NHSScotland’s National Laboratories Programme: Towards a Distributed

Service Model.

www.labs.scot.nhs.uk

Dr Bill Bartlett. Clinical Lead

National Laboratories Programme NHS National Services Scotland

14 Territorial Boards

2 Special Boards

32 Local Authorities

31 Integration Joint Boards

1 Nation 5.3 million People

Speciality Specimens

Microbiology 5 Million

Histopathology 2 Million

Haematology 11 Million

Tests

Biochemistry 82 Million

• Approx 3800 FTE staff

• Annual costs circa

£300m

• 27 laboratory locations,

• 87 laboratories

Strategy & Policy Context

Workload

Health Services Cost Book 2014 to 2015 R130: -

The Challenge: The here and now!

Shared Services to National Laboratories Programme

Positioning Paper

Oct 2016

Strategic Paper

July 2017

Business Case

Apr 2018

Implementation

MANDATE

Data

IT

Innovation

Standardisation

Distributed Service Model Design Group

Guiding Principles Blueprint

Workstreams

National Laboratories Programme

www.labs.scot.nhs.uk

£6.6 M over 5 Years

SWOT & PESTEL

Right Test

Right Place

Right Time

Patient centric,

outcome focussed,

whole system wise service

Scotland wide access to

state of the art services

through a distributed

service model (DSM)

The Value Proposition

The Vision for Lab Services

DSM Investment objectives

Form Follows Function Distributed Service Model Functional consolidation not Centralisation

• A scalable configuration of facilities

that can meet future demand for

Laboratory services.

• Enhanced service resilience

through minimising variation and

enabling cross border working

• A sustainable, resilient, adaptable

workforce aligned to a credible

workforce plan

• Improved and equitable outcomes

for patients

• Enhanced value

Delivering the Vision

Data Group

IT Group

DSM Design Group

Business

Case

£6.6M

National Laboratories Programme: Key Enablers

• Vision

Laboratories DSM Blueprint

• Delivery of the vision

• Enables and supports regionalisation

Proposed Governance Framework

• Delivery & adds value

• Drives standardisation

Data Sharing: National Labs Information & Intelligence Platform (NLIIP)

• Enables the evolution

• Connection of new and old systems

Lab to Lab Connectivity: NPEx

• Assures consistency

High Level Specification for LIMS

Guiding Principles, Blueprint & Governance Structure: Managed Convergence

1. Enables national planning of services while enabling a focus on local needs (right testing, right place, and right time).

2. Is aligned with the National Clinical Strategy, supporting health care improvement with a Triple Aim focus.

3. Employs a Once for Scotland approach through an appropriate governance structure.

4. Enables national workforce planning.

5. Allows the free flow of materials, information, data, knowledge and skills across organisations.

6. Enables optimised demand on services locally and nationally via appropriate interfaces with users and planners.

………………………………16

DSM Guiding Principles

www.labs.scot.nhs.uk

The Blueprint

POTI

www.labs.scot.nhs.uk

• Process

• Operation

• Technology

• Information

Blueprint ID

Current model not optimised to deliver sustainable services to underpin current and future NHSScotland

requirements

National distributed service model (DSM) with unified vision configured to enable consistent delivery of

national, regional and local plans/ priorities enabling equity of access to servics..

Sta

rtIn

teri

mE

nd

Baseline and activity map of service use and project requirements.

Design and incrementally deliver a distributed service to meet current and emerging demands

Compliance of Boards/Regions with guiding principles, development of shared priorities, sharing of

outputs from processes such as procurement exercises

Measures of Success?

DSM Driver Diagram: Measures of Success?

Delivery of the Right Test, in the Right Place at the right time.

To provide high

quality fit for

purpose and

efficient form

follows function

DSM for

laboratory

services, able to

operate in new

and evolving

healthcare

environments,

maximising cost

utility (value).

1. Optimal use of skills and

knowledge: workforce

development across systems

2. Optimal use of space,

equipment and resources

4. Integrated support

functions

6. Infrastructure to enable

and support research and

development within and

outwith the services.

