Dick Fitzpatrick

Primary Care Emergency Service (PCES)

Option Appraisal

Open meeting – 7th May 2013

Workshop Participants

• NHS Fife Clinicians - 3

• NHS Fife Managers/Other - 5

• Public Participants – 5

• Independent Observers (SHC) - 2

Option Appraisal Overview

Outline of Option Appraisal Process

The Role of Option Appraisal

• To assess what outcomes will be achieved through changing services and investing/reinvesting money

• To assess the potential benefits of different options against common measures

• To assess options as objectively as possible• To focus on the ‘ends’ as well as the ‘means’

[SGHD ‘best practice’]

Why Hold an Option Appraisal Workshop?

• Conduct the decision-making process in an open and transparent manner

• Ensure that the views of stakeholders are taken into account in the decision-making process

• Enable the stakeholders to engage in the whole benefits appraisal process

• Determine the comparative level of benefits delivered by each option

The Core Elements of the Option Appraisal

Rank Criteria

Score Options

Weight Criteria

Benefit Criteria

Ranking of Options

Short listed Options

Benefit Criteria

Example

Buying a Car – Factors Influencing Choice (Benefit Criteria)

Reliability

Price

Accessories

Safety

Performance

Dealer Support

Benefit Headings & Key Feature SummaryPerson Centred•Care is responsive and appropriate to patients needs and the patient is included in clinical decisions:-•Access to appropriate services•Availability of transport•Care is delivered within an appropriate safe timeframe

Equitable•Providing care that does not vary in quality because of geography, location or socio-economic status:-•Standardisation of facilities and access to a full range of service provision•Access to staff who are suitably trained to meet the needs of urgent care and reduce the risk of harm

Safe•Avoiding injuries to patients from care that is intended to help them:-•Staff are appropriately trained to deal with presenting conditions and emergency situations•Support is available upon request to ensure urgent care does not become emergency care•Appropriate facilities are available to meet the care needs of the patient including diagnostics•Easy access to specialised skills and services is available •Significant events are avoided•The environment is safe for the clinicians/patients and there is easy access to security/assistance when required

Efficient•Avoidance of waste including energy, supplies, equipment, resources inc staff and ideas:-•No unnecessary journeys or inter-hospital transfers•Transfer to appropriate care provision is timely/appropriate•All specialist skills are available to maximise care provision•The available workforce has a range of skills and is flexible and responsive to meet the needs of the patients•Integration of services allows access to an increased specialised skills base•The infrastructure is designed to ensure that a wide range of presenting conditions can be safely/appropriately managed•The service is financially viable and appropriate

Effective•Providing services based on scientific knowledge:-•Range of services available to meet all presenting complaints•Training provision is appropriate and there is access to a multi-skilled workforce•Access to emergency treatment/drugs/investigations•Access to medical records to ensure continuity of care•Strategic planning and implementation to facilitate achievement of Quality Indicators

Timely •Reduction of harmful delays for those who give and receive care:-•Seamless transfer to ensure care provision is appropriate•Recognised pathway to appropriate care is documented agreed and followed.•Specialist investigation and intervention is available onsite

Ranking and Weighting the Criteria

Background

• Some criteria will have a greater bearing on the outcome of the option appraisal than others

• Ranking provides a guide to the relative importance of each criterion

• Weighting provides an opportunity to quantify the relative importance of each criterion

• We need to rank the criteria before weighting

Final Ranking of Criteria

Criteria Final Rank

Person Centred 3

Safe 1

Effective 2

Efficient 4

Equitable 6

Timely 5

Weighting the Criteria

• Weighting of criteria is the opportunity to determine the relative importance of each

• Can be a complex exercise but we used a technique which simplifies the process

• We assured results and agreed outcome prior to moving on

• Last step in the process ahead of scoring options

Benefit Criteria 1V2 2V3 3V4 4V5 5V6 Score Weight (%)

Safe 100 100 21.73

Effective 95 100 95.00 20.64

Person Centred 80 100 76.00 16.52

Efficient 95 100 72.20 15.69

Timely 90 100 64.98 14.12

Equitable 80 51.98 11.30

Weighting

Final Rank & Weight of Criteria

Criteria Final Rank Final Weighting

Safe 1 21.73%

Effective 2 20.64%

Person Centred 3 16.52%

Efficient 4 15.69%

Timely 5 14.12%

Equitable 6 11.30%

Appraising the Options

Summary of ResultsRank Score Option

1 785.18 Option 4: Transfer of full service from Glenrothes (PCTC) to Victoria (PCTC)

2 599.51 Option 3: Partial transfer from Glenrothes (PCTC) to Victoria (PCTC) - Midnight to 8am and full weekends

3 521.37 Option 5: Minor Injuries Unit

4 505.64 Option 2: Partial transfer from Glenrothes (PCTC) to Victoria (PCTC) - Midnight to 8am

5 390.66 Option 1: do nothing

Final Weighted Score For Each Option

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Weighted score across all groups for each option

Average scores, public scores and NHS Fife Staff scores

NHS Fife Options Appraisal March 2013

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Workshop Evaluation Feedback • 24 persons attended • 15 persons completed short questionnaire - included 5

members of the public

• 100% felt they were provided with the support needed during the option appraisal meeting

• 100% felt they had the opportunity to ask questions/for further information

• 93% felt their views were listened to during the option appraisal

• 100% felt they were made aware of how and when feedback will be received

Very Positive Feedback Q2. Please tell us if you understood the following:-

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Backgroundinformation

on thereview

Thepurpose ofthe optionappraisal

The processundertaken

for theoption

appraisal

How thepreferredoption(s)

wasreached

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fully understood

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Comments received • Excellent process – clearly explained and well managed. Dick

Fitzpatrick was an excellent choice and led the appraisal very well

• Well facilitated• Interesting and challenging• This was a very positive experience. Everyone was listened to

and their contributions valued. Excellent facilitation made the process flow

• Appraisal form should not have been numbered. Too much carbohydrate lunch

• I felt the views of the public meeting held in Glenrothes & surrounding areas were not made known during this appraisal

• The whole process for service change needs to be reviewed. The process needs to be shortened for smaller services and Boards needs more clarity over Major Service Change vis-à-vis Service Change

Learning for the future

• Useful to have pre-meeting

• Clarity about what constitutes “major change” and “service change”

• Being clear about timescales

• Healthier lunch!