Helping transform services to cut waiting times
Royal Free Hospital in London used the Map in redesigning its Carpal Tunnel Syndrome services, a test case for its 18 week-compliant clinical pathways project. Using the Map's original pathways as visual aids and information sources, along with NICE and other guidelines, workshops created a 'Royal Free best practice'. The Map helped assess what could be taken out of secondary care and into the community to streamline the service.
Dr Kerry Tinkler of Royal Free's 18 week pathways project explains how the Map helped transform Carpal Tunnel Syndrome services (4:30)
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Transcription
Interviewer: Can you explain to me what your role is at the Royal Free?
Kerry Tinkler: Yes, I'm the Associate Clinical Director for Physiological Measurement and I'm also part of the Eighteen Week Central Team. My main role within that is Service Redesign, Service Transformation in order to meet 18 week compliant clinical pathways.
Interviewer: And I understand the Map of Medicine is helping you to move towards achieving an 18 week wait, can you explain to us how that is working?
Kerry Tinkler: Yes, we are using the Map of Medicine as a tool really to help us achieve Service Redesign so the way I'm working is setting up workshops, getting everybody involved in the process, all the key stakeholders, basically sat around a table discussing how we could do things differently. We use the Map of Medicine, the current Maps that are on there now as a visual aid, also as an information tool along with NICE guidelines and any other clinical guidelines that might be available to develop new services, Royal Free Best Practice Services if you like and then we are going to adapt the Map of Medicine to reflect any changes that we make.
Interviewer: Do you see then that it is going to actually help you cut down time, it's a time saver?
Kerry Tinkler: Absolutely, that's the main point of it, any service transformation, the idea being that we reduce time that a patient takes from referral to treatment, obviously that's the whole point of the 18 week wait, but it's also about how we deliver the services, so can we take anything out into the community, some of the diagnostics for instance and the Map of Medicine we are using as a tool to help us look at that and look at the whole process and the pathways where diagnostics occur could we be doing things differently. The idea being that we would reduce the time but also just streamline the service so it's more effective for the patient.
Interviewer: So you've chose Carpal Tunnel Syndrome as your pilot, how do the timings work in the Map?
Kerry Tinkler: Well we actually chose Carpal Tunnel because there is lots of diagnostics within that obviously nerve conduction, plain X rays and any other diagnostics that might be appropriate and also it include therapies as well, we've got physiotherapy services there and we decided to look at what could be done, what could be taken out into primary care. There was already some work started but the Map of Medicine just aided that work and assisted us look at what can we take out to primary care and deliver care close to the patient and we set up a muscular skeletal CAT service so the patient will have their diagnostics and their physiotherapy out in the community and then be referred into secondary care if appropriate. We are aiming to get the Carpal Tunnel out 1st November, we want to go live with that service and then I want to roll it out across the whole trust in the next few weeks really, weeks to months. We need all patients to be on a 18 week compliant pathway by November really to meet the March 08 deadline.
Interviewer: What's the reaction been like amongst the Health Professionals, do they react positively to it?
Kerry Tinkler: We've had mainly positive responses obviously the Map was developed at the Royal Free and so we've got mainly positive responses, there is always some negativity out there but we've got some good leadership and we've got some clinicians basically passing on the message and it's getting out there, getting the message out there.
Interviewer: So do you have any tips for other adopters of the Map of Medicine? You seem to be suggesting for instance that having ambassadors for this process is a good way to go forward.
Kerry Tinkler: Absolutely, the Map of Medicine was developed by clinicians for clinicians so I think it is very important that we get some good leaders and clinicians on board with this to spread out the message and to say this is a very useful tool and can help with your clinical practice.
Interviewer: I notice that you're planning to audit the use of the Map and the pathway, how are you going to audit it?
Kerry Tinkler: Well what I actually mean by that, what I want services to do is to take ownership for this, okay as an essential 18 week team we are looking at service redesign and transformation but it's the leaders of that service that then need to take ownership of that new service and we need to look at how they are using it and how patients are coming through that process.
Interviewer: Are there some healthcare staff it's very difficult to persuade to use it more than others?
Kerry Tinkler: I don't think so really, there is always a little bit of scepticism about using an electronic tool for a clinical pathway and are we removing clinical decision making and clinical skills but I think actually that's just not true, I think we can embrace this and use it as a tool, it's not replacing your clinical skills and your clinical knowledge, it's used as a tool as well as.