I think there are a few tales like that from departments for whom the
target wasn't a particular issue at first - they cruised and wondered
what the fuss was about until the screws got turned. The 97% one seems
to have been the big problem for many of the high performers. I remember
at the beginning (like Katherine) finding it all a bit baffling and
casting around for ideas from others. However, it rapidly became clear
that the ED team should not be the motivators - you end up looking as
though you are trying to interest everyone else in "your" target. From
the beginning we talked of a local health economy target and tried to
sell the benefits that fell out (which often weren't immediately
apparent) to others. With hindsight I recognise that there are two
important system improvements that must happen; more efficient use of
medical beds and preventing patients being admitted for investigation
that can be done in the ED and CDU. These both free up beds, although as
I said last week maybe not enough. I think we could do a lot more
investigations in this ultra-short stay environment but imaging needs
significant investment to make this happen.
Don't cane yourself for not being the motivator - as you have found, all
that happens is they see self-interest. Ask not what you can do for the
4 hour target but what the PCT and Trust can do, to bowdlerise a great
quotation.
Best wishes
Rowley.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of
[log in to unmask]
Sent: 25 January 2005 12:23
To: [log in to unmask]
Subject: Emergency Care Leads
having been the lead for my trust, my arm was twisted until I said yes,
it has been a completely soul destroying year. My trust started at 97%
but it had been 100% the previous year, I predicted we would get the
first two targets which we did by working the A&E to death, See and
Treat, ENP's and anything else we could think of.
Unfortunately the PCT and trust did naff all themselves. There was no
financial support and it was only when we failed to achieve the third
target that they started to notice. The plot from our start was
consistently down and we crossed the upgoing target line just before the
third measuring period.
The immediate response from the ESC group lead was to concentrate on
telling us we were at fault in A&E and let the rest ride. The PCT has
still not accepted that they might somehow be at fault. They see it as a
trust target. The trust now see it as a whole system target and last
week was the first time they actually decided something must be done
about pressuring the in hospital teams into looking at some of their
archaic practices. We got a DVT specialist nurse in post last week but
there is still no buyin from half the hospital.
Some of this must be down to me not being a terribly efficient motivator
but 4 presentations to the consultant body with the response of "what do
we need to know about A&E targets for" and a refusal of anyone from the
PCT to have anything to do with the ESC until there was some money to
dish out from our targets, and then running for the hills when we asked
for action dragged me down.
We are now running at a consistent 93% due to waits for beds and Access
to specialist opinion. When they fill my See and Treat area (used to be
my obs ward until it was closed to save money) with beds like they did
last night and over the weekend, then I get an immediate increase in
group 1 breaches that normally run at 0.5% to 1%. Last night it went to
9%.
So I have had a wonderful time as Lead
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