of the Cancer pathways. Collaborating with specialties on agreed clinical pathways Improved Access to key diagnostic services. Use networking and cross system opportunities to foster relationships with wider specialties. Achieve TTG. Agree footprint requirements. Review clinical pathways for each specialty. Embed feedback in shared learning forum and promote successes. See High Level Acute Sector Plan Improved multidisciplinary working across all specialties. Discharge & Redirection with holistic care systems in community to reduce reattendance Achieve a balance to deliver planned care without detriment to USC Meeting Treatment Time Guarantees Continue increased focus on quality care delivery using patient feedback Shared vision for delivery of quality of care Support systems to improve communication with IJB/H&SCP Improve discharge planning Engage with the Discharge Hub to improve discharge experience. Embed 6EA principles into service. Maximise OD input to facilitate change at service level. Senior leadership and supported mandate for delivery of strategic review output. Discharge planning with holistic care systems in community Strategic Review and Support for Division of Medicine Dedicated OD Support for services to support external review delivery. Shared vision and Strategies with H&SCP. Alternatives in Shire/City services integrated Hub/S&C Patients cared for closer to home Deliver robust service focussed Job Plans to support Unit Service and Workforce Plans. Ensure that complex diagnostics are protected in Service Plans. DCD / DGM / Chief Nurse to utilise networking opportunities to work across divisions. Realignment of resources Use data to model resource allocation. Reinvigorate Divisional Service Planning Recognise that all services do not fall into USC/Elective care. Empower team to deliver and develop effective clinical care pathways Improve collaboration with other divisions. Utilise organisational structures effectively to support divisional working.
Surgical Divisional High Level Plan Priority Actions for 2019/20 Divisional Priorities Expected Impact Priority Actions for 2020/21 onwards Increase capacity via effective planning and bidding for improvement monies Increased activity and reduction of those waiting longer than 12 for in and outpatient procedures Year 2/3 plans to expand and maximise out of centre cap[city in Dr Grays and Stracathro Effective governance and monitoring of improvement activity implementation of surgical access manager role 30 month WTIP Set out a clear vision of the most efficient use of Level 2 and Level 3 capacity across Critical Care: Analysis of those specialities that could benefit greatest from regional models of care Provision of an Adult Respiratory Extracorporeal Membrane Oxygenation (ECMO) Service for Scotland (Bid Application 03/06/19) Scotland wide Development of regional speciality models Regional Working Build and develop links with regional reps for specialities Set out a clear vision of the most efficient use of Level 2 and Level 3 capacity across Critical Care: and region Regionalisation of Cataract service across North Debate and consider development of realistic medicine board for NHS Grampian Provision of an Adult Respiratory Extracorporeal Membrane Oxygenation (ECMO) Service for Scotland (Bid Application 03/06/19) Safe appropriate care in the best place possible Realistic Medicine Consider range of treatments, tests, interventions of low clinical value Develop case for ECMO service and present to NSS See High Level Acute Sector Plan Consider and plan to maximise surgical/planned activity over surge periods of activity to ensure trajectory toward plan delivery Move to fully operational Day Case surgical unit Ability to deliver on 30 month plan to reduce in and outpatient waits Set out a clear vision of the most efficient use of Level 2 and Level 3 capacity across Critical Care: Protecting planned care capacity Service planning of all surgical services to define bed base, theatre requirement Theatre Academy development and implementation Develop appropriately trained workforce for the Provision of an Adult Respiratory Extracorporeal Membrane Oxygenation (ECMO) Service for Scotland (Bid Application 03/06/19) Development of new and innovative roles to support future models of care and delivery Set out a clear vision of the most efficient use of Level 2 and Level 3 capacity across Critical Care: Workforce suitable for future Urology: Grow Specialist Nurse team.
