“Better For You” Overview and Scrutiny Committee 11 May 2010 … the collective power of our staff will radically transform patient care on a very large scale

CARING, SAFE, THOUGHTFUL This is a unique opportunity to make your voice heard and make NUH a better place for patients and staff

It is possible to work in different ways which will improve patient care, clinical outcomes and staff satisfaction. We need to respond to stormy waters ahead in a challenging economic climate International evidence shows that delivering best possible care through the most efficient (lean) processes, delivers excellent patient and staff outcomes, alongside financial efficiency Value for Money Clinical Outcomes Patient Experienc e Why we can change: Staff Satisfactio n

Our patients and staff deserve nothing less than the best. Through an inclusive Whole Hospital Change Programme we can all add significant value to the experiences of our patients and staff. We will be reinforcing through actions, rather than words, that “we are here for you” This will further enable us to deliver caring, safe and thoughtful services for our patients Why we want to change:

The Productive Ward “It is good that all levels of staff are involved… … When the project starts you take it to your heart” “We’ve never been involved with something like this before… …For us it’s about making sure that everyone has a chance to be involved”

"I want to enthuse all our staff with the same sense of excitement I feel about pushing the boundaries to make sure patients always get the best from us" "A fantastic opportunity to have the time and support required to make significant and measurable improvements to patient care and staff experience" ED Change Programme

Patient Engagement New way to engage with patients –Institute tools –In your shoes –Co - creation Engage with members Patient and Public Involvement

Value for Money Research Teaching and Training Staff Satisfaction Patient Experience Clinical Outcomes Better for You focuses on changes at all levels 9 Productive Hospital Productive Speciality Productive Community Shaping the infrastructure Shaping hospital-wide processes Shaping the wider health system Productive Team Perfecting the operational unit Enabling key patient and clinical value streams Optimal site and estate strategy Beds allocation and management Effective supporting processes and systems, e.g. medical record,theatres, Policies, procedures and standards Productive corporate functions Productive medical and surgical specialities - pathways, systems, processes, ways-of-working Improving trust-wide end-to-end elective, non-elective and trauma pathways from initial navigation to transfer of care Improving trust-wide pathways for specific cohorts – e.g. older people and children Completion of productive ward and theatre programmes as foundation for improving core clinical teams and building an improvement culture Build on “productive” work, using the productive ward and theatre as a foundation for more effective teams and initiatives including Patient Safety Looking beyond the boundaries of the hospital to support a more productive system through vertical integration and outreach Productive Individual Developing the individual Personal development, objective setting and performance

NavigateReceivePlace Clinically Manage Transfer Care Speciality Clinical Support Services Corporate Support Services Cultural ChangeService Redesign Knowing How We Are Doing Well Organised Hospital Operational Status at a Glance Strategic Alignment Internal and to Local Health Economy Board Leadership The NUH Way NUH Productive Hospital Process Enablers Operational Foundation Strategic Foundation Productive Hospital approach provides a framework for all change activity DRAFT FOR DISCUSSION 10

Principles of Lean and the Productive Ward Lean Getting the right things, to the right place, at the right time Improving process flows Organisation and standardisation Elimination of waste Releasing Time to Care (The Productive Ward) Focuses on improving ward processes and environments to help nurses and therapists spend more time on patient care thereby improving safety and efficiency.

Equates to 8, 12 hour shifts per year to reinvest in patient care Wipes near sluice puts all needed items together

Time savings Minimum of 23 second saving per IV antibiotic with no structural alteration to room.

Stores stock reduction £500 to £3000 saved of excess stock Right sizing’ ward based inventory

Fall is plotted on ‘measles chart’ to help problem solving and reduce falls (grouping suggests problem area)

Improving patient safety by improving the recording of observations

Productive ward aims to increases the direct nursing care time % direct time spent with patients DIRECT NURSING TIME To this… 80% direct time INDIRECT NURSING TIME

There are 14 main themes to the work being progressed ThemeScope 1Site StrategyFacilities strategy and utilisation, asset allocation and major reconfigurations 2Bed ManagementNew Trust-wide speciality processes and ICT systems for managing beds 3ElectiveElective pathway improvement at Trust-level and within elective specialities, Productive Theatre 4EmergencyEmergency pathway improvement at Trust-level and within emergency specialities 5ChildrenChildren’s pathway improvement and Children’s ‘Hospital’ development 6Support ServicesClinical support service improvement and service model development: imaging, pharmacy, pathology 7CorporateCorporate support service improvement, strategic function review and external business opportunities: cleaning, laundry, catering, HR, ICT, finance 8ProcurementProcurement and inventory control including central and trust-wide processes 9SafetyPatient safety programmes and safety-oriented processes and systems 10WardsWard-level activities following the Institute's Productive Ward improvement programme 11Speciality-specificSpeciality-specific transformational changes (e.g. Heart Services, Endoscopy) 12Service DevelopmentsTransformational service developments (e.g. Major trauma) 13TrainingOrganisational development (e.g. capability development for leaders) and support for continuous improvement and transformational change (e.g. tools, techniques, peer review, coaching) 14Performance Management Integrated performance management across individual (e.g. objective setting), team (e.g. clinical productivity) and speciality (e.g. strategic operational management and PLICS), and workforce systems and changes 18

Productive Elective Speciality addresses the full elective care pathway 100% patient scheduled 100% resource available for treatment (equipment, beds, staff) Zero cancellation for clinical reasons Theatre operating time allocated correctly Zero Day of surgery cancellation Zero late starts and overruns 90% of patients go direct to theatre 100% resource available for treatment (equipment, beds, staff) In-session utilisation 85% 100% patients with bed available Zero delays from recovery to wards 100% of available sessions and beds utilised 100% patients discharged on predicated discharge date Zero delayed discharges Reduced LOS (to be determined) To be determined by OPD project Potential benefits Hospital Speciality Route Receive Clinical Management Place Transfer of Care 19

Productive Emergency Speciality (Pathway) Reduce hand- offs Reduce LOS outside of specialty bed pool Improve clinical outcomes Enhance patient experience Improve staff satisfaction Specialty bed requirement identified and agreed Zero outliers Reduced LOS Reduce need for additional winter beds Monitor and reduce ‘internal’ waits Patients discharged on predicated discharge date Zero delayed discharges Patients navigated straight to speciality Reduce need for general medical beds on City campus Potential benefits Hospital Speciality Primary care Internal transfers Differentiated to City Undifferentiated to QMC Assmt of spec care needs or Direct to Specialty Specialty Bed Allocation Patient flows/LOS Discharge Productive Emergency Specialities Route Receive Clinical Management Place Transfer of Care 20

Imaging will include a number of projects -Reduction in booking turnaround time -Matched demand and capacity -Reduction of overburdening of staff -Reduction in duplicate test requests -Test time allocated appropriately -Reduction in DNAs -Reduction in hospital & patient cancellations -Reduction in the average inpatient and outpatient delay -Increased utilisation 100% of available sessions utilised Booked Time utilisation (In- session scan time 95%) Zero delays from test to wards Routine reports available within 48hrs Routine appraisal and CPD Ensure all reports received To contribute to elective, emergency and children’s pathway benefits - 100% patients discharged on predicated discharge date - Zero delayed discharges - Reduced LOS To be determined by specialties to include: - % reduction in requested tests Potential benefits Hospital Support services Route Receive Clinical Management Place Transfer of Care Primary/Tertiary/InternalReceipt of report Test/Report Scheduling Department/Wards/Theatres Productive Imaging 21

The programme will run over many years into the future, creating a culture of continuous improvement through regular staff-led reviews and improvement of processes and systems. Better for You:

Any Questions?