1. Helen Bevan 18 th March 2010

2. Copyright ©: NHS Institute for Innovation and Improvement 2008-2009 – All rights reserved The “Productive” (Releasing Time) Series

3. © Copyright NHS Institute for Innovation and Improvement 2009 Direct Care Time Motion Admin Discussion HandoversInformationRoles 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

4. © Copyright NHS Institute for Innovation and Improvement 2009 What we are learning from Releasing Time to Care How much energy can be unleashed by encouraging front line teams to question how they work and providing simple tools and skills to do this

5. © Copyright NHS Institute for Innovation and Improvement 2009 Energy focus Imagination, engagement, participation, moving and mobilising The “anatomy” of change Effectiveness and efficiency focus Metrics and measurements; technical systems and process design, clinical pathways, evidence based medicine Improving healthcare The “physiology” of change

6. © Copyright NHS Institute for Innovation and Improvement 2009 LOW HIGH Commitment of the people Control of the processes AlienatedAscendant ApatheticAnarchic Source: Wickens Where we are trying to get to… Lean organisation alignment

7. © Copyright NHS Institute for Innovation and Improvement 2009 Building on a strong foundation: The Productive Ward - the evidence Research study from NHS London Releasing Time to Care has been a significant catalyst for change It has resulted in measurable, positive impacts. 13 percentage points increase in median Direct Care Time 7 percentage points increase in median Patient Satisfaction Scores 23 percentage points increase in median Patient Observations Source: NHS London 2009 This equates to having an extra 255 full ‑ time nurses….while an equivalent level of service improvement without the programme would cost an estimated £7.5 million a year Nursing Management July 2009

8. © Copyright NHS Institute for Innovation and Improvement 2009 ‘Putting frontline staff in control’

9. © Copyright NHS Institute for Innovation and Improvement 2009 22 January 2009

10. © Copyright NHS Institute for Innovation and Improvement 2009

11. Modular Structure: Module Box Set

12. © Copyright NHS Institute for Innovation and Improvement 2009 Basic principles The Productives concentrate on the HOW, not the WHAT The vast majority of all healthcare guidance concentrates on end standards (i.e. the WHAT) Our staff need help with HOW to implement these standards, so they happen 24/7 – even on a Sunday night!

13. © Copyright NHS Institute for Innovation and Improvement 2009 Critical factors for success with any Productive Leadership at Executive level√ Aligned with strategic direction√ Governance of the programme√ Continuous improvement√ Capability and knowledge√ Right people in place√ Source: NHS London Review May 2009

14. © Copyright NHS Institute for Innovation and Improvement 2009

16. Team Design: The Activity Follow tends to show that, despite the aspiration to have well defined teams, team definition collapses as the shift goes on Bay 10 Bay 11 Bay 6 Bay 12 Bay 9 Bay 13 NS Red Team Bay 5 Bay 4 Bay 3 Bay 1 Off Ward

17. © Copyright NHS Institute for Innovation and Improvement 2009 Learning to See Using video in observation: Bringing to the surface custom and practice Mixed linen in clean disposal room

18. © Copyright NHS Institute for Innovation and Improvement 2009 Learning to See Using video in observation: Bringing to the surface custom and practice Patient access areas

19. © Copyright NHS Institute for Innovation and Improvement 2009 Learning to See Using video in observation: Bringing to the surface custom and practice Undesirable waste storage

20. © Copyright NHS Institute for Innovation and Improvement 2009 SORT

21. © Copyright NHS Institute for Innovation and Improvement 2009

22. SET

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25. Don’t forget, we live in a 3D world…..

