AN EFFECTIVE AND CREDIBLE APPROACH TO DELIVERING SOLUTIONS

Our solutions bring together the tools and informationrequired to effectively manage patient flow, both on an immediate basis and in the long-term. We use predictive regression algorithms, which include logistical, linear, Poisson and ARIMA techniques to predict increases/ decreases in capacity and activity. Our software solutions are built on R, SQL, Python and Azure, which provides rigour and accuracy. Our flow solutions provide real-time patient tracking to enable the optimisation of throughput, through optimised scheduling, patient flows and resource utilisation. We use the RFID Technology, which was first developed for mail sorting applications. When a patient-specific tag passes through a strategically placed portal (e.g. at theatre), or is scanned, it reads the unique tag ID and adds both the exact time of reading and the portal ID number. Subsequently, this data is transmitted to a server through a WiFi or LAN connection, allowing clinicians and managers to pinpoint the exact location of the patient, their point in their care pathway and any chokepoints in the patient journey.

 

Our solutions are being used by providers and commissioners to support improved:

· operational management
· strategic planning
· investment decision making
· process change
· pathway/ service redesign
Our solutions span multiple areas of acute activity, which collectively have an impact on flow and capacity. They can be deployed as individual modules which are targeted to specific areas of concern or as an overarching solution.

OUR RELEVANT PRODUCTS AND
SERVICES

The Acute Patient Journey:

Control Centre – This solution encompasses all the modules outlined below, providing real-time and predictive analytics; highlighting bottlenecks, disruptions to flow, from front door to back door and forecasting demand (based on historical activity), enabling teams to reshape capacity and redesign services for optimum performance.

Patient Admission:

Admissions Avoidance Activity – This module uses predictive analytics to identify (based on historical trust performance) patients who are at most risk of an unwarranted admission. Nurses, managers, primary carers and executives are able to use this module to amend clinical processes and decision-making as appropriate.

· Emergency Department Flow – This module provides real-time information on ED activity and capacity, which can be ‘drilled down’ to individual patient level. This provides the ED team with visibility over current waits, triage/assessment times and breaches as they happen, enabling them to take proactive action.

· Inpatient and Day Case Activity – This module provides clinicians and managers with visibility of bed utilisation, activity volumes, day case rates, readmission rates and average, zero day and >14-day LoS indicators split by admission type. This helps clinical/ non-clinical users to maximise inpatient and day case capacity.

· Outpatients Activity – This module supports clinicians and managers in reducing cancellations and do not attend rates, maintaining an optimum first to follow-up ratio and managing effective flow through the department.

Patient Discharge:

· Community Activity – This module provides visibility on capacity in a range of out-of-hospital settings. This enables clinicians, booking clerks, operational managers and executives to have greater control in the operational management of patients. We are able to link this module to the inpatient module (above), to automate elements of the progression of
patient pathways across care settings.

Patient pathways:

· Cancer Pathways – This module provides a summary of key cancer pathways indicators across the organisation on a dashboard. Clinicians and managers can filter the information by standard, tumour group, treatment modality and priority type to get a specific picture of how the organisation is performing in relation to this patient cohort. This ensures that key metrics are visible, and concerns are flagged.

· Long-term Conditions Pathways – This module supports staff in tracking the journey of patients with multiple long-term conditions through the acute system, ensuring that they
receive appropriate support and move through the system efficiently. The solution provides on multi-morbidities, drug prescribing, length of stay and predicted future demand
for services from this cohort. If required/ appropriate, we can use this module to automate elements of the progression of patients on their pathways

OUR APPROACH: DELIVERING
SERVICES & IMPLEMENTING CHANGE

We have a semi-standardised approach to delivering our solutions/modules. In each case we tailor this to meet the specific needs of the client. Our Approach: Enabling behavioural/ cultural change Our solutions are most effective where they positively impact organisational culture, behaviours and decision-making. As a result, we also provide clients with a Scorecard module to drive greater individual accountability. In addition to the module, we are also able to deploy NHS Leadership Academy accredited coaches to support the development of leadership and management behaviours that use the module and data in general to deliver continuous improvement and the efficient use of the organisation’s resources. Our impact
Our approach has been highly successful in supporting clients in improving patient flow and achieving other excellent outcomes. “D&D and its products are at the forefront of innovation and driven clinical care”. “D&D’s solutions have helped us to transform the quality of clinical care we deliver for our patients”. “D&D’s product has given the trust the ability to see and therefore act; something that the
Trust never had before”

INVOLVING THE PATIENT, CLINICAL
TEAM AND SERVICE USER

Our Approach to Involving Stakeholders Actively involving/engaging key stakeholders sits at the core of all of our solutions and services. This client engagement begins by first gaining a granular understanding of the situation on the ground, collating a range of publicly available data from national healthcare information sources. We process and visualise this data, in order to review and understand our client’s clinical, operational and financial performance.
We apply this knowledge to ensuring that we identify key stakeholders from the outset and work alongside them to find the right solution. We believe that including stakeholders in the process is critical, and this requires an investment of both time and effort in order to involve them in co-design, co-development and/or co-delivery. This is achieved through a range of approaches, summarised below. Patients, Relatives and Carers

● We use a variety of approaches to support patients, relatives and their carers in sharing their views with us, particularly when our tools are being used to augment service/pathway redesign processes. In addition to the more traditional engagement approaches – including workshops, questionnaires, town halls and 1-2-1 sessions – we can also use mobile technology to capture patient feedback, sensitively and in real-time.

