Releasing Time to Care

Why Releasing Time to Care?

• Fits with use of quality improvement methodology used for CQIs

• Uses ‘lean’ to improve processes and free up capacity

• Capacity released supports implementation of revised SCN role

Main theme

• Shifting emphasis from “what do we do” to “how do we do it”

• Productive ward is modular based

• Uses a variety of tools in bite-size portions to work through changes

• Very much a team involvement throughout the process

Main Aims

In Scope Out of Scope

The ward environment Saving the world (whole systems view)

Efficiencies Budget increases

Reduced LOS Reduction in staff levels

Majority of supporting diagnostics

Staff contracts

Frequency and authority for clinical decision making

Challenging individual clinical decision making outcomes

Patient admittance criteria

Direction and management of the ward Direction and management of the organisation as a whole

Now and the future The past

The team Individuals

Content

Creating solid foundations:

• Knowing How we are Doing Developing ward based measures to help the team make informed decisions.

• Well Organised Ward Make the ward areas work for your staff so that your staff don’t have to work around the ward areas.

• Patient Status at a Glance Patient information that improves communication, patient experience and patient flow

Focusing on key ward processes:

• Meals• Medicines• Admission and Planned Discharge• Shift Handovers• Patient Hygiene• Patient Observation • Nursing Procedures• Ward Round

• The SCN/CQI work streams are part of the wider nursing policy set out in Leading Better Care and Delivering Care, Enabling Health.

• This will necessitate the SCNs being released from having a clinical caseload, which is current practice in a significant number or areas. The use of the Clinical Quality Indicators and improvement methodology will equip SCNs to develop and sustain a culture of continuous quality improvement.

• This will in turn support the delivery of HEAT targets and organisational objectives within Board areas.

The Releasing Time to Care programme provides a structured framework for the use of continuous improvement methodologies with the ultimate aim of ‘releasing time to care’ in ward areas. This Programme has the potential to support SCNs to use a variety of quality improvement tools in their areas with the aim of having more capacity within the current resource envelope

NHS Scotland Releasing Time Care Evaluation

• Not a stand alone programme

• ‘pulled’ from the NHS

• Let’s pilot it first– does it support Leading Better Care?– Does it ‘fit’ NHSScotland?

Measuring success -Evaluation of programme in NHS

Scotland• NHS Ayrshire and Arran - Crosshouse Hospital - general surgical

ward• NHS Forth Valley - Falkirk Royal Infirmary – elective orthopaedic

surgical/rehabilitation ward• NHS Grampian - Woodend Hospital - acute care of the elderly ward• NHS Fife – Glenrothes Community Hospital – rehabilitation and GP

admissions ward• NHS Lothian - Royal Infirmary - acute assessment medicine for the

elderly ward• NHS Borders – Borders General Hospital – elective/trauma

orthopaedic ward• NHS Lanarkshire - Trauma orthopaedic ward• NHS Tayside – Ninewells Hospital – gastroenterology ward

Evaluation Results

• Improved leadership ability

• Increase in direct patient care time

• Improved efficiency

• Improved staff morale and team working

Percentage improvement in staff nurse time spent providing direct patient care following implementing Releasing Time to Care

-10

0

10

20

30

40

50

BOARDS

E

D

C

B

A

% im

provement in

direct care time

Measuring quality - CQI’sClinical Quality Indicators

0%

20%

40%

60%

80%

100%

120%

August October November December

2008

Clinical Quality Indicators 2009

0%

20%

40%

60%

80%

100%

January February March April May June

Falls

Food Fluid & Nutrition

MOBS

Pressure Area Care

Measures Example

Safety Cross

Patient Experience

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Privacy & Dignity Involvement withinformation

Efficient&effective care

Knowledge ofdischarge

Time to Care

Patient Satisfaction Feb 2009

n/a

No

Sometimes

Yes, always

Patient Satisfaction Questionnaire

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Privacy & Dignity Involvement withinformation

Efficient& effective care Knowledge of discharge Time to Care

Sept

embe

r 200

8

n/a

No

Sometimes

Yes,always

Sustainable

Patient Safety

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

September December2008

Series1Hand Washing Compliance 2009

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

February March April May June July

February

Improving practice

improved the nursing process for setting up a dressing and reduced the process from 172 steps to 5 steps

• Stock returns - £700 - £3500

Improving efficiency

Not just…..

£2,607 redistributed

My staff take less time to look for items, ordering items and setting up trolleys

for tasks. They are also now thinking of other processes that can be changed to

release time to care.

SCN

• Staff have found implementing RTC:– time consuming – hard work – overall a hugely positive experience

Staff morale and team working

“The ward at times represented organised chaos, this has changed to a well organised ward, which is more conducive to providing quality care”

“Everyone has taken real pride in the ward”

SCN

In reality………..

Quality

Ownership

Empowerment

Teamwork

Communication

Staff Shift Thermometer

0%

20%

40%

60%

80%

100%

120%

September October November December

2008

Brilliant

Somewhere inbetween

Rotten

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

February April June

2009

Staff Shift Thermometer

Brilliant

Somewhere inbetween

Rotten

Ownership & empowering

Other measures

Sickness absence

MRSA rates

C. Diff rates

Length of stay

Compliment and complaints

Vacancies

• Also module specific

Fit with other national streams of work

• Hospital Acquired Infections - MRSA and CDiff infection rates.

• Scottish Patient Safety Programme - patient observations, pressure ulcers and falls.

• 18 weeks referral to treatment programme - expected date of discharge.

• Better Together Programme – patient satisfaction.• Nursing & Midwifery Workforce and Workload Planning –

unplanned absence rates.• Clinical Quality Indicators – pressure ulcer, falls, meals

and patient observations.• Quality Improvement Scotland Improvement

programmes – meals, falls and pressure ulcers.

Our Ward:

Our Vision: We strive to have a ward that is-Bright, clean and well organised

Where patients feel safe, comfortable and are treated with dignity and respectWhere care is provided by friendly, competent staff in a calm atmosphere

The staff of ?? are proud to work as a team, continually striving to provide an excellentstandard of evidence based care to our patients and carers.

Our ambition is to have a ward that is safe and effective for patients while providing an excellent learning environment for all staff

What We Have Done:Waste Walk

Key Findings

Prep room Patient status board

Notices on wallsSluice

The problems we experience now:

Constant interruptions, In-accessibility of drug keys,Lots of medicines, controlled drugs and IV infusions.

What We Have Done:Activity FollowKey Findings

Medicine- roundsCd’s, iv antibiotics, keysDiscussion-patient flow

Admin –profilesMotion-walkingInterruptions

The obstacles we experienced:

2008 A S O N D

Waste Walk 1

HolidaysActivity Follow1 R

evie

w

Re

vie

w

5’S

VIS

ION

Busy ward with high patient flow. Temporary decrease in staffing establishment

Challenging to involve everyone within existing resources Stressful for staff

Key success factors

• Active executive support

• Dedicated facilitation support

• Ward team training time

• Time to implement

• Support services involvement

Next Steps

• Available to NHS Boards if they wish to implement

• Criteria to consider• Provision of regional training with support

from NHS Boards• Releasing Time to Care Mental Health• The future – Releasing Time to Care

Community Hospitals, Community & Theatres

Building on Success