Day One Co Core Trainin aining May 2015 Welcome! Washrooms - - PowerPoint PPT Presentation

Day One Co Core Trainin aining May 2015

Welcome!

• Washrooms & Exits
• Breaks & Lunch
• Phones & Email
• Plan for the coming days

Icebreaker!

“Ground Rules” for this Workshop

• Everyone has a valuable contribution to make
• There are no stupid questions!
• Please do not interrupt others and respect their views
• Be open and honest
• No blame or criticism
• Confidentiality
• Think creatively/generate ideas
• Let’s keep to time – we have a lot to get through and are here to work

Any others?

The Productive Series

The Productive Community Services

Cost effective care Team performance and leadership Safe and reliable care Patient’s experience &

• utcomes

Principles of The Productive Series

Basic principles

The Productives concentrate on the HOW, not the WHAT

• The vast majority of all healthcare guidance concentrates on

end standards (i.e. the WHAT)

• Our staff need help with HOW to implement these

standards, so they happen 24/7 – even on a Sunday night!

Concentrating on the HOW, not the WHAT

Basic principles

• Scalable, bottom up, top enabled application of proven methods in a

ward setting

• A mechanism for engaging and empowering staff so they can

challenge the status quo and lead the changes they want to make for themselves

• A structured approach with clear management roles and

responsibilities

• Modular, self directed learning structure
• Context specific – entirely ward focused
• Making “new” methods accessible
• Equipping ward leaders with methods to lead their staff towards

safer, more dignified, more reliable and more efficient care

Learning from the Productives so far…

• Energy can be unleashed by encouraging front-line

teams to question how they work and by providing simple tools and skills to help them do this

• It is possible to achieve virtually universal take up
• Excitement can be created and then steered, rather

than forcefully “over-designing” a programme

• Modules are leadership methods rather than

improvement tools

What can The Productives do for patients?

Increase direct care time Reduce patient complaints

(St George's Healthcare NHS Trust

Its about treating the person holistically and empowering them to take control of their conditions

Coventry Community Health Services

Patient experience and direct feedback means that we can act on and address issues immediately Hinchingbrooke

Health Care NHS Trust

Staff survey indicated that 100% of staff felt they had more time to spend with patients and involve them in their

• wn care

Salford Royal Foundation Trust

It gives the patients something back that they may have lost - control

What does Productive Ward offer the executive Board?

• A systematic way of delivering safe, dignified, reliable, and

efficient care to patients

• A mechanism for engaging and empowering staff so they can

challenge the status quo and lead the changes they want to make for themselves

• A structured improvement approach with clear management

roles

What is your Boards involvement with your Productive implementation?

‘When was progress with implementation last

• n your Board papers?

Is your plan for implementation strategically aligned to your organisational goals? What quality indicators are you measuring and reporting to the Board on a regular basis?’

Ursula Ward CEO Portsmouth Hospitals NHS Trust

Are you connected with your frontline staff?

‘opportunity to have systematic conversations with ward staff.’ the Productive series ‘joins the board room to the ward floor. Productive Ward is my way, with my senior team, of making sure that we are in touch with the frontline delivery of care.’

David Astley, formally CEO St Georges Healthcare Trust

• Evidence and Impact

Evidence

“The Productive Ward has the potential to deliver

£270m in productivity and efficiency savings across 139 acute trusts in NHS England by March 2014.”

Rapid Impact Assessment of The Productive Ward NHS Institute for Innovation and Improvement, 2011

The Productive Ward can help organisations make significant improvements in their productivity and efficiency. Improving healthcare quality at scale and pace - Lessons from The Productive Ward: Releasing time to care™ programme National Nursing Research Unit at King’s College

The Productive series has been transformational in the acute sector and has every chance of being equally transformational [in the community]. I think it’s a really key driver for change.”

Jim Easton, National Director for Improvement and Efficiency Department of Health

Building on a strong foundation: The Productive Ward - the evidence

• Research study from NHS London
• Releasing time to care has been a significant catalyst for change
• It has resulted in measurable, positive impacts.

– 13 percentage points increase in median Direct Care Time – 7 percentage points increase in median Patient Satisfaction Scores – 23 percentage points increase in median Patient Observations

Source: NHS London 2009 This equates to having an extra 255 full-time nurses….while an equivalent level of service improvement without the programme would cost an estimated £7.5 million a year Nursing Management July 2009

Key Factors for Success

10 influencing factors identified & supported by the Kings NRU study

Test against the organisational goals and strategy. Seen by many as a ‘good’ thing to do but not tested against it being the ‘right’ thing to do when considering the hospital’s improvement capacity and strategic priorities. Clarify the expectations of the trust leadership in taking an active role in the

