Date 5th September 2016

Site Aberdeen Royal InfirmaryContact Details Christina Cameron NHSG Programme Manager. Tel : 01224558427

Helen Paddon Site & Capacity Manager ARI, Louise Brodie QIFTitle Evaluating effect and impact of hospital safety briefing and huddles in

relation to capacity, flow and Safety6EA EA1: Clinically Focused and Empowered Management

AimUndertake evaluation of the daily safety and flow huddle at 1 year post implementation.

Does the huddle support & empower staff to ensure patient & staff safety and hospital flow? Evaluate the structure and outcome of the huddles Ascertain their effectiveness towards the delivery of national unscheduled care targets? Identify improvements that may be made to the huddle to support clinical teams to improve

patient experience, hospital journey and timely discharge.

Anticipated Benefit [Description of anticipated benefit]

Improved communications, with a developing culture of shared learning and problem solving across all disciplines.

Patient focussed journeys of care in preference of bed management encompassing safety issues as standard.

Supporting multidisciplinary teams to identify, overcome and resolve barriers to improving service wide safety and flow.

Implementation & Approach [Improvement & Engagement approaches used]

The Acute Sector daily Safety and Flow brief/huddle was implemented May 2015 and is consistently led by the Site and Capacity Manager.

Our huddles have evolved using improvement methodology, evaluating and developing content, structure, templates, electronic communications and practise with the support of PDSA’s and the improvement team.

Local Evaluation in Aug 2015, and a further evaluation in Nov 2015 as part of the national ‘ Hospital Safety & Flow Huddle temperature check’ resulted in the following changes :

Positive practice stories are shared at the huddle Monday & Fridays Introduction of ‘an at a glance board/electronic communication’ with traffic light system

highlighting identified risk Instigation of significant event analysis at the meeting The briefing has now evolved to 3 follow through huddles daily (0800,12md,4pm) alongside a

10pm conference call. A cross system huddle at 930am daily involving community hospital, discharge hub,

ambulance service, Dr Grays and Woodend hospital has since been established ensuring a whole system wide approach.

In May 2016, further evaluation was undertaken. 53 electronic questionnaires were returned, representive of staff who regularly participate in the safety huddles. Our clinical effectiveness team collated and analysed this evaluation.

Case Study Submission

Outcomes [Outcomes and evidence of impact of improvement on 6EAs, overall 4 hour performance or specific flow group(s)]

Trackcare PMS provides us with live hospital wide status, staffing and capacity. It highlights current hospital activity, presentations and ward predicted admissions. This informs our daily flow priorities and discussions at the briefing. Huddles remain short and sharp (15-20 minutes) focusing upon key safety and staffing issues.

92% felt that the safety & flow huddle was embedded in their daily routine. 87% feel comfortable raising issues and concerns at the briefing 74% feel the Site and Capacity Team support them to resolve flow and safety concerns at the

briefings 85% feel they leave the briefing with clarity regarding actions and escalation of flow or safety

issues raised. 72% felt that the briefings have led to a more collaborative approach resolving staffing issues

across the hospital. There is recognition that staffing levels remains a key concern. This is being addressed at present as a matter of importance, with a senior nurse secondment concerned specifically with workforce.

62% felt improved communication and management of ‘boarded’ patients’ hospital wide. 81% of respondents report ‘feeling safe to go’ as they leave the huddle each day.

These findings are indicative that the briefing is not purely focussed on beds and flow but taking into account safety concerns. This is currently being enhanced with patient safety team feedback at the beginning of the morning briefing on the safety issues/incidents reported overnight and the actions taken.

Key Lessons Learned

Key lessons learned & further improvement we will consider from evaluation of the safety brief huddles are:

Continue to invest time and energy in optimising staff engagement, particularly medical attendance, this would improve early/timely decision making.

Remain consistent and concise in the leadership of the huddles and key messages being delivered; ensure the focus is kept on the patient journey, safety and not beds.

Improve attendance at weekend and public holidays- more challenging to get decisions at these times.

Encourage presence of associate Medical and Nurse Director so staff know they are aware of concerns discussed and they in turn may feedback how they are working to support and resolve these.

Further clarity around escalation – not all disciplines feel clear on local/site escalation. Further focussed attention to EIDL is necessary to improve patient experience and timely

discharge. Boarding practise is varied, responses suggest although improvement recognised, ‘boarding

patients’ required further focus. Increased visibility of Senior Management and Site and Capacity team was considered more

supportive to staff in attempts to improve flow. Evaluation revealed that some staff thought that the patient story and positive impact on staff

morale was often rushed, suggestions on changing the focus of these to ask areas to share their stories of good clinical/professional practice has already been adopted.

Your case study with considered for presentation and publication in monthly update. Please indicate if you do not agree.

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Return to: UnscheduledCareTeam@gov.scot by first Monday of every month

6 Essential Actions - Action Effect Diagram