Quality of services are not as good as we would like Patient outcomes are not favourable with the best Positive experiences of our services are not as high as we would like Challenging financial climate with reducing resources Need to improve quality of services and reduce costs New national performance standards require a focus on quality and outcomes – not simply response times Partnership with Local Health Boards and other partners is not strong enough or joined up Opportunity to play a central role in unscheduled and planned patient care system Inefficient processes leading to unnecessary waste and variation Lack of consistency in applying policies and practice across the organisation – results in wide variation in service quality Lack of detailed understanding about demand and capacity Fallen behind UK ambulance service in many areas of basic good practice Disengaged/ disempowered staff Poor morale High levels of sickness absence Dysfunctional working e.g. clinical v operational Poor understanding of roles/responsibilities Lack of leadership and management capability Poor performance accepted, not managed Insufficient skills, competence and experience in some key areas Lack of support, education and training for some key staff groups management and communications The Transformation Journey 2011/2012 Getting the Basics Right 2012/2013 Sustaining the System 2013/2014 Feeling the Full Benefits Review and improve processes and systems in priority areas Establish clarity regarding roles and responsibilities Plan and implement new service models Develop leadership and management capacity/capability Improve measurement and performance management arrangements Increase improvement skills of workforce New service models in place Local capacity and capability improved Management/ performance management systems working well Locally managed quality improvement programmes Roll out and implementation of system and process improvements Well informed and empowered staff New service models fully embedded Improvement champions in place Quality improvement approach fully adopted Quality improvement culture in place:- reducing harm, waste and variation central to everything we do Full benefits of the new models/culture/skills realised We have assessed our progress against Step 1 – Getting the Basis Right and there are a number of areas where significant improvement has been achieved: Review and Improve processes: we have reviewed our systems and processes for Unscheduled Care in great detail with a large process mapping exercise and systems diagnostics being completed. The review process for Planned Patient Care Services has also progressed well but further work is required to implement the key drivers for improvement. Establish clarity regarding roles and responsibilities: a significant amount of work has been undertaken regarding the introduction of an improved organisational structure, with implementation expected in the early part of 2012. This will provide absolute clarity regarding roles and responsibilities within a modern ambulance Trust.
UNSCHEDULED CARE SERVICES OUTCOME OBJECTIVE 2012/2013 KPI REF TARGET DATE EXEC LEAD KEY ACTIONS MEASURE (where applicable) EXPECTED CHANGE STANDARDS FOR HEALTH LINK Improve the rate of return of spontaneous circulation at hospital arrival for patients In develop- ment March 2013 Medical Director Undertake audit of cardiac arrest - advanced life support (ALS) provision against JRCALC guidelines Adopt and implement the most up to date UK Resus Council / JRCALC guidelines Develop and introduce audit tool for CTLs to be able to measure practice at station / team / individual level % of patients who have undergone cardio pulmonary resuscitation (CPR) have a return of spontaneous circulation (ROSC) on hospital arrival Increase 6, 7, 8 Improve the survival rate for patients suffering cardiac from survival to discharge In develop- ment March 2013 Medical Director Agree and implement data recording / reporting requirements with each LHB - measure WAST's contribution to survival to discharge outcome (i.e. report on patients delivered by WAST with ROSC and subsequently survived to discharge) Utstein rate – overall survival rate reported by hospital % patients admitted to hospital by ambulance with ROSC are discharged to survival Increase Increase 6, 7, 8 To improve the outcomes of patients suffering from acute ST-elevation myocardial infarction (STEMI) O03 O04 March 2013 Medical Director Undertake audit of STEMI management (care bundle) against JRCALC guidelines % transferred to PPCI within 150 mins Increase Increase 6, 7, 8
