Leading Better Care and 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

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 % improvement in direct care time

Improving efficiency improved the nursing process for setting up a dressing and reduced the process from 172 steps to 5 steps Stock returns - £700 - £3500

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 morale and team working Staff have found implementing RTC: time consuming hard work overall a hugely positive experience

“Everyone has taken real pride in the ward” “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

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.

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