presentation title: 32pt arial regular, black recommended maximum length: 1 line transforming...
Post on 20-Dec-2015
215 Views
Preview:
TRANSCRIPT
Transforming community services: the Productive series
Helen Bevan
The Productives: “Releasing Time” series
• The Productive Ward
• The Productive Mental Health Ward
• The Productive Community Hospital
• The Productive Leader
• The Productive Operating Theatre
• Productive Community Services
• Powerful, common sense knowledge on how to improve key units of care
• How to achieve great results for patients and staff using the latest evidence based approaches
• Mobilising front line staff• The practical application of
the most effective change methods such as Lean or Six Sigma but framed in a different way
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
Direct Care Time
Motion Admin Discussion Handovers InformationRoles
Opportunity to increase safety and reliability of
care
Rol
e T
ime
(e.g
. n
urse
)
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”
Releasing time to care: The Productive Ward
The Productive Ward: the evidence
NHS Institute impact assessment March 2009
Nottingham University Hospitals:• sickness rate fell from 8% to 5%• nurse direct care time increased from 38% to 45%
Manchester University Hospitals Foundation Trust:• increase in direct care time of 8%• reduction in short term sickness
Portsmouth City Hospital:• 10 months of no pressure ulceration on flagship ward• 30% drop in falls rate
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
• Benefits will continue to accrue so long as there is continued support
• There are 6 key factors which have driven success 1. Leadership engagement2. Strategic alignment3. Governance4. Measurement5. Capability and learning6. Resourcing - people
Source: NHS London 2009
The Productive Ward: the evidence
• The Productive Ward programme has huge perceived value and it is easy to identify local evidence of impact
• Has been framed and communicated in ways that connect with staff’s need and will for change
• Thrives where local communication and leadership are strong
• Huge potential for on-going spread
Source: King’s College London, June 2009
Teamworking 86.3
Staff experience 82.2
Efficiency 80.4
Patient experience 76
Safety 75.2
Clinical effectiveness
62.4
Research study from National Nursing Research Unit
Type of impact reported by respondents
% responsesranked “high”
Improvement opportunities within Releasing Time to Care: Productive Community Services
Receiving a referral
Preparing for the visit
Time to look for and complete missing information on referrals1
Limited communication and interactions between Community staff and other professionals
3
Discharge procedures create additional work for staff and affect continuity of care for patients
2
Driving takes longer than necessary due to routes not being fully optimised and difficulties finding specific addresses
6
Unnecessary trips are made to collect forgotten equipment or get urgent stock5
Organising and collecting prescriptions is a non-essential task4
Time is spent waiting to access patients’ houses7
Patients are not always at home when staff visit, or DNA at clinics8
Some of time staff spend with patients does not directly address care needs10
Staff have to wait for other carers if they are already in a patients’ house9
The care may be refused as being unnecessary or unwanted11
Overall
Observed issue Primary benefit
Delays in providing clinical care at home17 Shorter waiting times for patients
The best levels of care are not always provided due to low levels of skill for the treatments required
15Improved quality of care
Community staff are unclear on how they are doing against objective criteria16Improved management process, support changes
Staff record the same information 2, 3 or 4 times in many different areas12
Visiting the patient
Following up the visit
8 hours/week
13 hours/week
2 hours/week
15 hours/week
10 hours/week
4 hours/week
6 hours/week
15 hours/week
7 hours/week
2 hours/week
Staff skills are not fully utilised14
Utilising staff skills;
20 hours/week
2 hours/week
Sta
ff P
rodu
ctiv
ity
Technology is often inappropriate for a mobile workforce13 30 hours/week
Source: Workshop issue identification 4th November 2008
Gen
eric
Sp
ecia
list
Wound Continence
78%
22%
Stroke
GP and other professionals expect District Nurse to give
patient pads to deal with continence
Care plans need to be clear
80% of the issues identified were generic to all conditions
C
The generic nature of the issues suggested the “house” modules should be generic to all conditions and not pathway specific
