Elective Recovery (Theatres / ATOM)

Tuesday 16th June 2020 Where are we right now with Elective Care?

We have completed low Our Surgeons Patients are Donning & levels of are keen to Categorised Doffing of Possible bed Elective care start based upon PPE Constraints for 10+ weeks operating Urgency / again Need (Estimate of 30% reduction in beds due to distancing) Patients may be Our Anaesthetists and recovered in Waiting for Nurses have been Theatres due to working on Direct Concerns sufficient Recovery COVID care, are over air changes fatigued and may even capacity and reliability have levels of PTSD staffing levels of PPE supplies

Abdominal The threat Procedures are of a second not being conducted wave of Laparoscopically Concerns over COVID Anaesthetic Drug availability

• Is now REALLY the best time to be introducing more change? 2 Deloitte Public Sector: Confidential – for approved external use What does COVID actually mean for our Demand & Capacity? If we account for this complexity “perfectly”…….

Pre Covid Peak Covid Pre CovidClean finish Transition Waiting List is Stable, and AlmostWaiting No Elective List is Stable,Care and ActivityWaiting in line withList grewDemand over the Due to COVID operational Activity in line with Demand Low GP consultations period of Peak COVID, but Constraints, the actual Low Referrals Post COVID Capacity matched demand for a period has been Low OPD Appointments demand – resulting in a higher, and remains high until Waiting List Growth growth of the Queue, but that normality is reached. queue has become stable This leads to a continued again growth in waiting lists during transition

Green Line is the Activity Completed (hrs of Theatre Time vs Week of Addition to WL Queue is Stable Red Line is theQueue Hours Has of Doubled Theatre over Time 10 currently waitingQueue has vs Doubledthe week but of has Addition to WL Queue has Tripled weeksBlack Line is the total demand perstabilised week. The AREA under the red line is the “Snapshot” of the queue size at any one given moment in time.

Stability in Queue results in these lines being the same shape, but the axis moves forward in time. 3 Deloitte Public Sector: Confidential – for approved external use What does COVID actually mean for our Demand & Capacity? If we account for this complexity “perfectly”…….

Pre Covid Peak Covid Clean finish Transition Waiting List is Stable, and Almost No Elective Care Waiting List grew over the Due to COVID operational Activity in line with Demand Low GP consultations period of Peak COVID, but Constraints, the actual Low Referrals Post COVID Capacity matched demand for a period has been Low OPD Appointments demand – resulting in a higher, and remains high until Waiting List Growth growth of the Queue, but that normality is reached. queue has become stable This leads to a continued again growth in waiting lists during transition

Queue is Stable Queue Has Doubled over 10 Queue has Doubled but has Queue has Tripled weeks stabilised

4 Deloitte Public Sector: Confidential – for approved external use Theatres – ATOM (Pre-COVID) Using ATOM to provide a continuous improvement approach and maximise the use of theatre time.

Key elements of our approach ATOM is an evidence based Uses advanced data science to calculate improvement approach to generate Clinically developed AI, over 8 accurate procedure times designed to optimal capacity and use of Theatre years and using >1,500,000 prevent overbooking, cancellations and patient procedures Sessions. It uses Artificial Intelligence to staff frustration, whilst also maximising the classify procedures based upon the patient mix to finish “slightly early” Surgeon / Patients notes at the time of addition to the waiting list, as well as data science to calculate highly accurate procedure times, moving away from averages and taking into account surgeon and patient specific co- morbidities or complexities whilst also PDSA Cycles are used at every step of The implementation methodology is central to allowing for natural down time. development to ensure the changes to the its success. We deploy a process of testing process are congruent with staff’s needs and contrasting predicted procedure times with all staff groups to demonstrate accuracy before formal sign off and deployment. Key features

Calculates Generates Reads & Provides accurate Demand Provides Classifies optimal consultant and Optimal surgeon Session specific Waiting list Session Fill free text Templates times in Hrs

5 Deloitte Public Sector: Confidential – for approved external use How does ATOM establish the foundation of Demand?

ATOM time prediction is generated from ATOM Procedures are a repository of procedures developed over 8 years historic Procedures (classified through with NHS Trusts. Procedures are at a lower level of granularity than the ATOM Demand Prediction the NLP) and incorporates the range of NHS Digital OPCS codes. times and typical theatre flow