3. Realisation of benefits

from new and emerging

technologies and knowledge

5. Effective Clinical

Interface; Input & Output

1.1 Embed lean processes and thinking

1.2 Define and develop specialist/generic work concept

1.3 24/7 Service Design

1.4 Culture of staff engagement and involvement

1.5 Maintain and develop specialist/generic competencies

1.6 Alignment of staff profiles to work profiles

1.7 Enable cross border working

1.8 Effective training and CPD for laboratory staff.

1.9 Role development with six steps workforce planning

2.1 Embed lean processes and thinking

2.2 Assessment of current and future space requirements and exploit existing resource

2.3 Explore resource sharing between disciplines /localities

2.4 Effective management of resources.

2.5 Functional consolidation of services to ensure optimal patient flow, capacity and outcomes

2.6 Develop logistics and communications

2.7 Standardisation and convergence (methods, SOPs, nomenclatures, codes etc)

3.1 New technologies: automation, molecular, mass spec

3.2 Ensure appropriate degrees of automation and modern testing strategies.

3.3 Develop point of care testing where appropriate.

3.4 Digitisation

3.5 Artificial/augmented intelligence

3.6 Rapid translation of best evidence and new knowledge into practice

3.7 Develop do once and share capability

3.8 Make outcome based business cases that demonstrate whole system value the norm

4.1 Development of generic support functions to co-ordinate activities across traditional laboratory

discipline, professional and geographical boundaries.

5.1 Electronic interface with decision support to enable optimal service demand by an evolving user

base

5.2 Infrastructure to enable closer collaborative working with users to improve clinical effectiveness.

5.3 Support for clinical audit and development of clinical and laboratory based practice.

5.4 Development of laboratory based clinical informatics functionality

5.5 Development of whole system view of service with outcome KPI development

5.6 Engagement with evolving health care delivery initiatives/structures to enable shaping of service

and focus of resources (Triple Aim/realistic medicine/precision medicine)

6.1 Develop R & D programme for laboratory services.

6.2 Staff/systems support clinical research .

6.3 Sufficient resource to support medical education and R&D

Aim

Primary DriversSecondary DriversBlueprint Consistent

Driver Diagram for Development of

Laboratory Services V0.2

Focus on value: Triple Aim

Triple Aim

Benefits

Quality of HealthCare

Health of the

Population

Value & Financial Stability

Governance: 3 Regions with National

Oversight

• Enables consistent & incremental delivery of the vision.

• Enables and supports the regionalization agenda.

• Right test, right place, right time

• Efficiency, effectiveness, equitability,

resilience, affordability

Roadmap/s that enable local development aligned to the national blueprint priorities.

Challenges: • Governance.

• Requirement for

more ambition on the ground re transformation.

• Big focus on the here and now. Vision?

• Immature user provider interface

Governance Spring 2019

Value Focus and Benefits Realisation

Triple Aim

Benefits

Quality of HealthCare

Health of the

Population

Value & Financial Stability

Quality Outcomes: improvement driven by Triple Aim

Right Test

Right Place

Right Time

Laboratory professionals need to be whole system focussed

New Quality Construct for labs!

Value Focus

Whole System Value Paradigm

• Synthesis of data, information, knowledge & evidence in an accessible and usable format.

• Significance of change

• Governance around reporting.

• User processes designed to maximise the impact of the diagnostics

•Triple Aim Value

•Right repertoire, right place right time.

•Form follows function

•Appropriate quality

•Whole system focus

• Access to diagnostics

•Informs design processes

•Decision Support to enable optimised demand

•Hides organisational complexity

•Enables flow of information

Interface Distributed

Service Model

Fit for Purpose

Reporting

Application and Impact

Help users to ask the right

questions. Smart interface

Efficient form follows

function delivery. Technology enabled.

Data, information & knowledge management.

Smart reporting

Whole system focus.

Value

KPIs Cost or Value: New Quality Construct?

Old Efficiency Based:

Cost

New Effectiveness Based:

Value

Whole system focus: Benefits: Value Lab focus: Efficiency, Savings ?

Deliver efficiency divert resources into Effectiveness

Whole System Challenge

National

Regional

Multi-Board

Board

Hospital

Primary Care

Community

Patient

Planning Level

Consistent Quality

Form Follows Function

Blueprint Compliance

Varying Need

Education

R & D

Process

Organisation

Technology

Information

Vision: Blueprint Aim

Driver Diagram

Drivers Identified.