Women and Children Divisional High Level Plan Priority Actions for 2019/20 Divisional Priorities Expected Impact Expected outcomes Reducing Demand By implementation of full Grampian Guidance across all specialities & SCI gateway referral template redesign to ensure all criteria are met before referral can be submitted. Improve Access Meet National Waiting Times Targets Reduce Waits for Patients Waiting Times (Priority 1) Fewer patients breeching waiting time and cancer targets Waiting time initiative clinics with less external capacities Job plans address service needs Support the program board to implement continuity of carer model Successfully implement all recommendations Confirmation of tertiary status for our Neonatal unit Full implementation of Obstetric and Neonatal services as per Best Start recommendation Best Start (Priority 2) Development of community hub Take necessary actions so that Neonatal unit to be the tertiary neonatal unit Consultant availability at peak times Facing the Future (Priority 3) Delivery of Safe efficient high quality paediatric care Achievement of standards as recommended by Facing the Future Explore development of advanced roles Expand delivery of safe effective paediatric services closer to home See High Level Acute Sector Plan Support the longer term plan for sustainability of services at Dr Gray s Improved safe service delivered to the population of Moray Substantively employed workforce to deliver service Access to a safe and effective service in Moray DGH Support the Implementation of the DGH Phase 2 Plan (Priority 4) Work in collaboration across Gynae, Obstetrics and Paediatric services as a regional approach Ensuring all service redesign is ongoing and implemented before moving to new location Maximise efficiency of services through optimal facilities, integration/colocatio n of services and modern ways of working Baird Family Hospital (Priority 5) Redesign of services will be on track Staff engagement to be improved Training needs assessment Workforce planning and utilisation for future way of working
Draft High Level Plan for the Clinical Support Services Division Priority Actions for 2019/20 Divisional Priorities Expected Impact Expected Outcomes Clarify and communicate pressures and priorities within radiology Prioritise current capacity to optimise impact and support delivery of acute sector/system objectives Sustainable 7 day service Reduction in unwarranted variation which optimises care and best use of available capacity Radiology Individuals receive appropriate radiology tests/interventions when they require these which effectively supports timely diagnosis and treatment Implement a Quality Performance Management approach to reduce unwarranted variation, optimise value/patient outcomes and maximise available resources. Initially focus on Nuclear Medicine, Gynaecology and Breast As part of pathway redesign via B&A and Elective Care programme optimise value/impact of radiological investigations Implement agreed Interventional Radiology Plan, initially focussing on optimising efficiency of IR theatres and increasing workforce Work with key services to maximise CT USC pathway Fewer patients breach the 31 and 62 day cancer waiting standards Service plans and pathways are inclusive of support services oversight via the Grampian Cancer Strategy Group Improved access to cancer services (diagnostic and treatment) Cancer Services Continue to develop cancer pathways to improve outcomes and performance contribute to the delivery of Cancer Pathways Increase capacity by optimising the Dr Grays Spey Unit Relocate Brachytherapy Service Increase workforce /service sustainability Maximise resources & patient outcomes Increase sustainability of Labs Services. Implement the agreed Pathology Service and Workforce Redesign Plan focusing on training of biomedical scientist in GI and gynaecology See High Level Acute Sector Plan Labs Services Individuals receive appropriate lab tests when they require these which effectively supports timely diagnosis and treatment Microbiology medical staff roles linked to infection control microbiology medical staff roles linked to infection control query was this 6/8 PA Develop a greater understanding of impact/opportunities of companion testing for drugs on the Genetics Service. Implement initial priority for spend to save in colorectal cancer pathway. Implement a Quality Performance Management approach to reduce unwarranted variation, optimise value/patient outcomes and maximise available resources. IT Individuals receive timely information to support decision making on diagnosis and treatment Infrastructur e More resilient systems to support effective, efficient and timely clinical decision making. Upgrade of Labs IT System as pert of the National Project SBAR to AIG Agree and implement plans to enhance IT resilience re labs and radiology Agree priorities for ensuring appropriate connectivity for POCT within and external to Acute Sector By end March 2020, improve timely discharge flow by replacing the pharmacy dispensing robotic and implementing standard operating procedure Appropriate equipment is in place to sustainably deliver effective and efficient care Equipment Individuals receive the right care, and at the right time Agree and implement a prioritised and phased replacement plan for imaging equipment IR Theatre, CARM By end of March 2020 construction programme for installation of procured Cyclotron is agreed and in place By November 2019, review and revise processes for the prioritisation and management of the equipment replacement programme in the Acute Sector
