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Implementation Policies and Procedures

Policies and Procedures

There are 11 questions that need to be answered to enable Trusts to pull together a mandate for change. Six can be termed strategic, the others specific to the implementation project. This checklist is useful in the implementation of a new strategy such as the introduction of an enhanced breast service.

Strategic

For a full breakdown of how the new model of care impacts on the strategic direction of the NHS, see the business case that Trust teams had signed off as part of the NTAC process. However, there are key questions that should be answered locally in order to scope how this model of care will be incorporated into the Trust, including:

Has a clinical champion been appointed?
Have clear objectives been set for local implementation?
Has a team been created that will initiate, oversee and evaluate success?
Can the team understand the dynamics of what is required to take the plan forward, and has it experience of similar adoption barriers?
Do they have the necessary number of people that can handle the necessary detail?
Has the team got a review mechanism in place for managing and communicating the variances that will occur during the implementation of the plan? ( Click here for a suggested communication strategy template that Trusts may wish to utilise).

Local Procedural Changes

Local factors should be part of a detailed analysis of the implementation project. Prior experience of the NTAC implementation sites will be core to understanding how this will look locally. This is one of the values of the post-project analysis and review - to build a foundation of expertise for future programmes.

Have the key tasks been identified?
Have the success milestones been identified?
Do the resource requirements of the plan (time, money, people, equipment,) appear reasonable and consistent with existing best practice?
Is the new service cost effective?
Have the key risks of each of the main components been identified and managed (designed out, shared, and mitigated)?

Funding

The business opportunity presented by the reconfiguration of the breast service supports recent initiatives from the Department of Health for patient choice, making each participating Trust a preferred choice for patients with improved patient care and access to clinical services. This will have financial implications for the Trust's under the Payment by Result Regime. Opportunities offered to Trusts including:

The creation a robust agreement with commissioners to secure the funding to enable service delivery.
Develop a new, integrated service which provides a higher quality of life for the patient (see the Patient Pathway: how will it change? section).

An understanding of financial implications should be understood, along with an understanding of the options available to Trusts who are looking to implement this technology. It is also important to engage commissioners and Trusts finance managers in this process from the outset.

Click here for a commissioning paper that can be sent to PCTs to encourage such interaction.

Click here to go to the Business Case Section of the How-to-Why-to-Guide.

Staff Development

Introducing this technology into the organisation requires some reconfiguration of pathology staff and potentially the hiring of additional breast care nurses. A Staff Profile Checklist has been developed by NTAC Implementation Sites, which provides some guidance on who might be appropriate within Pathology to carry out this test. (Also see New and Promising Practices for more information on operational procedures within Pathology).

Click here for an Agenda for Change banded job description and the person specification which was created by The Princess Alexandra Trust), and has been core to overseeing the introduction of the technology in that Trust. This job / role has acted as a coordinator to ensure the patient pathway was fully implemented at a local level.

The Department of Health has recently commissioned a toolkit which was followed in two of the NTAC implementation sites, which supports 'the changing needs of services and pathways of care. It aims to ensure that the right people with the right skills are in place, rather than constraining the service by limiting it to traditional established roles'. (Source: Department of Health).

The toolkit's main aim is to log what the workforce currently does in individual pathology services and to help managers to model changes to the workforce profile when:

Work is redesigned or the competence required to do so is reassessed;
Demand for tests varies; and
Improvements in productivity are achieved.

It is aimed at directorate managers (senior managers, scientists and clinicians who have overall responsibility for the pathology service) and will help to gain the evidence needed to support plans (such as the introduction of the revised model of care this technology can facilitate) for the pathology workforce. (Source: Department of Health).

NTAC's implementation sites recommend using this tool when considering service improvement across pathology but in particular to ensure a methodical approach to successfully implement this particular test / technology. Click here for the entire tool, which includes 'A Guide for Pathology Managers', 'How to use the model', 'PAT list - final', 'Guidance for department managers', 'main model' and task entry'.