This document is also available in pdf format (1514k)
to the first issue of Change For The Better the newsletter from the Centre for Change and Innovation (CCI).
Change and innovation are nothing new in the NHS. They're a constant feature of the work of NHS staff. At the CCI we focus on improvements and help staff learn from each other. We do this by:
providing information and advice, as well as other resources;
supporting programmes in specific areas like GP practices, outpatient departments, cancer care, and mental health services;
helping staff develop solutions to their own problems using learning material on our website ( www.cci.scot.nhs.uk );
providing examples of national and international good practice in clinical and service redesign;
providing support to help staff deal with local service problems; and
encouraging flexible and innovative ways of working and supporting new roles in the workforce.
This quarterly newsletter is to brief you about changes that are happening in care and tell you about events. Together we've done a lot, but we want the pace to quicken! Patients and staff want what is best in NHSScotland to be spread to the rest of NHSScotland.
With this issue we are attaching a CD. This is our first audio programme about the work of the CCI. It has been produced for the CCI with the assistance of BBC Radio Scotland and includes interviews with staff and patients who have helped to introduce new practices that have made a difference.
It's only 20 minutes long so please listen and give us your feedback by emailing us at firstname.lastname@example.org . You might even want to listen to it at your team meeting, or committee, as part of your usual agenda.
Free CD go towww.cci.scot.nhs.uk
on Outpatient waiting
The CCI's Outpatients' Programme aims to help the NHS meet the target that by December 2005 no patient will wait longer than 26 weeks for a first outpatient appointment with a Consultant. It is supporting the establishment of new patient-focused booking systems throughout Scotland. It also includes developing national patient pathways for common conditions, and major redesign programmes targeted at "high wait" specialities such as ENT and Orthopaedics. We are piloting referral management arrangements and establishing arrangements for the sharing of good practice.
We've had two Good Practice conferences bringing together hundreds of clinical and non-clinical health care staff from across Scotland. They heard from speakers from all over the UK and took part in learning labs on key service improvement topics such as Patient- Focused Booking and Referral Management.
Success in reducing outpatient waiting times across Scotland is celebrated in a new CCI report which aims to spread good practice throughout the service.
The report " Improving Outpatient Waiting Times: What Matters, What Works, What Next" features a series of successful case studies. They show:
A reduction from 23 weeks to 12 weeks for routine cardiology appointments at Stirling Royal Infirmary following the establishment of a nurse-led clinic.
A reduction from 30 months to 6 months for podiatry appointments in Perth and Kinross following the introduction of a new assessment process. A reduction from 30 weeks to 3 weeks in waiting times for ultrasound scanning in South Glasgow following a redesign of the service.
Examples of service improvements from Wales, England and Northern Ireland.
More examples are available on the website.
For more information, contact the programme manager: email@example.com
Since the CCI was set up in November 2002, frontline staff have tackled specific areas of healthcare
that needed immediate action. Here are some top changes as examples of the good that can come
of modernising services. You can see that the simplest changes make a big difference to patients
and to staff....
1. A dermatologist in Dumfries was struck by the fact that his dog could see the vet in 3 days, but his patients had to wait 3 months. By using telephone consultation, teaching patients how to check themselves, rather than having follow-up appointments, and through other changes, he got waiting down to 1-2 weeks.
2. Treatment for DVT traditionally needs 5 days in hospital, but in Ayrshire and Arran, specialist nurses provide a service using new drugs, which takes about three-and-a-half hours in hospital, followed by care at home.
3. In the Western Isles, patients were waiting up to 16 weeks to be seen by a visiting specialist. Now, using digital technology, details of their condition and images are passed to the clinician, and a local nurse can administer treatments such as UV light therapy. The consultant has to travel from Inverness half as much and patients get treated close to home.
4. Outpatient waiting times have been reduced from 68 weeks to 6 weeks, transforming the experience for routine endoscopy at St John's Hospital in Livingstone following the introduction of a new referral system.
5. After consultation with staff and patients, the Western General Hospital introduced dedicated parking spaces for patients attending for chemotherapy, transforming the experience for patients and carers.
Remember, you have the ability to make changes yourself. You don't need permission to suggest ways of improving patient care. Talk to your local Service Redesign Committee or contact us directly by email at firstname.lastname@example.org
We gave Service Redesign Committees over 26 million to make change happen locally. What did you do to help spend that?
Cancer care - the CSI programme
Cancer teams, clinical and non-clinical staff, use "process mapping" to generate ideas for change - and then they just do it. Here are some of the ideas that have been put into action and are delivering real benefit for patients.
Janice Kemp, Lynn Smith and Dawn Sturrock leading their CSIP Process Mapping Event.