1 week wait1 week wait1hr/week x manager + 9hr/wk1hr/week x manager + 9hr/wk
10hr/week for East Somer-set (~30hr/wk for E+W Somerset, bath/Wiltshire)
Continence specialists
• Referrals normally come to us by patients asking for pads
2 or 3 days wait
Continence referral• Self referral• GP
75–80%• Consul-tant• MS nurse• Chemists
• Divide up patients between
Read or assess form from GP. If assigned in clinic based may be reassigned to house call ~70% most referrals are clinic as can see of patients in clinic
Scheduling of clinics• Appointment
with clinic • Assessment
form to patient to bring to clinic
Reschedule Clinic visit by patient x 3 or 4 followups
Handwrite letter
When time avai-lable during week
Letter <_> draft form phone call, email 1~2%
New referral form by fax
• GPs refer patients to continence specialists and consultants at the same time (1 month)
• Nursing home staff need more training. Their assessment forms are completed ‘incorrectly’
On going issue due to their staff turnover
• Idiot proof the assessment form – it exists
• Change from paper to electronic fool proof form – like on line banking
• Taunton area clinic visits passed to Taunton
• Specialist staff spend 1.5 days, ~2 days per week on administration
• Hours are lost as PT nurses <_> lost hours are not reallocated to an extra staff <____> – 30hr/wk
• “We have very limited admin. support. I run my own clinic diaries, send appointment letter, etc.” – Di
FTEs Actual Gap
37.5 37.5 0
37.5 25.0 12.5
37.5 20.0 17.5
Total gap hr per wk
30.0
Over 6 months
• 1/3 of clinics are typed
• 2/3 of clinics –no admin help (8–18 months)
• Call patients to arrange home visits and try to schedule a few together if nearby
Phone 1hr per day calling and recalling to arrange • Di and Catherine are
the only 2 full time team members. Others part time.– Catherine <___>– Di x <_____>– Band 5 x 3 –
<____>
• 1st visit assess
• Physical examinations or visual bladder scans on all patients
• Plan or refer no exact number of visits
• Cure treatment
• Managed treatment
• Refer on to another service
• 9 out of 10 handwrite letter
• <__> up and <__> then sent to <___> and lip <____>
• Refer to another service
• E.g., Physio• Bowl clinic• Gynae-
cologist
1hr/week x manager + 9hr/wk1hr/week x manager + 9hr/wk
10hr/week for East Somer-set (~30hr/wk for E+W Somerset, bath/Wiltshire)
10hr/week for East Somer-set (~30hr/wk for E+W Somerset, bath/Wiltshire)
3–4 week wait3–4 week wait
3–4 week3–4 week
• 1/2hr/patient initial • 1/4hr/patient followup
x 9 appointments per clinic
1/2 day per week
1/2 day per week
East Somerset – 1 person
• DNAs – 1 per clinic
20 referral/week
East West
1
2
3
• 1hr/visit• 2 or 3 visit/patient• 7 visit/wk East Somerset• Travel time
– The issues highlighted in the condition specific workshops were the same as those identified during the ‘ride-alongs’ with district nurses and other specialists
– Issues were generic and not linked to a specific single condition pathway
Somerset continence specialist team, pathway work shop
Development so far
Focussed on field work services
Concentrated on the ‘how to’
Developed tools to help staff
Built and tested by staff in the community
Productive Community Services will…
Increase patient-facing contact time,
Reduce inefficient work practices,
Improve the quality and safety of care.
Re-vitalise the workforce
Put staff at the forefront of redesigning their own services
Our plans for launch…
Autumn 2009 – Foundation Modules
Spring 2010 – Planning and Delivery Modules
Well Organised Working Environment ...
…helps front line teams to analyse their current activities and to develop and test more effective working systems.
Annual time spent looking for cupboard items (hours)
31.2
91.0
Before After
66%
Labeled
Eye-level
Free space
Items most commonly searched for were placed in well-labelled eye level shelves
Well Organised Working Environment…
Patient Status at a glance ...
…enables multi-professional and multi-location teams to understand the status of every patient, using the most up-to-date “visual management” techniques.
Patient Status at a Glance..
…is a good idea! I have more awareness of what’s going on.
…acts as a guide to discuss patients while prompting us to follow things up.
…breaks down a problem and has given us purpose and power.
..say District Nurses
Patient Status at a Glance..
…saves time
20
4556%
Before After
For a nurse team of six with daily handover meetings, this saves over 60 work days p.a.
As meetings shortened and time effectiveness increased, team contributions strengthened
Handover meeting duration
minutes
Patient Status at a Glance..
