1. Safer Handover Rapid Improvement Event 9th – 11th May 2017
OUTBRIEF

2. Context (Reason for Action)
Handover key stream of Safer Salford Programme
Handover between services and professionals was identified as a key safety risk
Frustration across the system regarding current processes and impact on workloads
Event created to bring together primary and secondary care to co-design effective processes
Seamless patient journeys underpin our ambition for integrated care
Real willingness to work together to effect change jointly

3. Focusing on Value: Statement
All information relevant to my care must be reliably communicated to me and those supporting me in a clear, accurate and unambiguous manner. It must be readily available and ensure that responsibility for actions are clearly set out (v.3)

4. Safer Handover Referral from primary to secondary care
OUTBRIEF

5. Current State Key messages: Top 3 observations
Differing GP Practice referral processes are a barrier to standardisation across the board.
A lack of understanding of each others internal processes and the associated unintended consequences
Its complicated!
Top 3 waste/measures
Duplication of effort for all AND unnecessary communication
It can take up to 114 days for a standard referral but ONLY 30 minutes value added for patient
84 steps in the current process but ONLY 3 value added for the patient
Key gaps to address in future state
Multiple handoffs create risk
Lack of opportunity for primary and secondary care clinicians to have a clinical conversation

6. Put the patient at the centre of the process and empower them
Ideal State
Key messages:
Put the patient at the centre of the process and empower them
What will improve?
Patient safety & satisfaction
Clinician satisfaction
Create Capacity
How?
Streamlining, simplifying and standardising processes.
Neighbourhood based care
And .. IT infrastructure is CRITICAL

7. Future State Key messages:
Reduce unnecessary handover … Minimising the risk of harm
Handover will be safer because the process is simplified, standardised and electronic
Shared understanding about the purpose of the interaction
Added Value Steps:
From 84 steps to 17
From 26 handoffs 4

8. Key actions post event
Set up an information transfer group for clinic referrals
Set up an information transfer group for acute referrals
Test a ‘World Café’-style event
Set up the process to collect and present data by GP Neighbourhood
Test e-check in within a secondary care setting.
Test live communication for potential acute admissions (the Bat phone!)

9. Lessons Learnt
It’s a miracle that patients ever get what they need! … But it happens in spite of the system because people work harder not smarter
There is a huge commitment from all to change the system
Technology MUST enable safe handover
Recognition that silo working is no longer sustainable, reliable, efficient and, most importantly, safe

10. Safer Handover Improving safety of patient transfers from secondary to primary care

11. Current State Key messages: Top 3 observations
Duplication of work and cross-checking
Lack of certainty/visibility of actions and communications
Unknown ownership and responsibility for elements of patient care.
Top waste/measures
Duplication of communications(Verbal and written)
Delays in planning and process of discharge
Time investigating/fact finding for clinical information
Key gaps to address in future state
Integrated communications/pt records/medicines records
Reduction of unnecessary communications and handoffs
Accurate medicines information sharing
Culture change - Collaboration

12. Ideal State
What the vision will do: One care organisation with a appropriate access to and sharing of real-time electronic records , including with the patient, with the right health care professionals and carers, at the right place at the right time.
Improve:
Patient information sharing between primary and secondary and community services.
Improve safety and mitigate risk and reduce avoidable patient harm.
Having real time relevant information easily available when required via robust interoperable IT systems.
Added Value Steps:
Reduction of waste - Communication steps reduced from 64 steps to 30 for one discharge
From infinity handoffs reduced to a more measured and manageable number.
Communicate tasks (auditable and visible) rather than documents
Improved confidence and trust in the system and people
Reduce harm - no readmissions, avoidable deaths or complaints
Increases organisation efficiency
Improve patient and staff satisfaction
Current working model – Rapid discharge for EoL patients

13. Future State Key messages:
“Realistic”: How can the present state be improved?
Culture change of shared responsibility of patients and resources across the ICO.
Developing a system to share tasks between secondary and primary care which with make communications leaner
Culture change to recognise value and importance of discharge documentation with preparing of discharge document earlier during admission, high quality medication review and recording, improved consultant sign off of discharge summaries, more patient involvement and discharge “counselling”.
Improved training and feedback on use of IT systems.
Agreed limited number of high level snomed codes.
Improve use of read-time Integrated Care Plans.
Named Care Co-ordinator/person to facilitate all aspects of safe transfer of care responsibility and/or patient

14. Key actions post event
Culture change of shared responsibility of patients and resources across the ICO. – ICO Exec Team, (SRFT, CCG, SPCT)
Developing a system to share tasks between secondary and primary care which will make communications leaner – IT across Primary and Secondary Care – Clinical Comms Group (Phil and Owain) – prepare all GPs for a task-manager – SPCT Neighbourhood teams
Culture change to recognise value and importance of discharge documentation with preparing of discharge plan and document earlier during admission, high quality medication review and recording, improved consultant sign off of discharge summaries, more patient involvement and patient discharge “counselling” – Sara Barton
Improved training and feedback on use of IT systems. – Liz Lamerton, Phil Bell and Jeremy Tankel
Agreed we need a standard way to use snomed codes – GDE pathway
Improve use of read-time Integrated Care Plans – Louise Butler
Named Care Coordinator/person to facilitate all aspects of safe transfer of care responsibility and/or the patient – Barbara Slater

15. Lessons Learnt It’s good to talk
Assumptions and misunderstandings are rife
IT can do more than we know – if we use it right
IT can be a barrier – changes are needed
Reducing the IT options, so everyone does it consistently, can be better.

16. Key Messages

17. What we need support with: Safer Handover Key Messages and Challenges
Safety at handover of care is the priority for everyone
Handover process needs to be simplified
We want a joined up system
We need to reduce the number of handovers and therefore the risk attached
Support required for overcoming challenges:
Support to move forward further and faster based on the momentum of this event
Clarity from both organisations on how the action plan will be taken forward and owned
Governance : Clinical Standards Board? Programmed into two assurance structures.
Support with developing and making a collaborative approach happen
IM&T that enables the system to deliver joined up, patient centric care
Review of governance to ensure joint ownership, implementation and completion of actions.

18. What we need support with: Key messages – Bigger Picture
Heart in Salford to blur boundaries and work as a single health and social care economy. One team philosophy.
Drive and desire to redesign and implement a new patient centric system. Future changes must be clinically led.
Improving patient flow to ensure the patient is getting the right care, in the right place, at the right time
Increasing options for patients and clinicians
Support for direction of travel and a need to align innovations from this event into the bigger picture vision
Don’t allow it to be watered down by outside influences

19. Lessons Learnt
Bringing everyone involved in the system creates a one team approach that works for everyone
Sharing understanding and knowledge of different areas within the system improves team working and appreciation of workload
Delegates are champions of safer handover and future change
A commitment is needed to having ongoing opportunities to take the time out to improve processes and systems

20. Summary

21. Thank you!