Dalhousie University Business Case Submission 2017-2018

NHS England’s SCAN4SAFETY: Scalability options, analysis & recommendations Scarlett Kelly & Chris Smith April 16th, 2018

Background • •

National Health Service (NHS) is a nationally governed health system; & SCAN4SAFETY is NHS’s eProcurement strategy that will ensure adoption of global supply chain management standards and processes.

Purpose •

Design a strategy to scale SCAN4SAFETY across the remaining 148 trusts of NHS England within 4 years.

NHS Principles 1.

2.

3.

4.

5.

Provide a comprehensive service available to all; Access is based on need and not the ability to pay; Aspire for the highest standards of excellence; Put patients at the centre of care; Work across organizational boundaries and in partnership with other organizations; 6. Provide best value for taxpayers’ money; & 7. Be accountable to the public.

NHS Values • • •

Working together for patients; Respect and dignity; Everyone counts;

• • •

Compassion; Improving lives; & Commitment to quality of care.

Stakeholder Analysis • • • •

Manufacturers Transporters Suppliers GS1

• Advocates • Organized groups

Private Sector

Patients & Families

Policy Makers

• Secretary of State for Health

Health Systems

• CCGs • Trusts • Champions/ Leaders

SWOT Analysis Strengths Enhance data sharing across/within departments; political support for program.

Weaknesses Mishandling of technology; technology malfunctions; hidden costs in implementation.

Opportunities Increased capacity in data analytics; tracking and scanning technology is not novel.

Threats Brexit; cyber security threats are increasing; cyber security awareness is low.

Scalable Options Analysis COSMO

POMS

Centralization Of SCAN4SAFETY’s Management Operations

Peripheral Operation Management – SCAN4SAFETY

Each trust manages its own timeline, which may not align with other trusts and the whole project timeline.

Stakeholder Easy to coordinate when less stakeholders Less resistance when there is decentralized power to control. engagement control the scaling process.

Central control and oversight to ensure Timeline scaling is on time.

Cost

Centralized control of cost and clearer accountability in scaling.

Easier to standardize data management Technology practice and security. Central coordination in case of technology failure.

Management

Incentive to save time and cost at trust level.

Responses to technology and data management challenges is more efficient in terms of timeliness.

Step-by-step change management initiates Bottom-up change management is the innovative spirit. easier because there are incentives.

Policy and Top-down control enables policy and law law creation and implementation.

Stakeholders’ inputs can contribute to policy and law making.

Recommended Option: COSMO National Health Services

01

Senior leadership and coordination.

Buyers

02

Trust-level implementation with change champions.

Suppliers

03

Manufacturers, distributers, etc. level implementation.

NHS Leadership & Coordination Mission Right patient, right product, right place, and right process.

Vision Patient, product, place, and process.

Goals Location identification; catalogue management; and patient identification.

Objectives Inventory management; purchase-to-pay; and product recall.

New Trust Enrolment

High-Level Trust Implementation Plan

154 Wave 4 x23 (Apr, 2021)

106

Legend Trust adoption curve

Wave 3(b) x25 (Oct, 2020)

Wave 3(a) x25 (Apr, 2020)

56 31

6

Wave 2(b) x25 (Oct, 2019)

Wave 2(a) x25 (Apr, 2019)

Wave 1 x25 (Apr, 2018)

NHS Leadership & Coordination

Pilot Sites x6 (Jan, 2016)

PDCA

Evaluate & Standardize

PDCA

Evaluate & Standardize

PDCA

Evaluate & Standardize

Education and Engagement Sessions

2016

2017

2018

2019 Years

2020

2021

2022

Localized Trust Action Plan Stage

Task

Current State Assessment

Assemble backbone group Data gathering internally Data gathering externally Data analysis & action plan development

Competitive Bidding Process

Trust submits Expression of Interests

Implementation

Implement action plan

NHS reviews Expression of Interests NHS selects trusts

Backbone review, reflect, and revise NHS milestone review

Collaborate

Contribute to Knowledge Hub Support new trust participation

Year Pre

0

Peri

0.5

1

Post

1.5

2

-

-

Supplier Implementation Plan Sept 30 Publish GTINs for: Class D IVD, Class III, & Implantables

NHS Leadership & Coordination

MD&IVD Supplier Milestones

Legend Supplier Milestone

Sept 30 Assign GTIN to: Class D IVD, Class III, & Implantables

Sept 30 Assign GTIN to: Class IIa, IIb, & Class B&C IVDs

Sept 30 Label products for: Class D IVD, Class III, & Implantables

Sept 30 Label products for: Class IIa, IIb, & Class B&C IVDs

Sept 30 Publish GTINs for: Class IIa, IIb, & Class B&C IVDs

Sept 30 Publish GTINs for: GDSN for Class I, & Class A IVDs

Sept 30 Label products for: Class I, & Class A IVDs

Sept 30 Assign GTIN to: Class I, & Class A IVDs

PDCA

Evaluate & Standardize

PDCA

Evaluate & Standardize

Education and Engagement Sessions

2016

2017

2018 Years

2019

2020

Communication and Collaboration Strategies

SCAN4SAFETY

Buyers Local Trust’s backbone organization, supply chain members, and NHS.

adoption acceleration

Suppliers Senior leadership from manufacturers (e.g., medical devices, pharmaceuticals, etc.), distributers, etc.

