Creating the effective Day Case Unit at Milton Keynes University Hospital

The day case facility, comprising a mobile operating theatre and a ward, staffed by a Vanguard clinical team, is helping Milton Keynes University Hospital dramatically reduce waiting lists.

Watch the interview or read the transcript, below.

For greater insight, there is a case study, here

Chris:
Hi Claire. Let’s start with an easy one. You’ve had the two Vanguard units, the mobile theatre and the recovery ward, on site for three months, now. It would be great to hear how it’s going.

Claire:
It’s going really, very well. Better than I possibly imagined. We’ve done about 334 cases, and we’ve reduced our overall waiting list size by about 600. And, within that, about 554 long waiters. One of the real benefits we’ve found is that because we’ve got the staffed unit, with the (Vanguard) theatre staff, we’ve been able to really work flexibly with what we put through the unit. So, we can work quite nimbly and react to where our waiting list pressures are. So, we’ve aligned it to general surgery, urology, gynae, a bit of orthopaedics and oral surgery.

Chris:
Excellent. It would be really good just to understand a bit of the context before you made the decision on the unit, in terms of how the trust was performing on your recovery waiting lists and the key areas that you took into consideration before making the decision to get the units on site.

Claire:
Well, I started in surgery in August, working with the divisional triumvirate, the senior management team, and it quickly became apparent to us all, really, that we had a significant waiting list issue that needed to be resolved. Our major concern was around theatre capacity. We had consultants doubled up in certain sessions or going without some theatre sessions. So, we looked at outsourcing, various different options and then we thought, why don’t we go for a mobile unit, because that’s still within our control. We decided that we would explore that and it gives us an extra ten sessions a week.

Chris:
It sounds like you’re using it from a broad, procedure basis, which can make it quite difficult in terms of driving efficiency through the unit. And it’s a little bit of a watchword at the moment, isn’t it, in terms
of using your facilities more efficiently? So, it would be really good to understand how you’ve managed to make efficiency improvements.

Claire:
Having looked at the data, you can definitely see that efficiency has improved month on month and week on week. We started off by doing just slightly shy of five patients per list, but we’ve managed, working with the Vanguard team, to get it up to 5.9 per list. And, in fact, on a Wednesday, one of our
orthopaedic surgeons is doing, 18 on a list or 16 on a list. And the (Vanguard) theatre staff bring with them expertise of how it runs in other organisations. So, they do tell us, “Actually your list for this day is particularly light, you might want to add some more on to it.” So that two-way working, the communication, has been really critical to driving those efficiencies.

Chris:
I’m really interested because obviously you’ve taken the decision to have a theatre and the ward but to do it as a standalone day care unit. Now, that must create benefits, but also some challenges by not
being plugged into the main hospital. So, in terms of that thinking on a day case piece and how it’s working as a standalone unit, how are you finding that?

Claire:
It does bring certain challenges but we work closely with our anaesthetic colleagues to make sure that the criteria that we select the patients for is safe and not increasing patient risk. We tend to do ASA ones and twos over there at the moment and that seems to be working really well.

Chris:
Excellent. That allows you to use the theatres that you would have had the day cases in, and do the lower acuity work more effectively.

Claire:
Yes, absolutely. Absolutely. So, it has improved throughput. Yes.

Chris:
Awesome. And my understanding is, actually, you talked about it earlier, about 340 patients through the unit, but overall, probably double that in terms of the waiting list. So, that suggests that there are other areas that you are driving efficiency improvements through…

Claire:
So, whilst the unit has delivered that amount of activity, what we’ve done is we’ve pulled out some sessions. So, for example urology, we’ve moved out of main theatres to backfill it with something else. The same with orthopaedics. So, actually, we’re getting more. We’re getting the efficiencies from the
orthopaedic sessions being over at Vanguard, but also getting benefits of backfilling it with additional activity from pinch point specialties.

Chris:
What you have at the moment is the day case unit, which is the Vanguard theatre and the mobile ward and I’m interested to know how you’re coordinating the activity across the mobile unit and also the main theatres, and the impact that it’s having.

Claire:
The introduction of the Vanguard solution has increased our day case rates by about 11%, which is fantastic. It’s also enabled us to avoid going for extended days. We are doing additional weekend work, so again, it’s given us additional capacity so we can use the weekend works to further clear our backlogs.

Chris:
Excellent. Overall, as you look at how things are progressing now, what would you say are your key measures of success, that would say, “Absolutely, that achieved what we wanted it to achieve”?

