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Implementation and Evaluation of Effectiveness

Technology implementation is a continuous process that will by its very nature adapt to the Trusts changing circumstances and the needs of the local health economy. It is important however to continually evaluate the effectiveness on a technology in terms of efficiency and impact.

Effective evaluation will allow commissioners and Trust Management to rethink and adapt local objectives, priorities, and strategies as 'implementation proceeds'. Continuous evaluation also facilitates making changes if aspects of the plan are not working. The following questions should be addressed when planning the evaluation of implementation. They can also assist in planning and agreeing infrastructural changes within the acute setting:

How and when will you evaluate the impact that implementation has had on patient care and service efficiency?
Who will be responsible for collecting ongoing data to assess the effectiveness of the plan and its implementation? (Click here for a potential job description and person specification that Trusts may consider building into the business case).
What windows of opportunity exist for reviewing the impact of implementation? (For example, the plan might be reviewed as part of the Trusts/Departments regular performance review meetings.)
How will accountability for implementation be assessed?
How will the level of technological proficiency gained by pathology staff be reviewed? (The Department of Health's workforce redesign tool for pathology can be found here).
How will the Trust use the technology to evaluate teaching and learning?
What Trust-wide mechanism will be created to allow changes in the implementation of the technology and the plan itself?

The Enhanced Recovery Programme is undertaken in partnership with the NHS Institute for Innovation and Improvement, NHS Improvement, the NHS Cancer Action Team, the 18 Weeks Implementation Team, and the Department of Health and is an important metric to score success against once implementation has taken place. Enhanced Recovery Programmes (ERPs) - often referred to as Rapid or Accelerated Recovery are evidence-based approaches to care and they are multidisciplinary, multimodal care packages that seek to prepare patients for, and reduce the total impact of, surgery - helping them to recover more quickly.

More information on the Enhanced Recovery Programme can be found here.

Measuring Success

The primary task of implementing this technology is to improve patient outcomes during and following breast cancer surgery. A fundamental goal for Trusts moving forward is to measure the impact of this technique and identify the potential benefits, costs and practical issues associated with the routine implementation of the intra-operative test.

The following measurements may be used to assess patient outcomes and impact on productivity and the use of resources, which will allow Trusts to provide relevant information to help providers and commissioners make informed choices about how the adoption of this technique and to assess how it could make a positive difference to NHS performance and the well being of patients:

Post operative morbidity and mortality,
Length of overall hospital stay,
Readmission and reoperation rates,
The use of the technology (and its financial implications),
Patient impact,
Outpatient capacity / changes to waiting lists.

Another mechanism for evaluating the effectiveness of implementation is through some of the concepts laid out by the Improving Surgical Outcomes Group (ISOG).

ISOG is an independent medical group comprising surgeons, anaesthetists, critical care consultants and others involved in operative management and care. The group is concerned with improving patient outcomes and modernising care for patients undergoing major surgery.

In June 2005 the Group produced a report entitled 'Modernising Care for Patients Undergoing Major Surgery'. It highlights that 20,000 patients die every year in the NHS following surgery. The report also includes recommendations for how surgical care should be modernised.

The report stated that: "It is recognised that more patients need to be transferred directly to ICU and HDU following surgery than current NHS bed numbers allow, and a combination of improvements in intra-operative care and increasing planned critical care admission for those at increased risk of complications is now known to reduce the overall number of ICU and HDU bed days used".

To review the ISOG report click here.