Erasmus Rotterdam University Business Case Submission 2017-2018

SCAN4SAFETY Date April 16 2018

UPSCALING STRATEGY Members van der Feen, Mariska Jansen, Tessa JelovÄ?an, Eva

TABLE OF CONTENTS 1. Introduction Scan4Safety ○ Problems in Healthcare Sector ○ The Scan4Safety Programme ○ The Core Enablers & The Primary Use Cases

2. Upscaling the Scan4Safety 2.1 Programme Level – Scan4Safety in England 2.2 Project level 2.3 Sub-project level

3. The implementation of Scan4Safety ○ Implementation Strategy – Organisational Team ○ Implementation Strategy – Operational Team ○ Implementation Strategy – Technological Team

4. Measures of Impact Programme Strategy ○ Evaluation– Measurements of Impact

5. Stakeholders

○ Scan4Safety Stakeholders ○ Scan4Safety Bottlenecks & Solutions ○ Public Opinion & Media

6. Challenges of Upscaling

○ Challenges Scan4Safety in NHS Trusts Stakeholders ○ Risks of Scan4Safety Scalability ○ Crisis Management

7. Ending of the Programme

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1

Introduction Scan4Safety

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PROBLEMS IN HEALTHCARE SECTOR

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AGEING POPULATION Increase of chronic diseases Increase in demand for healthcare

ADVERSE EVENTS Serious vs. Non-serious Expected or unexpected Study-related, possibly or not-study related

EXPIRED PRODUCTS Weak inventory management system

INCREASE IN HEALTHCARE COSTS

DECREASE IN PATIENT SAFETY

INCREASE IN OBSOLETES AND COSTS

→ In last 10 years a 50% increase to £120 billion in 2016/2017

→ 850,000 patients experience adverse events each year

→ £ 1,000,000 annual savings from inventory reduction

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THE SCAN4SAFETY PROGRAMME The Scan4Safety is a nationwide programme which encompasses implementation projects in all trusts under National Health Service in England. In order to carry out the programme, multiple organisational teams must be set up with predefined roles and responsibilities.

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OBJECTIVES Scan4Safety

STRENGHTEN PATIENT CARE QUALITY AND SAFETY

Being able to track & trace all patients, products and locations in a hospital will increase patient safety.

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INCREASE OPERATIONAL EFFICIENCY

The track & trace of products improve inventory management and the system link to patients enables fair reimbursements of costs.

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INCREASE CLINICAL PRODUCTIVITY

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REDUCE PRODUCT AND PRACTICE VARIATION

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The registration of product and location data in the patient record increases the speed of identifying the right patient during a product recall.

Scan4Safety enables analysing the variation between the practices and use of products during treatment of patients across medical specialist or specific diseases.

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1

THE CORE ENABLERS & THE PRIMARY USE CASES 3

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Three primary use cases Inventory management

Three core enablers (GS1)

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Location numbering

Catalogue management Patient identification

Purchase-to-pay

Product safely recall 1

Scan4Safety Strategy The strategy of the implementation of the Scan4Safety represents a base for three core enablers and three primary use cases

The three core enablers are supporting three primary cases and must be

Standards and concrete goals and key performance indicators of Scan4Safety

flawless to make the inventory management, purchase-to-pay system and

programme have already been defined within the previous 6 pilot trusts. So the

product safety recall processes work in all the NHS trusts. A well defined

answer to the question of WHAT to upscale, or the content of the programme is

strategy is the base for the processes to be implemented.

already known and it is now important to define HOW to upscale the

programme and replicate it to all other trusts.

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Upscaling the Scan4Safety

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UPSCALING SCAN4SAFETY

8 GEOGRAPHICAL DISPERSION In England, the areas around Liverpool, Manchester and London are densely populated.

Currently, the six demonstrator trusts in Derby, Leeds, North tees and Hartlepool, Plymouth, Cornwall and Salisbury, are not close to these dense areas where a lot of NHS trusts are located. A logical geographical dispersion can help to implement Scan4Safety efficiently in more hospitals, because the ambassadors from the demonstrator trusts are less likely to move farther in the country. Though the ambassadors are an important stakeholder in successful and efficient implementation.

WAVE 4*23 WAVE 3(b)*25 WAVE 3(a)*25 WAVE 2(b)*25

Therefore, in the current evaluation process, as developed by Scan4Safety, the geographical location should be taken into account when selecting the potential trusts for WAVE 1. The role of ambassadors and other stakeholders will be explained in the next slides when the upscaling strategy is explained.