Risk Mitigation Plans Mitigation Plan

1. Lack legal tools when managing and sharing large datasets.

Develop tailored internal guidelines to clarify data ownership, storage, and usage.

2. Technical failure/error.

Develop backup plans with suppliers.

3. Difficulty in engaging a large number of stakeholders.

Ongoing communication. Form an emergency team.

4. Delay due to unexpected events.

Build the timeline reminder in the communication strategies. Flexible to move tasks around to push forward the whole implementation.

High Risk

1 Severity

Risk

3 4

2

Low Risk Likelihood

Executive Summary Background: • Scan4Safety is NHS’s eProcurement strategy that will ensure adoption of global supply chain management standards and processes.

Analysis: • The focus of Scan4Safety is on system-level standardization in supply chain and business processes to promote safety and lower cost.

Strategy: • Scaling up that focuses on location numbering, catalogue management, and patient identification.

Next Steps: • Scaling up that focuses on procedure ID costing, eMedicines, asset management, iatrogenic conditions, ‘never event’ conditions, and outcome analytics.

Appendices

Appendices Acronyms NHS Organizational Structure Stakeholder Analysis SWOT Analysis NHS Leadership & Alignment Action Plan Criteria Action Plan Strategy Formulation Action Plan Considerations Trust Performance Standards Trust Performance Measures Internal Communication Plan External Communication Plan

Slide 17 Slide 18 Slide 19 Slide 23 Slide 27 Slide 28 Slide 29 Slide 30 Slide 31 Slide 32 Slide 33 Slide 34

Acronyms GS1: Global Standards One is a not-for-profit organisation that develops and maintains global standards for business communication.

GTIN: Global Trade Identification Number is a globally unique 14-digit number used to identify trade items, products, or services.

GLN: Global Location Number is the GS1 Identification Key used for any location (physical, operational or legal) that needs to be identified for use in the supply chain.

GSRN: Global Service Relation Number is the GS1 Identification Key used to identify the relationship between a service provider and patient.

PEPPOL: Pan-European Public Procurement On-Line is an internet-based, interconnected network of interoperable data pools which supports electronic data exchange between suppliers and buyers.

NHS Organizational Structure Secretary of State (SoS) for Health The Department of Health

NHS England Clinical Commissioning Groups Acute Trusts

Ambulance Trusts

Community and Mental Health Trusts

Private Sector Value Proposition •

Access to objective health system data and evidence of outcomes to inform innovative product design and development in order to increase product competitiveness.

Key Roles •

Leverage position of power in industry to influence change.

Key Considerations •

How much desires and motivations do they have within industry to push for change?

Patients and Families Value Proposition •

Receive safe and quality care which would reduce fear of “never events” (e.g., wrong site surgeries, death/disability, etc.).

Key Roles •

Continue to freely express concerns and provide feedback from the user perspectives.

Key Considerations • •

Can patients and families freely engage with each other?

Are their voices being meaningfully heard?

Policy Makers Value Proposition •

Key Roles •

Authorize system changes based on quality evidence and advice.

Achieve quality outcomes across defined population and reduce cost of providing that care, which fulfill the legislative mandate.

Key Considerations •

Are there trust or power issues that might undermine the motivation to initiate/authorize change?

Health Systems Value Proposition •

Leaders in quality and advocacy for patients – scan for safety, increase visibility, support continuous care, and ensure access to accurate information; and Reduce burden on health care organizations, who work with tight budget and need to use limited resources wisely.

•

Key Roles •

Create and convene interorganizational arrangements to bring together resources and functional strengths.

Key Considerations • • •

Are mechanisms like teams commonly used?

How can organizations become the mobilizers?

Are they trusted and neutral?

Political

Strength: PESTLE Analysis •

Ethical

Legal

Technological

Social

Economic

•

Enhances reputation of excellence and professionalism; & Secretary of State for Health supports program.

•

Decreased costs due to inventory reduction and increased patient safety promotion.

•

Increased organizational culture of sharing data and collaborating across/within departments.

• •

Standardization will reduce human errors; & Scan4Safety will increase staff efficiency and effectiveness.

• •

Decrease in lawsuits; & Increase of legitimate information to use as legal defense.

•

Clarity in who is accountable for “never events” (e.g., wrong site surgery, death, etc.).

Political leadership may not have the capacity to overcome complexity in changes.

Economic

•

Potential unknown hidden costs (e.g., extra information technology (IT) specialist, true costs of malfunctions, etc.).

• •

Relevant staff can face learning curve conflicting with duties; & Staff may not engage with technology.

•

Technology malfunctions can be mishandled.

•

Different types of lawsuits can happen (e.g., staff may improperly use or share data).