• peration of a strong governance system. This will give the team clear

visibility of the progress and outcomes of The Productive Ward programme and the means to resolve issues where senior intervention is required Imperative that connection is explicitly made to the nursing vision and

• rganisational objectives for the trust

Develop the staff skills and knowledge to change work processes and coach others: grow a culture of shared knowledge across the organisation and region Ward based measurement needs to be considered a priority, linked with existing measures and analysed by the ward team who respond to changes and drive through improvement The showcase ward’s primary leadership support, the matron needs to be in a position to function in a supporting manner Nursing leadership in the hospital needs to be explicitly involved in the high level planning, briefing and engagement prior to the project, including clarifying the time requirement for both senior staff involvement and ward based staff

Focusing the project lead on managing the project and coaching rather than the doing. Due to the natural abilities of the project lead the ward lead may be undermined and by-passed in efforts to implement changes Choose wards that are performing well and do not have a history of underperformance The Productive Ward relies on collaborative management. This can be a challenge to some ward leadership structures that do not demonstrate this consistently, consider what support may be required Reporting to the hospital senior leadership team needs to be defined and regular

Rampton Hospital – positive impact for staff

Press Coverage

Patient feedback from Papworth Hospital

Patient feedback from Papworth Hospital

• After extensive surgery Rob Marchment spent several weeks on a surgical unit ,

where he observed the staff working through The Productive ward.

• He took note of their proudly displayed ward vision and wondered if they could live

up to their ideals.

• After his stay the Trust received a letter from Rob. Thinking back to the ward vision,

he explained that “it was possible to connect all the aims to what was being lived out

• n a daily basis on the ward.”
• During his stay Rob saw a well organised and calm working environment that

facilitated efficient and excellent teamwork.

The mutual respect was evident even before I saw the “Ward Vision” They [staff] are more special than they realise.

Evidence of other benefits

15% reduction in length of stay 50% reduction in staff interruptions

Patient complaints reduced by 64% Patient complaints reduced by 64% Medical errors reduced by 87% 400% increase in early discharges £40k stock savings in

• ne ward

Note: In some cases The Productive Ward has attributed to the above benefits (Improving healthcare quality at scale and pace - Lessons from The Productive Ward: Releasing time to care™ programme National Nursing Research Unit at King’s College)

Can be transferable to different health/specialist care settings across integrated services

Cleaning Rehabilitation and Recovery Human Resources Emergency care Paediatrics Forensic Maternity

‘Putting frontline staff in control’

Impact from Airedale NHS Foundation Trust

In 2008/09 12 reported cases In 2010/11 3 reported cases MRSA In 2008/09 128 reported cases In 2010/11 11 reported cases CDiff

RIA findings in relation to C-diff and MRSA

C-Diff & MRSA: The Trust has attributed a year on

year cost saving of £177,300 to the avoidance of MRSA and £98,100 to the avoidance of C-diff. These figures are based on avoided bed day costs.

Unplanned Absence

This year we also looked at Unplanned Absences. Trialling on Ward 2 and in August rolled out to all the wards RIA findings in relation to Staff Absence: 50% attributable to PW with a year on year financial saving

• f £184,748

Typical impact and results

What does the Productive Ward offer patients, staff & wards?

• Direct care time increased from 25% to 46%
• Observation frequency increased by 20%
• Handover time reduced by a third but quality increased
• Meal wastage rate down from 7% to 1%
• £400 of stock returned to central stores

Impact example

Portsmouth City Hospital

• 30% drop in fall rate
• 10 months of zero pressure

ulceration on showcase ward (acute long stay

• rthopaedic ward)

Impact example South Staffordshire & Shropshire Mental Health Trust

Medicine round took 3.5 hours to complete due to continual

• interruptions. After implementing

the medicine round the round now routinely takes 40 minutes

Impact example Northampton General NHS Trust

Measurable improvements in direct care time with an average increase of 16% whilst interruptions to nurses carrying out patient care have reduced by an average of 47%.

Impact Example

Chelsea & Westminster Hospital

By holding the nursing handover around the PSAG board staff saved 30 hours and 20 mins of nursing time per week

The Productive World!

The Productive Ward House

The Productive Mental Health Ward House

Direct Care Time

Motion Admin Discussion Handovers Information Roles

Opportunity to increase safety and reliability of care Role Time (e.g. nurse) Total Time “Everything I need to do my job is conveniently located” ‘The paperwork is easy to understand and quick to complete’ I am not interrupted by people requesting information or looking for things ‘’Handovers are concise, timely and provide all the information I need” ‘It is clear to everyone who is responsible for what” ‘We have the information we need to solve our own problems, and find out if we were successful”

The focus is on direct patient care

Module Features: Improvement Process

Why teach nurses new problem solving techniques, such as PDSA, when they use

• ne every single

day?! Example of the Productive Ward’s no nonsense approach

Core ward objectives and measures

Core preparation

Core preparation

Core preparation

The Steering Group:

• Inclusive
• Strong nurse representation
• Objectivity
• ‘Reality checking leadership understanding’

Core preparation

The Project Team:

• Executive Sponsor(s)
• Project Leader
• Improvement Facilitators
• Ward Team

Core preparation

Core preparation

Core preparation

Key approaches - pace

Pace of Spread:

• Importance of early learning
• Skills transfer
• Existing improvement capability
• Strategic Alignment
• Start slow, build credible momentum over time

• Any Questions?