Develop and introduce audit tool for CTLs to be able to measure practice at station / team / individual level Work with Cardiac Network & LHBs to implement protocols and direct (fast - track) pathways to PPCI labs / units % of eligible patients suffering an ST-elevation myocardial infarction receiving thrombolysis within 60-minutes % of 999 patients who receive appropriate care bundle (i.e. compliance with JRCALC guidelines for STEMI care Increase To improve the rates of FAST compliance and direct transfer to a stroke team within 60 minutes for patients suffering a stroke O06 March 2013 Medical Director Undertake audit of Stroke management (care bundle) against JRCALC guidelines Develop and introduce audit tool for CTLs to be able to measure practice at station / team / individual level Identify level of STROKE care provided by each LHB (e.g. Stroke Centres, or dedicated Stroke Teams) % of positive FAST patients (assessed face to face) who are directly admitted to Stroke Team within 60 minutes of call % of positive FAST patients (assessed face to face) who receive appropriate Stroke care bundle (i.e. compliance with JRCALC guidelines for Stroke care) Increase Increase 6, 7, 8 To improve the identification and management of fractured hip/femur through improved rates of compliance with the falls care bundle O07 March 2013 Medical Director Undertake audit of current management (care bundle) of older people who have a suspected lower limb fracture against JRCALC % of older people who have fallen and have suspected fracture Increase 6, 7, 8, 10
guidelines Implement ‘fast track’ pathway Conduct audit into and update other existing pathways Develop and introduce audit tool for CTLs to be able to measure practice at station / team / individual level Develop and implement further care pathways and update directory of services and falls registers across the health and social care community of hip / femur receiving appropriate care bundle (e.g. analgesia, lower limb immobilisation) % of older people who have fallen and have suspected fracture of hip / femur admitted to hospital within 60 minutes Increase ACCESS OBJECTIVE 2012/2013 KPI REF TARGET DATE EXEC LEAD KEY ACTIONS MEASURE (where applicable) EXPECTED CHANGE STANDARDS FOR HEALTH LINK To improve the ‘Choose Well’ programme advising the public of how to make better informed choices of ambulance / health services March 2013 Medical Director Further develop partnerships with Health Boards and update the Directory of Services and make available on NHS DW web-site Review and improve the ‘Choose Well’ strategy / implementation plan Further develop partnerships with LHBs and update Directory of Services with LHB information Agree new services that will provide patients with a wider choice of services Implement the Corporate Communications Strategy to support ‘Choose Well’ Number of Cat C calls referred to self-care Number of website hits Number of patients conveyed to hospital Increase Increase Decrease 3, 5, 8, 18
Answer 95% of 999 calls within 6 seconds P02 P03 Sept 2012 Director of Service Delivery Improve alignment between demand and capacity in control rooms Achieve full implementation of generic call taker role Identify actions to improve call flow and set up routine system maintenance schedule Achieve virtual capability across all control rooms % of calls answered within 6 seconds % of calls abandoned Increase Decrease 8, 19 Answer 95% of 0845 calls within 120 seconds P01 Sept 2012 Director of Service Delivery Improve alignment between demand and capacity in control rooms Achieve full implementation of generic call taker role Identify actions to improve call flow and set up routine system maintenance schedule Achieve virtual capability across all control rooms % of calls answered within 120 seconds % of calls abandoned Increase Decrease 8, 19 70% of chief complaints identified within 30 seconds P05 Sept 2012 Director of Service Delivery Develop an improved range of control room guidelines for operational deployment Review, revise and re-launch a suite of key performance indicators to support call management quality improvement Provide training and support to call takers % of chief complaints identified within 30 seconds % of chief complaints identified within 60 seconds Increase Increase 8, 19 65% of vehicles allocated within 30 seconds of chief complaint identification P11 Sept 2012 Director of Service Delivery Review CAD/GPS technology to ensure its is optimised Review, revise and re-launch a suite of key performance indicators Development of mentoring system % of 999 calls assigned within 55 seconds % of 999 calls assigned within 120 seconds Increase increase 8, 19 Achieve 90% response rate to Cat C Green 3 calls (planned clinical telephone assessment) within 10 minutes of allocation by call taker P07 P08 P10 August 2012 Medical Director Conduct monthly audits of calls taken and categorisations reached, with appropriate feedback to call takers Provide monthly audit reports on the patient outcomes achieved through % of patients receiving a planned clinical telephone assessment within Increase 7, 8
