Day One Core Training May 2015
Welcome! • • • •
Washrooms & Exits Breaks & Lunch Phones & Email Plan for the coming days
Icebreaker!
“Ground Rules” for this Workshop • • • • • • • •
Everyone has a valuable contribution to make There are no stupid questions! Please do not interrupt others and respect their views Be open and honest No blame or criticism Confidentiality Think creatively/generate ideas Let’s keep to time – we have a lot to get through and are here to work Any others?
The Productive Series The Productive Community Services
Principles of The Productive Series Team performance and leadership
Safe and reliable care
Patient’s experience & outcomes
Cost effective care
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!
Concentrating on the HOW, not the WHAT
Basic principles •
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• • • • •
Scalable, bottom up, top enabled application of proven methods in a ward setting A mechanism for engaging and empowering staff so they can challenge the status quo and lead the changes they want to make for themselves A structured approach with clear management roles and responsibilities Modular, self directed learning structure Context specific – entirely ward focused Making “new” methods accessible Equipping ward leaders with methods to lead their staff towards safer, more dignified, more reliable and more efficient care
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
What can The Productives do for patients? Increase direct care time
Reduce patient complaints (St George's Healthcare NHS Trust
It gives the patients something back that they may have lost control
Patient experience and direct feedback means that we can act on and address issues immediately Hinchingbrooke Health Care NHS Trust
Staff survey indicated that 100% of staff felt they had more time to spend with patients and involve them in their own care Salford Royal Foundation Trust
Its about treating the person holistically and empowering them to take control of their conditions Coventry Community Health Services
What does Productive Ward offer the executive Board?
• A systematic way of delivering safe, dignified, reliable, and efficient care to patients
• A mechanism for engaging and empowering staff so they can challenge the status quo and lead the changes they want to make for themselves • A structured improvement approach with clear management roles
What is your Boards involvement with your Productive implementation? ‘When was progress with implementation last on your Board papers? Is your plan for implementation strategically aligned to your organisational goals? What quality indicators are you measuring and reporting to the Board on a regular basis?’
Ursula Ward CEO Portsmouth Hospitals NHS Trust
Are you connected with your frontline staff?
‘opportunity to have systematic conversations with ward staff.’ the Productive series ‘joins the board room to the ward floor. Productive Ward is my way, with my senior team, of making sure that we are in touch with the frontline delivery of care.’
David Astley, formally CEO St Georges Healthcare Trust
Evidence and Impact
Evidence “The Productive Ward has the potential to deliver £270m in productivity and efficiency savings across 139 acute trusts in NHS England by March 2014.” Rapid Impact Assessment of The Productive Ward NHS Institute for Innovation and Improvement, 2011
The Productive Ward can help organisations make significant improvements in their productivity and efficiency. Improving healthcare quality at scale and pace - Lessons from The Productive Ward: Releasing time to care™ programme National Nursing Research Unit at King’s College
The Productive series has been transformational in the acute sector and has every chance of being equally transformational [in the community]. I think it’s a really key driver for change.” Jim Easton, National Director for Improvement and Efficiency Department of Health
Building on a strong foundation: The Productive Ward - the evidence •
Research study from NHS London
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Releasing time to care has been a significant catalyst for change
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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
Key Factors for Success 10 influencing factors identified & supported by the Kings NRU study
Test against the organisational goals and strategy. Seen by many as a ‘good’ thing to do but not tested against it being the ‘right’ thing to do when considering the hospital’s improvement capacity and strategic priorities. Clarify the expectations of the trust leadership in taking an active role in the operation of a strong governance system. This will give the team clear visibility of the progress and outcomes of The Productive Ward programme and the means to resolve issues where senior intervention is required Imperative that connection is explicitly made to the nursing vision and organisational objectives for the trust
Develop the staff skills and knowledge to change work processes and coach others: grow a culture of shared knowledge across the organisation and region Ward based measurement needs to be considered a priority, linked with existing measures and analysed by the ward team who respond to changes and drive through improvement The showcase ward’s primary leadership support, the matron needs to be in a position to function in a supporting manner Nursing leadership in the hospital needs to be explicitly involved in the high level planning, briefing and engagement prior to the project, including clarifying the time requirement for both senior staff involvement and ward based staff
Focusing the project lead on managing the project and coaching rather than the doing. Due to the natural abilities of the project lead the ward lead may be undermined and by-passed in efforts to implement changes Choose wards that are performing well and do not have a history of underperformance The Productive Ward relies on collaborative management. This can be a challenge to some ward leadership structures that do not demonstrate this consistently, consider what support may be required
Reporting to the hospital senior leadership team needs to be defined and regular
Rampton Hospital – positive impact for staff
Press Coverage
Patient feedback from Papworth Hospital
Patient feedback from Papworth Hospital • • •
•
After extensive surgery Rob Marchment spent several weeks on a surgical unit , where he observed the staff working through The Productive ward. He took note of their proudly displayed ward vision and wondered if they could live up to their ideals. After his stay the Trust received a letter from Rob. Thinking back to the ward vision, he explained that “it was possible to connect all the aims to what was being lived out on a daily basis on the ward.” During his stay Rob saw a well organised and calm working environment that facilitated efficient and excellent teamwork. The mutual respect was evident even before I saw the “Ward Vision” They [staff] are more special than they realise.