Divisional Priorities Expected Impact Priority Actions 19/20 Expected Outcomes Establishment of a Dr Gray s Hospital Transformation Board A defined vision for Dr Gray s Hospital A preferred model of care that is safe and sustainable and delivers the required level of acute hospital care to the population of Moray, within networked services across Grampian and the wider North of Scotland Development of a comprehensive data pack to inform baseline hospital activity The development of sustainable service models 3-5 year Transformation Plan Ensure links are clear with existing NHSG and regional programmes of work Collaborating with acute sector on agreed whole-system clinical pathways Development of a Workforce planning approach to deliver outcomes Workforce plan that reflects operating model An agreed operational delivery and strategic planning approach within Dr Gray s Hospital to ensure robust line management and governance arrangements at a team, hospital, HSCP and wider NHS Grampian level through an improved operational capacity Clear, consistent and improved hospital governance arrangements Whole Hospital Commissioning Brief Whole Hospital Leadership & Management Approach Clarity of line management and professional leadership arrangements across specialty teams Increased oversight and operational responsiveness and mitigation of service risk Review of local management structure Refreshed Accountability & Assurance process Defining the workforce profile required across the hospital site The delivery of an affordable, sustainable and efficient operating model underpinned by a substantively employed and appropriately skill-mixed workforce by end of 2020/21 A clear financial model that reflects the future operating model of the hospital Dr Gray s Hospital Review of High Cost Locum usage A cost reduction plan reflective of the defined future operating model Financial Plan Risk assess impact of service redesign on other NHS Grampian services Clarification of any wider system impact Further develop Dr Gray s Hospital as a test bed for innovation The Innovation Hospital approach will create an attractive working culture for a range of health care professionals and improve staff recruitment and retention and hospital sustainability and contribute to improved system access benefits Raising the profile of Dr Gray s Hospital Selecting innovations that would have a positive impact on service delivery e.g. waiting times Defining Dr Gray s Hospital as a vanguard test site Innovation and technology development Engagement of all staff across Dr Gray s in opportunities to develop innovation skills Developing an innovation culture Ensuring all innovation projects have a regional impact Position Dr Gray s Hospital within the innovation network for the NoS Establish a baseline of staff education and training across the hospital An education and training plan ensures that staff are appropriately trained to deliver safe, efficient and effective care that delivers NHSG corporate objectives and NES requirements All Staff are trained for their role Education & Training Plan Assess impact of composite workforce investment on current workforce model The development of a flexible and adaptable workforce Work with PEFs and Deanery to ensure education and training environment meets expected standards The environment meets the requirements of NES
Cancer High Level Outline for Acute Strategic Plan Priority Actions for 2019/20 WORK ACROSS DIVISIONS Cancer Priorities Desired Outcomes/Ambitions 1. 2. 3. 4. Collaboration Transparency measures in action plan re accountability (service/division/sector) Enhance equitable access to diagnostics, specifically radiology and pathology Improve theatre utilisation by service re-design Enhance efficiency of pathways by: - IT Support - Technical advancement - Resource for tracking 5. Annual review of all tumour group pathways and redesign Provision of High Quality and Safe Care Cancer Improved Access to Cancer Services (diagnostic & treatment) 1. Service plans & pathways are inclusive of support & divisional services oversight via the Grampian Strategy Group Continue to develop Cancer Pathways to improve outcomes & performance contribute to pathway development & delivery Increase capacity by identifying additionality with theatre sessions and clinic capacity Theatre modelling matched with demand & capacity Fewer patients breach the 31 & 62 day cancer waiting standards Clear backlog and having plans for future backlog clearance 2. Compassionate Care 3. 4. 5. 6. Radiology Sustainable 7 day service for Radiology Reduction in unwarranted variation which optimises care & best use of available capacity See Acute High Level Plan 1. 2. Clarify and communication pressures & priorities within radiology Implement agreed Interventional Radiology Plan, focussing on optimising efficiency of IR theatres and increasing workload Work with key services to maximise CT USC pathway. Grow radiology cancer monitoring capacity Support redevelopment of Radiology Peer Review and Discrepancy Process Collaborative Working with Patients, Families, Staff and Partners 3. 4. 5. 1. 2. Agree & implement plans to enhance resilience in Labs Reduce unwarranted variation, optimise value / patient outcomes & maximise available resources Work across divisions to advocate matched clinical expansion Work to reduce single practitioner specialist pathology Pathology & Labs Increase workforce / Service sustainability Maximise resources of Patient Outcomes 3. 4. To Be A Continually Learning Organisation 1. 2. 3. 4. Clinical outcomes atlas of variation Annual review of all tumour groups pathways & redesign ISD data survival by tumour type Link with highly performing Health Boards to share learning [Divisionally] KPI S / QPI S / Realistic Medicine 1. 2. 3. 4. 5. 6. 7. Shared performance standards Shared vision Cancer Management Meetings locally (Acute) / NHSG Cancer Strategy Regional North Cancer Alliance Work Workforce Safe Staffing Act National Cancer Clinical Strategy Group Strengthen and support local and regional working with new & ongoing initiatives to support people living with Cancer and their families Local / Regional National Priorities Direction Strive for Excellence
