Seven Day Services Improvement Programme

Birmingham, Sandwell and Solihull Collaborative

Professor Matthew CookeDeputy Medical Director (Strategy & transformation)

Heart of England NHS FT

‘7 day services is only part of a whole system transformation’

Improving health outcomes across England by providing improvement and change expertise

• Optimising hospital flow, including discharge to ensure front

end emergency care capacity.

• Flow is a whole system issue.

• Where are the bottle necks?

Improving health outcomes across England by providing improvement and change expertise

How we are addressing it:

   Perfect Week, including with community SAFER care bundle   Monitoring systems, including Jonah   Feedback mechanisms   Gap analysis   Discharge hub 7/7   Access to community facilities 7/7

Improving health outcomes across England by providing improvement and change expertise

Perfect Week, including with community

• The perfect week methodology is a way of resetting a broken system relying on a mixture of social movement theory, multiple rapid improvement methodology and strong leadership and support mechanisms.

• It has been developed to help solve poor flow in hospitals resulting in overcrowding in emergency departments. One week of intense improvement activity can improve flow across the whole hospital resulting in safer, higher quality care and it can then be sustained.

Improving health outcomes across England by providing improvement and change expertise

S - Senior Review, all patients have a Daily Consultant Review , sick and discharge patients seen before 10am

A - All patients a Planned Discharge Date

F - Flow , every ward should have a min. of 1 bed available from 9am to enable emergency assessment and theatre services to flow safely.

E – Early discharge, 50% of our patients will be discharged from base inpatient wards before midday.

R – Review, a weekly systematic review of patients with extended lengths of stay ( > 14 days  

Improving health outcomes across England by providing improvement and change expertise

• Monitoring systems, including Jonah• Feedback mechanisms

Improving health outcomes across England by providing improvement and change expertise

Gap analysis

Therapies

Nursing

Senior Medical

Junior Medical

Clinical support

Non-clinical support

Improving health outcomes across England by providing improvement and change expertise

• Discharge hub 7/7• Access to community facilities 7/7

Improving health outcomes across England by providing improvement and change expertise

Mortality rates – same by day of week

Improving health outcomes across England by providing improvement and change expertise

Discharge rates still reduced at weekend

Mon Tue Wed Thur Fri Sat SunDay of Discharge

0

2000

4000

6000

8000

10000

12000

14000

Discharges by day of discharge

242526272829303132333435363738394041424344454647484950515253 1 2 3 4 5 6 7 8 9 1011121314151617181920210%

5%

10%

15%

20%

25% % discharged at Weekend - Monday 4th June to Sunday 27th May (Nonelec Only)

Improving health outcomes across England by providing improvement and change expertise

LOS of stay varies but……

Mon Tue Wed Thur Fri Sat SunDay of Admission

1.9

2.0

2.1

2.2

2.3

2.4

2.5

Average LOS by day of admission

Reducing variation• By day• By team• By individual

It is not a seven day services programme

Improving health outcomes across England by providing improvement and change expertise

Improving health outcomes across England by providing improvement and change expertise

Questions ?