WAVE 2(a)*25 WAVE 1*25 DEMONSTRATOR TRUSTS

Time

ARRANGEMENT OF TRUSTS IN WAVES All trusts should get an equal support for the implementation of the Scan4Safety strategy. Rules should apply in case trusts subscribe multiple times or want to share the 2 million support. First of all, the available budget for the next round should not be awarded to trust which already received financial support, to ensure all trust get the opportunity to use the support as initial investment. Through, another type of support can be provided to the trusts in the implementation process. Furthermore, the size of the NHS trusts varies, therefore the 2 million support for every trust might not lead to the same results.

Evaluation criteria about the size and current level of maturity regarding Scan4Safety practices are important factor in the evaluation criteria for the trusts.

Joint trusts‘ applications of new trusts are allowed, if there is a valid reason to collaborate in the implementation process. We assume there are NHS trust which already collaborate in various ways and Scan4Safety collaboration can lead to efficiency gains. On a local level they can learn quickly from each other and create buy-in at the surrounding stakeholders (if the trust are closely located to each other).

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UPSCALING SCAN4SAFETY FRAMEWORK

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Organisational structure of the Scan4Safety is divided into three levels: programme, projects and subprojects. Programme represents the whole Scan4Safety initiated

by NHS. It is the top organisational level which encompasses, manages, leads, supervises, defines outcomes, and overlooks the 154 projects. Projects are individual “roll out” replications of an implementation process. One project corresponds to one trust and is further divided into subprojects, which are implementations of individual parts in departments of hospitals (IT, HR, SCM departments…).

1. PROGRAMME Scan4Safety in the NHS

3. SUB-PROJECT Departmental projects of implementation of Scan4Safety

2. PROJECT Implementation of Scan4Safety in one NHS trust

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THE UPSCALING STRUCTURE 2.1 PROGRAMME LEVEL STEERING BOARD

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2.2 PROJECT LEVEL

2.3 SUB-PROJECT LEVEL

PROJECT TEAMS

SUB-PROJECT TEAMS

1. PROGRAMME Scan4Safety in the NHS

3. SUB-PROJECT Departmental projects of implementation of Scan4Safety

2. PROJECT Implementation of Scan4Safety in one NHS trust

2.1

PROGRAMME LEVEL - SCAN4SAFETY IN ENGLAND The top organisational level of the programme is managed by the Steering Board, which is appointed by the Department of Health of England and the key players in the current Scan4Safety Strategy & programme.

The programme level is managed by the Steering Board which consists of: A. Content Management Office (CMO) - Responsible for the strategy of the Scan4Safety implementation among all trusts B. Project Management Office (PMO) - Responsible for the implementation of the programme at the individual trusts.

These two management offices within the steering board collaborate extensively, but the split is necessary to keep insight in the overall goals and the implementation within the trust.

A. Content Management Office

B. Project Management Office

The CMO and CPO are both split into four focus areas: (1) Management, (2) organisational, (3) operational, (4) technological.

The organisational area is focussing on the willingness of the management and staff of the trust to implement Scan4Safety. The operational team focuses on the tools needed and activities performed by the employees on an operational level. Furthermore, the technological team is dealing with the IT infrastructure and compliance with current infrastructure in the trusts. These areas are linked to the implementation areas on project levels in the trusts, explained in detail in chapter 3 of the slides.

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2.1

A. CONTENT MANAGEMENT OFFICE

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The main body of the steering board is the Content Management Office, which is the main organisational body which leads, manages, controls, supervises and defines the content of the whole programme of Scan4Safety for all the NHS trusts. It is the management board of the entire programme and is responsible for the entire programme. The CMO is responsible to set up the content of the programme and projects and to manage the resources needed. The CMO will consist of the establishers of the Scan4Safety programme, people closely involved during the implementation at the demonstrator sites and external experts of the healthcare supply chain.

CONTENT OF THE PROGRAMME Purpose

Define what is the purpose of Scan4Safety for the main stakeholders (Based on the current Scan4Safety program, the bad and good practices of the demonstrator sites and the role of stakeholders of Scan4Safety on a national level)

Strategic Goals

Define what will be achieved at the end of the project → E.g., 100% implementation of location numberingcatalogue management for 70% of the NHS trusts by 2022 → E.g. 80% automated e-commerce processes in all NHS trusts Define Key Performance Indicators for all trusts (Part of them are described in the MoS) Strategic goals should be achievable and should reflect the realistic assessment

Strategy

Define ways how to achieve the predefined strategic goals

RESOURCES OF THE PROGRAMME Financial

CMO needs to coordinate the funds which were appointed for the programme. It is responsible for all concerns related to costs of the implementation and appointed funds.