that 30 minutes travelling time on a vehicle SUPPORT FUNCTIONS ENABLERS ICT & Informatics OBJECTIVE 2012/2013 KPI REF TARGET DATE EXEC LEAD KEY ACTIONS MEASURE (where applicable) EXPECTED CHANGE STANDARDS FOR HEALTH LINK Evaluate / implement upgrade to CAD system Dec 2012 Director of Strategy, Planning & Performance Develop business case for proposed upgrades Attain approval and secure funding Develop implementation plan Implement plan n/a 6, 7, 8, 9, 19, 20 Implement Data Warehouse single information platform June 2012 Director of Finance Review current business case and secure funding Implement IT solution n/a 6, 19, 20 Implement PCS On-Line booking solution Dec 2012 Director of Finance Develop Business Case, secure funding and attain approval to commence Implement IT solution % patients booked on-line Increase 6, 19, 20 Develop PCS appointment reminder system Dec 2012 Director of Finance Develop Business Case, secure funding and attain approval to commence Implement IT solution % patients reminded of appointments Increase 6, 8, 19, 20 Implement Cleric system updates Sept 2012 Director of Finance Identify appropriate updates Implement required upgrades n/a 8, 9, 19, 20 Develop and implement a phased and costed plan to implement the ICT Strategy June 2012 Director of Finance Identify required resource to deliver plan Development of implementation plan n/a 6, 19, 20 Estates OBJECTIVE 2012/2013 KPI REF TARGET DATE EXEC LEAD KEY ACTIONS MEASURE (where applicable) EXPECTED CHANGE STANDARDS FOR HEALTH
LINK Implement and commission the Dobshill MRD Sept 2012 Director of Strategy, Planning & Performance Complete actual build of MRD Undertake staff training / awareness Commission all services n/a 6, 7, 12, 19 Commence building of the Wrexham ARC March 2013 Director of Strategy, Planning & Performance Conduct design and build of ARC Undertake project actions associated with commissioning activities n/a 6, 7, 12, 19 Finalise and implement the Estates capital programme L11 July 2012 Director of Strategy, Planning & Performance Analyse and plan stages for implementing the Estates SOC n/a 6, 7, 12, 19 Establish and implement a medium term estates maintenance programme L11 May 2012 Director of Strategy, Planning & Performance Analysis of medium term maintenance needs Development of maintenance 3-year plan Identification of funding internally Implementation of maintenance plan n/a 6, 7, 12, 19 Workforce & OD OBJECTIVE 2012/2013 KPI REF TARGET DATE EXEC LEAD KEY ACTIONS MEASURE (where applicable) EXPECTED CHANGE STANDARDS FOR HEALTH LINK Implement the workforce plan to develop the required clinical mix to support the new clinical response model March 2013 Director of W&OD Identify the required skill mix and workforce profile Undertake a gap analysis Develop and implement a plan on a phased approach n/a 24, 25, 26 Reduce sickness absence rates to 5.62% L03 March 2013 Director of W&OD Provide further education and training to staff on wellness and attendance management Implement plan for introducing a new enhanced Occupational Health service Strengthen line management arrangements for sickness absence % sickness absence % of overtime used to cover short and long term absence Decrease Decrease 25 Review and implement revised N/A August Director of Identify the preferred structure n/a 24
OBJECTIVE 2012/2013 KPI REF TARGET DATE EXEC LEAD KEY ACTIONS MEASURE (where applicable) EXPECTED CHANGE STANDARDS FOR HEALTH LINK Determine clinical skill mix required to support the new clinical model for Unscheduled Care and the Planned Patient Care model June 2012 Medical Director Identification of Clinical skill requirements Agreement with all stakeholders If appropriate pilot a range of options n/a 24 Implement revised Clinical Team Leader role Sept 2012 Director of Service Delivery Define the specifications for clinical leadership required through the role Develop a communication and training plan for CTLs Implement plan n/a 24 Produce Business Case for purchase of Electronic Clinical Record system Sept 2012 Director of Strategy, Planning & Performance Develop business case, secure funding and attain approval to implement Implement on a phased approach n/a 6, 7, 8, 9, 10, 19, 20 Strengthen clinical governance framework to support clinicians to maximise their scope of practice March 2013 Medical Director Identification of clinical skills requirements Conduct a gap analysis of current versus required clinical skills Develop a framework and training plan Implement plan n/a 6, 7, 8, 16, 21, 24 Continue to improve the infection control arrangements March 2013 Medical Director Conduct audit of current infection control measures Identify areas requiring further improvement Develop action plan Implement plan % compliance with dress code % of station / vehicle audits undertaken Increase Increase 13 Achieve statutory requirements for the Safeguarding of Children and Protection of Vulnerable Adults March 2013 Medical Director Review and improve the Safeguarding Strategy and implement required improvements Revise management structures and arrangements Implement HIW action plan % of AIs/SAIs involving Safeguarding issues % of actions of HIW action plan Decrease Increase 11