Box 2.

Approach to implementation

IT changes
Changes were made to the Trust’s patient administration system (PAS) to enable clinical priorities to be recorded and linked to the electronic patient record system (Cerner). Previously, clinical priorities were held in spreadsheets, which add minimal value. A mandatory field for prioritisation was added to the surgical order form. This meant that prioritisation was built into the clinical workflow. It made it impossible to schedule an operation or procedure without documenting the clinical priority. It enabled the aggregation of clinical prioritisation data at different levels (eg department, division). This data has been an invaluable input into recovery planning and decision making around use of capacity and procurement of additional capacity.
Training focused on both the clinical use of the matrix and technical aspects. Regarding clinical use, large classroom sessions were arranged, during which the project’s clinical lead talked through the purpose and use of the matrix, using clinical cases to highlight key aspects. These were recorded so clinicians could watch them in their own time. Regarding the technical aspects, training materials were developed and eight student volunteers were trained to facilitate one-to-one remote session with the consultants, which were mainly focused on the process of setting up clinical worklists in Cerner.
Embedding the change in policies and procedures
The process for scheduling was iterated: schedulers were asked to schedule based on the clinical priorities on Cerner. Consultants were told that the only way to expedite a patient’s treatment was through changing the clinical priority on Cerner. This meant changes to the lists were fair and transparent. The process was also linked to the process for reviewing clinical harm. For example, all patients listed as ‘P2’ are regularly cross-checked against ‘to come in’ (TCI) lists to ensure their surgery is scheduled to occur within a month, and a clinical harm review is triggered if the surgery is not scheduled to occur within 8 weeks of prioritisation.
Robust governance was established to support safe and rapid implementation of the new process. A clinical prioritisation working group was set up to plan and monitor implementation. Key performance metrics (such as number of P2s without a TCI) are presented at the existing Elective Surgery Recovery Group to support targeted problem solving. Key performance metrics, and any knotty issues, are discussed at the Elective Care Recovery Board and ultimately the Trust’s Quality and Safety Group.