Kaiser Update March 2005

1. Kaiser UpdateMarch 2005 Northumbria/Northumberland

2. Emergency Care Integrated network of emergency care services – By day

3. We have been interested in • Long Term Conditions • Care Facilitation-Interqual • Contact Centre • Buildings • Impressed by • Culture • Use of Information

4. The Kaiser Triangle Case manager navigator and support usually telephone Case management Complex: co morbidity High resource use More intensive management Group education Care management High risk Supported Self management Good control Routine medical review Risk stratification Population wide prevention

5. Education and Training Team Specialist Use ofInformation Care Primary Educated Patient & Carer Community Teams Whole System Planning & Delivery-3Rs

6. Chronic Disease Objectives Effective, Responsive, Anticipatory Structured Care Expensive, Reactive, Unplanned Care Effective Chronic Disease Management-3Rs Patient Empowered Care Planning

7. Bob’s Pearls of Wisdom • The NHS will not be as successful for patients as it needs to be, as long as we still see ourselves as either primary care or secondary care • What can we do about our structural boundaries?

8. Care Streams

9. Successful Whole System Service Delivery

10. ‘Reid unveils new changes to LTC Care’ – 5th January 05 • Major overhaul of the in the way care is provided to patients will LTC • Organisations will • Community Matron • Identify people with LTC, 3 Rs • Educate patients with LTC • National Service Framework (NSF) for Long Term Conditions will be published later this year

11. LTC-Launch event • Clear statement of intent-Aims • Clash of Views • Generalist Vs Specialist views • ‘My Service’ or ‘The Service’ • Out of ‘site’, out of mind • Heard this all before • Boundaries are still a problem • Management • Organisation vertical/Network horizontal • Capacity-numbers, skills and attitude • Permission and AUTHORITY • Leadership Capacity • Engagement - Still a problem

12. Managed Clinical Networks • Whole system and responsible for the full pathway • Bring to the table ‘the Assets’-and AGREE the plan • Clear Freedoms -Could be beyond ‘the unthinkable’ • Fences -What is inside the fence (within the gift) • Decision by agreement then have to deliver it operationally • Statements of roles and responsibilities, freedoms and fences • Clinically led but populated by the right input from the ‘coalface’ • Information jointly owned and shared to inform the planning and decision making processes • Operationally accountable through the original organisations but jointly responsible through the partnership planning process • Requires Leadership, Engagement, Management

13. Added value National and local priorities and targets Education and Training opportunities See the whole picture Give guidance and direction to LTC streams Cross stream Learning Relative and comparative risk management begins Apply common models User and public involvement Patients with complex and multiple conditions Senior clinical and managerial level input Long Term Condition Partnership Board-Manage the Cross-cutting themes

14. Chronic Neuro Cancer ! Rheum O/porosis OA Pain

15. DM Resp M/Skel GI CHD Stroke Managed Clinical Networks

16. Cross-Cutting Themes Use of Information Medicine Case E&T Management Management

17. N’umbria G.M. and Director Care Trust Directors N’umbria OSM Care Trust Managers Department Managers Care Trust Staff Ward or other management Original Management Structure

18. Director for LTC N’umbria Director ?Later CT Director Network Manager Changed N’umbria OSM Role Changed CT Manager and GMs Role Wards or Departments Primary Care CT Staff First Stages

19. Existing Structure-(Medical and Emergency Only) Northumbria PCOs Urgent Care Brd CIDAR MOB ECOB Access Prim care 14 Care streams

20. Wider Context Care Trust &?PCT Northumbria Northumberland Urgent care Carestream Medicine & Emergency care Board Primary Care Access/ Comm Service Long Term Conditions Partnership Board-LTCPB

21. Change in Style

22. Secondary care Primary care D D 1999

23. Secondary care Primary care Specialist care Supporting and managing quality diabetes care 2002

24. Achievements in North Tyneside 1991 -2001 • Structured Care District wide 97% • Biomedical measurements 80 – 97% • Satisfaction with care 84 – 95% • Sustained for 10 years • also • Reduced amputation rate / Reduced bed occupancy • All measures equal to those achieved in the UKPDS but with routine care – a majority within primary care

25. Respiratory Services-Winner of National Award for LTC • Individualised assessment, in hospital, outpatient clinic and at home • Promoting self care and independent living • Enabling people • Evidence based • Research and audit • User experience and views • Collaboration with health professionals, internal and external

26. Results and Quality • Outreach • 43% reduction in readmissions • Reduced admission into nursing or residential care • 70% improved breathing control • Supported discharge • Median length of stay 4 days • 5% readmission rate • 8% length of stay 1 day

