A Proposal For Improving Waiting Times

Introduction:

The purpose of this report is to set out formal consultation of proposal by MRN Consultancies to improve physiotherapy services by reducing waiting times to achieve organizational strategic goal. This proposal also acknowledges current service delivery model and its implementation, also it considers service improvements and financial benefits. This transformation can be very challenging for the organisation which in turn obliges significant shift from current service delivery model. MRN consultancy would help to strengthen by recommending the changes to current management approach with a better understanding on patient demands and execution of recommendations to meet those needs to achieve organisational goals. Further this report would make recommendations based on our hypothesis in association with analysis of qualitative and quantitate data through various frameworks.

The main strategic objective of MRN Consultancies is to study existing pathways by comparing them with other community-based services across various health boards in Scotland. Furthermore, provision of new pathways which can fast-track appointments with a speedier intervention which can delay in condition progression with more seamless services that can be offered by clinician and patient could be seen sooner and an improvement in patient waiting times can be achieved. Project brief outlines on four major NHS Scotland quality strategic aims to provide patient centred care in a safe and effective environment by achieving financial sustainability, further works in line with Scottish Government 2020 vision in providing services in homely settings.

Service Background and Context

Headquartered in Paisley, Renfrewshire Health and Social Care Partnership have laid out its priorities to ensure health and social care services are securely integrated to achieve anticipatory and preventative care around the needs of individuals. Rehab and Enablement service (RES) was established in May 2012 by bringing together several community-based rehabilitation teams to deliver a more co-ordained approach to patient care. In conjunction to ageing population with their growing complexities in health and social care needs; associated with scare resources and budget constraints partnership needs innovative solutions and comprehensive approach to address those health inequalities and provide sustainable care; bring better outcomes for patients by avoiding fragmented and uncoordinated care and better use of resources with single budget for service. Across Scotland Health Boards it is extremely challenging to maintain capacity and achieve sustainability in delivering physiotherapy services within partnerships within the standard service waiting time targets. Physiotherapists with a widening skill mix can support and tailor services to patient's as per their needs, where there is a significant redesign of health and social care services are required.

Due to the complexities and obvious interactive working environment with in the team's patients were spending weeks to get usual consultation and treatment and complete their appointments. Considering no standard waiting time targets for provision of community physiotherapy service within the partnership has raised patient dissatisfaction along with poor infrastructure framework; through lack of single sharable electronic patient record system; scarce resources; budget constraints have stifled communications and services within the partnership. Also, an increase in geriatric population requires more health and social care, therefore manifests an increase in demand for more robust, speedy and cost-effective services from multidisciplinary teams with effective partnerships.

There is a current need to redesign current service delivery pathway in community physiotherapy to reduce waiting times, further to consider significant challenges including capacity, sustainability, staff recruitment and retention. Through knowledge on various projects from different services MRN consultancy’s current proposal could bring enormous improvement in managing patient waiting times and improve community physiotherapy service efficacy to meet patient expected outcomes further enable in improving general care quality. This proposal has been designed to address the gaps in service pathways, human resources, budget allocation and strategic ambition of organization.

Methodology

The proposed work schedule includes only Phase 1, 2 & 3, where assistance would be provided throughout all phases as requested. Once the contract is being signed off we would like to discuss on project plan & deliverables & objectives, project schedule, departments to access healthcare data, expectations from client on project deliverables.

Project Organisation & Planning

The Gantt chart (below) explains key segments in the project and how the project objectives are delivered within the agreed time schedule. Our team of experts visit RES team to mobilise discussions for confirming their understanding on project scope, objectives and expectations of client on project outcomes. This will be an incredible opportunity for introductions and clarifications of agreed time scales, logistics, specific approaches and methodologies for project delivery along with financial viability of this project. MRN Consultancy utilizes three phase project plan and methodology to produce deliverables based on scope of proposal harmonized according to ISO 20700 standards.

Deliverables

Based on our experience and understanding on scope of this project we are proposing these deliverables

• Engagement to Inform the development of new pathways to improve community physiotherapy waiting times
• Run Pilots with In the Health and Social Care Partnership detailing framework and work plan
• Comparative analysis of similar services within the partnerships and Clinical Governance Standards and a report on their effectiveness (existing pathways)

Project Outcomes:

• Patient appointments to reflect on their clinical priority
• Improve communication between patients and clinicians
• Better appointment cancellation policy and operational procedures
• Clarity of roles, responsibilities and leadership
• Improve information technology infrastructure.