Claire:
I think there were a lot of enabling steps. So, certainly the communication with Vanguard and our organisation was fantastic from start to finish. We kept in close contact. We have built really good
relationships and quickly. I think that was critical, so we could understand time frames and also it was helpful to have Vanguard’s experience, in terms of how they’ve implemented it elsewhere and to avoid some of the pitfalls. So that was really beneficial. And as I said, I think it has exceeded my expectations
and my measure of success is refreshing my Patient Tracking List report on a Monday and looking to see by how much our overall waiting list has reduced. And we’re doing the best for our patients and that’s what really matters to me.

Chris:
Excellent. That’s really good to hear because, ultimately, at the end of the day, this is all about getting more patients through the hospital to get treatment that they need. Specifically on the Vanguard,
I think we looked at quite a few, different sites across the hospital site. So how did that go in terms of getting the units in and getting it commissioned, etc? How did you find that?

Claire:
Again, it was critical that we were able to build those close relationships with the Vanguard team. Our Estates team worked really closely with you guys and again, any barriers, we quickly identified and expedited, but actually, it went really smoothly. We delivered against the timelines that we said that we
would deliver against, which was a concern. And Estates were happy with the way it went and the communication that they had with your team.

Chris:
Excellent. So, how are they finding it, working on the unit and being in that separate standalone area.

Claire:
The surgeon feedback has been that it’s a really nice unit to work on. We did opt for the option for Vanguard to provide theatre staff because that’s our pinch point in main theatre. So again, that helped us. The staff of the day surgery side of things, I think they like it. It’s a really nice environment to be in. It’s nice and calm. Our day surgery unit in the main hospital is at times used as escalation for emergency inpatients. So, it’s a nice change for them to have access to the unit. And I have also heard that patients
are really, really liking that experience also.

Chris
Well, that was going to be my next question, actually. How are patients finding it?

Claire:
We’ve had some really, really positive feedback. It’s things like, it’s calm, it’s quiet, good communication. They understand where they are on the lists and things work really, really seamlessly. In fact, one of our members of staff came through and gave it a glowing, glowing report.

Chris:
Good to hear. So, clearly, you’ve had the unit in for three months, you’ve talked already, around the impact it’s had on waiting lists, which is great to hear, as well. So, it would be good to hear what your plans are for the unit over the next 3 to 6 months, in terms of how you move it on to another level…

Claire:
So, as you would expect, we’ve become quite reliant upon the extra capacity that it’s given us. Working through trajectories in terms of trying to reduce our waiting list further, to meet the 65-week national ask, is going to be severely compromised without the Vanguard capacity, so we’re looking at extending it, certainly. And again, because of the (Vanguard) theatre staff skill mix, we can cox and box in terms of what we put in there. So, we really like that level of flexibility. We don’t have any sessions going free on Vanguard.

Chris:
It’s always really important to get good collaboration between the Vanguard team and the trust team. So, it’d be really good to hear from you how that collaboration has gone.

Claire:
It’s gone really, really well. Much, much better than anticipated. And I think that’s because we formed the close relationships right from the ‘get-go’ with the Vanguard team. What I would like to say is, is a huge thank you to your team for sharing their expertise, and also, to our team. So, our estates team, our
admissions team, who have worked really hard to make sure that all the lists are filled, and our elective bed manager, as well as our surgeons and our anaesthetic teams.

Chris:
That’s really good to hear because it is a huge team effort, and it’s those guys that are on the frontline. But also, like you say the back-office teams that pull it all together and just make sure the patients are where they need to be.

Claire:
Exactly.

Chris:
So, we talked earlier just around the patient experience and the feedback that we’ve had being excellent in terms of patients when they’ve been on the unit. But it’d be really good just to get a bit of a sense from you around the real value that this brings to patients as well, and the additional capacity that it will bring to patients by being able to get their treatment sooner.

Claire:
Definitely, our patients are receiving, treatment sooner as a consequence of us reducing our waiting times. We had a real issue in general surgery. They only used to have half a session a week. So, half an all-day session. They’ve now moved from that to having two all-day sessions. So, they’ve been able to really make significant inroads into their waiting lists, and as a consequence, patients are waiting less time, which is only better for outcomes.

Chris:
It’s interesting because we all talk patient numbers because that’s what we do but in reality, behind every single one of those patients there’s a story, whatever that might be a fear, anxiety or a pain that they’re in at the moment as well. So, yes, it’s a genuine, benefit from our perspective and we love being
able to help you to help your patients. And Claire, it’s really fitting just to finish, to say thank you to you and the broader team at Milton Keynes University Hospital as well. You know, the collaboration, the energy, the passion that you brought to it has been hugely appreciated. And we love, genuinely love,
working with you to be able to benefit your patients. So, it’s a heartfelt thank you.

Claire:
Thank you, ever so much. And I echo exactly the same for your team, also. Thank you.