● This is an approach we have applied to the development of a high-quality A&E solution for a large NHS hospital. Through it, we were able to achieve a high-level of engagement, as well as the co-development of a locally owned and responsive solution. NHS Provider/Commissioning Leaders

● Draper & Dash delivers a free annual Executive Patient Flow Summit for all NHS senior leaders, in order to enable the advancement of healthcare solutions specifically related to improving quality, safety, efficiency, and overall world-class patient care. We use this event to share and recognise, through
awards, best practice in service delivery across the NHS.

● We delivered our most recent summit in October 2019, garnering excellentparticipant feedback and supporting  attendees, alongside their host trusts, in better leveraging best practice to address their clinical, operational and financial
challenges. Clinical Leaders

● Draper & Dash works with a network of 20 teaching hospitals across the NHS. The aim of the network is to work together in developing methodologies t improve flow through optimised medical productivity. The network is overseen by a steering group chaired by senior colleagues at Sheffield, Barts and the
London and University Hospital Coventry & Warwickshire Teaching Hospitals, and we support the network using a range of hospital-level data including: ○ Service trajectory analysis
○ Reviews of performance and efficiency across a variety of settings
○ Financial and productivity metrics
○ Clinical quality indicators

● We also work with a network of 17 Specialist Children’s Hospitals. The purpose of this group is to benchmark performance across a range of metrics, including
those relevant to flow, and to share good practice alongside approaches to the provision of specialist children’s care. We convene the network annually, developing an agreed programme of work through a series of facilitated workshops.

● All of our projects are typically sponsored/co-sponsored by the organisation’s Medical and Nursing Directors. This ensures that the implementation of our solutions is clinically-led and is used, where appropriate, to inform the trust’s overall clinical strategy. Clinical/Non-Clinical Frontline Staff

● We involve staff in a wide variety of ways, all designed to gather the most value from their limited availability. The specifics of how we involve them are largely dependent on where we are in terms of client engagement, but revolve around four key mechanisms undertaken over three stages of the implementation process, summarised below.
○ Pre-implementation Facilitated workshops to enable co-development of our solutions alongside the staff who will be using them.
○ Implementation Day-to-day staff engagement during the testing phases, ensuring that any concerns are addressed and staff are supported to use the solution appropriately. Further down the line during the handover process, we perform formal learning reviews with individuals and teams, ensuring
that they are able to continue to use our solutions in the long-term and effectively derive the maximum benefit from them.
○ Post-implementation Regular client satisfaction surveys which enable Draper & Dash to take corrective actions, where required, and to support us in improving our products.

● This approach has proved effective in supporting clients to proactively realise efficiency savings, and in ensuring that we are continuously improving our solutions. Service Users/Wider Stakeholders

● We share our knowledge and emerging best practice with wider stakeholders through a range of channels, including both our summits and podcast.

● We have built a sizable and dedicated ‘community of interest’. Through this, we have delivered greater awareness of thought leadership, as well as the involvement of NHS staff and service users, through a range of channels including Stitcher, Spotify and iTunes. Our Impact Our ability to involve key stakeholders is key to how organisations are able to derive
true value from our products. Deployment of just our solutions alone, without the additional involvement of our transformation services, has resulted in annual average
savings of £97k over the cost of the solution across the organisations where they have been deployed.

THE REAL WORLD IMPACT OF OUR
SOLUTIONS

Draper & Dash has supported organisations in achieving demonstrable improvements to their clinical, financial, and operational performance. We have shared below the details of three case studies illustrating how our solutions have enabled improvements in (i) patient outcomes, (ii) patient experience, (iii) cost savings and (iv) efficiencyimprovements.

