safe morning discharge of patients · 8 kaizen office capability t s tem exec approved - series of...
TRANSCRIPT
Western
Sussex
Hospitals
NHS
Foundation
Trust
Safe morning discharge of Patients
Anil Mathew - Group Director of Continuous Improvement
Piervirgilio Parrella -Senior Patient First Improvement Lead
Helena Bird - Interim Head of Pharmacy
6 July 2017
“Western Sussex has the best learning culture across the whole of the NHS” – Jeremy Hunt, Secretary of State for Health and Social Care (1 Feb 2018)
2
Todays presentation
• Patient First & our Kaizen approach
• ‘Safe Morning discharge of Patients’ Project
• Sharing & Collaboration
• Final Reflections
• Q&A
3
Critical ‘enablers’ to drive Lean / Change programmes
Teamwork / Problem Solving
Performance Management
Clear Strategy
Roles & Responsibilities
Standard WorkDecision-making
Alignment
Continuous Improvement
of stakeholders
to common goals
in place and in use
in place
Strong culture of
using facts & datato show Winning or Losing
(using real-time information) Documented
Processes
Clear and Understood
Communication
across all Levels
4
Our Strategy - ‘Patient First’ Triangle
Patient Care & Experience
Managing Budget
Staff Engagement Avoidable Harm & improve Mortality
Patient Flow
TRUE NORTH
5 Kaizen Office
Capability
Str
ate
gy D
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loym
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t P
roje
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Pa
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Fir
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pro
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me
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Sys
tem
The FIVE Pillars
6 Kaizen Office
Capability
Str
ate
gy D
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loym
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Imp
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Pa
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Fir
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Sys
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Shortlisted “Patient Safety Awards” 2018
- for Education and Training
The FIVE Pillars
7 Kaizen Office
Capability
Str
ate
gy D
ep
loym
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t
Imp
rovem
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t P
roje
cts
Pa
tie
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Fir
st
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pro
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me
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Sys
tem
The FIVE Pillars
8 Kaizen Office
Capability
Str
ate
gy D
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loym
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Imp
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roje
cts
Pa
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Fir
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pro
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Sys
temExec approved - Series of High Impact large
improvement initiatives using Lean methodology -
aligned to True North and Breakthrough Objectives
eg, Safe Morning Discharge of Patients
The FIVE Pillars
9 Kaizen Office
Capability
Str
ate
gy D
ep
loym
en
t
Imp
rovem
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t P
roje
cts
Pa
tie
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Fir
st
Im
pro
ve
me
nt
Sys
tem
“Front line” Daily Improvement Huddles including
alignment to Trust (Strategy Deployment) through
“Driver Metrics”
The FIVE Pillars
Safe Morning Discharge of Patients Improvement Project
Piervirgilio / Helena
6th July 2018
11
Problem Statement – its evolution
2016: Non Elective Flow
2017: Increase Discharges for Short Stay Wards
2018: ‘Safe morning discharges of Patients’
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Safe Morning Discharge of Patients
A&E EF WARDS
From a PUSH to a PULL System
AdmissionsDischarges
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Baseline:
16%
.
Morning Discharges
Our Challenge
Interim Target
High-level Plan
Pro
ble
ms
Challenge for : Balcombe Ward
Divisional Coach: Jeannie Baumann
Exec Sponsor : Nicola Ranger
TTOs
Haematology waiting senior
review in the afternoon
Transport for eol
▪Hard goal:
45%
Top 3 Issues 30%
14
Kaizen Approach & RACI
Exec
Medical
Director
Flow
Director
COO
Medicine
Director
Sponsor
Daily
Escalations
Accountability
Ward Coach
CGM
Ward Coach
CGM
Ward Coach
CGM
Ward Coach
CGM
Ward Coach
CGM
Gemba and
Coaching
EFs
Gastro
Dome
Resp
Mix
Develop A3
and RCA
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Ward - Problem solving & Data Collection
Coaching
session
Divisional
Buddy and
Ward Sister
Kamishibai
Board
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Performance Management – in operation
Agenda &
IPOVisible KPIs
(weekly trends)
Actions &
Accountability
Weekly Project Huddle (15min)
Leader
Standard
Work
Exec Sponsorship
Top 10 Target Wards
and weekly RAG status
17
Wards identify their Top 3 Issues
• Internal challenges:
Time of Board-round
Communication
• External challenges: (escalated to Sponsor and Directors)
TTOs
Time of Package of Care availability
Procedure of booking Transport
18
Patient deemed
MFFD
TTO prescribed on EPMA
TTO screening by Pharmacist
started
Is TTO correct?
How did you
contact the
doctor?
DOCTOR actioned -
TTO corrected
TTO dispensed
by Pharmacy
EDS narrative
completed on SEMA
PHARMACIST1) Record how informed
2)Record date & time screeningstarted
PHARMACIST Record Y or N
PHARMACIST - Record date
and time
PHARMACY TECHNICIAN1) Record where dispensed (ward or dispensary)
2) Record date & time
No
YesTTO screening by Pharmacist
completed
PHARMACIST Record date and time screening completed
Initial Process Flow
DOCTOR -Record date
& time
DOCTOR -Record date
& time
DOCTOR -Record date
& time
19
Problem Statement:
The TTO turnaround process has a high level of NRFT (50%).
This level of efficiency is not fit to meet bed turn demand.
Current state:
RFT 50%
Target:
RFT 75% (Ambition 100%)
Solution: • Pilot on Becket Ward: Doctor and pharmacist will write TTOs
together in designated time.