Research:

Organisational study is more important in project management which facilitates to learn and understand about certainties and uncertainties of current model to analyse existing relationships within the internal and external environment. Furthermore, in order to study the priorities of top management and their style which are the major influencing factors on project management. MRN consultancy focus on certain areas which can be very crucial for this proposal such as: Capacity Management Organisation Strategic vision in line with Scottish Government 2020 Vision Management processes and structures Financial Mechanisms Existing policies (Regional and National context)

Engagement Sessions:

• Engagement with regional GP’s to understand strong connection links and referral pathways as it is always the preferred service by the patients to access other services within the region. For patients, with chronic musculoskeletal conditions, it is their preference to get assessed by GP’s, where we identified a common theme to access wrong services.
• Engagement with other stakeholders (District Nurses, Social Workers, Care Managers, Paramedics) to maximise their knowledge and understanding on current pathways and further to analyse their views and expectations on community physiotherapy service.
• Engagement with Senior Service Managers, Professional Lead to examine how complicated is current system which have paved pathway for confusions and higher expectations.

Mapping Strategies:

Public Engagement Sessions are more crucial part of this proposal considering that people are not getting their needs met under current system as they must wait for weeks to months to access physiotherapy services. MRN Consultants are the experts in processing mapping and drivering diagrams tools for service improvement projects. Considering them as very powerful and interactive makes clinicians and public to understand how complicated health and services can be in their process design and this can be ranging from number of referrals they receive to consultation hours and how a patient makes their journey in this process. As a firm we run these sessions for a group of 15-25 people which can easily take 3-4 hours to complete. Various stages involved in process mapping from planning the session, building a process map, analysing a map and finally making recommendations. The main outcomes through this mapping technique are:

Reduce Unnecessary steps/handovers

Identify and eliminate Unnecessary delays

Identify waste and reduce duplication

Identify illogical sequences

Identify bottlenecks

What the process is like for those involved

Data Analysis & Evaluation

Data can be collected as required for the project and any additional data can be collected based on our understanding. We chose qualitative and quantitative paradigms to capture, analyse and study the data which are all established in this project cycle to prescribe evidence-based decision. Furthermore, our research methodologies facilitate to understand the difference between the data paradigms and this enables us to achieve broad understanding on current proposal. These two studies assist us to understand the impact of illnesses and treatment pathways inside the organisation. Moreover, it further facilitates to understand patient centric care and organisational performance, clinical governance (evidence-based approaches) and patient satisfaction on service delivery deprived of limiting to future marketing research where clinicians and service managers can plan and forecast the future challenges. The data for qualitative paradigm collected through one to one interviews, focus groups, to study and analyse current research on organisational structure, policies and standard operational procedures.

Interviews: Respondents (GP’S, Senior Service Managers) should be well informed prior to the interview and it can last between 20-40 minutes and they are one off with a set of questionnaires designed for data analysis.

Focus Groups: Where concentration is given on gathering collective data and the size of the group that can be a mixture of multiple stakeholders for multiple stakeholder analysis which can last between 1-2 hours.

Our approach for quantitative research is specifically designed which is highly structured and statistical where our approaches are:

With clearly defined questions through surveys, where it is targeted to wider groups and communities (front line clinical staff, administrative department and patient groups or forums) Online Survey (questionnaire and postal questionnaire) for Public engagement

Study and examine previous project or service records on community physiotherapy waiting times, capacity, and budget control and service improvements.

Where the obtained data through qualitative paradigm is evaluated through sequential analysis which assists researcher to visit his previous context, questions and develop hypothesis as they arrive through regular sequencing or analysis.

Final Report

Our final report, assures in hiding confidential and identifiable information, only includes public version of this report. Based on the data analysis, we prepare report as we are analysing the data further and we will prepare databases which we used for our analysis for any ongoing support if required. While completed, the report will be submitted to management as scheduled. This final report focusses on improvement opportunities and tie up to agreed outcomes at initiation of project. The report further identifies root causes of issue with recommendations and further improvements as required

Presentation and further support

MRN consultancy presents these reports to client group and interested parties by experience consultants. MRN consultants hold a vast experience in presenting such kind of work to wider audiences in the past. We will present through the contract period and any further assistance that can be offered either through face to face consultant or through e-mail or telephone calls.