2.1

A. CONTENT MANAGEMENT OFFICE cont.

CMO needs to ensure that the right employees and enough employees are carrying out the project. Since the scope of the programme is very large, the capacity of employees working on the programme level, project and subproject level must be ensured. The programme will face many stages - in first year only 25 individual projects will be running, whereas when WAVE 4 starts, there will be 75 individual project running. That will in reality mean that significantly more Project Teams will be appointed and CMO will have to ensure there is enough employees in its own office, since it will need to supervise 4x many projects as initially. CMO should gradually increase the number of employees and resolve them from the positions towards the end of the programme when the needed capacity will decrease.

Human

Additionally, CMO must ensure that appointed employees are competent for the appointed tasks. Due to the scale and complexity of the programme, employees must obtain practical experience from previous projects, so the initial organisational teams should comprise of employees who worked on first pilot projects. The level of past experience and gained knowledge from the implementation of the programme and competences of individuals should determine the vacancy position an individual will fill. Especially these two characteristics are of high importance for appointing employees.

Employees will be working on the project either full or part time. Full time employees are relocated and work specifically only on the project, whereas part time employees, or Ambassadors, are the employees from projects that have already been carried out and can help with the past gained knowledge from their departments and help with a faster integration. They are chosen voluntarily and only spend a fraction of their working time helping with implementation at other trusts, and teach, support and transfer the knowledge of practical use of the new systems.

Material

To ensure high level of standardization and due to lack of some core capabilities to carry out the programme, CMO will need to outsource certain services and purchase materials (technology, scanners, consultancies etc.) and choose the suppliers which will satisfy the requirements. With CMO having the authorisation over the suppliers, it has a larger buying power, lower purchasing prices and standardized services and products.

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2.1

B. PROJECT MANAGEMENT OFFICE

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The Project Management Office operates under the Content Management Office (CMO). Although it operates under the CMO, it independently leads the implementation of the programme through projects in individual trusts. Contrary to the CMO, Project Management Office (PMO) sets up the implementation plan, whereas CMO prepares the content.

PMO follows the next phases:

Planning and standardization

Execution, control and support

Use Work Breakdown Structure to decompose the project into phases and further to smallest tasks of the implementation process. Using a highly detailed WBS develop the next plans: ➔ Technical - what task needs to be performed ➔ Financial - develop the cost structure of the project ➔ Time plan - develop the schedule of all specific tasks ➔ Material - develop a plan of materials used for the implementation ➔ Risk management - crisis scenarios

After individual projects start, PMO controls the development of the implementation by comparing the initial plan with the current state of the process in trusts. If the trust is falling behind the schedule, immediate measures have to be taken to find the source of the problem and help to solve the problem. In case the source of the problem is in the content, the PMO has to consult with the CMO.

Use Gantt Chart to illustrate the project schedule and dependencies between individual tasks.

Standardize the implementation process. All trusts should follow the same process. Knowledge management team evaluates the appropriateness of the implementation plan and proposes changes if practical experience show changes are relevant.

PMO collects documentations from Project Teams to evaluate the state of the implementation process. It must allow Project Teams to submit objective reports to be able to identify problems and react on them.

At the end of the project gather and prepare the documentation what goals have or have not been reached and reasons why. Prepare trusts for a post-implementation phase where they refine processes and eliminate all the mistakes that might jeopardize the system.

2.1

KNOWLEDGE MANAGEMENT

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The initial implementation plan is determined by the Project Management Office. Take the good case practices from the six trusts where Scan4Safety programme was already carried out.

Define the best approaches which were proven to be successful/efficient/effective and make a plan for the implementation strategy for the next trusts.

In order for the Knowledge Management Team to make the right decisions, Project Teams or other responsible bodies must submit reliable reports, which present the real situation, submit objective documented outcomes, key learning points, and development outcomes. Continue transferring good case practises where trusts have reached pre-set KPIs and are delivering positive results.

The defined implementation plan should follow the same procedure for the next trusts to ensure the structured systematic approach. This way inefficiencies in the implementation processes can be reduced. The plan has to be standardised and fixed to fit all the trusts. However, through time and acquired experience, amendments to the initial plan have to me made.