CASE STUDY 1: LARGE TEACHING
HOSPITAL

Context/Background
Our client was a large teaching hospital with 1,100 beds and a revenue budget of £640m per annum, providing secondary care to one of the oldest populations in England and specialist stroke, heart attack and cancer services. Despite a strong track
record in respect to quality, patient access and finances, the trust had ongoing issues related to patient flow, primarily due to ineffective management of cancer patients and those with multiple long-term conditions (LTCs). This eventually contributed to the underachievement of several performance standards, a rising Hospital Standardised Mortality Ratio (HSMR) and a predicted in-year financial deficit of £25 million.
Our solution In recognition of these challenges, the Chief Operating Officer (COO) asked Draper & Dash to support in identifying the causative issues and driving improvements in the trusts’ performance. To do this, we worked with trust staff to fully understand the context and key clinical, financial and operational metrics. Through the application of our analytics, we were able to highlight significant under-reporting of co-morbidities for people with LTCs, ineffective flow management and several issues with data quality. Outcomes Delivered
Our work provided a more accurate and comprehensive understanding of the journey for patients with cancer and other LTCs. It enabled improved patient flow, capacity,
and data reporting, resulting in: Improved patient outcomes
The trust saw a substantial drop in HSMR from 1.15:1 to 0.97:1 within the space of a calendar year. Improved patient experience The trust saw improved Emergency Department (ED) performance in Q1, Q2 and Q3 of 2016/17 compared to 2014/15, and in Q1 and Q2 over 2015/16 despite increases in
activity. Cost savings Our solutions supported Cost Improvement Projects which delivered approximately
£31 million (2015/16) and £27 million (2016/17) of efficiency improvements, made up of pay and non-pay savings, productivity improvements, and associated income.
Efficiency improvements The trust saw a reduction in black alerts, issued when there are no beds available, from 91 in 2014/15 to 7 in 2015/16 and 11 in 2016/17. The trust was also able to meet the 18-week RTT target in Q1, Q2 and Q3 of 2016/17. The trust acknowledged in its annual report that it was only due to the increased efficiency in respect to inpatient and outpatient services that it was possible to meet these targets.

CASE STUDY 2: LARGE LONDON NHS
TRUST

Context/Background
The trust is one of the largest NHS foundation trusts in the UK. In 2017, the trust was facing increasing financial and clinical pressures on its core services, with increasing numbers of patients attending its three A&E departments, poor flow through the ED, and underperformance relative to waiting time targets. Our solution In response to these challenges, the trust’s leadership team approached us to ask for help in providing transformation teams, clinicians, managers and executives, with increased visibility and analytics to support sustained improvements in trust performance. We worked with a range of key stakeholders to co-design the solution,
as well as to develop and deploy a suite of our solutions, including our Emergency Department and Inpatient & Day case Activity modules. Outcomes Delivered Our solutions supported the trust in delivering a range of benefits, including: Improved patient outcomes: Draper & Dash aided in the development of a range of new pathways, which substantially improved patient outcomes, including reducing the length of stay for hip and knee operations from 4 to 3 days. Improved patient experience
After the deployment of our Emergency Department module, average A&E waiting times at the trust decreased by 33% between 2017/18 and 2018/19, despite a 7% increase in attendance. Cost savings We supported the trust in delivering £43 million of efficiency savings in 2018/19, comprising 5% of its controllable income. Efficiency improvements With support from Draper & Dash solutions, the trust’s average in-patient length of stay for patients admitted in a non-elective capacity for 2018/19 was 3.9 days, a significant improvement from 5.1 in 2017/18. Similarly, the average in-patient length of stay for patients admitted in an elective capacity for 2018/19 was 3.8 days, a significant improvement from 4.6 in 2017/18. The Trust’s reference cost index (RCI), which measures the relative efficiency of the Trust, fell from 97 to 96 from 2017/18 to
2018/19. The trust continues to use a number of D&D modules, utilised by clinicians, operational managers and the business intelligence team to improve performance
quality, safety and efficiency.

CASE STUDY 3: A DISTRICT GENERAL
AND TEACHING HOSPITAL

Context/Background
The hospital has approximately 360 beds and delivers more than 1.3 million patient contacts annually, through 4,400 staff. As a result of ongoing efficiency, productivity and financial challenges, the trust ended the financial year with a significant financial deficit. Our solution In recognition of the need to improve operational and financial performance, the trust
approached Draper & Dash to co-develop a solution that provided its transformation teams, clinicians, managers and executives increased visibility and real-time analytics,
in order to support sustained improvements in quality, safety and consistency across its services. In response, we developed an overarching patient flow solution, composed of a suite of modules related to ED flow, Cancer Pathway Optimisation,
Inpatient Activity, Outpatient Activity, Mortality & Outcomes, and Stranded Patients. Outcomes Delivered Our solutions supported the Trust in the delivery of a range of benefits, including: Improved patient outcomes Patient services/pathways saw a marked improvement, resulting in a reduced Summary Hospital Mortality Indicator (SHMI) from 2014/15 to 2015/16, as well as a reduction in trust readmissions within 30 days from 2014/15 to 2015/16.
Improved patient experience Following deployment of key Draper & Dash modules, the number of operations
carried out as day surgeries improved from 84.17% in 2014/15 to 84.88% in 2015/16 against a target of 78.12%. Additionally, the trust saw a reduction in the average length of stay across all specialties, as well as a reduction in mixed sex breaches from
30 in 2014/15 to 0 in 2015/16. Cost savings Achieving the cultural change required to realise financial savings took time. The hospital’s reported deficit of £7.3 million (2014/15) grew to £14.8 million (2015/16). However, as our solutions began to gain traction, this deficit fell to £3.7 million (2016/17), eventually even reaching a surplus of £0.8 million (2017/18).
Efficiency improvements The outpatient first-to-follow-up ratio improved from 1.6 in 2014/15 to 1.49 in 2015/16 against a target of 2.31.