“To Self Test or not to Self Test – That is the Darzi Question”

1. “To Self Test or not to Self Test – That is the Darzi Question” Possessing or acting with the desire to do noble and romantic deeds, without thought of realism and practicality

2. Why did we do it? • Patient pressure • Darzi • Improving technology • It seemed the right thing to do

3. How did we get there? • Full management review of the situation • Benefit analysis • Beg steal and borrow ideas don’t re-invent the wheel…

4. The Boring Management stuff – or how we justified it • PEST Analysis • Stakeholder analysis • Force Field Analysis • LEAN Systems

5. Political Economic Social Technological

6. Political • “Those looking at planned care found more care • could, and should, be provided closer to people’s • homes, with greater use of technology, and • outpatient care not always meaning a trip to hospital.” • Darzi’s report (Darzi, 2008, p. 18) • Innovation Funding from the SHA is based on any project showing • “more for less” • Adoption and spread of new and innovative ways of working • New and improved processes • Improved patient pathways or procedures • New models of care • The shift of services into more cost effective settings • Technologies that improve the quality and productivity of care • Project/programme costs to support the delivery of the funded initiative”

7. Government Pressure may sometimes seem quite forceful

8. Economic • “The credit crunch” has left the UK government with borrowings in excess of £159.2 billion in the 2009 -2010 tax year (ONS, 2009) • The expenditure on the NHS was shown to double between the financial period 1998 -1999 and 2000 -2001 • current estimated cost of admitting a patient to a hospital ward is in excess of £1200.00 (DOH, 2008) • The cost endured by patients: transport, fuel or public transport, parking fees , lost time at work. • “One quarter of families use grandparental childcare each week with this care valued at £3.9billion.” (Grandparents, 2008, p. 2) • meter cost in the region of £400.00

9. Social • The number of younger patients taking oral anticoagulants is increasing - fit therapy into ever changing lifestyles • Shop workers are required to provide 24 hour shopping so why not healthcare • Demand for flexibility particularly in the retired population is the dramatic increase in wintering abroad • Increased expectations via the media:

11. Technological • DAWN computer aided dosing software • Digital messaging • Short Messaging Service (SMS) • The (INR) testing meters are now a mature and well tested technology allowing for their safe use by patients with good correlation to laboratory testing (PASA, 2008).

12. Stakeholder Analysis

13. DRIVING FORCES RESISTING FORCES STAFF Patients SHA GPs Darzi Current State Future State GPs Force Field Analysis

14. What did the Management Analysis Prove It’s a bit better than guessing Sounds like we should Go for it

15. Patient record book Patient record book Patient record book INR into DAWN system Dose calculated and printed Does Dose need to be Telephoned Updated Patient record Book Returned to Patient via Royal Mail What happened before!

16. LEAN! • Improve Quality • Understand the needs and desires of the customer designing the processes to meet their expectations and requirements • Eliminate Waste • Waste is defined any process or part of a process which consumes any resource including time and space but does not add value to the process or outcome.

17. INR into DAWN system Dose calculated and returned by SMS Return Cumulative Patient Record via Royal Mail What Did We Want to Happen

18. INR into DAWN system Dose calculated and returned verbally by phone Return Cumulative Patient Record via Royal Mail What Did We Manage Dose calculated and returned by SMS £10,080.00 would buy an interface to provide SMS and Email return automatically along with next test Reminders. Please make cheques payable to Jeff Walker.

19. How Does it Work • Initial contact • First appointment to discus contract and how system works • Patient gains GP agreement (or not) • Three further training appointments

20. Joan's Bit – the real work Introducing NPT at Midyorks

21. Why Self test ? • Reduce workload • Improve compliance • Sharing responsibility of care • Committed to provide a service • Listen to Users of that service • Cos Jeff says so!!

22. Patient Criteria • Long Term OAT patients • Over 18 years of age • Able to understand English or have access to an interpreter • Have the dexterity to use a device to test their INR • Agree to attend four sessions of training in the anticoagulant clinic • Have the support of their general practitioner to self test their INR

23. Key Differences • Positively motivated patients • Develop proactive approach to therapy • Continuous improvement and reduction of risk • Sharing responsibility of care • Ownership of equipment

24. The Contract • Patients responsibilities • Do as you’re told… (or else) • Lab responsibilities • Nothing changes really • GP responsibilities • Sign up that the patient is capable • No commitment to prescribe test strips

25. Problems • Leaflet committee!!!! • Clinical governance • Cost of equipment • GP’s • Community Pharmacists • PCT

26. Benefits • Improve compliance • Develop partnership with staff • Patient satisfaction • Staff satisfaction

27. What Did We Achieve? • Compliments!!!!!!! • “… you have given me my life back” • “… at last someone understands my needs” • “I’m not worried about loosing my job now”

28. What Did We Achieve? • Better control • Anecdotally yes – audits to come (next years talk?) • Better relationship with patients • Patient satisfaction • Compliments…. • Staff satisfaction • Due to relationship improvements much better

29. What did we learn? • Management tools only tell half the story • There will be resistance • Keep it small to start with • It’s hard work

30. Was it worth it? • Absolutely

31. Questions ?