Every Patient Matters and QIPP Programme Update

You said - We did: Actions taken ‘at a glance’Staffing

• A lean event identified ‘waste’ in the recruitment process. The average time to hire - from advert to start date - is now 14.3 weeks compared to the former 20 weeks. Improvements can still be made. There is a new recruitment management team in place, staffing solutions have redesigned their processes and updates on vacancies are communicated regularly to managers.

Focus on Cellular Pathology

It is important that histology specimens are reported by the laboratory in a timely fashion to facilitate the patient journey. This is a requirement for cases taken during the investigation and treatment of cancer. In 2010 65% were reported in seven days, and 86% reported in 10 days. The Royal College of Pathologists target is 80% reported in seven days, and 90% in 10 days. The department reviewed their processes in detail using Lean methodology, and now meets the Royal College of Pathologists key performance indicators, and the more stretching NHS improvement seven-day turnaround target of 95%, which has been achieved by existing staff.

Focus on the future

The challenge is to continue to deliver improvements in a resource-constrained environment. This can only be achieved if we become more innovative, allow staff time to think creatively, and support them in delivering quality improvement projects. Staff in the Qulturum (Quality Improvement Department) can support you with this; they have expertise in clinical audit, patient feedback, risk management and quality improvement. Some of the team have knowledge of change management methodology from working with external organisations such as the King’s Fund, Health Foundation and the Institute for Healthcare Improvement. Contact sharonmanhi@nhs.net for more information - Bring your quality improvement ideas to us and we can help you! Training in Lean thinking and quality improvement is available to staff. Next course dates are 23, 26 and 27 September. Contact Lisa.Lewis2@nhs.net for more information.

Focus on Mariska Oddy

In July this year, I started a secondment in the Qulturum, working alongside Pete Fox, Jan Lynn and Mike Oliver. The opportunity arose following completion of Lean training and working as a change agent. I have been looking at ways of reducing admissions of frequent attenders. I facilitated an event for stakeholders, including a GP, ambulance service colleagues, emergency department staff and the mental health teams to look at the current patient pathway for patients with mental health issues. Further workshops are planned to take this work forward. It is evident that in working with our stakeholders, change is possible and will ultimately benefit patients.

Following the ‘blood boilers’ event in May 2012 - when you had your say - we share with you the progress that staff across the Trust have made on issues that were raised.

Unlike previous years, this year’s QIPP (Quality, Innovation, Productivity and Prevention) programme has incorporated ideas that you have brought to the fore, especially through the blood boiler events. Our most successful transformation projects are currently clinician led, and are, in the main, focusing on ways to improve patient flow through the hospital.

This newsletter is a snapshot of the QIPP projects happening across the Trust and future updates will appear in the monthly @RUH Bath staff magazine and on the Every Patient Matters web pages.

Top Blood Boiler Themes:

Staffing, 42

Lack of Customer Service/Respect, 37

Beds - Capacity, 23

Beds - Patient Moves, 10

Car Parking, 27IM&T, 26

Millennium, 25

Purchasing, 24

Discharge Planning, 22

Process, 21

Estates, 17

Staffing

Lack of Customer Service/Respect

Beds - Capacity

Beds - Patient Moves

Car Parking

IM&T

Millennium

Purchasing

Discharge Planning

Process

Estates

Focus on Day Surgery

Staff from both day surgery and theatres looked at patient flow through the unit and developed an action plan - “what good looks like” - to improve both patient experience and staff morale. Work is currently taking place to redecorate the waiting area. The wider aim of improving patient flow and experience, and the number of patients treated as day cases, which in turn should reduce patient complaints, is of high importance to the Trust. This is now one of this year’s QIPP projects, which has the full support of the executive team.

At a glance

Lack of customer service/respect• Feedback from a trust-wide communications review, which involved questionnaires and

independent market research, will help to prioritise what is important to you all. The wide range of feedback from staff will help us to define the Trust values and behaviours, which will be meaningful to staff. We will test them with you to make sure they are right, and to ensure we have a set of values and behaviours developed by you, for you.