NLP Time Prediction

Mrs Jones Waiting List

Patient Surgeon Notes ATOM Procedure Johnathan Wilkinson ACL reconstruction knee Anterior Cruciate Ligament (ACL) Reconstruction Josh Lewsey ACL reconstruction left knee Anterior Cruciate Ligament (ACL) Reconstruction Jason Robinson left ACL arthroscopic reconstruction Anterior Cruciate Ligament (ACL) Reconstruction Michael Tindall arthroscopy + all reconstruction right knee ga Anterior Cruciate Ligament (ACL) Reconstruction William Greenwood ACL reconstruction left knee hams Anterior Cruciate Ligament (ACL) Reconstruction Benjamin Cohen ACL reconstruction left knee (hams) Anterior Cruciate Ligament (ACL) Reconstruction Mathew Dawson ACL reconstruction of right knee Anterior Cruciate Ligament (ACL) Reconstruction Stephen Thompson ACL reconstruction of the left knee arthroscopic approved Anterior Cruciate Ligament (ACL) Reconstruction Mrs Jones, when Phillip Vickery arthroscopic ACL reconstruction (left) | farsi interp booked 12/9 Anterior Cruciate Ligament (ACL) Reconstruction (Complex) performing a simple Martin Johnson ACL reconstruction right Anterior Cruciate Ligament (ACL) Reconstruction ACL Reconstruction Benjamin Kay ACL reconstruction right knee na 29.07.16-05.08.16 canc x1 Anterior Cruciate Ligament (ACL) Reconstruction requires 82 Minutes Lawrence Dallaglio ACL reconstruction right knee 24 wks Anterior Cruciate Ligament (ACL) Reconstruction of Theatre Capacity

6 Deloitte Public Sector: Confidential – for approved external use How does ATOM establish the Impact from COVID? We are supporting Trusts who are already using ATOM to understand the new Theatre process and modify the ATOM times to be able to book accurately in the COVID transition period, categorise the waiting list, and plan increases in planned activity in order to mitigate over time.

Day to Day COVID Outcomes Waiting List Theatre Operational The following shows new post-COVID procedure times Categorisation Process Constraints based on the ATOM scheduler Usual COVID Procedure Description Category Conditions Conditions Abdomino Perineal Excision of Rectum Key: 3 415 (06:55) 464 (07:44) (APER) (Laparoscopic / Swedish) Inputs Advancement Flap 3 93 (01:33) 126 (02:06)

Challenges Anterior Resection (High / Unspecified 3 357 (05:57) 403 (06:43) / Laparoscopic) + Adhesiolysis Anterior Resection (Low / 2 400 (06:40) 448 (07:28) Laparoscopic) + Ileostomy Appendicectomy (laparoscopic) 1a 113 (01:53) 147 (02:27) Colonoscopy (with or without biopsy) 2 66 (01:06) 97 (01:37) Benefits Improved waiting list Gives the speed to initiate change Improved booking process New weekly Impartiality Demand Development of a recovery plan (Not including (enhanced provision) Set KPIs backlog)

React dynamically to challenges in Tailor-made and bespoke to your operating environment individual surgeons 7 Deloitte Public Sector: Confidential – for approved external use ATOM Automated List Fill Our AI performs the task of processing patients on waiting lists through to effective list booking, including patient contact

Outcomes Key elements of our approach • Use of Robotic Process Automation (RPA) • Autonomous AI working from addition to • Patients are allocated to theatre sessions based Waiting List to patient being treated upon urgency and timing to Constant Data fill the list effectively • Clinical Involvement and input into the 01 Feed • List fill is based upon decision points and hand offs for the AI urgency first and then time in order to use the capacity • Accurate and Agile compilation of Patient • Lists are filled based upon Mix to ensure optimal use of capacity NLP Procedure Selection of known COVID issues Classification & 02 03 Patients for Each whilst preventing over runs or Categorisation List cancellations • Management of the Waiting list is optimised for a changing landscape during Patient Contact Patient Booking the Transition period and beyond (Voice / Text) 04 05 into PAS / TIMS • Waiting list growth is minimised during the • Use of AI Voice / RPA Text Transition period • Patients are contacted via Text or Voice where applicable • Staff time is generated in order to focus on • Patients with no mobile • Use of Robotic Process other elements of Elective care provision, phones require voice Automation (RPA) such as ensuring PPE and ben availability • Patients who cannot be • Patients are booked contacted through AI systems onto theatre sessions • Speed of Implementation results in will be logged for human • Staff time is created in benefits being seen rapidly and within the interaction order to handle other COVID period issues, such as PPE, Kit 8 and Consumables Deloitte Confidential – For Approved External Use

This publication has been written in general terms and we recommend that you obtain professional advice before acting or refraining from action on any of the contents of this publication. Deloitte MCS Limited accepts no liability for any loss occasioned to any person acting or refraining from action as a result of any material in this publication.

Deloitte MCS Limited is registered in England and Wales with registered number 03311052 and its registered office at Hill House, 1 Little New Street, London, EC4A 3TR, United Kingdom.

Deloitte MCS Limited is a subsidiary of Deloitte LLP, which is the United Kingdom affiliate of Deloitte NSE LLP, a member firm of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee (“DTTL”). DTTL and each of its member firms are legally separate and independent entities. DTTL and Deloitte NSE LLP do not provide services to clients. Please see www.deloitte.com/about to learn more about our global network of member firms.