Overview & Update of the PW initiative in Ireland Mark White, National Lead PW Director NMPD HSE-SE RCSI Masterclass Thurs 6 th November 2014

What is Productive Ward: RTC? “ It is a ward-based Quality improvement programme that enables and empowers ward teams to improve the safety, quality and delivery of care, with a focus on releasing more time to care”

Productive Ward Aims: To increase the proportion of time nurses spend in direct patient care To improve experience for staff and for patients To make structural changes to the use of ward spaces to improve efficiency in terms of time effort and money (NNRU & NHSI 2010).

Productive Ward Module ‘House’

Quality improvement activities that include: improving clinical leadership by equipping ward leaders with methods to lead and help their staff to deliver safer, more dignified care empowering ward-based teams to take ownership and control of ward- based processes developing stronger, more confident front-line leaders creating a ward based culture of measurement and improvement applying lean/improvement methods and tools in a ward setting encouraging an entire patient focus with all of the changes/improvements improving team-manager relationships through collaborative working and corporate engagement

PW in Ireland Standalone Clinical Programme, (cross-programme initiative) Expression of interest to engage with PW initiative in Autumn 2011 Phase 1 sites identified x 17 hospitals (24 wards) MI Training December implementation started Jan 2012 Phase 2 sites (same process, refined) commenced implementation Jan 2013 (9 hospitals; 20 wards) Phase 3 sites commenced January 2014 (8 Hospitals; 46 wards)

Productive Ward Phase 1-3 HSE West Letterkenny General Hospital Sligo General Hospital Our Lady’s Manorhamilton Roscommon County Hospital Ennis General Hospital St Johns Hospital Limerick HSE South South Infirmary/Victoria University Hospital Cork University Maternity Hospital HSE DNE Cavan General Hospital OLOL Drogheda Beaumont Hospital Connolly Hospital HSE DML St. Vincent’s University Hospital Coombe University Hospital Midlands Regional Hospital Portlaois Midlands Regional Hospital Tullamore HSE South (SE) University Hospital Waterford SthTipp General Hospital HSE South Phase 2 Mercy University Hospital Macroom Comm Hospital HSE South Phase 2 Mercy University Hospital Macroom Comm Hospital HSE West Phase 2 Nenagh General Hospital UCHG HSE West Phase 2 Nenagh General Hospital UCHG HSE NE Phase 2 Our Lady’s Navan HSE NE Phase 2 Our Lady’s Navan HSE DML Phase 2 National Rehab Hospital Peamount Hospital HSE DML Phase 2 National Rehab Hospital Peamount Hospital HSE South Phase 3 Merrymount Hospice HSE South Phase 3 Merrymount Hospice HSE South (SE) Phase 3 St Lukes Hospital Kilkenny HSE South (SE) Phase 3 St Lukes Hospital Kilkenny HSE DNE Phase 3 National Orthopaedic Cappagh St Josephs, Raheny HSE DNE Phase 3 National Orthopaedic Cappagh St Josephs, Raheny HSE West Phase 3 Portiuncla Hospital UL Maternity Hospital UL Dorradoyle Merlin Park Hospital HSE West Phase 3 Portiuncla Hospital UL Maternity Hospital UL Dorradoyle Merlin Park Hospital

Total to Date... Hospital Sites = 34 Wards = 90 Bed Numbers= 1970

National Results – Macro view Hospital SiteWardDPC-time T1 DPC-time T2 Increase or Decrease CoombeOur Lady's Ward46%59% ↑ National Rehabilitation HospitalSt. Patrick's Ward59%49% ↑ Peamount HealthcareARRU - Age Related Rehab Unit37%51% ↑ St. Vincent's University Hosp - SVUHSt. Anne's Ward 42%49% ↑ St. Vincent's University Hosp - SVUHSt. Patrick's Ward 56%63% ↑ MRH-TullamoreMedical 254% ↔ Beaumont HospitalAdams McConnell Ward33%39% ↑ Our Lady's Hospital NavanMale Medical Ward35%55% ↑ Mercy University HospitalSt. Catherine's Ward56%53% ↓ (SIVUH) Cork Elective Level 1 South Ward38%42% ↑ (SIVUH) CorkObs 1 Level 1 47%45% ↓ ENNIS - MWRHSurgical Day Ward 34%44% ↑ Galway University HospitalSt. Anne's Medical Ward48%30% ↓ Galway University HospitalSt. Michael's Ward45%30% ↓ Roscommon HospitalSt. Colman's Ward34%60% ↑ Letterkenny General Hospital Stroke and Medical Rehabilitation Unit 53%47% ↓

WARD RESULTS – The Micro view ST. PATRICK’S WARD -SVUH Direct care: 52% Jan 2012 → 63% Jan 2013 Staff Nurses increased time spent in direct patient care by 11% Length of stay: 37.8 days Jan 2013 → 18.3 days Aug 2013 Length of stay on St. Patrick’s Ward has reduced by 19.5 days Well organised ward results: Sourcing enteral feeding supplies: hrs per annum saving Restocking MOU supplies: 28hrs per annum saving CPAP/BIPAP retrieval: 9.84 hrs per annum saving Restocking linen trolley: 71 hours per annum saving Restocking IV fluids: hours per annum saving Stock returns March 2012: €7,663 Total time saving from these improvements alone = hours per year

WARD RESULTS – The Micro View ST. ANNE’S WARD -SVUH Direct care: 42% Pre-implementation → 49% Post-implementation Staff Nurses increased time spent in direct patient care by 7% Well organised ward results: Stock spend: €11,700 Jan 2013 → €7, Aug 2013 Stock spend reduced by €4,481 when compared to the start of the year Drug rounds: 1hr 20 min Pre-implementation → 24mins Post- implementation Drug rounds reduced by 56 minutes = 6.5 hours per week Retrieving equipment for central line dressings: 98 footsteps (15 mins) Pre-implementation ↓ = 400 minutes saved per month 17 footsteps (5 mins) Post- implementation

Before Productive Ward ST. PATRICK’S WARD SVUH

After Productive Ward ST. PATRICK’S WARD SVUH

Before Productive Ward ST. PATRICK’S WARD SVUH

After Productive Ward ST. PATRICK’S WARD SVUH

Before Productive Ward ST. PATRICK’S WARD SVUH

After Productive Ward ST. PATRICK’S WARD SVUH

Success……..

Our Lessons Fertile Ground, Start small Right supports/structures/investments Corporate buy-in and engagement (long-term) Measurement, reporting, monitoring Freedom, autonomy, Finance Promotion, Marketing Celebration Acknowledging its not a silver bullet

The future…. Hospital Group PW implementation Lead Productive Hospital Site PW

Supporting QI Journey & Learning

The Research/Evaluation Foci Phase 1 Sites: Person/Patient Centeredness Patient /Family Experience Implementation/Facilitati on Impact Financial tracking & Impact Phase 2 Sites: Staff/Work Engagement Context/Work Environment Improvement Data

The Research/Evaluation Methods & Instrumentation Phase 1 Sites: Person-centered Practice Index Context Assessment Index Focus Groups & Interviews Person-centred climate Questionnaire Patient Experience Questionnaire Phase 2 Sites: Utrecht Work Engagement Scale (UWES 17) Ward-team interviews context/impact factors Monthly Improvement Reports

Evaluation Results

Publications…. Thank you