• There are two dedicated slots:
• 1 in the morning for discharges in the same day
• 1 in the afternoon for discharges for the next day (Aligned to
SAFER CQUIN). This will be the majority for discharge planning
and foreseen.
Benefits:
• RFT TTOs % will be increased to at least 75% and fulfilled in
real time.
• Quality of information, particularly for medicine changes, will be
improved.
• Reduction in the number of post discharge follow up
conversations.
• Reduced risk of printing wrong TTOs and being fwd out.
• Education for Junior Dr in relation to medicine.
• Referral of high risk medicine e.g. Warfarin.
• LOS reduction up to 1 day (0.5 on average)
Key Metric(s): • TTOs RFT%
• Time to complete TTOs
Results: RFT 97%
Time to completion TTO decreased
from 4 hours to 20 min
20
0
50
100
150
200
250
300
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Dec-16 Jan-17 Feb-17 Mar-17 Apr-17
Non-Elective Flow Improvements
Becket Lavant Castle Lead time for TTO
Problem Solving Workshop withPharmacists / Junior Doctors & Kaizen Team
Time to Process TTOs(minutes)TTOs Right-First-Time %
BEFORE AFTER
Data - Summary
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Dashboard - Monitoring
22
Monitoring phase
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14.5
15
15.5
16
16.5
08
-Jan
15
-Jan
22
-Jan
29
-Jan
05
-Feb
12
-Feb
19
-Feb
26
-Feb
05
-Mar
12
-Mar
19
-Mar
26
-Mar
02
-Ap
r0
9-A
pr
16
-Ap
r2
3-A
pr
30
-Ap
r0
7-M
ay1
4-M
ay2
1-M
ay2
8-M
ay0
4-J
un
11
-Ju
n1
8-J
un
25
-Ju
n0
2-J
ul
09
-Ju
l1
6-J
ul
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-Ju
l3
0-J
ul
06
-Au
g1
3-A
ug
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-Au
g2
7-A
ug
03
-Sep
10
-Sep
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-Sep
24
-Sep
01
-Oct
08
-Oct
15
-Oct
22
-Oct
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-Oct
05
-No
v1
2-N
ov
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-No
v2
6-N
ov
03
-Dec
10
-Dec
17
-Dec
24
-Dec
31
-Dec
07
-Jan
14
-Jan
21
-Jan
28
-Jan
04
-Feb
11
-Feb
18
-Feb
25
-Feb
04
-Mar
11
-Mar
18
-Mar
25
-Mar
01
-Ap
r0
8-A
pr
15
-Ap
r2
2-A
pr
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-Ap
r0
6-M
ay1
3-M
ay2
0-M
ay2
7-M
ay0
3-J
un
10
-Ju
n1
7-J
un
24
-Ju
n0
1-J
ul
Discharge Hour 3 per. Mov. Avg. (Discharge Hour)
0%
20%
40%
60%
80%
100%
120%
Bro
adw
ater
Ash
ling
Mid
dle
ton
Cas
tle
Bu
ckin
gha
m
Bo
xgro
ve
Bir
dh
am
Du
rrin
gto
n
Bo
sham
Acu
te C
ard
iac
Un
it
Dit
chlin
g
Pe
two
rth
Em
erg
ency
Flo
or
2 (
CH
I)
Be
cket
EF
Zon
e C
Bo
tolp
hs
Sels
ey
Ba
rro
w
Ford
Clin
ical
Dec
isio
n U
nit
(W
OR
)
EF
Zon
e B
Clin
ical
Dec
isio
n U
nit
(C
HI)
Co
urt
lan
ds
Em
erg
ency
Flo
or
1 (
CH
I)
Ba
lco
mb
e
Ch
an
cto
nb
ury
Su
ite
Fish
bo
urn
e
Em
erg
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Flo
or
3 (
CH
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Lava
nt
Ear
tham
Err
ingh
am
Wit
teri
ng
EF
Zon
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Ch
iltin
gto
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Eas
tbro
ok
Cla
ph
am
Co
om
bes
Ch
ilgro
ve
Worthing Non-Elective Discharges SRH Non-Elective Discharges
Median Time
of Discharge
% of Morning
Discharges
23
What our Staff say ?
“Release patients in the morning enable the staff to
concentrate on the sickest patients with full staff
availability”
- Alma Depena – Durrington Ward Sister
“As the NHS is 70 today and I’ve been working for 39 years
in many roles!! I’ve seen lots of quality improvement
initiatives come and go but I have to say the Kaizen
approach we are following at Western is the most inclusive
and successful philosophy I’ve experienced”
- Jeannie Baumann – Flow Director
24
Next Steps
• Internal Challenges• Sustainability
• R&R of Coaches/Directors/Exec
• Leader Standard Work / Gemba programme
• External Challenges• Booking Transportation / Packages of Care
• Further Kaizen Workshops planned
25
Project alignment to Patient First
Safe managed Patient Care
Managing Budget
Staff teamwork / clearer R&R ‘Leaner processes’
Earlier ‘Bed’
availability
26
Sharing and Collaboration
27
CEO & Exec Leadership
Patient First (True North)
Strategy
Engaged Staff
& Communication
Benchmarking
Lean / Six Sigma Structured approach
High Performing Kaizen Team
Final Reflections
28
Thank you !
Contact details: [email protected]
Follow us on Twitter: @WSHTKaizen
Western Sussex Trust “Open Day” – Friday 5th October !
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Western Sussex Kaizen Way
BACK UP
30
PF