Barium enemas from 8 weeks wait down to 2 in Glasgow. It's not more work, it's a different way of working. A surgeon, clinic and radiology staff just improved the communication between them.
In Dundee, patients referred to chest physicians are being seen in 10-12 days. This is 11 days faster than before. Clerical staff, GPs and consultants together made some simple changes in the way they worked. It only took a few months to achieve.
Abnormalities in chest X-rays in the Borders are now reported by radiographers reducing waiting time by up to a week for referrals to specialists. The team saw the need and the consultant trained the radiographers.
These are just some of the positive changes taking place in cancer services across Scotland. A CCI team of seven regional facilitators works closely with the clinical leads of cancer services and provides staff with practical support and expertise to improve patient care within Scotland's three regional
cancer networks. The key is to keep it simple, make small changes quickly and measure the difference that you make.
For further information, contact the Programme Manager: email@example.com
in Local Practices
"Doing Well" is a programme involving doctors, nurses, psychologists, counsellors, the voluntary sector and anyone else in general practice who cares for people with mild depression.
When people go to the GP they don't often get the most appropriate help, so this programme is looking at self-help techniques, self-help coaches, tool-kits, support groups, and other therapies supported by nurses and psychologists. The programme will be formally evaluated by academic researchers, collecting information that will be of value both locally and nationally. Within a few weeks of getting funding, some good ideas are already in action. In Glasgow groups have started for people with depression, delivered by a voluntary organisation which is run by, and with, service users.
A national network supports both development sites in the programme and all of the other health board areas that are interested in tackling this issue.
For further information, contact the Programme Manager: firstname.lastname@example.org
access in primary care
Delays are being reduced in primary care by new ways of working. The CCI's Scottish Primary Care Collaborative programme is designed to change the way general practice works, to improve routine access for patients and by enhancing the quality of care for people with chronic diseases. The first wave involved around 100 practices, and there is more to come. By introducing changes such as avoiding booked appointments at the busiest times and dealing with patients' clinical problems by phone, a real difference can be made. Within 9 months, practices showed:
51% improvement in waiting times to see a GP;
23% improvement on waiting times for a practice nurse; and
15% increase in patients seen on the day of their choice.
The programme also helps the management of care for people with diabetes. The improvements shown so far are:
14% improvement in those with a HBA1C reading in the target zone;
18% improvement in those with a cholesterol reading in the target zone;
16% increase in those with blood pressure in the target zone; and
41% improvement in those having their eyes checked in the previous 15 months.
The Collaborative has now been extended to a second wave of practices. Thirteen out of 15 NHS Boards are taking part. Now around three-and-a-half million patients can benefit from this improvement process.
You can hear about one example from a GP practice in Dunoon on the attached CD.
For further information contact the Programme Manager: email@example.com
Why Listen not to our CD in your car or at home?
It's a short programme about the CCI, including interviews with staff about how changes they've made have improved patient care and improved staff satisfaction. Let us know what you think. You can download the programme from our website: www.cci.scot.nhs.uk
In association with
where the people are
Lots of NHS staff can't come to conferences, or study days. So CCI staff came to visit you, all over Scotland, on a bus. During this tour we visited 14 sites in eight Board areas. Staff got the chance to use the CCI website and the eLibrary resource on the bus. We are now arranging to visit locations that we missed (unfortunately without the bus) at local request. We've got useful published material including practical advice about how to change your work for the better, and we brought it right out to frontline staff.
Malcolm Chisholm, Minister for Health and
Community Care on board the CCI bus at Cameron Hospital, Fife
The CCI bus
to learn more
The CCI website is a rich source of information to help staff throughout NHSScotland improve services for patients.
The website provides information on both national and local programmes as well as illustrating how successful change can be achieved through a series of best practice examples. It includes practical guidance on managing teams, in the form of diagnostic tools, and special readings on the subject. There are even sample study days that you can down load and use, including the overhead presentations for computer or slides.
And there is the link to the NES eLibrary a gateway into an unparalleled collection of web-based information and resources to help all staff in their working lives. It contains over 4,000 electronic journals, 200 electronic books and over 20 major databases.
The website contains three key areas:
1. CCI NATIONAL AND LOCAL PROGRAMMES information about CCI programmes, events and key contacts as well as access to relevant web links and reports, and examples of good practice.
2. TOOLKIT FOR CHANGE the Manage Your Team section covers topics that managers face daily, offering diagnostic tools and techniques to help deal with them; and the Develop Your Organisation section provides knowledge, ideas and solutions for training needs.
3. eLIBRARY LINK with emphasis on estates and management, as well as the clinical material.
To access the good practice and eLibrary sections of the CCI website from a home computer you will need an Athens password. There is a link on the CCI homepage to apply for a password free of charge.
