Business planning for
Clinical Librarian
Services
Jacqui LeMay
Head of Knowledge Services
University Hospitals of Coventry and Warwickshire NHS Trust
SHINE Study Day
Aberdeen
21st March 2013
“Never in any hospital
that I have worked in,
has somebody worked
so hard to come up with
the best available
evidence.”
Doing your homework
• Know your audience
• Know the process
• Scope and learn the drivers
• Do your background research – what IS the evidence?
• Network for example BCs
• Pilot interest, find your champions, use them.
• Be prepared for a fight!
Approval Process
Stage 1:
This will consist of a brief submission with input from appropriate clinicians and managers
from within the Division/Core Department … approved by the appropriate Executive
Director, normally the Chief Operating Officer, and copied to the Head of Business
Planning for including on the business case log
Briefing paper:
 BACKGROUND
•
Current arrangements
•
Drivers for change
 SWOT
 BRIEF DESCRIPTION OF PROPOSED CHANGE
 BENEFITS
 ANTICIPATED IMPACT
 LEVEL OF DISCUSSION AND SUPPORT
 ANTICIPATED COSTS
Stage 2: Following approval - a more detailed business case.
 SERVICE TO BE PROVIDED
 THE CASE FOR CHANGE
• Current Provision
• Strategic Context
• Drivers for Change – Gap between current position and strategic
need
• Option Appraisal
 DESCRIPTION OF PROPOSED CHANGE
• Non Clinical Impact
• Objectives/Benefits
• Stakeholder Impact
 RESOURCE CONSEQUENCES ( Costs, Pay, Non pay and Capital)
• Funding of Start Up Costs
• Sources and Value of Funding/Income
• Costs v Funding
 IMPLEMENTATION PLAN
 RISK ANALYSIS / CONTINGENCY PLAN FOR PREFERRED OPTION
 MONITORING/EVALUATION
 EXIT STRATEGY
Speaking the right language?
Q1
What strategic drivers would you use to IMPACT the need
for your Trust to approve your business case?
Q1:Drivers – themes to document evidence
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•
•
•
•
•
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Demonstrates the use of evidence based practice
Supports quality patient safety agenda
Facilitates education
Promotes a reflective organisational culture dedicated to
improvement and shared learning
Empowers patient choice
Provides a systematic and comprehensive model in achieving
quality patient care.
Contribution to achievement of national healthcare standards and
performance indicators
Contribution to the achievement of Trust Foundation status
Demonstrates compliance with National quality drivers
Q1:Drivers: make it visual
P
olitical Factors
E
conomic Factors
S
ociocultural Factors
T
echnological Factors
REPORTS: DARZI, HILL, TOOKE
STANDARDS: NSF QUALITY IMPROVEMENT,
NHS QUALITY ASSURANCE ASSESSMENTS.
VISION: NHS CONSTITUTION, FOUNDATION
STATUS, INNOVATION, EVIDENCE BASED
PRODUCTIVITY
Healthcare Commission Assessment Based
Indicators*
Foundation status
Hospital length of stay and outpatient waiting
times
Litigation against Trust
Negative publicity/bad reputation/loss of income
from Patient Choice
Product marketability
Patient satisfaction
Joint working for common goal
Lifelong Learning
Evidence based and reflective organisational
culture
System development
Q2
• How much would it cost? Provide a breakdown of
set up and recurrent cost implications for the
Trust.
Q2: Cost:
• Revenue – recurrent: Pay
• Other considerations
• Capital – one off: Non-pay
• Increased costs:
– ILLs
– Administration time
– Administration resources
– Resource expectation
• Increased income
– Departmental accounts
Clinical Query:
Outcome
Cost saving
Does the use of local
anaesthesia in vitreoretinal
surgery compromise the
patient?
There was no evidence of
compromise to surgical outcome
or patient safety.
Change from 80% GA to 80%
LA procedures.
£140,000 p.a.
Do patients with anaemia
treated with Desferrioxamine
require routine medical retina
follow-up?
Evidence review found no value
in routine follow up of these
patients.
Saving 50 outpatients appointments p.a.
£5,500
Patient (2) specific queries
relating to challenging viral
retinitis and fungal
endophthalmitis
Rapid review of patient
management, therapy and
discharge saving on lengthy
inpatient stays.
£6, 356 (based on 2 weeks stay only)
Is it necessary for patients to
withdraw aspirin use prior to
oculoplastic surgical
procedures?
Evidence highlighted that it was
not detrimental to patients to
continue their aspirin therapy for
a range of oculoplastic surgical
procedures.
Reduction in surgical waiting times.
Facilitated use of short notice surgical cancellations.
Shortened length of pre-operative assessments.
Is it safe for patients with
intraocular gas tamponades to
travel by air following
vitreoretinal surgery?
Evidence showed that it was not
safe for patients to undertake
any activities at high altitude or
to receive nitrous oxide
anaesthesia
Work with the VR Evidence in Practice Group resulted
in patients leaving theatre with a warning wristband.
The wristband is now provided by BOC on the
purchase of intraocular gas internationally and the
team achieved a National Award for Evidence in
Practice.
Q3
How does your business proposal stand up against other
options for the implementation of evidence based
practice?
– Option appraisal
– See handouts
Q4
What outcome measures would you use to
demonstrate the clinical and non-clinical impact your
service would bring to your Trust?
Outcome measures
• Changed intended practice
– choice of diagnostic test
– choice of therapy
– choice of procedure
• Confirmed meeting best practice
• Confirmed lack of evidence
• Changed prognosis
• Avoided unnecessary
– referral
– outpatient appointment
• Shortened
– hospital length of stay
– waiting time to treatment
• Prevention
– Risk
– Complaint
– Morbidity
– Mortality
• Corporate
– Change in service delivery
– Cost saving
– Change in Care Pathway
– Guideline development
– Audit
– Research
– Legal investigation
– Knowledge base
Do not give in or give up
• First attempt 2005
• Second attempt
– BC document stage 1 approval
process (June 2009)
– BC document stage 2 – Trust Board
(December 2009)
– Seeking Divisional Funding
(December 2009 – April 2010)
– Recruitment process (May –
October 2010)
– BC Evaluation Meeting (July 2011)
– CEBIS System (December 2009 –
February 2013)
Any Questions?
Thank you
Jacqui LeMay
Tel: 02476 968838
E-mail: jacqui.lemay@uhcw.nhs.uk