Evidence of other benefits £40k stock savings in one ward
15% reduction in length of stay
50% reduction in staff interruptions
Patient complaints reduced by 64%
400% increase in early discharges
Medical errors reduced by 87%
Patient complaints reduced by 64%
Note: In some cases The Productive Ward has attributed to the above benefits (Improving healthcare quality at scale and pace - Lessons from The Productive Ward: Releasing time to care™ programme National Nursing Research Unit at King’s College)
Can be transferable to different health/specialist care settings across integrated services Maternity Cleaning
Forensic
Rehabilitation and Recovery
Paediatrics
Human Resources
Emergency care
‘Putting frontline staff in control’
Impact from Airedale NHS Foundation Trust CDiff In 2008/09 128 reported cases In 2010/11 11 reported cases
MRSA
In 2008/09 12 reported cases In 2010/11 3 reported cases
RIA findings in relation to C-diff and MRSA
C-Diff & MRSA: The Trust has attributed a year on year cost saving of £177,300 to the avoidance of MRSA and £98,100 to the avoidance of C-diff. These figures are based on avoided bed day costs.
Unplanned Absence This year we also looked at Unplanned Absences. Trialling on Ward 2 and in August rolled out to all the wards
RIA findings in relation to Staff Absence: 50% attributable to PW with a year on year financial saving of £184,748
Typical impact and results What does the Productive Ward offer patients, staff & wards? • Direct care time increased from 25% to 46% • Observation frequency increased by 20% • Handover time reduced by a third but quality increased • Meal wastage rate down from 7% to 1% • £400 of stock returned to central stores
Impact example
Portsmouth City Hospital • 30% drop in fall rate • 10 months of zero pressure ulceration on showcase ward (acute long stay orthopaedic ward)
Impact example South Staffordshire & Shropshire Mental Health Trust Medicine round took 3.5 hours to complete due to continual interruptions. After implementing the medicine round the round now routinely takes 40 minutes
Impact example
Northampton General NHS Trust Measurable improvements in direct care time with an average increase of 16% whilst interruptions to nurses carrying out patient care have reduced by an average of 47%.
Impact Example
Chelsea & Westminster Hospital By holding the nursing handover around the PSAG board staff saved 30 hours and 20 mins of nursing time per week
The Productive World!
The Productive Ward House
The Productive Mental Health Ward House
The focus is on direct patient care “Everything I need to do my job is conveniently located”
Role Time (e.g. nurse)
‘The paperwork is ‘We have the information easy to understand we need to solve our own and quick to problems, and find out I am not interrupted by if complete’ we were successful” ‘It is people clear torequesting everyone ‘’Handovers are information or looking who is responsible for for concise, timely and things what” provide all the information I need” Opportunity to increase safety and reliability of care
Total Time
Motion
Admin
Discussion
Handovers
Roles
Information
Direct Care Time
Module Features: Improvement Process Why teach nurses new problem solving techniques, such as PDSA, when they use one every single day?! Example of the Productive Ward’s no nonsense approach
Core ward objectives and measures
Core preparation
Core preparation
Core preparation The Steering Group: • Inclusive • Strong nurse representation • Objectivity
• ‘Reality checking leadership understanding’
Core preparation The Project Team: • Executive Sponsor(s) • Project Leader • Improvement Facilitators
• Ward Team
Core preparation
Core preparation
Core preparation
Key approaches - pace Pace of Spread: • Importance of early learning • Skills transfer • Existing improvement capability
• Strategic Alignment • Start slow, build credible momentum over time
Any Questions?