How to define the good practices: select the practises which brought the desired outcome check if the selected practises are viable (for either different types of trusts‌) check if combining best case practises (reducing the inefficient parts and/or improve them) brings potential better outcomes select the best performing practises

In the scope of Project Management Office, a special team is appointed to constantly evaluate KPIs in hospitals which are already showing results. Based on positive outcomes, the Knowledge Management Team should recognise the best cases (either implementation or content wise) and if applicable, redefine the initial implementation plan.

2.1

DOCUMENTATION In order to deliver satisfactory results, the processes have to be documented. Content Management Office as a buying organisation and Project Management Office as a supplying organisation are advised to prepare the following documents: Project Order - accepted and signed by the Project Manager (PMO) and confirmed and signed by a Member of Content Management Office. It is the basis for starting the project.

Project Start-up Plan I. - the Project Manager predicts the start and the end of the planning phase, it is the basis for the reservation of resources needed for elaboration of a substantive concept and elaboration of the Project Implementation Plan.

Project Start-up Plan II. - standardized report on the state of the works on the project planning, which is the basis of the Project Management Office for the preparation of reports to the CMO, project contractor, and other recipients of project status reports.

Project Implementation Plan I. - accepted and signed by project subscriber and Project Managers. With this document, the project manager finally confirms the ability to carry out the Order of the project and on the basis of confirmation, signature of the client, assumes responsibility for the realization of the content of this document.

Project Implementation Plan II. - standardized status report part of the implementation of the project, which is the basis of the Project Management Office for the preparation of reports to the CMO, project contractor, and other recipients of project status reports.

Project implementation - changes and arrangements - the document which allows Content Management Office and Project Management Office to document, record and sign agreed derogations, changes, operational arrangements for solving problems in the implementation phase of the project. Misconceptions are important for returning the project into planned frameworks and for justifying certain final results on the final project report when the actual results deviate from the planned ones.

Final report of the project - the Project Manager delivers the results of the project. The signature of the Content Management Office represents a formal completion of the project.

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2.2

PROJECT LEVEL

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The entire Scan4Safety programme covers 154 individual projects of implementation of Scan4Safety in individual trusts in England. One project represents the implementation at one of the trusts operating under NHS. The nature of projects is deterministic, meaning that projects are roll outs or replications of the initial project. The advantage of roll outs is that most of elements are repetitive and can be replicated.

For each project a Project Team is set up, which will coordinate and carry out the implementation plan. Project Team is responsible for delivering weekly reports to Project Management Office, which controls all Project Teams.

PROJECT TEAM OPERATIONAL TEAM

TECHNOLOGICAL TEAM

ORGANISATIONAL TEAM

Phases of project planning ➔ designing the project team ➔ organizing working conditions ➔ planning of communication in the project team and with the PMO ➔ determining the extent of work by WBS ➔ distribution of work and responsibility in the team ➔ identification and cooperation with contractors and suppliers ➔ linking work and providers ➔ termination - time planning and coordination with milestones ➔ identifying and solving bottlenecks, crisis analysis ➔ calculating the project's planned project costs

Ambassadors - in order to efficiently transfer the knowledge from trusts which have already implemented the Scan4Safety, appoint employees from good case practises to cooperate in the implementation in other trusts to offer assistance and experience on site.

2.3

SUB-PROJECT LEVEL Sub-Project Teams ORGANISATIONAL TEAM OPERATIONAL TEAM TECHNOLOGICAL TEAM Sub-project teams: Based on the level of complexity of the programme, there may be multiple levels of subprojects.

Roles of employees carrying out the specifications of subprojects should be specified in detail.

A project is furthermore divided into sub-projects which are subject to different departments involved in the process. They carry out the tasks specified in the WBS prepared by PMO. Subprojects are carried out in parallel.

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The Implementation of Scan4Safety

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Overview ORGANISATIONAL TEAM

20 OPERATIONAL TEAM

TECHNOLOGICAL TEAM

Inventory Management

LOCATION NUMBERING Purchase-to-Pay CATALOGUE MANAGEMENT PATIENT IDENTIFICATION

Product Safety Recall

The illustration shows the relation between the sub-project teams and the three core enablers to improve inventory management, the purchase-to-pay process and product recalls.

1.

