Importance of operational grip on cancer recovery The

Importance of operational grip on cancer recovery The journey from despair to hope to success.

Importance of operational grip on cancer recovery Introduction - Where we? - IST support - A few simple changes helped turn cancer performance around - Focused support on challenged areas - Culture change “We’re taking cancer seriously” - Going from failing 2 ww and 62 day to passing 3 quarters in a row - Still got a way to go! RBH May 2017 2

Importance of operational grip on cancer recovery Background - Failing performance - High numbers on the PTL - High number of interim managers - Turnover in cancer team - Dermatology issue - Clinical Admin Team (CAT) restructure + turnover - Acceptance RBH May 2017 3

Importance of operational grip on cancer recovery IST involvement - Demand & Capacity Review on 1 st OPA, Diagnostic and IP wait - Advice around PTL meeting – Attendees – Format – Expectations - Training – Support on content and delivery RBH May 2017 4

Importance of operational grip on cancer recovery Turning point - Demand & Capacity work complete and capacity on line and gap quantified. - Expectation that 2 ww performance should be sorted for Quarter 1 2016. - Reality – at the end of April we had 268 breaches = whole quarter tolerance gone by end of the first month. - Agreed an ambitious but realistic goal of passing 62 day by Quarter 3 2016 RBH May 2017 5

Importance of operational grip on cancer recovery Process - Pathway divided into a logical approach: – 2 WW – Diagnostics – 62 Day - Quarterly trajectories by IST reflected this approach - Trust CCG and NHSI approved the trajectories RBH May 2017

Importance of operational grip on cancer recovery Relationship management - Cancer Action Group – Weekly meeting, very quick – Chief Operating Officer, Planned Care Leaders, Cancer Pathways Manager, Access Manager, Service Managers as required – Discuss performance and predicted performance, decide short term action and support long term action - CCG transparency – Monthly executive led meetings including performance leads – less reactive reporting and a more transparent approach – Led by Chief Operating Officer – Open and challenging forum - Quarterly trajectories agreed with the NHSI / NHSE RBH May 2017 7

Importance of operational grip on cancer recovery Gaining operational grip- 2 WW - Daily Cancer Ops Meeting – Very quick – Snapshot of breaches and referrals – Attended by all specialties ranging from Booking Officer to Service Manager – Senior Chair – Visual management, high impact – Very quick to set up – Iterative! – Engaged and empowered teams who can own the pathway RBH May 2017 8

Importance of operational grip on cancer recovery RBH May 2017 9

Importance of operational grip on cancer recovery Gaining grip- 2 WW - Open conversations with patients about choice to reduce cancellations Your GP has referred you very urgently to exclude a potentially serious issue such as cancer. We strongly advise you to accept this appointment. - 88 2 ww choice breaches in April ’ 16 – 89. 5% - 39 2 ww total breaches in June ’ 16 – 97. 2% - Lowest performing month since was Sept ’ 16 – 69 choice breaches, 95. 1% - 1 complaint - “Aim for 7 days to achieve 14” RBH May 2017 10

Importance of operational grip on cancer recovery Gaining grip - Radiology - Getting priority clear for diagnostics – Amended PAS order priority – Changed from “ 2 ww” to “ 2 ww suspected cancer” – Reduced inappropriate use of the 2 ww priority and capacity – Allowed services to prioritise the 2 ww booking process – Much clearer demand for true 62 day patients – Push to get diagnostics through in 7 days RBH May 2017 11

Importance of operational grip on cancer recovery Gaining grip – Endoscopy - Endoscopy weekly meeting - Attended by clinicians, nurses and management - Additional management support - High clinical engagement - Problems broken down into manageable chunks - Structured and well supported - Most problems were solved by the service teams - Prioritised and visible demand managed by an empowered team RBH May 2017 12

Importance of operational grip on cancer recovery Gaining Grip - 62 Day - Focus of tracking changed - Decrease in number of active patients on PTL – Jan 2016 saw over 2000 patients compared to now, between 1200 -1400 patients. - Infoflex updated to fit our tracking needs - PTL meetings re-launched and given top priority – Every patient discussed – Come with completed actions – Up-to-date – Business as usual RBH May 2017 13

Importance of operational grip on cancer recovery Gaining Grip - 62 Day RBH May 2017

Importance of operational grip on cancer recovery Gaining Grip – Long Waiters - 104 day patients – Reviewed daily and actively managed – Rapid next steps – Escalation - Harm review – Start at day 90 – Clinical Harm Review board launched – Pathway reviewed by Lead Cancer Nurse – Chaired by Medical Director May 2017 15

Importance of operational grip on cancer recovery Gaining Grip - 62 Day - Breach board in MDTC room – White board on the wall – Separated by month, patient initial, site and Hospital number – Any patient at risk of breaching in this month or next – Very visible to whole team – Predict performance RBH May 2017 16

Importance of operational grip on cancer recovery Gaining Grip - 62 Day - IST review of training - Cancer training was introduced beyond the cancer team - All members of the clinical admin teams attended - Continue to be rolled out once a month - Training for the consultants is currently in the planning stages. RBH May 2017 17

Importance of operational grip on cancer recovery Ethos at RBH - Accept no 2 WW breach due to capacity - Only accept informed patient choice breaches - Understanding across all staff groups that the standards reflect: – High quality patient care – Improved outcomes – Trust priority for our patients - Achievement of the cancer standards is a good indicator that we are doing RBH May 2017 right by our patients 18

Importance of operational grip on cancer recovery Where we are now Current performance Q 4: 2 ww 96. 6%, 62 day 85. 7% Yearly performance 16/17: 2 ww 95. 4%, 62 day 85. 02% Continuing to work through: - CT CIN (contrast-induced nephropathy) - Constant updates to our demand capacity work - Quality of referrals - Vague symptom pathway - Tertiary referrals - Diagnosed by day 28 RBH May 2017 19

Importance of operational grip on cancer recovery 2 Week Wait Performance RBH May 2017 20

Importance of operational grip on cancer recovery 62 Day Performance RBH May 2017 21

Importance of operational grip on cancer recovery Summary - Lots of small changes and a few larger projects - Logical approach broken down into manageable chunks - Focused support, particularly in diagnostics - Culture change regarding patient choice - Constant 2 ww growth Year 13/14 14/15 15/16 16/17 2 ww Referrals 14, 576 16, 687 18, 470 19, 748 - Culture change at every level that we will push for continuous improvement. RBH May 2017 22

Laurie Scott Director of Operations Laurie. scott@royalberkshire. nhs. uk Chris Lowrie Directorate Manager Berkshire Cancer Centre Chris. lowrie@royalberkshire. nhs. uk Charlotte Wood Cancer Pathways Manager Charlotte. wood@royalberkshire. nhs. uk