… helped us to reduce interruptions to staff by 50% allowing us to do an extra 27 visits to patients each week Says Occupational Therapist
Keycode to colours, symbols
and colours clearly posted
next to the board
Daily meetings are held where next steps
are agreed and recorded for Amber or
Red patients
Managing Caseload and Staffing ...
…gets the most out of the people and avoids bottlenecks by managing caseloads better and planning staff activity more effectively.
Managing Caseload and Staffing…
We’re surprised by how much time is spent on travel/admin/meetings. Only 35% spent with patients.
Our current understanding of demand and capacity is inadequate to manage our service well.
Evidence-based decision making is possible with the tools from this module.
The key to balancing demand and capacity is to smooth out staff availability and/or demand for the service.
say frontline staff
… increases patient-facing time
Size of gap More visits than staff capacity Less visits than staff capacity
+/- XXXCheck next day’s workload and create shortlist of pull forward patients from tomorrow
Check next day’s workloadShortlist push back from today
+/- XXX
Absent staff member: Move visits to another dayAbsent staff member: Drop non-critical visitAbsent staff member: Reallocate visits to another team member (including across internal teams)
Additional visits for high priority patientsAllocate/complete outstanding non-routine work
+/- XXX
Team Leader drop downReallocate to external teamCancel trainingCreate waiting list
Pull referrals from other teams
DAILY CAPACITY CALCULATOR
Week Beginning
Band 3Band 5
Band 6/7
Staff Type (Band)
Staff availability
(Hours)Staff capacity
(Hours)Planned patient
work (Hours)Gap
(Hours)
Staff availability
(Hours)Actual staff
capacity (Hours)
Unplanned patient work completed
(Hours)
Planned patient work completed
(Hours) Comments
MONDAY 3 → - = →
5 → - = →
6/7 → - = →
TOTAL QUALIFIED
→ - = →
TUESDAY 3 → - = →
5 → - = →
6/7 → - = →
TOTAL QUALIFIED
→ - = →
WEDNESDAY 3 → - = →
5 → - = →
6/7 → - = →
TOTAL QUALIFIED
→ - = →
THURSDAY 3 → - = →
5 → - = →
6/7 → - = →
TOTAL QUALIFIED → - = →
FRIDAY 3 → - = →
5 → - = →
6/7 → - = →
TOTAL QUALIFIED → - = →
SATURDAY 3 → - = →
5 → - = →
6/7 → - = →
TOTAL QUALIFIED
→ - = →
SUNDAY 3 → - = →
5 → - = →
6/7 → - = →
TOTAL QUALIFIED
→ - = →
What is our expectation for patient facing time:
COMPLETE AT START OF DAY: COMPLETE AT END OF DAY:
Four tools to support our demand and capacity planning process…
Monthly Time Out Planner
Monthly/Weekly Trend Tracker
Daily Capacity Calculator
Managing Caseload and Staffing…
Daily/Monthly Decision TablesWEEKLY CAPACITY TRACKER
Hours20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
1 2 3 4 5 6 7 8 9 10 11 12 13
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
TOTAL
Hours
Team: Year:
WEEKLY CAPACITY TRACKER
Hours20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
1 2 3 4 5 6 7 8 9 10 11 12 13
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Sta
ff P
FT
Pla
nned
Unp
lann
ed
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
TOTAL
Hours
Team: Year:
Knowing How We are Doing...
…enables local teams to understand team performance and set team improvement goals in areas such as safety, quality, productivity, patient experience and staff experience.
Knowing How We are Doing...
…has helped us to move us from a disjointed, demoralised, self doubting team, to one which is excited/motivated by the goals and opportunities we have to impact change within our PCT
… says Nurse Team Leader
Our testing and development to date suggests that PCS could fundamentally change the way you deliver healthcare
• Fits strategy with service design and reshapes the channels for delivering care
• Aligns teams in traditional silos on a single agenda like never before
• Potentially doubles the amount of patient care time delivered by the same staff
• Increases management skills such as planning and performance management
• Lifts the confidence and morale of the workforce• Transforms the culture to fact-based and data driven, able to take
improvement actions • Explores the possibility of real time data tracking for staff • Provides an opportunity to explore electronic medial records that
allow better access and mobility
For more information
http://www.institute.nhs.uk
top related