The location numbering is most relevant for the operational and technological team, because it’s about the IT infrastructure and the scanning of the locations when assigned to a number.

2.

This is the same for the catalogue management, the IT systems must be GS1 compliant executed by the technological team and the operational team makes sure all products have a GS1 barcodes, which is missing still in some of cases.

3.

The patient identification is relevant for all teams, the IT infrastructure is necessary, the staff needs to be trained to scan the patient at every care interaction or procedure and there are more stakeholders involved like the patient itself, what makes it also important for the organisational team.

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IMPLEMENTATION STRATEGY - ORGANISATIONAL TEAM PILLAR GOALS

ORGANISATIONAL STRATEGY ● ●

The willingness of the management & staff to implement the Scan4Safety strategy.

Management & staff has the knowledge and resources to implement the Scan4Safety strategy

INVOLVED STAKEHOLDERS

Support from Project Management Office - organisational team Support from the Management Board of the trust Organisational sub-project team of the trust: Human Resources

ACTION STEPS

1. Involve the staff in the real life situations, to show the quick wins of Scan4Safety.

2. Update or create the Delegation of Authority document and assign the tasks, goals, responsibilities and duties of each staff member. This creates a sense for responsibility and accountability.

3. Strengthen the dissemination of safety practices by the following methods: • Personal: technical assistance team (a team that answers questions, problems regarding safety), employee rewards • Impersonal: written guidelines and written procedures, manuals 4. Implement daily employee evaluations meetings to discuss day-to-day processes, their flaws and potential improvements. Organise them at the beginning of the shift. This will help all employees from all levels to feel responsibility over the process. E.g. even if you have no patient contact, but just scanning the barcodes at the entrance of the warehouse the bigger purpose of your job because clearer in this meeting 5. Establish a complete training and technical support programme for employees to gain the knowledge required for the Scan4Safety programme.

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IMPLEMENTATION STRATEGY - OPERATIONAL TEAM PILLAR GOALS

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OPERATIONAL STRATEGY ● ●

100% tracking and tracing of assets (e.g. medical devices, instruments, beds) Compliance of the new operational processes in the current processes.

INVOLVED STAKEHOLDERS

Support from Project Management Office - operational team Operational sub-project team of the trust: Supply Chain Management/Logistics/Inventory management /medical specialists

ACTION STEPS

1. Coding of each product to integrate it in the catalogue management system. Produce internal barcodes, if the manufacturers are not ready yet to put the right barcode on the product/package of the product.

2. Compliance & standardized procedures → Continuously check and evaluate the current status of implementation • Include the medical specialist in developing the standardized procedures. In the critical situations in the OR, the scanning processes have to be continued but cannot deliver any trouble.

3. Identify and reduce current waste by focusing on the seven types of waste in Lean manufacturing: • Overproduction, waiting, transporting, inappropriate processing, unnecessary inventory, excess motion and defects. Scan4Safety provides additional insights in the current processes and therefore allows reduction of waste.

4. Implement a Purchase-to-Pay system and standardized, strong inventory management system policies: • Define the inventory management policies: ordering policies, security, maintenance and cleaning, quality control, record keeping and tracking, in- and out-bound logistics, disposal of obsoletes and damaged goods.

Due to the new track and trace opportunties these inventory management policies can be optimized

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IMPLEMENTATION STRATEGY - TECHNOLOGICAL TEAM PILLAR GOALS

TECHNOLOGICAL STRATEGY ● ●

Strong IT infrastructure that supports the Scan4Safety actions like GS1 compliant system.

On the foreground/work floor the tools like barcode scanners work 100%.

INVOLVED STAKEHOLDERS

Support from Project Management Office - Technological team Operational sub-project team of the trust: IT department, logisitics department

ACTION STEPS

1. Develop the IT infrastructure: • Connect the inventory management system, surgical information system, Purchase-to-Pay with the Electronic Health Record of patients and suppliers ERP systems • Ensure the data protection mechanisms, anti-virus programmes and critical response systems on cyber attacks • Develop or implement the infrastructure for scanning and reading the care interaction moments of the patients in the trusts 2. Physical infrastructure: • Coding of each location with GS1 barcode • Install barcode scanners • Install barcode generation systems for wristbands of the patient • Label all GLN spaces

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Measures of Impact Programme Strategy

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EVALUATION – MEASURES OF IMPACT CATEGORY

IMPACTED TEAMS

MEASURES OF IMPACT*

PATIENT SAFETY

NH department, Steering Board and management boards of the trusts

• • •

Number of adverse events due to technological failure Number of adverse events due to human errors No. of hospital deaths (corrected by the nature of the medical condition)

ORGANISATIONAL CULTURE

Project Management Office organisational team, HR departments of individual trusts

• • •

Patient satisfaction surveys Employees satisfaction surveys Managerial satisfaction survey

OPERATIONAL EFFICIENCY

Project Management Office operational team, trusts‘s purchasing depatments, SCM

• • • • • •

Minimize 7 types of waste – apply measures for: Overproduction, waiting time, transporting time, unnecessary inventory inappropriate processing, excess motion, defects.