Actions Prioritised.

Benefits Measures.

Alignment Tool

•Blueprint Alignment.

•Documentation of KPIs.

•Identify whole system benefits in terms of Triple Aim.

Roadmap

Incremental Change

Work Plans.

Prioritisation.

Implementation.

Do Once and Share.

Actions DSM Benefits

National Laboratories Programme Blueprint Delivery Pathway

Form Follows Function Value Focussed DSM

Efficient

Effective

Equitable

Resilient

Affordable

Right Test Right Place Right Time

Triple Aim

Benefits

Quality of HealthCare

Health of the

Population

Value & Financial Stability

Benefits Realisation: proposals

• New quality construct to be promoted

• Increase knowledge of the Triple Aim

• Require all Improvements/investment to document well defined TA measures.

• Use the whole system value paradigm to shift the focus of lab staff and lab users

• Develop alignment tool to enable self assessment and identification of benefits.

– Develop scoring and recording system

• Map benefits to primary drivers in driver diagram.

Alignment Tool: Digital Pathology

Metrics and Stakeholders

KPIs in each of 5 DSM Benefit Domains

Assurance of Stakeholder involvement in delivery and definition

What we need to consider, where has work already started?

Optimal Use of Skills and Knowledge, Workforce development across systems

Realisation of benefits from new and emerging technologies and knowledge

Optimal Use of Space, Equipment & Resources

• SMVN have a prominent role in the DSG Workforce planning group • SCBMDN formation of a working group to investigate challenges including the future of the

Scientist Training Programme (STP) supporting (NES) • In 2019 SPAN will implement their Education and Training Strategy, by 2021 some BMS staff

will be diagnostic reporting

• SPAN supporting the implementation of Digital Pathology in two sites and supporting the implementation of voice recognition technology

• SCBMDN has proposed oral fluid misuse drug testing to the DSG advisory board

• SMVN driving standardisation of processes for Microbiology and Virology • SCBMDN and SPAN linking to National Demand Optimisation Group – part of the Innovation

group

Laboratory Networks Workplans

Infrastructure to enable and support R & D within and out with services

Effective Clinical Interface - Input & Output

1

2

3

5

6

Primary Drivers

• SCBMDN have been developing data collection across NHS Scotland. The information used to target variation and improve quality and the development of Atlas of Variation

• SPAN/SMVN developing a dataset for benchmarking purposes

• SCBMDN/SCIN Audit of CA125, identifying and addressing variation to ensure standardisation and equity of diagnosis

• SPAN liaising with Regional Cancer Networks to improve patient pathways

• SMVN designing a micro laboratory service for the future of Scotland inc. planning the procurement of Molecular Technology

Connectivity and Data

Incremental Change

IT Connectivity solution

• National funding for the procurement and

implementation of NPEx across Scotland

National Laboratories Information & Intelligence

Platform (NLIIP)

• National funding for the development and

implementation of NLIIP.

LIMS

• Consortium approach

Essential Infrastructure

Solving the IT/Data challenges

Rollout advanced

Proof of Concept complete

PIN Issued

Data Requiring Domains NLIIP

development with prioritised

functionality

Fully developed NLIIP designed to meet the

needs of a DSM for labs.

Intelligence & Information Platform

Standardised

Scope

Identify targets and requirements

Identify existing standards

Identify critical gaps

Prioritise

Prioritise Targets and risk assess the

list.

Develop a roadmap for delivery of

agreed priorities

Identify opportunities for

quick wins

Commission

Define work packages to deliver

sustainable solutions

Commission delivery through relevant

groups agree delivery plan

Identify opportunities for co-

production within UK

Oversight

Monitor progress on work packages against agreed

timelines

Agree/escalate deviations from

project plans

Document workstream

activities & ensure align with blue print

National Standards Board

+

+

=

DSM, designed with a focus on whole system value

=

Maximising Value: We can’t do this alone.

Requires:

• New thinking

• Collective ownership of a shared vision

• Ambition

• Willingness to embrace change and to think whole system

Co-production

Service Providers

Service Users

(patients)

Service Planners

E-health

Diagnostics Industry

Professional Bodies

Laboratory

services

Efficient

Effective

Equitable Resilient

Affordable

www.labs.scot.nhs.uk