•

Uncertainty surrounding data ownership leading to potential conflicts of interests.

Ethical

Legal

Technological

•

Social

Political

Weakness: PESTLE Analysis

Government of England’s reputation for legitimacy and respect increases.

Economic

•

SCAN4SAFETY can be translated into other country’s health system context in exchange for payment.

Social

•

Technological

Patients and staff are already accustomed to scanning/tracking technology in daily life (i.e., little buy-in required).

•

Increasing capacity in data analytics will be able to leverage data being collected from program to enhance services.

•

Data security and privacy laws are becoming increasingly common (e.g., European Union General Data Protection Regulation).

•

No external ethical opportunities are present.

Ethical

•

Legal

Political

Opportunity: PESTLE Analysis

Negotiations and implementation of Brexit may exhaust political capital and capacity.

Economic

•

Funding uncertainties may occur midimplementation due to political risks posed by Brexit.

Social

•

British citizens may not see immediate benefits of the program and question the large investment of taxpayer funds into it.

•

Cybersecurity threats are increasing and cybersecurity awareness is low.

Legal

•

Changes in data security and data privacy laws will require updates to ensure Scan4Safety is not in violation of them.

•

No external ethical threats are present.

Technological

•

Ethical Ethical

Political

Threat: PESTLE Analysis

NHS Leadership & Alignment Political Leadership Support from Secretary of State (Jeremy Hunt).

Policy Alignment Francis Report; Personalised Health and Care 2020; & Carter Report.

EU Law Alignment MDR – Regulation (EU) 2017/ 45; & IVDR – Regulation (EU) 2017/46.

Contract Management Support CCGs in contract renegotiations with suppliers.

Action Plan Criteria Comprehensive Clear Current Alignment Evaluation

Autonomy

Action Plan Strategy Formulation Transactive

Generative

Rationale

Symbolic

Strategic Alignment

Action Plan Considerations •

• • • • •

Strong leadership and capacity assessment to enhance technological monitor, risk detection, and avoid technological malfunctions; Consider legislation on data transfer/sharing related patient privacy protection; Develop staff guideline and release a portion of staff time for learning technology and cyber awareness; Create a troubleshoot hotline in case of technological difficulty or misunderstanding; Recognize champion of the initiation to motivate and influence healthcare staff; & Create budget that allocates a certain amount of funds for unexpected events .

Trust Performance Standards

Standard

Description

Return on Investment of the Projects in Decreased spending and increased saving from Trial Sites inventories Promote Patient Safety

Decrease adverse events induced death/disability rate

Paradigm Shift on the Current Health Achieve cultural change of staff’s willingness in Care Operations and Practice using technology and data, transparency, and trust Free clinicians in monitoring patients with the use Staff Impact on Clinicians’ Time and of technology and enable more time for clinicians to Labour provide quality care Increased data usage in tracking equipment and Tracking Sterile Trays & Products operations on sterile trays Inventory Cost Reduction Accurate Track & Trace

Use data to monitor inventory performance, reduce unnecessary ordering, and reduce waste Ensure the technology functionality in data collection and storage

Reduce Litigation Risks and Settlement Decrease the number of legal disputes around Costs accidental patient death or adverse events Asset Tracking of Small Equipment Use supply chain standards to track assets Avoid Cyber Attack on Software Simplify Product Registries

Increase knowledge of technology use and potential risks Use PEPPOL standards to enable digital buying products and services

Trust Performance Measures

Measure

Descriptions

At the completion of the implementation phase a 4:1 return of Return on Investment actual savings will be achieved resulting in a net saving of £1,000,000,000 Zero incidence of “never events” Patient Safety Reduced incidence of wrong procedures or expired/recalled products Paradigm Shift All management uses data in forecasting and planning processes Staff Impact Reduce staff time spent on inventory/supply chain processes Tracking Sterile Trays Reduction of staff time required to locate unused sterile trays and & Products products and track inventory Reduce costs of unnecessary inventory purchases and expiration Inventory Reduction of unused products A cost reduction of £2,400,000 per trust in operational efficiencies Accurate Track & Trace (e.g., medical record document processes, coding accuracy, etc.)

Litigation Settlements Reduce costs of lawsuit settlements and court costs Reduction of 20-40% of costs related to small/minor equipment Asset Tracking purchases Cyber Attack on Low incidence rate of cyber attack or threats Software High rate of cyber security software updates Product Registries Transformation from paper-based to digital-based registry

Internal Communications Key Messages • A culture of innovation, efficiency, and change; • Continuous updates to engage the maximum human capacity; & • A system of supporting and co-development.

Tools • A wider, more transparent, and more inclusive communication model as scaling up; & • Consistent communication tools (use of memos, updates, etc.).

External Communications Key Messages

• United front (collaboration & common goal); • Clear expectations and deadlines; & • Progress at the NHS side.

Tools • Selection of designated communication representatives; • Increase representation from all stakeholders as scaling up; & • Media leveraged as a channel to inform patients and their family.