Releasing Time to Care: Implementation with the Southern HSC Trust Kay Carroll Lead Nurse, Southern HSC Trust Sharon Kennedy Ward Manager, Southern HSC Trust

Implementation stages Regional Launch 1 October 2008 All 5 Trusts participating in the pilot stage Project Leads training 29/30 October Familiarisation event in each Pilot Trust Ward based staff training – 28th Nov,26th Jan, 12th Feb, 12th March 2009 Evaluation of pilots March 09 Rollout to other ward?

Releasing Time To care The Productive Ward Releasing time to care - is a systematic and inclusive approach to improving the reliability, safety and efficiency of the care that you deliver.

Releasing Time To care The Productive Ward Executive Lead Joy Youart Acting Director Acute Services Directorate

Project Leads Jacqueline Morton Head of Reform Glynis Henry Assistant Director Nursing Workforce Development & Training Nursing Governance

Key roles Senior management team and Trust Board Steering Group Executive Leader Project leads Ward Leader Ward team Support from other areas e.g. Finance, Information and Estates

Expectations of Executive leader To influence and work with staff on the wards and to influence and communicate with senior management team colleagues and Trusts Board members Ensuring there is senior management team / Board sign up and understanding of the Productive Ward Selling the benefits of PW to the organisation Clarifying the challenges for the organisation Ensuring the Board understands that PW is focused on improving the quality of care, not an opportunity to reduce costs Ensuring that senior colleagues understand the need to be visible on wards, supporting the staff

Expectations of Project Leader Responsible for the successful planning and implementation of the Productive Ward Project management – overseeing implementation Managing expectations Support to Executive Leader and Ward Manager Stakeholder management Communication and visible involvement Tracking progress Enabling ward staff Securing resource Reflection and learning from the process Being enthusiastic, credible & empathic

Expectations of Ward leader Understanding the basic principles of PW Understanding the benefits PW can bring to your ward Ensuring staff attendance at all training sessions Leading your staff in the implementation of PW in your ward Addressing emerging issues Working closely with your Project leader Regular communications with all ward staff including shift staff Being a point of contact for other interested wards

Introduction to Releasing time to care Two information sessions for staff. Meeting with Medical staff. Dissemination of information to other members of MDT. Communication Board in MDT room.

LEAN PHILOSOPHIES Elimination of Waste. Respect for people.

Lean Methodologies.  6S  Visual Management.  Process Flow analysis.  SMED.  Standard Operating Procedures.

Releasing Time To care The Productive Ward Knowing How Your Doing – Developing Ward based measures to help your team make informed decisions

ONLY 33 % OF NURSES TIME WAS SPENT ON DIRECT NURSING CARE N.H.S INSTITUTE FOR INNOVATION & IMPROVEMENT AVERAGE 40%

Measures Board 1.Infection control issues. Hand Hygiene audits. Commode Audits. Environmental audits. C Difficile MRSA / MSSA bacteraemia.

Measures Board Complaints. No of complaints. Reason for complaint. Profession indicated. Length of stay. EDD recorded.

Measures Board HUMAN RESOURCE ISSUES Sickness and Absenteeism rates. Nurse Bank and agency use and costs.

Display of a nursing dashboard in public area including Infection control, ALOS, complaints, sickness and absenteeism. Measures include the C DIFF infection rate which is supported by the hand hygiene audits scores. This allows the team track progress and to identify areas that may require a focus and improvement;

Releasing Time To care The Productive Ward Well organised ward. –Making Ward areas work for your team instead of hindering them in the delivery of care

Ward 1 South REORGANISATION OF STOCK 76% reduction in the number of steps taken to set up a catheterisation trolley 234 steps reduced to 61 steps 4:46 minutes reduced to 2:16 minutes

Cash Savings CASH SAVINGS £2080 Excess pharmacy returned £1200 Excess TSSU returned £880

Releasing Time To care The Productive Ward Patient Status at a Glance The ward team develops visual patient information that improves communication, patient experience and patient flow

PATIENT STATUS AT A GLANCE Patients name Name of consultant. EDD. Infection control status. Outliers. MDT Referral. Dietary options.

Releasing Time To care The Productive Ward Meals The ward team reduce the time spent physically delivering meals and allow more to assist with feeding and ensuring proactive nutritional assessment for ward patients

Releasing Time To care The Productive Ward Meals Establish new membership. Engage with  catering,  Portering  domestic  dieteticians and  communication team. Baseline data.  Audio video meals  Patient survey.  Implement “ 10 a day “

Roll out  Feedback to SMT.  Develop Roll out programme.  Ward Managers  Half day workshop May 09.  Two day residential June/ Sept.  LEAN methodology/ Releasing time to care.  Training Programme for Trainers for Southern Trust commenced Sept 09.

CHALLENGES: C --- Complex H --- Huge. A --- Achieved. L ---Learning. L --- Longevity E --- Engagement. N --- Negotiation. G --- Gains E ---- Evidence S --- Success/ support.

The Way Forward Releasing Time to Care is not a project … it focuses on improving ward processes and environments to help nurses and therapists spend more time on patient care thereby improving safety and efficiency.