27. Phase 3 An Update for Kaiser

28. Contact Centre Development Plan 2004 2005 2006 2007 2008 2003 Core outpatients WLI inpatient lists Pre-Op screening Choose & Book Capacity scheduling GSUPP & CAPIO Pathway for 18 week target NT outpatients Elective Care 50% Inpatient Booking Emergency Outpatient Appointments Emergency Care Bed management Chronic Disease Physio Line Respiratory CRM Pilot Gynae booking Family Care Diagnostic Services Choose & Book Diagnostics Staff Care Advisors IT helpdesk NT Auto Switch Switchboard Recruitment Digital Dictation Foundation Customer Relationship Management Support Services Phase 1 Old Payroll 8 admin staff Phase 2 Board Room 25 admin staff Phase 3 Balliol 45* staff Phase 4 Balliol + 12 Home Workers + Diagnostic & Therapy satellites Teams & Facilities Capital Cost £120k £300k £20k Revenue Cost £0k -£100k ? ? ? £0k

29. Core Contact Centre • Now doing 15,000 calls per month • Move to ‘proper’ contact centre this month • 50 seats (currently have 19) • Training and distribution facilities • Integrating switchboard in April so we have 24/7 service and a one stop number for all services

30. Physio Line Contact Centre • Currently patients wait up to 8 weeks for first appointment with physio • New pilot with 4wte clinical staff (physios) on the phones • Taking calls from musculoskeletal patients attending their GPs in Whitley Bay and Central locality • Aim for full phone review by physio within 48 hours using e-tools created within trust

31. Physio Line Contact Centre • Physio will assess patient and decide how to proceed… • Advise and discharge • Advise and follow up by phone • Book into appropriate appointment • Stream ‘red flags’ to appropriate location • Aim to manage 60% patients without need for face to face appointments • Full Northumbria roll out would take 10wte physios • If all goes well we hope to extend Physio Line to other clinical professionals and specialties

32. Digital Dictation & Speech Recognition • In Kaiser Atlanta we saw same day automated documentation production • We have delays of up to 6 weeks and spend over £1million per year on typing alone • We recognised the potential for us…

33. Digital Dictation & Speech Recognition • We have appointed a supplier and commence pilot March 2005 • Same day document production • Letters for patients while they wait • Discharge letters emailed to GPs same day • All hospital correspondence available electronically to all staff • Aspire to make 80% reduction in typing backlog and 40% efficiency savings

34. Care Facilitation- Use of Interqual

35. Care Facilitation - Care Facilitation - Care Facilitation - Care Facilitation - What is care facilitation ? • Clinical Decision Support Software Introduced • Aim for the Right patient in right bed all of the time with shortest hospital stay • Used software to tell us what beds we need • Patients’ journey facilitated by teams of Care Facilitators

36. Strengthening Back of House:Care Facilitation • Interqual used to check that patients are receiving the right level of care for their needs • Software used to assess care needs on admission, continued stay and safe to discharge. • Ensures that patients are not receiving to low or to high a level of care

37. Care Facilitation Admission Review Results N = 7,206

38. Of the total occupied days for the patients followed by care facilitators, most were at an inappropriate level 31,441 days 10,300 days 15,794 days

39. As well as giving us data, Care Facilitation is enabling us to cope Admissions are up Outpatient Referrals are up Beds are down Fewer Medical patients in surgical beds

40. What Interqual tells us we need to do… • re-designate our hospital beds • sort out timely diagnostic and therapy support • actively medically review the sickest patients • focus on levels of care for the avoidable admissions

42. What else are we interested in?

43. Culture, culture, culture Kaiser Learning Customer satisfaction matters – this requires personalised care & real choices • Performance based on patient satisfaction • Behaviours are based on the organisational values • Used as part of recruitment process • 360 degree appraisal (team and patients) • Performance management • Incentives and exit strategy • Process improvement • Whole systems leadership & OD programs • Behaviours based on values • Concentrating on the customer • Recruiting with the customer standards in mind and moulding people to be ‘our people’ • 360 degree involving patients Kaiser Learning Right Direction New Ideas

44. Real information is key Kaiser Learning • Whole system health information used to allocate resources • Information is used as the basis for all decision making • What we have done today, not last year • Real time information about demand, capacity, activity, and backlog Kaiser Learning Kaiser Learning New Ideas

45. What we would like from KP • Skills for • using information, • moulding behaviours, • improving performance • changing the culture • Systems change • Experience of KP people working with our teams • Medical staff using care facilitation • Support developing Integrated contact centre • Job swap or Shadowing equivalent Kaiser Staff eg Chief Exec, Med Director, Senior Exec