Distribution of time clinician: Ratio direct patient contact/administrative procedures Waiting time phases Utilization of locations and medical devices Claims denial rates Number of machine breakdowns

INVENTORY MANAGEMENT

Project Management Office operational team, trusts‘s purchasing departments, SCM

• • •

Stock levels: number of stockouts Waste: % of obsoletes, damaged goods and Level of handling costs (new GS1 barcode scanning etc.)

IT SYSTEM KPIs

Project Management Office technological team and IT departments of trusts

• • •

Average data availability Storage utility utilization Time between system failures

*These measures of impact are on a NHS trust level. The combined outcomes of all NHS Trusts will represent the impact on a National level. Financial performance is not taken into account here, because of the lack of knowledge. Furthermore, the MoS category wil lead to variying financial results per trust

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Stakeholders

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SCAN4SAFETY - STAKEHOLDERS

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The scaling up strategy and implementation of Scan4Safety as explained in the slides before can only be successful in case the all stakeholders stay involved. For each of the type of stakeholders there are certain barriers which can arise. Solutions are provided to overcome these barriers.

Department of Health (Government) ➔ ➔ ➔ ➔

Health secretary + staff Politicians Steering board (Content management office & Project management office) Care Quality Commission (CQC) (independent body, but sponsored by DH)

Outsource partners ➔ ➔

Consultants IT

Scan4Safety UK citizens ➔ ➔ ➔

Patients Patient federations Family members of patients

NHS trusts (hospitals) ➔ ➔ ➔ ➔ ➔ ➔ ➔

Management team Medical specialists (Doctors/Clinicians) Nurses Operations (SC, logisitics) IT specialists Purchasing department Administrators

NHS supply chain ➔ ➔ ➔ ➔

NHS suppliers Manufacturers (pharmaceuticals, medical devices, instruments) Distributors Logistic companies

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SCAN4SAFETY – BOTTLENECKS & SOLUTIONS Important stakeholders: Management of the NHS trusts

Medical specialist (Doctors & Clinicians)

NHS Staff

Patient

Potential bottlenecks * Strong focus on cost reduction * S4S needs initial investment * Many projects - prioritizing & Time * Already do own type of implementation *Have strong bargaining power, due to scarcity *Afraid to expose their practices (used products, costs and time) * Conflicting priorities / time constraints * No direct benefits from the beginning, hard to be motivated for >2 years * Lack the need to change the current process * Resistance and decrease of effort

* “Big brother is watching you” - Wristbands * Privacy & Data protection complaints * During the implementation the potential of disturbances increases, this can cause irritation

Solutions 1.

Official Scan4Safety certification

Successful implementation of S4S stages leads to an official S4S certificate for the trust. Measured on predefined MoS.

1.

Transparancy in demonstrator trusts results

Clear positive effects of the implementation in other hospitals can trigger action, especially if the potential hospital is on the same ‘maturity’ level.

1.

(Peers) involved in S4S content negotiations

Involved in how S4S can be best implement in the trust(s) they work in currently.

1.

Rewarding system for safety and productivity

Insight in their performance will include the clinical productivtity

1.

Team milestones & Awards

At the start of implementation create milestones per team, to make the staff feel responsible. Milestones have to be celebrated, when achieved!

1.

10 minute Daily Evaluation Meetings every

Start every day with a meeting to talk about the bottlenecks, accomplishments, visions and task of today.

1.

Promotional video at hospital entry

Explain the S4S transition, emphasize the safety benefits for the patient and explain what they can expect during their hospital journey.

1.