Patient flow/beds/patient moves/discharge planning• Hip fracture pathway project group is ensuring patients are treated in the right place at the right

time.• Surgery has established a new emergency surgery clinic on SAU and additional theatre sessions

to treat urgent patients.• Day surgery is focusing on increasing day case rates.• The ambulatory care unit has transferred elective patients into the new Medical Therapies Unit,

resulting in an increase in GP referrals by 22% over the last three months.• Acute oncology team provide rapid access to specialist advice for cancer patients and for

inpatients with suspected cancer. The team is reducing length of stay and unnecessary testing, avoiding inpatient admission where possible, and seeing patients urgently in outpatients.

• Right patient, right bed; the management of outliers - medical patients in surgical beds and vice versa - is a key priority for the site team and is a standing item at daily site meetings.

• Guidelines have been agreed to reduce the number of ward moves for patients on the end of life pathway. These are included in the Trust’s escalation policy and guidance is being distributed to wards.

• Discharge planning - a new bed board has been designed to aid patient flow and is in use on all wards. The ‘Green to Go’ group, led by the Head of Therapies, is leading on discharge planning.

• A review of systems in place to support patients on a mental health pathway is underway to ensure patients are receiving the best care in the right setting, and to prevent unnecessary patient admissions.

• A new urgent care programme board, chaired by the Chief Operating Officer Francesca Thompson, reviews all urgent care projects to ensure they are on track and delivering improvements, either at the front door with patient flow, or with discharges at the back door of the hospital.

Estates/parking• Changes to car parking include relocating late-shift and volunteers parking to near Bath & Wessex

House, installation of extra lighting, improved surface works, relaunch of the car share scheme and the re-opening of St John’s car park.

IM&T/Millennium• PCs in the appointment centre have been replaced and a full audit of hardware on all inpatient

wards has been completed and replacement kit installed where possible.• More smartcard sessions are to be scheduled in the Lansdown foyer, and advertised.• IT do a Tuesday morning walk round to resolve any urgent IT issues on wards and admin areas

are to be included, starting with medical secretaries. IT will endeavour to use non-technical language.

• New wrist band label printers that link directly to Millennium, are being piloted on the wards

In addition to the progress listed above, you can read more about ongoing work in relation to outpatients, theatre scheduling, diagnostics, and much more, on the Every Patient Matters/QIPP webpage.

Focus on medical recordsIn 2012 we had a backlog in uncoded activity - inpatient stays that hadn’t been billed for - equating to circa £3m in lost income. Medical records were not flowing around the Trust, so a lean event was held to understand the issues. Various groups attended and a task force was set up to implement changes and monitor progress. Orange stickers were implemented to clearly mark that notes were needed in coding, training was given on the use of patient lists and reports on outstanding coding were sent to wards. Coding activity is now performing in line with national guidance. We acknowledge the significant input from all involved and thank everyone for such a positive outcome.

Focus on recruitmentOver the last year the team has looked at their processes to see where improvements could be made to ensure vacancies are filled as soon as possible. They ran a successful open day to recruit nurses and HCAs; around 200 people attended. Interviews were held on the day and 35 offers were made. There are a number of improvements the team want to implement in the near future:• Use of an online service to reduce the

processing time for DBS checks (DBS replaced CRB checks)

• Use of NHS Jobs Version 2, which has a much wider scope than the current version. Further information will be released following confirmation.

Focus on emergency surgical pathwayThe lean event identified that surgical patients with non-life threatening conditions were having a poor experience, often waiting in a bed for up to five days for their operation. A new process was designed by staff with a new emergency surgery clinic based in SAU, and designated theatre lists. The service was piloted on 1 May 2013 with the appointment of Sarah Richards, locum Consultant in Emergency Surgery. At end of July, 311 patients had been treated on the new pathway, and 83% have had an admission prevented. Of the patients surveyed, 100% were happy with the service and one grateful patient sent a letter of thanks to the Chief Executive.

Focus on ambulatory careMaximising use of ambulatory care for GP expected patients avoids an ED attendance and provides rapid assessment for patients. Ambulatory care has created capacity in the unit by transferring patients into the Medical Therapies Unit. In June they treated 140 patients, compared to 115 in April. Staff are also using an ‘Experience Based Design’ tool to assess how the service feels for patients. The results will be available in September 2013.The RUH team is part of a national network of ambulatory care centres that are sharing best practice and learning from one another.