26. © Copyright NHS Institute for Innovation and Improvement 2009 SHINE

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28. STANDARDISE

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30. SUSTAIN

31. © Copyright NHS Institute for Innovation and Improvement 2009 10 point module checklist

32. © Copyright NHS Institute for Innovation and Improvement 2009 Example Audit Planner Table:

33. © Copyright NHS Institute for Innovation and Improvement 2009 Audit Planner in detail:

34. © Copyright NHS Institute for Innovation and Improvement 2009 Visualisation is a key principle used in: The Well Organised Ward Patient Status at a Glance Knowing How we are Doing With visualisation, we aim to be able to find the status of someone, something, or some process in three seconds Visualisation

35. © Copyright NHS Institute for Innovation and Improvement 2009 Visualisation and the 3 second rule

36. © Copyright NHS Institute for Innovation and Improvement 2009 Visualisation: Visualisation and the 3 second rule Floor markings and photographs detail location, number and contents of trolleys that should be stored in this room

37. © Copyright NHS Institute for Innovation and Improvement 2009

38. 38 An example: NHS Yorkshire and Humberside

39. © Copyright NHS Institute for Innovation and Improvement 2009 Examples of reach and impact in the NHS in Y&H are as follows: All 36 NHS healthcare provider organisations in Yorkshire and Humber are implementing one or more of the Productive programmes In four hospital systems, over 97% roll out of the Productive Ward or Productive Mental Health Ward to their front line team/wards (Sheffield, Hull & Airedale, RDASH - MH), Another hospital system has achieved over 75% roll out (Leeds). Two organisations have adapted Productive Ward for their Community Health teams- Kirklees 44 teams and Doncaster two teams Every provider organisation in Yorkshire and the Humber can provide examples of how the Productive methodology has resulted in improvements in the quality and productivity of care.

40. © Copyright NHS Institute for Innovation and Improvement 2009 Sheffield Teaching Hospitals A five hospital system 100 wards (approx) Went “live” January 2008 Local adoption, first group May 2008 last group March 2010

41. © Copyright NHS Institute for Innovation and Improvement 2009 Local adoption currently 97 areas working on programme 1 st outpatient area started September 08 10 outpatient areas now working on the programme labour and delivery started January 09 remaining maternity wards started March 2010 both day surgery units started Sept 09

42. © Copyright NHS Institute for Innovation and Improvement 2009 Successes –Direct care time increased by 32% (4.5 hours per nurse per shift) –Time spent walking / looking for equipment has reduced from 130 minutes (over 2 hours) to 25 minutes –Time spent on nursing documentation has reduced from 127 minutes to 82 minutes

43. © Copyright NHS Institute for Innovation and Improvement 2009 Successes No more looking for keys – digital locks for drug cupboard keys Short term sickness reduced from 10% to 1% and sustained Reduction in falls Handover reduced by 30 minutes per nurse per shift – 3 hours per day Ward round reduced from 60 – 90 minutes to 20 – 40 minutes

44. © Copyright NHS Institute for Innovation and Improvement 2009 Some areas using Productive Community Hospital Modules for patient flow: -Outpatients -Labour and delivery -Emergency admission Day case / short stay areas started Productive Ward foundation modules will combine with productive theatre process modules Adapted activity follow to reflect workload Productive Community Services encompass staff working cross boundary Medical Records using Productive Ward methods and combining it with Productive Leader methods Combining

45. © Copyright NHS Institute for Innovation and Improvement 2009 Director of Finance – “What actual cost savings have been made?” Director of Quality – “How much time has this module actually saved?” Director of HR – “What skills have the team actually improved?” Chief Executive – “How much more efficient have the team become by doing this programme? The Productives Module Impact Framework helps answer the following questions:

46. © Copyright NHS Institute for Innovation and Improvement 2009 The Productives Module Impact Framework: (i)can help you analyse qualitative and quantitative impact data (inc financial) (ii)can aggregate impact data across an organisation and across all Productive programmes (iii)can create impact reports at organisational and regional level at the touch of a button

47. © Copyright NHS Institute for Innovation and Improvement 2009 Impact Areas 1: Staff experience and wellbeing 2: Process improvements 4: Financial impacts 3: Knowledge and skills

48. © Copyright NHS Institute for Innovation and Improvement 2009

52. Learning from the Productives so far… Energy can be unleashed by encouraging front-line teams to question how they work and by providing simple tools and skills to help them do this It is possible to achieve virtually universal take up Excitement can be created and then steered, rather than forcefully “over-designing” a programme Modules are leadership methods rather than improvement tools