Feedback ‘scanning of wristbands’

Give them the opportunity to provide feedback about their experience of the scanning of the wristbands at every care intersection or procedure

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PUBLIC OPINION & MEDIA

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National Health Service operates under the Government and is subject to public funds. Whenever large projects involve spending large amounts of public funds, public and Government’s opposition will highlight the drawbacks and bottlenecks of such projects or will entirely oppose to it. In such cases, the public opinion can largely influence the course of the project. Nowadays, 70% of the UK citizens is dissatisfied with the National Health System and think it is going in the wrong direction. It is thus important that the public opinion is carefully managed.

In order to mitigate the risk of negative opinion of public, the next steps are proposed:

PR & Marketing

Establish a strong PR team in the scope of CMO, which will coordinate the public image of the project, cooperate with media and answer questions of the UK citizens.

Symposium

The beginning of the project is one of the most important phases. Organise a symposium for all involved employees of the healthcare trusts, as well as ambassadors from other Scan4Safety trusts. The symposium will highlight the start of the program and explain it and all its components. This will be done via anekdotes and the results of other trusts. This message will be transferred through the general public through media.

Royal influence

Members of the Royal Family are actively visiting hospitals in UK and are encouraging the developments in health care. Media are fond the Royal Family, when members of the Royal Family will visit hospitals because of Scan4Safety certification, the media will report about it.

Secretary of State for Health and Social Care

The current Secretary of State for Health and Social Care, Jeremy Hunt, recieved an ‘Humantatiran Award’ for increasing the patient safety within the NHS. Mr. Hunt wants the NHS to be the safest healthcare system in the world. There will most likely be active support for the Scan4Safety program.

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Challenges of Upscaling

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CHALLENGES SCAN4SAFETY IN NHS TRUSTS OPERATIONAL CHALLENGES

ORGANISATIONAL CHALLENGES

31 TECHNOLOGICAL CHALLENGES

CULTURE

COMPLIANCE

PHYSICAL INFRASTRUCTURE

•

Build better organizational culture

•

Compliance with the GS1 standards

•

•

Identifying and solving problems in time

•

Compliance with PEPPOL transaction standards

•

Working towards a patient-oriented way

•

Suppliers must use the GDSN to ensure an

•

scanners,

automated purchase to pay (P2P) process.

•

barcode generators,

•

portable devices for data input

ACCOUNTABILITY AND RESPONSIBILITY • •

•

Clearly assigning the roles, duties and responsibilities for all employees

•

Ensuring the standardization for safety

IT INFRASTRUCTURE

requirements of operational procedures by

•

Implement and carry out control measures

Transfer of understandable information about the GS1 and PEPPOL standards to healthcare stakeholders

•

install all the required tangible devices:

STANDARDIZED OPERATIONAL PROCEDURES

COMMUNICATION •

Systematically (in accordance with standards)

Transparency in sharing all relevant information

•

Number the locations - rooms

integrate GS1 compliant information (e.g.

educating all the key contributors to the system

barcodes, catalogue management and patient

Measuring and controlling the expected

identification) in the Electronic Health Record

performance of all stakeholders

(EHR) •

Connect inventory management system

•

Connect surgical information system

•

Connect Purchase-to-Pay with inventory management system and suppliers ERP systems

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RISKS OF SCAN4SAFETY SCALABILITY

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During the implementation process of Scan4Safety in all NHS trusts, various risks can arise for the Department of Health, the NHS trusts themselves and the success of the implementation. Below some of these risks are described, including an evaluation of alternatives to prevent these cases or solutions to if they occur.

POTENTIAL RISKS People 1.

2.

ALTERNATIVES 1.

Risk of not establishing skilled teams - Ambassadors/members of the teams have too travel long to the other NHS trusts, which can be a barrier to join the team. Another bottleneck can be that there are no employees of the S4S trust willing to voluntarily participate in the implementation of the initiative in another trust.

No ownership about the Scan4Safety program. Relevant employees of healthcare trust might feel no ownership, which could prevent them to succesfully fullfill the taks.

Content 1.

Unfit S4S content - If the content of the CMO does not fit the reality of the local healthcare trusts, there will be a descrepency between the content and the content that the healthcare trust needs.

2.

1.

Transport & Salary Optimise the travel for the ambassadors by offering them free transport and the possibility to travel first class. Another solution is minimzing the traveling time by offering the possibility to be digitally present at meetings. To mitigate the bottleneck of having no ambassadors, a finanical compensation will be given. However, it is very important that intrisic motivation is present in the chosen ambassadors.

No ownership See proposed solutions on slide stakeholder solutions and public opinion and media.

