2. New Zealand Ministry of Health Contact/Coordinator Joe McDonald Senior Advisor Quality, Improvement and Innovations Sector Capability and Innovations Directorate Phone (04) 8162571 Cell:021241 4956 Email: Joseph_McDonald@moh.govt.nz

3. Aim of Programme free up staff time in a busy day from unnecessary duplication or tasks so that they are able to increase the amount of time they spend on direct patient care.

4. Patients judge us on their experience of ward based care We know what affects patient dignity, but sometimes fail to maintain it We know what good infection control practice is, but sometimes fail to uphold it We know what safe medication management is, but still have near misses and incidents We know that nutritional management is vital for patients, yet some patients become malnourished

5. So if we know what should be happening, why don’t we do it?

6. What is stopping us from delivering the ‘gold standard’ of care? Split into small groups Write on paper provided what you think stops us You have 5 minutes Feedback to group after 5 minutes

7. Barriers RELIABILITY ERRORS INTERRUPTIONS TRAINING CONFUSION TIME STAFF RESOURCES TARGETS Unable to control

8. Puts patients at the centre of care and empowers front line staff to make the necessary changes to improve patient outcomes Canadian Delegation News Release (Sept 08)

9. The Productive Ward concentrates on the HOW, not the WHAT The vast majority of healthcare guidelines concentrate on end standards i.e. the WHAT We need help with HOW to implement these standards so that they happen 24/7 - even on Sunday night

10. Direct Care Time MotionAdminDiscussionHandoversInformationRoles Opportunity to increase safety and reliability of care Role Time (e.g. nurse) Total Time “Everything I need to do my job is conveniently located” ‘The paperwork is easy to understand and quick to complete’ I am not interrupted by people requesting information or looking for things ‘’Handovers are concise, timely and provide all the information I need” ‘It is clear to everyone who is responsible for what” ‘We have the information we need to solve our own problems, and find out if we were successful” The focus is on direct patient care

11. Drivers Ward nurses in acute settings spent an average of just 40% of their time on direct patient care. Research showed that three in four nurses said that this was not enough 90% of those polled said that patient care suffered as a result.

12. Basic Principles Led by front line staff Application of industrial/”lean” methods in a clinical setting Modular, self directed learning structure Designed for wards but generic enough to apply wider Equips all staff with methods to move towards safer, more dignified, reliable and efficient care

13. So if we know What are we moving from and where we are moving to… Then we can improve

14. Selected Impact The early results in 3a/b : Direct care time increase from 39% to 57% in three months Motion reduced from 18% of day to 8% in three months Interruptions have reduced by 50% Set placement of dynamaps and commodes is saving approximately 36 & 75 hrs per year respectively on am shift alone Recruitment and retention – 4FTE down to now fully staffed Discernable positive change in staff satisfaction and morale on the ward

15. Well Organised Ward Shift Handovers Admissions & Discharge Management Patient Observations Ward RoundNursing ProceduresPatient Hygiene Productive Ward Executive Leader’s Guide Knowing How we are Doing Meals Medicines Patient Status at a glance Project Leader’s Guide Ward Leader’s Guide Toolkit

17. Knowing How We Are Doing Foundation Module Developing ward based measures to help the team to make informed decisions Understand what is happening now Understand how the ward is performing Using the KHWD information to drive improvements on the ward Using information to help module selection Showcase achievement

18. S et of Balanced Measures Core Objectives Improve patient experience Improve efficiency of care Improve staff wellbeing Improve patient safety **Patient satisfactionOverall CarePain ManagementPatient Education Direct care time**Length Of StayWard cost perPatient episode**Nursing HPPD**Skill Mix Unplanned absences**Staff satisfactionTurnover Patient Observations**Falls**Pressure soresInfection Rate ** Magnet Nurse Sensitive Indicators

19. Safety cross is filled in to allow instant visual communication of ward status: For Example

24. What is the well organised ward The well organised ward is an approach to simplify the workplace and reduce waste by having everything in the right place, at the right time, ready to go.

25. Well Organised Ward SORT –Remove what is not needed SET –Right thing in right place SHINE –Regularly clean and maintain STANDARISE –An agreed consistent process SUSTAIN –Implement audits, based in the standards so 5S becomes everyday routine

32. Patient Status at a Glance The use of visual management to show important patient information so that it can be updated regularly, seen at a glance and used effectively. The aim is to make patient information clear and easily understandable for all disciplines. PSAG works towards the 3 second rule.

34. Tools that are used Ward Vision Activity follow Video Photos Process mapping Audits

37. . It is a one hour detailed recording of activities a member of staff undertakes It captures the task at hand and the location where it is performed These pieces of information are recorded every minute during the hour What is an Activity Follow?

38. To be able to understand what activities are being undertaken by the staff on the ward Find out how much time you spend on direct patient care Where the activities are taking place How long the activities take To find out what may be impinging on these activities. i.e. interruptions etc. Why do it?

41. The ward leader is pivotal to the implementation, success and sustainability of the programme

42. Releasing Time to Care is not easy!

44. A project - it is a culture change A political tool – particularly in regard to the “not enough resource” agenda A cost cutting tool – though as a consequence savings are made Releasing Time To Care is not:

45. Everybody, Somebody, Nobody and Anybody. Once upon a time, there were four people: Their names were Everybody, Somebody, Nobody and Anybody. Whenever there was an important job to be done, Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. When Nobody did it, Everybody got angry because it was Everybody's job. Everybody thought that Somebody would do it, but Nobody realised that Nobody would do it. So consequently Everybody blamed Somebody when Nobody did what Anybody could have done in the first place.