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Healthcare Management and Service Development Scenarios for FRCS
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Healthcare Management and Service Development Scenarios for FRCS
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Language: EN.
Segment:0 .
We'd like to make a start.
Please go ahead. Thank you very much for joining us today. We've got one of our colleagues, Hany Elbardesy, who is a arthroplasty fellow at Ashford in Kent, and he's going to talk to a bit about health care management and service improvement scenarios. Now, I know it sounds like a very complicated title and very dry. It is on the syllabus and they do turn up, so do pay attention.
I've also been asked by for us just to draw your attention to a few courses coming up. So we've got principles course coming up on the 23rd and 24th of April and also later on in the year. We've got our vibrant clinical cases. We're coming up as well, as well as basic science cases, all sort of key topics. They come up with the basic science of either parts of the Viber section.
So please, if you've got interested to join and sign up, they're very helpful. People found the very useful. All right. Without further ado, I'll leave you to hanny. Thank you there. Good evening, everyone, so this is big news tonight about the health care management and service development scenarios for a force exam.
So why the management rule for doctors is important. So like a few studies, one of the most common or a study about that by McKinsey in London School of economics, they stated that if the doctors or clinician participation in the management rule, that's called about 50% higher than other hospital.
So that's why, dealing with these scenarios are very important. Understanding the health care management for doctors is very, very important, and that's why it turned up recently in the last few exams in the last few years. Another thing is why it's important, because if you don't develop yourself, you are not adaptable to survive.
So like the species that survives was more ability to adapt to change. According to Darwin. So now, how so? The first question to from the examiner may ask you, OK, so we have a problem in your institution, like I'll give an example, like it's a waiting time in the ini department is long or the waiting list for your elective cases.
It's long. So how to look at how you can address that? So that is like the same thing this we like want you to know how you can do any change in your organization. So this is three techniques most of the candidates say, OK, it's all done audit like a funnel plot, but these are five minute questions to answer. So you have to have a lot of knowledge and you have to be prepared to ask these questions very well.
So we'll go step by step. So this is the techniques and the steps after that. So, number one, we have to know which part in the hospital, what's the problem? And according to that, you need to make a change. So the three techniques which are like war discovery, so the work of discovery, instead of assuming that you are, know how work is designed.
Examine examine it firsthand. That's actually conducted, then determine how to turn the inevitable surprises to uncover into assets. So instead of waiting for complications drawback negative feedback from the patient, try to discover that yourself. So the first technique is work discovery and what? What's your tools here?
Audits? found the blood curve, which is a performance analysis. The second technique, which is called better practice. So better practice simply, you are adopting other organization, best practice technique. So then screen the way work gets done in your organization through this best practice in order to generate new ideas. This is not audits.
So the different technique. So the aim to use the best practice to generate the better practice. OK, now you can generate new ideas. So you can do a meeting with the team to generate new ideas to convert the beast is a better practice to the best practice. The third technique is test training.
OK, so you have to test like what you can implement in your organizations, what the change you can do, what the ideas and try to do this training. Trained people to do that and see how it goes. So the three techniques against war discovery, and this is the only one that includes audits found the blood curve. But there is another two techniques everyone Mason in the exam, which are bitter practices and test training.
So please memorize these three techniques in your mind and this is your introduction to answer any questions in the health care management. So these three techniques are fix it to answer any questions. Because when you want to do any change, there is always there is driving forces by yourself. And there is restraining, so we have to convince the people that you need to change.
And now we'll go back here how to discover that by all these things. So what discovery better practices and training that is the people who know why you need to change. Because sometimes you are the only one. You see something wrong on the other. They don't agree with you. So we have to show to them there is a problem somewhere. There is a delay somewhere.
It is a waste of resources somewhere. And there is a technique. This is the second thing I want you to memorize and to answer is examine any health care scenario questions. So there is that eight stage mentioned by Qatar. We can like divided into four stages which initiate the change, which by like establishing the sense of urgency.
So you have praise that you have a problem in the institution. So that, for example, the waiting time for elective cases one year, that's yeah, that's a sense of urgency. The theater time, like you are doing, lists list number of cases every day that is a waste of resources. So that is one thing that the sense of urgency. The waiting time in the Department.
So it's long. That is the sense of urgency. So it is the first step. Remember that the first step in any change process is you have to raise a sense of urgency to the people, then gather with the team and the plan for a change, then implement your change and make it all over the institution. So initiate plan, implement institutionalize, that is the four steps.
OK so. We'll go now to some examples or some scenarios about the health care management. So you will he will ask the examiner will ask you for an example, OK, the waiting time in the emergency department is long, so some people wait for 36 hours to be seen by a doctor in the emergency department. So how you can deal with that?