Evaluation process It is very important the healthcare trusts are fully transperent, during thel evaluation and selection process. The risks of the discrepencies described will be reduced.

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RISKS OF SCAN4SAFETY SCALABILITY POTENTIAL RISKS

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ALTERNATIVES

Project (Implementation) 1.

Incomplete/insufficient documentation - If the documentation given by the (sub) project teams does fullfill the standards for documentation there will be a lack of knowledge on the higher levels. This will lead to inadequate management and implementation.

1.

Documentation format There will be a clear, structured and standardized format for the different project teams to fullfill the need for documentation.

Finances 1.

Risk of running out of money - The financial support of the department of health is 2 million. Full implementation of S4S is likely to require higher investment costs, especially when the NHS trust size is large. Therefore, finances might not allow to continue the process during the implementation 2.

Risk of the wrong goal -Due to the quick scalability of S4S is all trusts some trusts might not be ready for it and use the sponsored money for other purposes.

3.

Stop on money flow - Secretary of State’s Senior Team - New proposals from the DH for money to support the implementation at all trusts might be rejected. This will affect the implementation on a national scale.

1.

Evaluation process During the evaluation and selection process of new trusts for the wave, the current financial situation needs to be taken into account.

Flexibility to spend more than the support is important.

Maturity The maturity level plays a role to the extent S4S can be implemented in the targeted budget. A too low level results in postponement to WAVE 4 Project Management Office decision The PMO needs to continuously check, if one of the 2 cases is like to happen the implementation is likely to be postponed.

Own capabilities Depending on the timeline, the steering board can look to other financing opportunities. If many trusts still need to start on the implementation, the financially strong trusts should be supported more, to still start the new WAVE.

1.

1.

1.

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CRISIS MANAGEMENT

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The mentioned risks on the slide before were only a fraction of the possible risks. Each trust and each project will face many other difficulties in the implementation process. To mitigate the risks, each Project Team should prepare the following: 1.

OPERATIVE TEAM An important part of projects are testings. When certain technology or procedures are implemented, employees have to test them in a partially controlled environment. For the purpose of quick resolving of problems which might occur in the testing phase, an operative team has to be set up. It serves as a “help desk� during testing phases and corrects the mistakes or errors which might occur.

1.

CRISIS TEAM The Crisis Team consists of highly competent people and reacts in cases when the trust faces an obstacle which prohibits its operational continuity. In such cases the Crisis Team has to be able to react fast, make quick decisions and balance the consequences.

The Crisis Team per project can consist of local staff, but also has guidance from the Project Management Office of the Steering Board.

They will gather information about many possible crises during the implementation at all the trusts and therefore respond to the crisis with quick solutions.

1.

CRISIS SCENARIOS The formulation of potential scenarios for each project at the NHS trusts is important to be prepared and solve the problems quickly.

Especially if the life of patients is involved this is even more important. Crisis scenarios have to include as many negative outcomes as possible and scnearios on how to quickly resolve the problems. Such scenarios might include transferring all patients to neighbouring hospitals.

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ENDING OF THE PROGRAMME The ending phase of the programme must not be neglected, it might be one of the most important phases which can too quickly be overlooked. The parties must ensure that: 1.

2.

3.

Check if planned KPIs are met, evaluate the outcomes and search for reasons where KPIs were not met. Perform a benchmark analysis, evaluate the achieved project objectives, the time limits, costs, analyze experiences, good practices and weaknesses, assess the results and contribution of the participants, collect and archive documentation reports, dissolve the Project Team after the submission and signing of the Final Report.

Although the implementation of the programme might end and it would seem that problems have been resolved, in practise many troubles will still arise which will additionally have to be solved: a. Employees might still not be willing to participate and adequately use the systems. According to Gauss, around 15 % of employees will still either not be able to use the system properly or will not be willing to cooperate. In such cases, those employees must be additionally trained or be transferred to another job. b. A part of the problems will occur after a couple of months or in the course of the next year when trusts will be dealing with special cases, which occur once in a while. In such cases additional technical or operational support will be needed. c. Some projects might not reach set KPIs or might not finish its implementation goals. In such cases additional fundings or support will be needed. Evaluate each individual situation and decide what measures to take further.

The Final Report of the project is signed and delivered to all concerned parties.

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Tessa Jansen tessajansen5@gmail.com

Mariska van der Feen Mariskavanderfeen@gmail.com

April 16, 2018

Eva JelovÄ?an Jelovcan.eva@gmail.com