tips to engage stakeholders in 7 day services

Top tips to engage your stakeholders in the delivery of 7 day services Hosted by: Thelma Daly Sustainable Improvement Team NHS England

7 March 2017

Objectives

During this session you will hear about:

• Reducing unwarranted 7DS variation: How to engage your

internal stakeholders for clinical leadership and planning

• How to engage your wider system partners: The commissioner,

clinician and patient perspective

• ‘Spreading the word’ – Resources to help clinicians on how to

deliver the 7DS standards

7 Day Hospitals – Session objectives

Agenda

Our Guest Speakers today are:

• Chair: Thelma Daly, Improvement Manager, Sustainable Improvement Team, NHS England

• Lynne Sheridan, Head of Delivery Development, Maidstone and Tunbridge Wells NHS Trust

• Belinda Boulton, Director of Transformation, Oxford University Hospitals NHS Foundation Trust

• Ruth McNamara, Integrated Care Projects Lead

• Dr Juliane Kause, Care Group Lead Emergency Care, Lead Consultant Out of Hours Care and Seven Day Services, University Hospital Southampton NHS Foundation Trust

• Questions and discussion

• Resources and future webinars

7 Day Hospitals – Guest Speakers

7 Day Services Reducing Unwarranted Variation

Getting It Right From The Start: Engaging Internal Stakeholders for Clinical Leadership and Planning

NHS Improvement Webinar – 7.3.17

Getting It Right From The Start: Engaging Internal Stakeholders for clinical leadership and planning

Organisational Stocktake - Commenced November 2016

Key questions:

* Who is currently (or has been) involved in this programme?

* What is the current level of organisational understanding/awareness/engagement?

* What stage is our programme plan documentation at?

* Who are our key players?

* What are our gaps against the standards?

* What data do we have on variation

* What have the previous National surveys shown us?

* What organisational importance does the Programme have?

Creation of a critical path (see next slide)

Establishment of a Steering Group (Medical Director Led) (Internal: Medical Director, Lead Manager, PMO Lead, Clinical Audit Lead, Business Intelligence Lead)

(External: NHS Improvement Lead, CCG Lead)

Getting It Right From The Start:

Getting It Right From The Start: Engagement Process:

Generation of a presentation to key staff groups to bring the

programme to life and get it on the agenda:

• Demystify programme, remove the ‘fear’ barrier and present compelling data

that means something locally to engage clinicians and managers

• Presentation content:

* Overview of National Programme’s requirements

* Simplify the standards and explain them

* National findings and statistics (mortality and variation)

* Local data (Dr Foster mortality) and variation data by day of week

* ED attendances, NE admissions, discharges, conversion rates, readmissions

relative risk of death by day of admission and discharge

* Summary of National survey results from last 2 surveys

* List out the ‘to do’ list and requirements of the key clinical and managerial staff

* Review the requirements of the forthcoming National survey


Staff and Groups presented to:

• Trust Medical Executive

• All General Managers

• Clinical Directors’ meeting

• All Divisional Boards

• Clinical Commissioning Group

Getting It Right From The Start: Engaging Internal Stakeholders for clinical leadership and

planning

Copy of our slide from internal presentations……………

Our Next Steps – We need your help

Clinical Lead to be nominated for each Directorate

Baseline assessment tool completion – for stocktake against standards

Directorate level action plans - for production after above

Programme plan and trajectory updated with action plan detail

Steering Group Participation for key Leads (with National Team involvement)

March Survey requirements


Further refinement of engagement plan:

• Communications Plan

• Linking of 7DS to all relevant internal groups and processes (Clinical Groups inc Mortality, LOS etc, and managerial groups Divisional and Directorate Boards,

Trust Medical Executive, Clinical Directors Meeting, Executive Performance Review Meetings)

• Engage with all leads for internal processes and publications (STP and Strategy Lead, Operational Plan Lead, Quality Account Lead etc)

• Induction of all Clinical Leads by Medical Director and Lead Manager

• Inclusion of Divisional Directors in Steering Group to report on progress

• Making 7DS part of ‘Business as Usual’

Spreading the word and resources to help clinicians: Oxford 7DS Online Guide

Belinda Boulton, Director of Transformation Ruth McNamara, Project Manager

7 March 2017

OUH Resources for 7DS

Rewind….

In 2013 following the Francis Report • We ran seminars for all staff to discuss the findings, recommendations

and what we could do at OUH

• We put slides on the intranet, delivered local presentations and encouraged feedback

• We introduced consultant standards for inpatient care (pending NHSE 7 day standards)

• We scrutinised our SHMI and Dr Foster data for weekend and weekday mortality comparisons. We discussed our performance at local meetings, and reported it to the Board

• We held a summit with our staff and commissioners to see what we could do to improve 7 day services


Rewind….

In 2013 following the Francis Report We carried out a very detailed Gap Analysis against the 10 clinical standards to help us focus on the right areas. Through this we managed to achieve an extra £1.2m funding to support staffing relating to 7DS e.g.

• Discharge Lounge staffed 7 days per week

• Pharmacy – extended opening hours, ward based pharmacists

• Command & control structure to support patient flow

• Extra MRI + CT lists

• Extra endoscopy

• Physio + OT


Rewind….

In 2013 following the Francis Report • We carried out a very detailed gap analysis against the 10 clinical

standards to help us focus on the right areas.

