In January 2020, The Guy’s and St Thomas’ NHS Foundation Trust approached Ideal with the following issues:
- The Trust had reported an RTT performance of 84.6% in September 2019. Whilst there was an action plan being designed to address some of the causes of this, it was understood that capacity to deliver improvement is suboptimal without support.
- The Trust had uncovered through a sample validation exercise a significant number of referrals on its patient tracking list with errors.
- The Trust wanted to understand the root cause of the issues and address them at source.
The Trust outlined their requirements as:
- PTL validation to:
- Reduce amount of data quality (DQ) issues
- Determine root causes
- Identify staff groups/specialities/directorate that require training
- PTL validation to:
- DQ Issue Targeted training with RTT rules and correct system usage.
- Training in SOPs and Patient Access policy
- Collaborate and knowledge share with Elective Assurance Team.
How Ideal helped
The Trust commissioned Ideal to supply 20,000 validations and additional elbow support within the directorates. Ideal provided 6 experienced RTT DQ analysts and a Senior Data Project Manager. In consultation with the Trust they developed and established an approach to the validation of the open pathways on the PIM’s system. The Team were able to validate and correct the pathways and also identify training requirements using an issue log.
Using this issue log, the Senior Data Project Manager was able to:
- Lead the ‘at elbow’ support of clinical and nonclinical staff to improve RTT recording and ensure consistent application of the patient access policy.
- Collaborate with the Elective Assurance Manager to refine and improve the training materials created by the Trust
- Schedule and deliver sessions to groups based on job roles and responsibilities, tailoring materials to suit.
The proposed solution was to address not only the current situation, but to ensure sustainability of improvement is to deliver against these requirements in a logical and robust phased approach.
To ensure a comprehensive and sustainable improvement across the tracking lists, it was essential that the plan was based on effective ‘treatment’ of causative factors of the current position.
Covid-19 and Remote Working
During the mid-cycle of the project, the team was faced with an additional challenge of daily increments to social distancing restrictions to ensure the team’s safety was ensured. Transitioning from a full team on site with flexible shift patterns to complete remote working, we helped them to maintain robust data quality within their elective services whilst the internal teams focused on responding to the COVID-19 pressures.
Our Senior Data Project Manager maintained direct liaison with Trust management through email, tele-conferencing and online messaging platforms and continued to provide feedback, assurance and submit weekly reports throughout the project, which has been delivered ahead of schedule even during the height of pressures caused by Covid-19.
The team have enabled the Trust to reach their goal of reducing their overall waiting list size.
We validated an average of 335 pathways per day throughout the project, delivering a total of over 23,600 individual patient pathways on the PTL from the longest waiter, over 52 weeks, down to below 18 weeks wait, correcting the quality of the data held on the Trust’s PIMS system.
The ‘at elbow’ training has increased awareness of RTT waiting times recording and the importance of data accuracy.
At the end of the project a comprehensive deep dive report based on the findings was completed and submitted which provided the trust with additional insights with a breakdown by service as well as recommendations for further sustainable improvements.
The team were embedded with the in-house elective assurance team which lended itself to enhanced service delivery having immediate access to the local knowledge and experience. Additionally, the team was able to share their broad experience and offer external assurance of the in-house team and upskill as was required.
- Overall the team of 6 validated over 23,600 records within the three-month period, stopping over 22% of the pathways validated.
- The impact of the validation was far greater due to the high percentage of pathways that were required to be linked and merged into fewer numbers.
- Over the course of the project, the Referral to treatment (RTT) patient tracking list (PTL) volume was reduced by approximately 8,500 pathways which was around a 10% reduction.