Introduction
The objective of the National Theatres Project ( NTP) is to achieve Best Value for theatre services by appropriately increasing patient throughput, thereby using resources more productively and efficiently.
The purpose of this Technical Appendix is to provide further detail to the main report on the project work undertaken and to give examples of analysis and investigation of findings from the use of the balanced scorecard approach to comparative performance.
Summary of Supporting Information
In June 2005 the National Theatres Project agreed the following activities with the National Benchmarking Project Board:
- a national theatres glossary with agreed definitions to be drawn up and implemented
- a minimum standard dataset to be agreed across Scotland
- development of routes for ensuring local accountability
- evaluation of existing/available theatre systems.
Glossary and Definitions
A draft Glossary and Definitions was produced in conjunction with the Service. Where there was already agreement from existing national bodies on specific definitions, these were incorporated. Where no such agreement existed, definitions were agreed by a wide group of theatre users and where necessary amended following consultation (national events and Board visits).
This draft was progressed through the National Clinical Dataset Development Programme Board and has been subject to a full formal consultation process with a view to implementation in 2007.
A summary of terms and definitions appears as Appendix A.
Minimum Dataset
A National Data Points Day was held in August 2005 with stakeholders from across the Service to determine the information required in order to manage theatres effectively. A theatre services balanced scorecard which covers strategic and operational indicators was produced from the output of the day. This scorecard has been subsequently refined and further developed with a focus on patient outcomes and clinical governance matters with a wide range of Service input from across Scotland.
The latest draft balanced scorecard, and some notes on the potential application of the balanced scorecard in a theatres context can be found in Appendix B.
A subset of these indicators have been proposed as mandatory national indicators to be collected by Boards from 2007/08 onwards. These are shown in Appendix C, while Appendix D provides more detailed definitions of the measures.
Scorecard Pilots
Following development of the balanced scorecard, two pilot implementations tested:
- the use of the balanced scorecard to monitor and manage continuous improvement in theatres
- accountability and responsibility structures to achieve ownership and control of the theatre capacity and improvement in theatre services.
Appendix E shows an outline reporting framework, and examples of the management reports developed during the pilots can be found in Appendix F.
Data from the pilots was used to populate the balanced scorecard as far as possible. This populated scorecard forms Appendix G. Where data could be extracted from an existing theatre system, much of the scorecard could be populated with relative ease. Where a manual system was in place it was not possible to populate as much of the scorecard. Accordingly two full pilot site scorecard comparisons were not able to be generated as only one site had a comprehensive electronic theatre system with the other pilot site providing manual returns for pilot reporting.
Following completion of the pilots, the data collected was analysed and effective ways of representing this information were explored. Appendices H to K illustrate these.
Capability Scoping
During March to July 2006 visits were made to all mainland Health Boards. The purpose of these was to:
- carry out a detailed assessment of currently available local theatres information
- evaluate existing theatres system implementations
- validate and assess nationally collected theatres data
- seek Board input to the National Theatres Project and balanced scorecard development
- communicate the purpose and objectives of the National Theatres Project to Health Boards and interested staff.
The detailed findings from the capability scoping are contained in Appendix L and the template used to structure the visits can be found in Appendix M.