releasing time to care. why releasing time to care? fits with use of quality improvement methodology...
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Releasing Time to Care
Why Releasing Time to Care?
• Fits with use of quality improvement methodology used for CQIs
• Uses ‘lean’ to improve processes and free up capacity
• Capacity released supports implementation of revised SCN role
Main theme
• Shifting emphasis from “what do we do” to “how do we do it”
• Productive ward is modular based
• Uses a variety of tools in bite-size portions to work through changes
• Very much a team involvement throughout the process
Main Aims
In Scope Out of Scope
The ward environment Saving the world (whole systems view)
Efficiencies Budget increases
Reduced LOS Reduction in staff levels
Majority of supporting diagnostics
Staff contracts
Frequency and authority for clinical decision making
Challenging individual clinical decision making outcomes
Patient admittance criteria
Direction and management of the ward Direction and management of the organisation as a whole
Now and the future The past
The team Individuals
Content
Creating solid foundations:
• Knowing How we are Doing Developing ward based measures to help the team make informed decisions.
• Well Organised Ward Make the ward areas work for your staff so that your staff don’t have to work around the ward areas.
• Patient Status at a Glance Patient information that improves communication, patient experience and patient flow
Focusing on key ward processes:
• Meals• Medicines• Admission and Planned Discharge• Shift Handovers• Patient Hygiene• Patient Observation • Nursing Procedures• Ward Round
• The SCN/CQI work streams are part of the wider nursing policy set out in Leading Better Care and Delivering Care, Enabling Health.
• This will necessitate the SCNs being released from having a clinical caseload, which is current practice in a significant number or areas. The use of the Clinical Quality Indicators and improvement methodology will equip SCNs to develop and sustain a culture of continuous quality improvement.
• This will in turn support the delivery of HEAT targets and organisational objectives within Board areas.
The Releasing Time to Care programme provides a structured framework for the use of continuous improvement methodologies with the ultimate aim of ‘releasing time to care’ in ward areas. This Programme has the potential to support SCNs to use a variety of quality improvement tools in their areas with the aim of having more capacity within the current resource envelope
NHS Scotland Releasing Time Care Evaluation
• Not a stand alone programme
• ‘pulled’ from the NHS
• Let’s pilot it first– does it support Leading Better Care?– Does it ‘fit’ NHSScotland?
Measuring success -Evaluation of programme in NHS
Scotland• NHS Ayrshire and Arran - Crosshouse Hospital - general surgical
ward• NHS Forth Valley - Falkirk Royal Infirmary – elective orthopaedic
surgical/rehabilitation ward• NHS Grampian - Woodend Hospital - acute care of the elderly ward• NHS Fife – Glenrothes Community Hospital – rehabilitation and GP
admissions ward• NHS Lothian - Royal Infirmary - acute assessment medicine for the
elderly ward• NHS Borders – Borders General Hospital – elective/trauma
orthopaedic ward• NHS Lanarkshire - Trauma orthopaedic ward• NHS Tayside – Ninewells Hospital – gastroenterology ward
Evaluation Results
• Improved leadership ability
• Increase in direct patient care time
• Improved efficiency
• Improved staff morale and team working
Percentage improvement in staff nurse time spent providing direct patient care following implementing Releasing Time to Care
-10
0
10
20
30
40
50
BOARDS
E
D
C
B
A
% im
provement in
direct care time
Measuring quality - CQI’sClinical Quality Indicators
0%
20%
40%
60%
80%
100%
120%
August October November December
2008
Clinical Quality Indicators 2009
0%
20%
40%
60%
80%
100%
January February March April May June
Falls
Food Fluid & Nutrition
MOBS
Pressure Area Care
Measures Example
Safety Cross
Patient Experience
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Privacy & Dignity Involvement withinformation
Efficient&effective care
Knowledge ofdischarge
Time to Care
Patient Satisfaction Feb 2009
n/a
No
Sometimes
Yes, always
Patient Satisfaction Questionnaire
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Privacy & Dignity Involvement withinformation
Efficient& effective care Knowledge of discharge Time to Care
Sept
embe
r 200
8
n/a
No
Sometimes
Yes,always
Sustainable
Patient Safety
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
September December2008
Series1Hand Washing Compliance 2009
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
February March April May June July
February
Improving practice
improved the nursing process for setting up a dressing and reduced the process from 172 steps to 5 steps
• Stock returns - £700 - £3500
Improving efficiency
Not just…..
£2,607 redistributed
My staff take less time to look for items, ordering items and setting up trolleys
for tasks. They are also now thinking of other processes that can be changed to
release time to care.
SCN
• Staff have found implementing RTC:– time consuming – hard work – overall a hugely positive experience
Staff morale and team working
“The ward at times represented organised chaos, this has changed to a well organised ward, which is more conducive to providing quality care”
“Everyone has taken real pride in the ward”
SCN
In reality………..
Quality
Ownership
Empowerment
Teamwork
Communication
Staff Shift Thermometer
0%
20%
40%
60%
80%
100%
120%
September October November December
2008
Brilliant
Somewhere inbetween
Rotten
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
February April June
2009
Staff Shift Thermometer
Brilliant
Somewhere inbetween
Rotten
Ownership & empowering
Other measures
Sickness absence
MRSA rates
C. Diff rates
Length of stay
Compliment and complaints
Vacancies
• Also module specific
Fit with other national streams of work
• Hospital Acquired Infections - MRSA and CDiff infection rates.
• Scottish Patient Safety Programme - patient observations, pressure ulcers and falls.
• 18 weeks referral to treatment programme - expected date of discharge.
• Better Together Programme – patient satisfaction.• Nursing & Midwifery Workforce and Workload Planning –
unplanned absence rates.• Clinical Quality Indicators – pressure ulcer, falls, meals
and patient observations.• Quality Improvement Scotland Improvement
programmes – meals, falls and pressure ulcers.
Our Ward:
Our Vision: We strive to have a ward that is-Bright, clean and well organised
Where patients feel safe, comfortable and are treated with dignity and respectWhere care is provided by friendly, competent staff in a calm atmosphere
The staff of ?? are proud to work as a team, continually striving to provide an excellentstandard of evidence based care to our patients and carers.
Our ambition is to have a ward that is safe and effective for patients while providing an excellent learning environment for all staff
What We Have Done:Waste Walk
Key Findings
Prep room Patient status board
Notices on wallsSluice
The problems we experience now:
Constant interruptions, In-accessibility of drug keys,Lots of medicines, controlled drugs and IV infusions.
What We Have Done:Activity FollowKey Findings
Medicine- roundsCd’s, iv antibiotics, keysDiscussion-patient flow
Admin –profilesMotion-walkingInterruptions
The obstacles we experienced:
2008 A S O N D
Waste Walk 1
HolidaysActivity Follow1 R
evie
w
Re
vie
w
5’S
VIS
ION
Busy ward with high patient flow. Temporary decrease in staffing establishment
Challenging to involve everyone within existing resources Stressful for staff
Key success factors
• Active executive support
• Dedicated facilitation support
• Ward team training time
• Time to implement
• Support services involvement
Next Steps
• Available to NHS Boards if they wish to implement
• Criteria to consider• Provision of regional training with support
from NHS Boards• Releasing Time to Care Mental Health• The future – Releasing Time to Care
Community Hospitals, Community & Theatres
Building on Success