Scottish Health Awards sponsored by the Daily Record
Prizes totalling 25,000 to be won.
Following the success of the first Health Awards held in 2002, the Scottish Daily Record is delighted to announce that this bi-annual event will take place on Thursday 28 October, 2004, and will recognise and reward Scotland's most committed and caring NHS workers.
We are looking to give recognition to the workers in NHSScotland who are prepared to go the extra mile. People who should be recognised for their commitment to the NHS and their loyalty and devotion to their patients. People who genuinely make a difference.
There is a category for every NHS worker and the areas they work in whether it's the local doctors' or dental practice, the support workers, the nursing teams, ambulance department or women and children's services. They must work for NHSScotland, with the exception of the Healthy Lifestyle Awards nominees.
Completed forms must be submitted by Monday 13 September 2004. Click here for a PDF version of the form.
The short-listed finalists will be assessed by a group of experienced judges and the winners will be presented with their awards at a Gala Dinner and Awards Ceremony in Edinburgh on Thursday 28 October.
Please return your form to:
Scottish Health Awards
7 Castle Street
HELPLINE: 08000 27 28 24
Teams of doctors and dentists in practices or hospitals across Scotland provide vital help, support and advice on a daily basis.
NHS Nursing teams working in general care, community care or specialist care provide an invaluable service 24 hours every day, 365 days of the year.
The specialist skills of the many different therapists in NHSScotland, ranging from physiotherapy to dental hygiene, help improve quality of life for large numbers of people every year.
Unsung Hero Award:
The jewels in any team getting on with their work but bringing much more than could ever be expected to the people they work with or encounter in the course of their day or night.
Support Workers Award:
The indispensable support staff without whom NHSScotland couldn't function auxiliaries, cleaners, porters to name just a few.
The unpaid assistance that makes a visit to hospital or an encounter with ill-health a bit easier or more bearable from hospital radio, WRVS, volunteer drivers and many others.
Ambulance Team Award:
Working in all kinds of situations the ambulance teams work hard to provide fast responses and critical care to the highest standards.
Top Team Award:
Scotland's top NHS team could come from any service, anywhere in the country.
Older People Care Award:
The teams caring for older people make life easier, more comfortable and provide valuable reassurance.
Mental Health Team Award:
The mental health teams work with some of the most vulnerable members of our communities.
Cancer Care Team Award:
So many lives are touched by cancer and the specialist cancer care teams are always on hand.
Heart Disease Team Award:
The teams working with NHSScotland to deal with heart disease are fighting a hard battle.
Women and Children's Services Award:
Providing specialist care, the women's and children's teams cover a wide range of services from the midwife to the special children's doctor and from neo-natal teams to Special Baby Units.
NHS Healthy Lifestyle Award:
Who's promoting a healthy lifestyle in Scotland? Is your hospital offering a super-healthy menu, is your local occupational health department promoting health, nutrition and fitness?
Scottish Health Awards 2004
The bi-annual Scottish Health Awards will be run again this year. First run in 2002 the awards seek to promote excellence, to celebrate and recognise the dedication, professionalism and humanity of the workers in the National Health Service in Scotland. The 12 award categories are themed on People and Services with an emphasis on teams (rather than individuals) wherever possible. This seeks to recognise and reward Scotland's most committed and caring NHS workers who dedicate time and care above and beyond what could be reasonably expected in their job. For more information visit our website, www.cci.scot.nhs.uk
We welcome your nominations. Please use the entry form attached on the fold out of this newsletter
(or down load it from our website).
Women and Children
NHS Healthy Lifestyle Award
Centre for Change and Innovation
St Andrew's House
Tel: 0131-244 3027
Tune in to ' Information TV' on Sky Channel 588 to see the first of two Scottish Executive sponsored television programmes about change in NHSScotland. The programmes, called Changing For A Healthier Scotland, are aimed at Scottish healthcare staff and focus on the improvements made by frontline staff with the help of the CCI. The first programme starts on 21 July 2004 and will be broadcast three times a week: Wednesdays at 3 pm, Thursdays at 8 pm and Sundays at 11 am. Let us know what you think by filling in our questionnaire on our website: www.cci.scot.nhs.uk
Win a personal consultation with a life coach
Analyse your personal and working life, identify areas for improvement and build a strategy to help achieve your aspirations. Kevin McGeever, Director of Persona Training and Development, has been working with leaders in industry and public services for 6 years and has offered to give three one-to-one coaching sessions to the winner of our prize draw.
To enter our competition just visit our website at www.cci.scot.nhs.uk and click on the competition button. Send us an email with your name and place of work address and you will automatically be entered into our prize draw. The competition winner's name will be announced on our website at the end of August.