1. How to organise for Safety Express Lisa Nobes Head of Nursing Development West Suffolk Hospitals Trust

2. Plan - Who Strategic team – Executive Chief Nurse – Deputy Medical Director – Governance and Safety Lead – Head of Nursing Development Shared documentation – Discussed strategy document, driver diagram

3. Plan - SMART Focusing on the harms as overall aim but using the drivers as a means to achieve that SpecificTargets for reduction of harms via implementation of key drivers MeasurableUse of incident reporting mechanisms AchievableStaged ceilings to make the reductions more realisable RelevantIncreasing reliable provision of harm free care Time BoundOver the year to April 2012

4. Plan - Implementation Important to dovetail additional key initiatives into programme – HIA – Productive ward – Local projects Not just another programme – Fits with strategic and operational direction and objectives

5. Plan - Where Identified wards – Poorest performing – wards that really need the input Minimal recent attention Initially a concern to share dataset BUT programme about improvement Intensive approach – Phased, ward by ward, multi driver approach

6. Plan - Measurement Incidence reporting mechanisms Quality management systems Introduced safety thermometer Drivers impact on a whole range of our quality indicators Baseline dataset – Harms – Other quality factors e.g. patient experience

7. Plan - Measurement Set reduction trajectory based on national aim – Staged reduction over 15 months – Ceilings = figure staff are aiming to reduce to Target = inappropriate – Used realistic, phased ceilings E.g. Ideal falls ceiling = 2, Current falls =7 Ceiling Q 1 = 5, Q 2 = 4, Q 3 = 3, Q 4 = 2 Motivating staff at each Q, encourages buy-in

8. Plan - Who Ward team – Productive ward facilitator – Matron – Ward manager – Band 6 – Band 5 – Assistant practitioners – Health care assistants – Allied Health Professional rep

9. Plan - What 3 x ½ day facilitated sessions – Session 1 SE documentation, driver diagram Baseline data - safety thermometer, incident reporting – Session 2 How staff felt about the ward, ward organisation Current ward processes, structure of a day on the ward, system of intentional rounding – Session 3 Implementation of drivers through intentional rounding, rounding log Communication, leadership

10. Plan - How Parallel leadership sessions with ward leaders – Change management – Personal qualities – Driving improvement Prior to Do 3 sessions with all ward staff – Explain new process, rounding, drivers – Some resistance met (now biggest advocates) Additional resources required – TIME – Staff released to plan (reduced as experience gained)

11. Do Across 4 pilot wards – phased intensive implementation, ward by ward – 2/3 months – Ward managers very involved – Integrating other project learning / modules in Productive meal times – Intentional rounding triggered by risk

12. Do – Adaptation of rounding tool Stroke ward different to rehabilitation ward – Additional processes (re)launched Introduction Measurement – Safety thermometer data Sample = 50% (approx 64 patients) per month Collected by clinical project lead – Incident reporting / quality management data Continued standard data collection by ward staff

13. Study First impact = increased moral – Interest shown, improved processes = Happier staff Harms reduced across all pilot wards Reduction of harm to higher risk patients – Medium/low risk patients a strong theme in the data – Identified the gap

14. Study Measurements – Falls – VTE – Pus – CaUTI

15. Act Adapted intentional rounding tool 2-3 times – For more vulnerable, high risk patients Second type of rounding tool now in Do phase – For less vulnerable, medium/low risk patients Leadership crucial – Clinical leadership programme planned for band 5s Different intensive periods with each ward – People dependant, different abilities, experiences, confidence levels

16. Act Discussed at matrons meeting – Internal/peer competition – Whose ward at the top of the league? Equipment – Recognised need to provide the tools to deliver what begin asked of them Risk management – Daily pro-active rounds by Matrons and ward managers – Assessing increased risk, before an incident occurs Cycle of SE a self – fulfilling prophecy – Name of the project starts to proceed – Wards dont want to be left behind

17. Top Tips for Implementation Are you the right person for the job? – You really have to want to do it Do the people around you want to be involved? – You need a supportive team – Internal and external organisations Do you have the will, the energy and all the right people on board?

18. Key impacts from SE Increased confidence – Me, personally, professionally – The ward staff, professionally – Following a framework – Empowered by the approach

19. Spread We are a Trust that wants to improve – Sustainability is bead by success – Rollout across all units – Continue testing/adapting low-medium risk intentional rounding tool – A vehicle for regional work, linking with partner Trusts