1. Releasing Time to Care

2. Why Releasing Time to Care? Fits with use of quality improvement methodology used for CQIs Uses ‘lean’ to improve processes and free up capacity Capacity released supports implementation of revised SCN role

3. Main theme Shifting emphasis from “what do we do” to “how do we do it” Productive ward is modular based Uses a variety of tools in bite-size portions to work through changes Very much a team involvement throughout the process

4. Main Aims

5. In ScopeOut of Scope The ward environmentSaving the world (whole systems view) EfficienciesBudget increases Reduced LOSReduction in staff levels Majority of supporting diagnostics Staff contracts Frequency and authority for clinical decision making Challenging individual clinical decision making outcomes Patient admittance criteria Direction and management of the wardDirection and management of the organisation as a whole Now and the futureThe past The teamIndividuals

6. Content

9. Creating solid foundations: Knowing How we are Doing Developing ward based measures to help the team make informed decisions. Well Organised Ward Make the ward areas work for your staff so that your staff don’t have to work around the ward areas. Patient Status at a Glance Patient information that improves communication, patient experience and patient flow

10. Focusing on key ward processes: Meals Medicines Admission and Planned Discharge Shift Handovers Patient Hygiene Patient Observation Nursing Procedures Ward Round

11. The SCN/CQI work streams are part of the wider nursing policy set out in Leading Better Care and Delivering Care, Enabling Health. This will necessitate the SCNs being released from having a clinical caseload, which is current practice in a significant number or areas. The use of the Clinical Quality Indicators and improvement methodology will equip SCNs to develop and sustain a culture of continuous quality improvement. This will in turn support the delivery of HEAT targets and organisational objectives within Board areas.

12. The Releasing Time to Care programme provides a structured framework for the use of continuous improvement methodologies with the ultimate aim of ‘releasing time to care’ in ward areas. This Programme has the potential to support SCNs to use a variety of quality improvement tools in their areas with the aim of having more capacity within the current resource envelope

13. NHS Scotland Releasing Time Care Evaluation Not a stand alone programme ‘pulled’ from the NHS Let’s pilot it first –does it support Leading Better Care? –Does it ‘fit’ NHSScotland?

14. Measuring success - Evaluation of programme in NHS Scotland NHS Ayrshire and Arran - Crosshouse Hospital - general surgical ward NHS Forth Valley - Falkirk Royal Infirmary – elective orthopaedic surgical/rehabilitation ward NHS Grampian - Woodend Hospital - acute care of the elderly ward NHS Fife – Glenrothes Community Hospital – rehabilitation and GP admissions ward NHS Lothian - Royal Infirmary - acute assessment medicine for the elderly ward NHS Borders – Borders General Hospital – elective/trauma orthopaedic ward NHS Lanarkshire - Trauma orthopaedic ward NHS Tayside – Ninewells Hospital – gastroenterology ward

15. Evaluation Results Improved leadership ability Increase in direct patient care time Improved efficiency Improved staff morale and team working

16. Percentage improvement in staff nurse time spent providing direct patient care following implementing Releasing Time to Care % improvement indirect care time

17. Measuring quality - CQI’s

18. Measures Example Safety Cross

19. Patient Experience Sustainable

20. Patient Safety Improving practice

21.  improved the nursing process for setting up a dressing and reduced the process from 172 steps to 5 steps Stock returns - £700 - £3500 Improving efficiency

22. Not just….. £2,607 redistributed

29. My staff take less time to look for items, ordering items and setting up trolleys for tasks. They are also now thinking of other processes that can be changed to release time to care. SCN

30. Staff have found implementing RTC: –time consuming –hard work –overall a hugely positive experience Staff morale and team working

31. “The ward at times represented organised chaos, this has changed to a well organised ward, which is more conducive to providing quality care” “Everyone has taken real pride in the ward” SCN

32. In reality……….. Quality Ownership Empowerment Teamwork Communication

33. Staff Shift Thermometer Ownership & empowering

34. Other measures Sickness absence MRSA rates C. Diff rates Length of stay Compliment and complaints Vacancies Also module specific

35. Fit with other national streams of work Hospital Acquired Infections - MRSA and CDiff infection rates. Scottish Patient Safety Programme - patient observations, pressure ulcers and falls. 18 weeks referral to treatment programme - expected date of discharge. Better Together Programme – patient satisfaction. Nursing & Midwifery Workforce and Workload Planning – unplanned absence rates. Clinical Quality Indicators – pressure ulcer, falls, meals and patient observations. Quality Improvement Scotland Improvement programmes – meals, falls and pressure ulcers.

36. Busy ward with high patient flow. Temporary decrease in staffing establishment Challenging to involve everyone within existing resources Stressful for staff

37. Key success factors Active executive support Dedicated facilitation support Ward team training time Time to implement Support services involvement

38. Next Steps Available to NHS Boards if they wish to implement Criteria to consider Provision of regional training with support from NHS Boards Releasing Time to Care Mental Health The future – Releasing Time to Care Community Hospitals, Community & Theatres

39. Building on Success