Barriers

Training Confusion Resources Staff Time Lack

• f

control Targets Errors Reliability Interruptions

The Productive Ward is not easy

Ward Leadership

Leading by example……. ………and develop skills in the team

Need to be visible in your commitment Need to follow the processes Need to empower the team Develop a communicate strategy Demonstrate your processes are reliable Ensure the changes are sustained Make information based decisions Facilitate skills development in the team Embrace change Develop leadership

10 Point Checklist

• Found on CLWK.ca
• Essential for base

line measure

• Every module has
• ne
• Shows

improvements

Exciting and huge potential, but…

• There are no “magic” answers
• Significant implications for the ward staff and

executives (nursing director)

• Requires commitment, planning and resources at

all levels in the organisation

The challenge

Creating a vision…..

• A compelling statement that tells everyone what the

ambition for the ward is

• Sets the bar for what you want to achieve
• Helps those outside the ward team to understand your

aspirations and allows them to join in and provide support

Creating a vision……

Visualise the perfect ward: – what would it look like? – how would it feel to work there? – what would patients say about it? – what would clinicians and managers say about it?

PATIENTS - WHERE WOULD WE BE WITHOUT THEM ROUTINE - WHERE WOULD WE BE WITHOUT IT OUTSTANDING - WHERE WOULD WE BE WITHOUT BEING SO DECISIONS - WHERE WOULD WE BE WITHOUT MAKING THEM US - WHERE WOULD WE BE WITHOUT EACH OTHER COMPASSION - WHERE WOULD WE BE IF WE DID NOT SHOW ANY TEAM - WHERE WOULD WE BE WITHOUT WORKING AS ONE INITIATIVE - WHERE WOULD WE BE WITHOUT USING SOME VERSITILE - WHERE WOULD WE BE WITHOUT BEING SO ENERGY - WHERE WOULD WE BE WITHOUT IT WHAT A GREAT IDEA AND EVEN GREATER RECONGNITION & DETERMINATION TO SUCCEED. .

Ward Vision

Vision example……

“The Ward 3 team aim to provide a calm, safe, relaxed environment for patients and staff. We will ensure that nurses work with autonomy, that we are patient focused and work to promote and support recovery. The team intends to uphold an enthusiastic, motivated and professional approach in an environment that is well organised, efficient and stress free. We are committed to a continuous process of reviewing how we work so that we can release time to care”

Vision example……

• All patients and visitors to Ward D6 will have a positive

experience and be cared for by a dedicated multi professional team in a calm, well organised and clean environment

• The care patients receive will be of the highest quality

based on best practice. It will be safe, reliable and consistent and delivered by well trained staff who are supported by the hospital management to continually improve and raise standards

• The staff on ward D6 strive to make this ward the best ward

in the hospital for staff to work on, for managers to manage, for relatives to visit and for patients to be cared in

Vision……

What to do with it once created: – Display it in prominent place in your ward – Use it to help you choose what to improve first when you’re unsure of your priorities – Work hard to make it happen

• Understand what is happening now
• Display measures on a board
• Use meetings on performance to drive

improvement

• Regularly update information

Knowing How We’re Doing (KHWD) Module

Introduction to Measurement Mike Davidge

https://www.youtube.com/watch?v=Za1o77jAnbw

The measures dashboard

Additional Measures

• length of stay
• ward cost per spell

Knowing How We are Doing (KHWD) Module

• Understand what is happening now
• Display measures on a board
• Use meetings on performance to drive improvement
• Regularly update information

From a test site…….

Safety crosses

Trend Over Time

How will you display your data?

How will you display your data?

Visualisation and the 3 second rule

Link to your vision

• How do you know you that you have reached

your vision?

• How can you track your improvements ?
• How do you ensure you continue to improve

when vision is achieved?

SMART Example

“ provide quality care delivered in a clean and safe environment “

• Simple ~ Focus “pressure ulcers” Clear definition ~ reduce

the rate of pressure ulcers on the ward

• Measureable ~ ward staff to collect data daily on ward
• Aspirational ~ reduce the rate per month to less than 3 cases
• Realistic ~ set a target that is achievable but will stretch the

team – don’t be tempted to go for a zero rate straight away

• Time bound ~ within 3 months