Our Strategy and Knowledge:

A group of 20 healthcare consultancy expertise founded MRN Consultancy in 2008, with a vision which has always been on improving health and care services to deliver real change for the sector, where we had worked with various health and social care organizations across the UK covering 5 million population with a combined budget of £10 Million pounds. Our values reflect on every element of work we deliver further that ensures better value for money and ensuring better patient outcome. As a team we deliver services with utmost enthusiasm, honesty and dedication which are imbedded in our core strategic goals. Our customers are NHS Greater Glasgow and Clyde, NHS Lanarkshire, East Renfrewshire Health and Social Care Partnerships where we had executed, delivered and implemented successful projects on strategy, evidenced base practice, service transformation, leadership. Our deliverable model center at Glasgow, which is locally based with feasible staff can provide relevant expertise service, continuity of service at effective price and this means we deliver effective services to improve quality of life for people. Our strategy is to support service organizations to determine priorities and focuse on their strategic plan for sucecssful delivery of the service. We use various tool kits to analyse & interprete complex data to design models and pathways for service improvement. Further a significant importance is given on clinical governance and risk management for a sustainable organizational transformation.

Our Team and their Responsibilities

R Mudivarthy, PhD, is a Managing Director in MRN Consulting Inc.’s health and Social care practice. With 15 years of experience in health and social care consulting where his main attributes are in data management and programme evaluation. Through years of experience he is an expert in data validation for policy research where his recent work for NHS Greater Glasgow and Clyde on delivering policy research for managing Orthopaedics waiting times, where his methodology for data analysis were highly appreciated by the trust and its partners. Where his other commendable work on Inpatient payment methods with Nuffield Hospitals Glasgow where he designed a robust payment method for patient expenses reimbursement. Dr R Mudivarthy has received master’s in research and PhD from Data Analytics from University of Glasgow and he is also a certified Prince 2 Practitioner where he holds direct experience in project management. Robert Muir is a senior consultant at MRN Consulting Inc’c. He is a certified Prince 2 practitioner with 10 years of experience in Project Management, further an MBA graduate from University of Strathclyde. With particular expertise in the data analytics, data mining and information systems, Robert has provided valuable services in designing process maps, pathways to various health boards across NHS Scotland and his recent work on service improvement for

Royal Alexandra Hospital Maternity Ward has been highly appreciated where he designed a template on how to improve patient outcomes on post caesarean section. He further holds technical responsivities in developing and implementation of data base applications. Theresa Brown, a Researcher at MRN Consultancy, is a prince 2 practitioner with 5 years of experience in project management and an MSc Graduate in Healthcare Economics from University of Glasgow. She holds commendable experience in process mapping and designing driver diagram for service improvement. Her recent experience with Queen Elizabeth University Hospital Paediatric Ward in designing process map is effective to provide seamless service in managing waiting times and improving quality of care. Her primary area of experience and responsibilities are related to handling gigantic data and analysing that through advanced data analytic tools which is very essential for technical projects.

The table below exemplifies the anticipated costs breakdown for this project proposal and all that cost are excluding VAT. Is shows rough estimation of consultant day rates and their availability for the proposal along with other direct costs.

Ethics and Accountability

By being honest, open and trustworthy at every level of service delivery, further be more accountable by adhering to clear professional boundaries and comply with the agreed ways of working. MRN consultancy, being a member of The Management Consultancies Association (MCA) and Chartered Management Institute (CMI) prove us that we are a credible, loyal and trustworthy consultancy and harmonized according to ISO 20700 Management Consultancy Standards.

Promote Dignity

We always act in the best interest of client and respect their stakeholders, further considering this as a health and social care project we exhibit utmost care and compassion in emphasizing scenarios at engagement sessions.

Respect right to confidentiality

We communicate in an open and effective way where all the relevant conversations are dealt with utmost confidentiality and any patient related information can be withheld. Always follows client’s standards and guidelines in disclosing and discussing any clinical related issues.

Our recruitment and human resource ensures our work force is balanced represents best candidates regardless off their age, gender, nationality, race, sexual orientation, socio-economic status and religion. As per our policy we support our staff to achieve their career advancements through service and professional development training and our salary increments are based on knowledge skilled framework which are weighed against employee performance and achievements during that period.

Data Security

The information we gather during out engagement that will be treated in confidence. Only our staff involved in this project can only access this sensitive information. Further we are fully compliant to current GDPR standards along with data protection act 1998. All the data will be processed fairly and lawfully.In terms of austerity management, the consultants play a significant role in bringing trust and knowledge to improve services in public sector organisation and provide patient or customer satisfaction. Exclusive of hampering to trust of service managers at public sector, our consultants influence them with decision-making skills extensively on selected areas which are conceptualised in our current proposal to bring credibility to our methods. Our team aims to minimise ambiguity from project planning to report submission where we provide remedies to the issues highlighted at initial phase of project brief. Considering the poor visibility of robust strategy on community physiotherapy waiting times, our hypothesis was to predetermine the result and effectively working on minimising wasteful approaches. Various frameworks were considered to add logical and coherent argument and to justify our reflected approach with this project proposal. Where we believed, there can be direct and indirect impacts on the client and the organisation of our services. Directly by being involved in discussions, engagement sessions and indirectly through the trust and relationship built during the process of consultation. The key challenges we come across during this project proposal was limited access to data, strong organisational culture, hierarchical leadership, various strategies and policies which are interlinked and Information Technology where most of the resources required for the project proposal that were stored disproportionately and finally poor communication channels with varied skill mix. It has been a great challenge for the consultant by being an autonomous professional as to deal with highly complex bureaucratic health care system.

