1. Acute Service Management Liz Moore Director of Acute Services NHS Ayrshire & Arran

2. Background Decide to Admit – 2009 Constrained Facilities – assess/admit through Emergency Departments Business Cases – Building for Better Care – 2009/10 Emergency Care Quality Improvement Programme – 2011

3. New Developments Business Case – 2012 / 2013 University Hospital Ayr Emergency Department Construction commences – September 2014 Construction Complete – December 2015 Combined Assessment Unit Construction commences – December 2015 Construction Complete – March 2017 29 En-suite Rooms Assessment Bays Ambulatory Areas University Hospital Crosshouse Combined Assessment Unit Construction commences – October 2014 Construction Complete – March 2016 35 En-suite Rooms Assessment Bays Ambulatory Areas

4. Management Structure Directors Unscheduled Care / Planned Care / Care of the ElderlyCommunity Services Managers Speciality specific across sites 2 Acute Hospitals  Ayr – 350 Beds  Crosshouse – 650 Beds Community Hospitals  Ayrshire Central Hospital  East Ayrshire Community Hospital  Kirklandside Hospital  Girvan Community Hospital  Arran War Memorial Hospital  Lady Margaret Millport

5. Management Structure Acute Services Director – University Hospital Ayr University Hospital Crosshouse Health & Social Care Partnership developments Restructured – Hospital Specific Management (Ayr/Crosshouse) Emergency Care Quality Improvement Programme/LUCAP

7. Safer Patient Developments New structure – Safety Focus/Hospital Team Focus Get to really know site/people. Help change happen Service issues every day / weekend / overnight Job Roles – 7 day working Assistant Director of Acute Services for each site

8. Hospital Huddle – January 2014 Thanks to Lynn – Edinburgh Royal Infirmary 30+ staff attended walk/talk through Associate Medical Director and SPSP Fellow Set Date – Hospital Huddles/7 day working – June 2014 Safer Patient Developments

9. Launched Together Huddle / 7 Day Working Huddle Chaired by Assistant Directors 8am on both sites: 30 – 50 staff attend Safety: Scripts – Focused information Safety Issues/Patient Flow Anticipate activity of day/respond Visible Commitment of Team/Managers/Collective Responsibility for hospital

10. University Hospital Ayr – 12 Staff: –Assistant Directors –GMs –AGMs –CNMs University Hospital Crosshouse – 16 Staff: –Assistant Director –GMs –AGMs –CNMs Weekday shift 12noon – 8pm: Overnight on-call Weekend shifts (same manager): Friday 12noon – 8pm Saturday 8am – 4pm Sunday 8am – 4pm Remainder of weekend -On-call Extended Days/7 Day Working

11. Feedback Structures What do our Managers say? 7 Day Working Hard to do jobs when no others working weekends Emails pouring in over weekdays when on days off Weekend Support Less calls late at night/weekends Less weekday meeting time Performance visibly improved

12. Outcomes Rapid response to adverse events/support staff Reduction in Out of Hours activity which should have been completed in-hours/tea time patient flow blocks Improves patient flow and performance against 4 hour standard Enhanced multi-disciplinary working Morning discharge? Weekend discharge?

13. NHS Ayrshire & Arran A&E 4 hour performance January 2013 to August 2014

14. UH Crosshouse and UH Ayr A&E 4 hour performance January 2013 to August 2014

15. Question How do we really deliver patient discharge before 12noon?