North East Region Integrated Eye Care System (NERIECs)

Introduction

Ophthalmology in Ireland has one of the longest waiting lists with 46,998 people waiting for a first visit outpatient appointment . In the Mater hospital , this number is 8000 and in the North East region it estimated at 15-17,000. To successfully navigate our way out of the cycle of waiting lists and delays which were exacerbated by both COVID-19 and the Cyber Attack of 2021, we needed to re-imagine how we deliver eye care in Ireland. The use of Lean Six Sigma to redesign process has been shown to be effective at a local level in Mater Ophthalmology services and with Ireland East Hospital Group (IEHG) initiatives but also on a larger level in the UK with the Get It Right First Time (GIRFT) process. The NERIECs team are using a combination of Person-centred and Lean Six Sigma approaches to address the process problems and work with teams to co-design solutions. Lean Six Sigma provides the framework for data collection, analysis, planning and scheduling, while engagement within the team and with other colleagues, patients and their families is underpinned by person-centred principles.

Project Outline

The project aims to redesign the current processes that underpin Ophthalmology service delivery in the North East of Ireland. NERIECs is specifically looking at five main areas of interest:

Cataract
macular degeneration
glaucoma
paediatric amblyopia
eye emergency referrals.

Extensive stakeholder engagement has taken place since March 2021 and the team worked collaboratively with multidisciplinary teams across the North East in CHO and hospital settings. Extensive patient engagement commenced in 2021, and in undertaking both patient and staff engagement we have built on our experience of research into team interventions that identify conditions that help to enact a shared sense of responsibility, develop a sense of common purpose, create mutual understanding, and motivate the team towards successful outcomes including more integrated care. We are employing Lean Six Sigma methodologies to define problem statements, measure and collect data, analyse this data and develop improvement plans. This has involved the end to end process mapping of the entire eye care service delivery in the North East

The project aims to demonstrate a system level integration with subsequent improvement in patient care and access. This integration will be across geographic lines, levels of care (primary, secondary, tertiary, and post-acute care) and by way of pathways.

Project Outputs

We are measuring the outputs as determined by:-

reduced wait times for patients
increased activity in our services
reduced touch points for patients along their care pathway
improved patient clinical outcomes and care experiences by virtue of reduced delays and appropriate expertise at appropriate points in the pathway
patient involvement in the redesign of existing services to determine what is critical to quality
Enhanced patient and staff experiences of care

Results to date include the following for the redesigned Cataract pathway:

Right First Time (RFT) referrals now 95%.
Optometrist first referrals 80%
Conversion rate to surgery 95%
Time returned to care for regional GP’s 51 days in 2022.
Increased patient and staff satisfaction.
Decreased travel time for patients with one (as opposed to 4)
pre-operative visit.
Median time to surgery reduced by >50%.