A recent change in reforms and policies has brought a significant shift in health and social care delivery, however it has also brought challenges as such by being inconsistent between two systems in exchange of information, incompleteness in maintaining sustainability and with greater impending on clinical decision making intuitively by making the system as uncertain through rapid changes in political, economic and social circumstances. Based on our hypothesis, we had recognised major transformational challenges that are ahead for NHS and the Community Physiotherapy team need a forward view considering these changes are inevitably visible to public. In order to minimise perturbations in the process of consultation, the MRN consultants are well equipped with process orientation and project management skills to empower organisational change. However, according to Yerkes (2007b), one of the main principle is “trust” where both parties have to trust the process along with our processes being simple and free from errors. We are further embedded with skills to deal with organisational change by understanding human behaviour and understand their resistance to change (Yerkes, 2005).

In majority of cases, due to lack of adequate reasoning, technical and analytical skills of consultants influence their relationship with their clients. However, in order to make our consulting interventions more successful, the MRN Consultancy has chosen hypothesis, decision making tress, frameworks to build our own logical tools to allow us to be more coherent in considering issues and building relationships with our recommendations. MRN consultancy recognised the importance of hypothesis and linked it to overall organisational sustainability and further benefitted in evaluation of data for implementation of recommendations. Study conducted by Prier and Stone (2004) reason for unsuccessful projects are due to insufficient internal communication skills to overcome this our experts used ‘five why’s ‘this format was extensively used in engagement sessions which attracted client and its stakeholders from planning to recommendations where our experts are more experienced in developing hypothesis tree or decision-making tree to elicit challenges and build logical relationships.

Throughout our consulting, we aim to maintain an honest communication with clients and external stakeholders. As per Luhmann (2002, p.169), communication is effective where we decided to use logical model since beginning of project to iterate what is important and eliminate illogical sequences and in retrospective it is used to understand the changes as we keep building on these logical based scenarios and we aim to conduct these at various venues where we believe that, it generates openness and make participants more interactive. Furthermore, our staffs are trained to use same shared language to emphasize that we are communicating same thing as to minimise delays in process (Sadie, 2007).

However, the main concern we had come across during this process was underdeveloped community physiotherapy pathways and illogical or flawed sequencing in service delivery model, further organisational strategic leaders have not done enough in identification of these challenges. Having said, the logical model development can only be achieved if there is logic behind this which we identified at our initial project brief sessions and made those as outcomes for this proposal. There is no particular template which can be used during the process, however our assumptions are based on the hypothesis further based on inputs both internal and external, activities what influences those inputs and how they are linked to outcomes and finally how impactful they are on overall organisation in achieving its sustainability. Our consultants hold that expert knowledge which is more advanced than clients understanding, and it is sharable during the project. As Mckinsey writer on their website;” We invest significant resources in building Knowledge. We see it as our mission to bring this knowledge to our clients…” (McKinsey & Company 2006).

MRN Consultancy has used its own template in constructing a logical which can be beneficial for community physiotherapy service to improve its waiting times. Our frameworks are based on business model, profitability and service merges. Regarding business model, we concentrated on organisational structure where we studied organisational policies, standard operational procedures at local, regional and national context; technology studied current advancements in digitalisation and scope for improvement if recommend, and for profitability we studied existing investment, funding and contracts with external stakeholders.

We are moving from traditional consulting approach to systematic approach where along with human beings, its technology and systems are major part of communications. To improve client relationships and minimise overlapping in our analysis and evaluation further to complement our hypothesis and logical thinking we use SAS advanced data analytics application to analyse data and generate better real time solutions.

The current proposal is considered as a quality improvement strategy where to improve the waiting times of community physiotherapy teams in RES team. Our initial activities were on planning to understand our customers and their needs. Further we concentered to understand current strategy, operations and identify any gaps in performance. Finally, we made recommendations in the form of process redesign for quality improvement. In current situation on improving waiting times for better patient satisfaction to achieve organisation sustainability. Our methodology and tools are designed in such a way to examine performance through out the cycle and made alterations as required.

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