of inefficiency; thus improving the patient experi-ence, resource utilisation, clinical outcomes, com-munication and team-working.

Abstract: The aim of the project was to improvethe trauma pathway starting from when the deci-sion is taken to admit for surgery and finishingwhen the patient is back on the ward having hadtheir operation. The scope of trauma patients in-cluded fractured neck of femur, in-patient trauma,out-patient trauma and tertiary trauma referrals tothe Limb Reconstruction Team.

LEAN is an approach that was developed by Toy-ota over 50 years ago and is designed to be used inall types of organisations. It is a practical system thatencourages teams to eliminate waste and createmore value within their place of work. An in-househospital improvement team (guided by KM&T Globalmanagement consultancy) facilitated multidisci-plinary workshops utilising the LEAN process to worktowards the perfect system or ‘future state’.

It became evident through group sessions thatLEAN thinking was crucial to improving quality,safety, service delivery and patient throughputwithin the departments that directly contributedto the pathway. By creating clear, easily seen,standardised processes, a foundation for continu-ous improvement could be created.

Intended learning outcomes:

� To understand the LEAN process.� To identify areas within their place of work thatwould benefit from LEAN.� To organise a multidisciplinary workshop thatwill identify weaknesses/strengths in the spe-cific pathway being examined.

Recommended reading:Aherne, J., 2007. Think lean. Nursing Manage-

ment 13 (10), 13–15.Castle, A., 2007. Lean thinking on the wards.

Nursing Standard 22 (8), 16–18.Waters, A., 2007. Mapping key to cutting com-

plaints. Nursing Standard 22 (8), 18–19.

doi:10.1016/j.joon.2009.07.023

Hard work – The patient’s experience in aplaster cast (concurrent)Marion Williams

Royal Gwent Hospital, Newport, Gwent, UK

Aim: To describe the findings of a small scale re-search project which explored the lived experienceof the patient with a lower limb plaster cast.

Abstract: Plaster casts have been routinely usedto treat fractures for over 150 years. This qualita-tive research study explored the patients’ experi-ences with a lower limb plaster cast, establishingwhether these experiences had common themesand determining how the themes identified couldinform nursing practice.

A purposive sampling strategy was used (n = 4)with the inclusion criteria that the participantshould have been in a lower limb cast for at least4 weeks, be over 18 years of age, treated as anout-patient with no surgical intervention and previ-ously fully mobile. Data were collected in the formof unstructured interviews which were recordedand transcribed. The individual manuscripts wereanalysed using interpretive phenomenologicalanalysis. This enabled common themes to be iden-tified which were then related to the existingliterature.

Seven main themes were identified. One theme,‘hard work’ illustrated how difficult every-daytasks became and another ‘it gets you down’ de-scribed how the participants began to feel frus-trated and sorry for them selves. ‘Differentcircumstances’ showed how participants put theirsituation in context in order to cope. Other themeswere: ‘Making it Better’, ‘Back to Normal’, ‘Pain’and ‘Getting Through it’.

The data were further explored in relation to theRoper et al. (1996) model for nursing illustratinghow the five main elements inter-related. Davis’(1997) adaptation of the Roper et al. (1996) modelto develop a model for orthopaedic nursing has alsobeen investigated.

This research recommends that patient assess-ment includes consideration of coping mechanismsfor the duration of treatment in a cast.

Intended learning outcomes:

� List the main features of Interpretive Phenome-nological Analysis.� Summarise the possible experience of a patientin a plaster cast.� Discuss the use of established nursing models forthis patient group.

Recommended reading:Davis, P., 1997. Using models and theories in

orthopaedic nursing. Journal of Orthopaedic Nurs-ing 1 (1), 41–47.

Lazarus, R., Folkman, S., 1984. Stress, Appraisaland Coping. Springer Publishing Company, NewYork.

Roper, N., Logan, W., Tierney, A., 1996. TheElements of Nursing, fourth ed. Churchill Living-stone, New York.

142 Abstracts

Smith, J., Jarman, M., Osborn, M., 1999. Doinginterpretive phenomenological analysis. In: Mur-ray, M., Chamberlain, K. (Eds.), Qualitative HealthPsychology. Sage, London.

doi:10.1016/j.joon.2009.07.024

Use of the Productive Ward principle to improveworking conditions and service delivery(concurrent)Karen Bowley, Rebecca Delpino

Solihull Hospital, UK

Aim: To explain and share how the principles of‘Releasing Time to Care’ have been used in prac-tice to develop services with documented evidenceof improvements in standards of care and staffsatisfaction.

Abstract:Ward15provides a ‘cando’ patient cen-tred service, in a busy hectic ward constantly underall kinds of pressures. Although staff work hard tomaintain standards of care, this project has enabledus to stand back, evaluate what we do and how weare doing it, using a variety of new methods.

The main reason we have been able to achieveso much is that we have taken time to involveand move forward the whole team, giving themthe permission to come up with the ideas.

So far the project has enabled us to:

� Reduce waste and organise workspace, allowingstaff to spend more time with the patientinstead of looking for the necessary equipment.� Analyse how our Ward is performing. Graphs andaudit scores are displayed for all staff, patientsand visitors to see, staff are comfortable withresults displayed in a public place and the pridein our ward has measurably increased.� Identify areas for improvement to submit intelli-gent and informed business cases.� Take forward initiatives that will be rolled outTrust wide.

We are streamlining care delivery with the back-ing of the project and making a difference to thequality of care that the patient receives.

This structure is assisting us in our long termplan to deliver the service we aspire to and thatis required by the health service of the future.

Intended learning outcomes:

� Awareness of principles behind ‘Releasing Timeto Care’.

� Knowledge of methods used to organise servicesand measure improvement.� Provide a useful guide to tools that can be used toimprove user satisfaction and staff well being.

Recommended reading:Allen, D., Kingdon, M., Murrin, K., Rudkin, D.,

1999. What If? – How to Start a Creative Revolutionat Work. Clapstone, Oxford.

NHS Institute for Innovation and Improvement,2007. Releasing Time to Care. The Productive Wardwww.institute.nhs.uk/productiveward.

Silversin, J., Kornacki, M.J., 2003. Implementingchange: from ideas to reality. Family Practice Man-agement 10(1), 57–62.

doi:10.1016/j.joon.2009.07.025

From person centered to person driven(concurrent)Claire Bailey, Joe Bolger

Royal Bolton Hospital NHS Foundation Trust, UK

Abstract: The orthopaedic team had success inreducing mortality but recognised they needed towork in partnership with patients to improve theirexperiences.

Planning and preparation: The Trust has manyestablished methods for collecting patient’s com-ments/feedback. However, there is no formalstructure for working in partnership with patientsto improve their experience. We do not always in-clude them in designing a service. A programme ofwork was initiated within Orthopaedics to under-stand and improve our patients’ experience andwe decided upon an adaptation of experiencebased design.

Involvement and Partnership: The key stake-holders were our patients. For the purpose of theprogramme, 50 elective orthopaedic inpatientswere asked to complete a patient diary. Ten elec-tive joint replacement patients were selected atrandom to take part in the video and patient/staffsession approach.

Implementation: Seven patients agreed to befilmed- either in their own home or the hospital.Patients were simply invited to tell their story.The films were edited and shown to staff over fourstructured interactive sessions. Staff reactionswere filmed using a ‘Big Brother’-style ‘diary room’format. A number of improvement ideas were dis-cussed between patients and staff.

Selected abstracts from the 23rd Royal College of Nursing Society 143