So, OK. Now we'll have to give some idea. OK, so we'll will go back to the quarter eight stage, initiate plan, implement institutionalize and then you have to give idea one of this idea acute surgical assessment unit. Why? it's important because you will bypass the waiting times. So there's a certain people with a certain criteria will bypass the waiting time in the emergency department and will go to a dedicated unit.
So that is the reason why we have acute surgical assessment unit. So the unit would allow surgical patients attending the emergency department in this institution to bypass traditional assessment pathway and then proceed directly through the dedicated unit. That is the sense of urgency. So your target.
This will facilitate more efficient evaluation of the patient and exhibited operative intervention where it's required. So which type of patient? So it's not a critical patients, but acute. So you have a selection for the patient and you will give the team or the triage nurse a criteria for certain patients that will be bypassed the waiting time and then go straight away to the EU.
And there is a nurses dedicated nurse in that unit we review, the patient will check that all the criteria. I have been applied, that's correct. Then inform the surgical team. And after that, the surgical team will deal with these patients. So now you deal with the problem, which is a waiting time in the emergency department and most of the hospital has ICU, but we don't know why that is.
That is the reason some hospital has this unit. Another thing, so virtual fracture clinic, why it's important, the same thing. The problem was the sense of urgency. You have the waiting time for like for the people to be seen by the doctors in the fracture clinic, sometimes three to four weeks, sometimes seven weeks in the busy hospital.
So that stage, like the fracture will be healed. So there's no point at that stage of any complication to be seen by the doctor. So we need to filter the numbers. Of the people to make a quick decision for a certain kind of people and to make the number for the patient to be seen by the doctors face to face in the flagship clinic will be like no waiting time, like one or two weeks.
And will be efficient. That's that increase the efficiency of treatment for the patients, so the virtual clinic or aiming to improve the efficiency and standardize patient care and reduce clinic appointments for injuries that can be managed conservatively. So that is the sense of urgency, because you have about in the UK, the $2 million fractures every year, 30% of the people attended the emergency department or related to musculoskeletal and soft tissue injuries.
So if you have a plan for this patient, go to the virtual fracture clinic that will be reviewed by the consultant. Next day, and he will decide which patients will be face to face and which patient will go to the physiotherapy and which patients can be discharged without any treatment. So we'll give a quick decision that's to make the service very efficient.
So that is outcome, so the waiting time will be reduced. And about a third one, 36 percent, more than one third of the patient would be discharged. There is no need to attend to the clinic and that would be more cost effective. And so you save the time and money of the NHS or the institution and you save the time and money for the patient as well.
So there is no need for the patient to travel to the hospital, to wait for two or three hours, to be seen to be seen by the doctors. And that was certainly. Another scenario here, which is a major trauma center, which is a big like. It's a big topic, actually. And you can be asked about the major trauma center in general.
Or you can like a subheading of major trauma center like trauma network or trauma coordinator or all these things could be like separately been asked. How is it that questions could be asked here, so no 1 May ask you how to develop? The major trauma center or how to transform or to convert your hospital to a major trauma center. So first of all, you have to understand why is a major trauma center is important?
Because before initiating this idea or this to for the UK to have a major trauma centres, they found that the people like younger than 45 years old. With a trauma, the mortality is high without a major trauma center, like because the patient will be go to the primary hospital, then might be transferred to another hospital due to lack of facilities, and that will increase the mortality and morbidity as well.
That is why we need a major trauma center. So how we can achieve that, how we can initiate or develop major trauma centers. So it's the four main things, so the first thing is the safety and quality. So that is your answer. You will start your answering about the major trauma center about this for like main things.
Number one, safety, and equality. Quality number two, monitoring the outcomes. Number three rule in the trauma network for arrangements for the patients. Very, very important to memorize these things. Now we'll go one by one. So the safety and the quality. For for the major trauma center. So you have a trauma team, 20 four, seven.
And did you have a trauma team lead must be in the place and this trauma lead or the trauma they have experienced in the trauma? They would not like transfer any patient. So we can deal with any kind of trauma. So you have to have all subscapularis and trauma. You can deal with a stable fracture, you can deal with the spine fractures, can deal with open fractures.
OK, so we have a consultant appropriately trained to measure to manage any major trauma. And plus that you need a trauma lead, which the background in orthopedic general surgery, emergency medicine, that's very important. Second thing, you need a special service and a special service. And there is a core service, the core, which is orthopedics, general surgery, anesthesia, emergency and ECU that is in every hospital.
But you need a specialist service as well. So you need a neurosurgery spine, spinal cord surgery, vascular cardiothoracic, plastic, max facts, EMT and diagnostic and interventional radiology. So you have to have that. And just to say core service and specialist service. B with the second stage was the trauma coordinator, which might come separately, what is the trauma co-ordinator, what is the role of the trauma coordinator service?
