Summary
The Thrive endoscopy tool was developed to increase productivity, enable efficiencies in waiting list management and accelerate the cancer pathway via early diagnosis. The approach to spreading this innovation was further developed in response to increased waiting list pressure during the pandemic.
What the project involved
In 2017 the Cheshire and Merseyside Cancer Alliance prioritised endoscopy as an area for improvement in accelerating cancer diagnostic pathways. St Helens and Knowsley Teaching Hospitals (STHK) were interested in taking forward work to improve efficiency and was commissioned to host an endoscopy improvement project.
As part of this project a review was commissioned which highlighted the challenges posed to monitoring productivity by inconsistent data collection.
Clinicians from STHK worked with an IT platform provider to develop a tool to monitor endoscopy unit usage and help staff manage patient lists. The cloud-based tool, called Thrive, holds non-identifiable patient data and produces reports that help inform approaches to improve efficiency.
The tool uses the British Society of Gastroenterology (BSG) points system which assesses the time needed for a particular procedure. This allows greater understanding of the nuances about the impact of procedure complexity on waiting times, and an understanding of how the composition of a waiting list impacts the clinical skills and experience required to manage patients. This ensures that service quality and equality of access remain central to managing endoscopy lists.
The Cancer Alliance provided funding for initial development of the tool. Once it had been trialled and the potential for adoption established, further funding was provided to the Cheshire and Merseyside Endoscopy Network to support its spread into other trusts.
The Innovation Agency supported this innovation with commercial expertise and funding for a real-world evaluation.
Adoption and spread or improvement methodology
The Cheshire and Merseyside Cancer Alliance identified endoscopy as a priority area for improvement. St Helens and Knowsley Teaching Hospitals (STHK) was then commissioned to host an endoscopy improvement project.
A review was commissioned that highlighted the challenges that inconsistent data collection posed to monitoring productivity. STHK clinicians worked with an IT specialist to develop a tool to monitor endoscopy unit usage.
The Cancer Alliance funded early development of the tool and, following its trial, more funding was given to the local endoscopy network to help spread it to more trusts. The Innovation Agency funded an evaluation to support its adoption and spread.
Regular meetings of endoscopy units where Thrive has been deployed help improve efficiency, while QI methods are used to establish if improvements have been made.
The Cancer Alliance and the local network formed a recovery team to tackle pandemic demand imbalances. Thrive has been adopted in most units and the remainder are expected to sign up.
The Endoscopy Network has become a highly effective group of clinicians and managers who are leading an ambitious transformational programme.
Outcomes
By the start of 2020, three endoscopy units had adopted the tool. The pandemic further highlighted the need to address capacity and demand imbalances in endoscopy units, which led to the Cancer Alliance and the Endoscopy Network coming together to form the Endoscopy Operational Recovery Team.
The Cancer Alliance has identified improved productivity where units are using the tool consistently. Based on this, they have built improved productivity requirements into their resource allocation decision-making processes which has incentivised trusts to implement a productivity monitoring tool.
Implementation of the tool has the potential to improve patient experience by reducing waiting times and making access to endoscopy services more equitable.
The tool has been adopted in most Cheshire and Merseyside units, and remaining units are due to implement it.
The Endoscopy Network has grown into a highly effective network of clinicians and operational managers supported by a core team, leading an ambitious transformational programme.
Next steps
The digital scheduling tool enables greater efficiency in endoscopy services and the aim is to offer patients a choice of location for their treatment, to reduce the impact of variable waiting times and optimise access to diagnostic services.
Lancashire and South Cumbria Endoscopy Network, which neighbours Cheshire and Merseyside, is interested in adopting Thrive.
