Patient Outcomes and Benefits Chapter Summary Improving clinical outcomes Enhancing safety and quality Enhancing patient experience The clinical, quality and safety case for change has been demonstrated in the previous section. Improving the quality of service and achieving excellent health outcomes for all patients. This Is a fundamental aim of the proposed orthopaedic service redesign. The patient benefits and outcomes of the proposed model are outlined below. Working in partnership with patients, the service will seek to obtain patient views on their experience and how the quality and value of the service at all sites can be improved. Enhancing Patient Experience The following table highlights the benefits of enhancing patient experience: Figure 2 – Enhancing Patient Experience Delivery Improvement Introduction of a comprehensive Trauma Service at Aintree 7 day consultant delivered service Right Surgeon Right Time. Skills to deal with all types of injury without delay. Reduced waits for surgery for both inpatient and day case trauma surgery Post operative follow up appointments can be delivered closer to home at either the RLUH or AUH. Reduced length of stay with the delivery of discharge pathways that allow rehabilitation at home. Orthopaedic care remains available at local emergency department AUH or Royal for presenting patients. Virtual Fracture Clinic across both trusts. Shared decision making. Avoidance and reduction in unnecessary hospital appointments. Closer to home follow up in local fracture clinic if required. Access to telephone advice
Inability to deliver capital programme within the designated timeframe. Adversely affect plans for the RLUH New build as current plans do not have orthopaedic trauma in the bed or theatre base. Delay strategic reconfiguration. Option to maintain services in the existing RLUH on a basis. Phased implementation approach to reconfiguration is being considered while funding source is being secured. Availability of Capital Funds to support infrastructure upgrade If funding is unavailable then the project could be delayed. Capital investment would be prioritised by each Trust Board in order to deliver the preferred option. Delay in implementation May affect capacity to deliver orthopaedic services between both organisations. With an inability to maintain medical staffing levels, junior doctor rotas and attract trainees. Preferred option has the support of each Trust Board and Liverpool CCG. Option to maintain services in the existing RLUH on a basis. Project Implementation Team established and providing regular progress reports to Trust Boards. Programme Management Office will manage project implementation. Activity levels differ from projections Affordability and/or capacity issues. Projections based on extensive activity modelling. Performance levels could be improved. Extended hours could be employed in key service areas such as theatres and radiology. Use of other providers on a short-term basis. Service Improvement Team could be attached to the project. Failure to plan and deliver workforce service change Industrial relations problems. Staff motivation or recruitment and retention harmed. Management focus on the day to day leaves services unreformed. Service wrong shape/size Insufficient staff to maintain service quality or unable to achieve workforce QEP. Clarity of workforce planning. Service improvement methodology agreed with weekly executive level scrutiny panel to prioritise and approve projects. Programme Management Office to monitor QEPs. Significant progress in partnership working with Staff Side. Staff engagement strategy. Benchmarking against other Acute Teaching Trusts.
May incur additional workforce costs During detailed workstream implementation work there is likely to be additional costs identified i.e. CSSD and Decontamination Costs. Extensive workforce planning undertaken. Strong financial support to the implementation. Preferred option is shown to deliver significant cost reduction. Appendix 6 sets out the full risk register.
3.3 Summary of appraisal against CSF domains The table below shows average scores (combining the 2 groups for in Workshop 1) for the options by each CSF and the figures that follows shows the average scores of each option against each CSF. 1 2 3 4 5 Quality CSF 1 The proposed option will improve the health and wellbeing of the population receiving services 3.00 2.50 0.50 3.00 3.00 CSF 2 The proposed option will allow service to deliver improved clinical outcomes and maintain clinical standards 2.00 2.00 1.50 2.50 2.50 CSF 3 The proposed option will allow services to deliver a positive patient experience and allow patients to be as involved as they wish to be in decision-making about their care and outcomes 2.00 1.50 1.00 2.00 2.00 CSF 4 The proposed option will improve staff satisfaction and facilitate appropriate recruitment, retention and training 1.50 1.00 1.50 2.50 2.00 Total 8.50 7.00 4.50 10.00 9.50 Feasibility CSF 5 The proposed option is deliverable within contractual and regulatory obligations 2.00 2.00 1.00 1.00 1.00 CSF 6 The proposed option appropriately recognises current and future workforce requirements 1.50 1.50 1.50 2.00 2.00 CSF 7 The proposed option optimises the delivery of services on the available estate 2.50 1.50 -1.00 -1.50 0.00 CSF 8 The proposed option is feasible and deliverable within the time constraints of the new Royal opening 1.50 1.50 -1.50 -3.00 -3.00 Total 7.50 6.50 0.00 -1.50 0.00 Financial sustainability CSF 9 The proposed option helps to achieve recurrent financial sustainability for orthopaedic services 1.00 0.50 -1.00 -3.00 -2.00 CSF 10 The proposed option is financially deliverable given likely funding constraints -1.00 -1.00 -2.00 -3.00 -3.00 Total 0.00 -0.50 -3.00 -6.00 -5.00 Strategic fit CSF 11 The proposed option aligns with the goals of the Healthier Liverpool Programme 2.00 2.00 2.50 3.00 3.00
5 Delay in implementation May affect capacity to deliver orthopaedic services between both organisations. With an inability to maintain medical staffing levels, junior doctor rotas and attract trainees. 2 4 8 Preferred option has the support of each Trust Board and Liverpool CCG. Option to maintain services in the existing RLUH on a short-term basis. Project Implementation Team established and providing regular progress reports to Trust Boards. Programme Management Office will manage project implementation. Cross rota support and flexibility between both organisations could be agreed. 2 3 6 6 Activity levels differ from projections Affordability and/or capacity issues. 3 3 9 Projections based on extensive activity modelling. Performance levels could be improved. Extended hours could be employed in key service areas such as theatres and radiology. Use of other providers on a short-term basis. Service Improvement Team could be attached to the project. 2 2 4 7 Failure to plan and deliver workforce service change Industrial relations problems. Staff motivation or recruitment and retention harmed. Management focus on the day to day leaves services unreformed. Service wrong shape/size Insufficient staff to maintain service quality or unable to achieve workforce QEP. 3 3 9 Clarity of workforce planning. Service improvement methodology agreed with weekly executive level scrutiny panel to prioritise and approve projects. Programme Management Office to monitor QEPs. Significant progress in partnership working with Staff Side. Staff engagement strategy. Benchmarking against other Acute Teaching Trusts. 2 3 6