So the trauma coordinator, it's a nurse trauma coordinator, nurse. Maybe more than one have 24 hours across seven days Monday to Sunday, even the weekend. To ensure the patient focus and coordinate trauma service from the admission to discharge, even after the discharge for the rehab, so she or he would be responsible for any trauma patients from the admission until they're both discharged as well.
Another thing you need to have a nursing service and staff. And not only like a general nurse, you have to have some specialist nurses. Well trained. So we have to send them for courses and you have these nurses should be well trained and have enough experience. 2 2 work in the major trauma center.
And this is you have also you have to have appropriate nursing skill mix like advanced nurse practitioner, clinical nurse specialist. In place to provide a care to all stage in the patient journey from the admission even after to the rehab.
Then health and social care, professional service and stuff. You have you have to have a range of relevant and appropriately trained health and social care professionals in the major trauma center. As well, so Monday to Sunday, so 20 four, seven, not 20 four, seven, but every day. And you have to have all the Diagnostic and the SLAP service, so you have to have like a CT scan, interventional radiology is very important.
Ultrasound everything. And we have. So You the other things, you have to have a rehab service and the rehab stuff, which is very important. There is a part of that like a trauma later that is part of the trauma Network Director of rehab, which should be appointed with the responsibility of the rehab service within the network.
So from the admission of the patient to the discharge, there is a trauma Network Director for the rehab. He's responsible for the plan, for the shot, for all patients, all the trauma patients. And you have to have a major trauma center rehab lead appointed to lead the rehab care for the trauma patients. And you have also rehab coordinators with him to arrange to find the places for the patient in the rehab center for how many days, how many weeks after the shot.
That all necessary, you always you also need a specialist nurse, rehab assistance, physiotherapists dietician, occupational therapists, speech and language therapists, medical school social worker. And psychologist neuropsychologists. All this has to be like you have all you have to have all these things.
Then facilities and infrastructure, so you have all the required personnel, but you need equipment and infrastructure. Number one, the facility, so in the emergency department, you are a major trauma center, so you in the building itself, you have a place to deliver safe and effective service in a timely manner, including resuscitation resource room trauma bays, which adjacent to the hybrid suite allow immediate access to the sea.
That is an example. See, this can interventional radiology. And you have a parking Bay available for different number of ambulance service. Sometimes you might need a helicopter like a bar for that or a space for that as well for effective transfer of patients from the remote areas. And also, you have a blast in the emergency department, Teresa, through the parking bays, proximity to the sit down area to allow the crew to park for the period longer than those required for simply offload patients.
That's why you need like a dedicated places for that. You have to mention that is part of the infrastructure or the building for the major trauma center. So also, it's important to monitor the outcomes, so. You have to measure trauma audit. And you have to submit all the data to the major trauma audit.
And you have to, like, incentivize that or optimize the quality of care of the MTC. We're the major trauma audit with the best practice that is what we discuss it in the initial slides. On other things you have to take, like annual extensive peer review process as part of the operation and Development of the trauma network or trauma system. So that's how to monitor its outcomes you have to do like major trauma audit.
Number three, which is the rule of the trauma network resources like save time. So it's bypass like instead of like transferring patients to the primary hospital. No, you have. If the paramedics have a certain criteria. For a certain patients, you will not transfer these patients to the primary hospital will go straight away to the major trauma centers that will save time and might save life as well.
And that's why the mortality rate is lower after initiating the major trauma centers. So the major trauma network and that sort of calls it appropriate ways of walking in line with the best practice with regard like trauma bypass, like an appropriate hospital, access for trauma patients, trauma bypass and you have the coordination of the rehab service. After the admission, so that is part of the role of the me of the trauma network as well.
Number four, as we discussed before, we have to make arrangements for the patient after discharge, which is part of the rehab and the trauma coordinator and trauma network, both three are important in that you have to make arrangements for the patients. So this one will go to the nursing home. These ones will go to the rehab center.
This one will go home, but will be dedicated nurse to look after him every second day or something like that. So we have to have a plan from like after the surgery or since admission. What is the plan for the shot, for each patient to save the patient, to save beds for the new patients? Thank you very much.
And if you'd like to go through the poll, please, honey. OK, so I think 8 out of 13 got the wrong answer, unfortunately, so yes, it's all the funnel plot curve, so there are a number two. So work discovery is audit funnel plot screen, so it gets done in your organization through the best practice. It's called better practice technique. So the right answer is no to.
Can you go for the second questions, please, hannah? Yeah, you should. If you just say, I'm sorry, honey, if you scroll down a bit, you should be able to see the answer at 54% Oh, OK. Sorry, Yes. Sorry Yeah.
So, yeah, the number 4 is the right answer. So it's about 50-50. Yeah and number three, the number two is the right answer. That's right. So, yeah, 62% sounds like the right answer. So it's number two, 30% Yeah and. I gave fab. Shall we move on to questions now?
Abdullah? David, do you want to go through the questions?