Training
Interruptions
Confusion
Reliability
Resources
Barriers Errors
Staff
Targets
Time Lack of
control
The Productive Ward is not easy
Ward Leadership
Leading by example……. ………and develop skills in the team Need to be visible in your commitment Need to follow the processes Need to empower the team
Develop a communicate strategy Demonstrate your processes are reliable Ensure the changes are sustained Make information based decisions Facilitate skills development in the team Embrace change Develop leadership
10 Point Checklist • Found on CLWK.ca
• Essential for base line measure • Every module has one • Shows improvements
The challenge Exciting and huge potential, but… • There are no “magic” answers • Significant implications for the ward staff and executives (nursing director) • Requires commitment, planning and resources at all levels in the organisation
Creating a vision….. • A compelling statement that tells everyone what the ambition for the ward is
• Sets the bar for what you want to achieve • Helps those outside the ward team to understand your aspirations and allows them to join in and provide support
Creating a vision…… Visualise the perfect ward: – – – –
what would it look like? how would it feel to work there? what would patients say about it? what would clinicians and managers say about it?
Ward Vision PATIENTS - WHERE WOULD WE BE WITHOUT THEM ROUTINE - WHERE WOULD WE BE WITHOUT IT OUTSTANDING - WHERE WOULD WE BE WITHOUT BEING SO DECISIONS - WHERE WOULD WE BE WITHOUT MAKING THEM US - WHERE WOULD WE BE WITHOUT EACH OTHER COMPASSION - WHERE WOULD WE BE IF WE DID NOT SHOW ANY TEAM - WHERE WOULD WE BE WITHOUT WORKING AS ONE INITIATIVE - WHERE WOULD WE BE WITHOUT USING SOME VERSITILE - WHERE WOULD WE BE WITHOUT BEING SO ENERGY - WHERE WOULD WE BE WITHOUT IT WHAT A GREAT IDEA AND EVEN GREATER RECONGNITION & DETERMINATION TO SUCCEED. .
Vision example…… “The Ward 3 team aim to provide a calm, safe, relaxed environment for patients and staff. We will ensure that nurses work with autonomy, that we are patient focused and work to promote and support recovery. The team intends to uphold an enthusiastic, motivated and professional approach in an environment that is well organised, efficient and stress free. We are committed to a continuous process of reviewing how we work so that we can release time to care”
Vision example…… • All patients and visitors to Ward D6 will have a positive experience and be cared for by a dedicated multi professional team in a calm, well organised and clean environment • The care patients receive will be of the highest quality based on best practice. It will be safe, reliable and consistent and delivered by well trained staff who are supported by the hospital management to continually improve and raise standards • The staff on ward D6 strive to make this ward the best ward in the hospital for staff to work on, for managers to manage, for relatives to visit and for patients to be cared in
Vision…… What to do with it once created: – Display it in prominent place in your ward – Use it to help you choose what to improve first when you’re unsure of your priorities – Work hard to make it happen
Knowing How We’re Doing (KHWD) Module • Understand what is happening now
• Display measures on a board • Use meetings on performance to drive improvement • Regularly update information
Introduction to Measurement Mike Davidge https://www.youtube.com/watch?v=Za1o77jAnbw
The measures dashboard
Additional Measures - length of stay - ward cost per spell
Knowing How We are Doing (KHWD) Module • Understand what is happening now • Display measures on a board • Use meetings on performance to drive improvement • Regularly update information
From a test site……. Safety crosses
Trend Over Time
How will you display your data?
How will you display your data?
Visualisation and the 3 second rule
Link to your vision
• How do you know you that you have reached your vision? • How can you track your improvements ? • How do you ensure you continue to improve when vision is achieved?
SMART Example “ provide quality care delivered in a clean and safe environment “ • Simple ~ Focus “pressure ulcers” Clear definition ~ reduce the rate of pressure ulcers on the ward • Measureable ~ ward staff to collect data daily on ward • Aspirational ~ reduce the rate per month to less than 3 cases • Realistic ~ set a target that is achievable but will stretch the team – don’t be tempted to go for a zero rate straight away • Time bound ~ within 3 months