• We put 7 day service projects into our Transformation programme

• We set CQUINs around 7 day services

• We set Quality Account priorities around 7 day services

• We made videos to discuss improvements and used our staff to explain the impact on their work

• We included 7 day service audits in our clinical audit programme and reported findings

• We included 7 day service work in regular reporting to the Clinical Governance Committee and upwards to the Board

• We were pleased with our results but when we notice a slip in performance for standard 2 (emergency admissions reviewed within 14 hrs) from 100% to 86% we discussed this widely with consultants

• We submitted an action plan to our clinical audit committee

• We submitted progress reports to the clinical governance committee and upwards to the Board

• As this was included in one of our Quality Account priorities we had to act quickly..

• Needless to say we were very pleased that our latest audit results returned to 100%

Our audit results…

Resource for our clinical staff

Seven Day Services at UHS the journey so far and strategic plan

7th March 2017

Juliane Kause

Lead Consultant for Out of Hours and Seven Day Services at

University Hospital Southampton

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Background

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University Hospital Southampton Approach

• 5 year strategy (2012) – initially focussed on strengthening out of hours care

• Involved in national work since 2015 • Very committed CEOs • Clinical Lead appointed • Significant investment in clinical posts – nurses,

pharmacists, consultants • Gap analysis of “out of hours” and then 7DS • It is becoming “what we do around here” • Not perfect and there remains much to do

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Strategic plan for 7DS

Transform “hospital at

night”

2012-2017

7DS Early implementer

site

April 2016

Action plan for UHS and

CCGs

STP and SRG

University Hospital Southampton Approach

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Transform “Hospital at night” to Out of hours team

• Senior leadership

• Hospital vs department/general vs specialist

• Shift harmonisation between different healthcare professions

• Strengthened handover

• Real time out of hours education

• Patient feedback

• Sleep and rest policy

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Early implementer site

• Foundations laid by OOH work at UHS

• Awareness raised and culture change started

• Staff/patient comms strategy

• Changes in service delivery: – New job roles: eg Doctors administrators, Medical

Assistants as ward round coordinators, Acute Care Fellows

– Educational packages for MDT

– Shift harmonisation – therefore team available to conduct consultant ward round

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7DS UHS plan

• ..always open, always ready.... • Embedded in STP and SRG. Next update August 2016 • Gap analysis by

– Care group/specialty – Workforce – Budget setting – Discharges: NEL – weekday vs weekend – Community links

• Our priorities for 2016/2017:

– Pharmacy – Therapy – Admin and clerical support in clinical areas – Mental health in ED – Early pregnancy unit

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Our challenges delivering 7DS at UHS

• Consistency of delivering clinical services seven days a week

• Weekend ultrasound services

• Weekend therapy services

• Weekend community services

• Boundaries between urgent and emergency care

– Role of primary care/community services

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UHS weekend effect

37

Day of admission Spells

Observed

(%)

Expected

(%)

Relative

Risk

Monday to Friday

2013-2014 48933

1591

(3.26)

1470

(3.01) 108.2

Saturday and

Sunday 2013-2014 16337 522 (3.2)

495

(3.04) 105.35

Monday to Friday

2015-2016 53416

1564

(2.93)

1628

(3.06) 96.02

Saturday and

Sunday 2015-2016 17901

522

(3.09)

561

(3.14) 98.28

UHS – consultant data

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Value of consultant delivered care

• Productive hospital – reference cost 0.96

• Medical Staff WAU - £598 compared to national median £523

• Based on data sources including ESR, HES, Financial

• How does this correlate to outcomes?

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UHS Staff survey Adam Lott, NHSE March/April 2016

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Corporate Managers

Medical Staff

Clinical Staff

Local leaders

How did we interview? • Interviews were not part of a formal research process.

They were conducted as part of an improvement process collecting feedback from the key stakeholders.

• Semi-structured interviews via telephone and face to face took place in mid April 2016.

• Responses provided were written down against each question asked.

• Participants were provided with opportunity to open up their feedback and give additional narrative against the topic of 7 day services and the clinical standards at their Trust.

• All participants were provided with contact details of the interviewer. This gave opportunity for further questions or to email or call with additional thoughts, ideas, experiences and issues.

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Workforce • “In hospitals ward based production lines to be invested in and serious

structural changes particular to careers of nurses – so good competent nurses stay on and run wards 27/4 rather than specialise and move out to non 24/7 work…. and how we incentives people to go back to the wards – and make them dynamic.”

• “…7 days is not difficult sell in hospital – staff think and know it’s about improving safety of patients - it’s not about working OOHs – it’s about doing too much generalist stuff for Trust as that’s the main needs – so end up doing therefore less specialised work they were employed for and most passionate about…”

• “No ward clerks at the weekend. At the weekend I am a secretary and am on the phone all the time...”

• “During the week there are two HCA per shift. During weekend, only 1. But can’t predict how many emergencies will come”.

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Improvement • “…may need to do some work around networking. Some of the very

difficult changes that need to be done affordably 7DS need more robust strategic regionally support – focussing down to locally too much is a big mistake…”

• “Want to do more than ticking the boxes and be very clear about how we make/meet standards – find out what really matters than stipulating reviews twice daily – like to investigate people in a timely 24/7 shorten some pathways.”

• “…Fairly careful thought is needed… as once we have made the decisions of what we want to do, do we have the support team to do it? There is a danger you get your decision making process going faster than your ability to make it happen…

• “…EPU Mon-Fri 9-7, not at all weekends. “If they were here to do emergency scans, we wouldn’t need to admit them…” [patients awaiting confirmation/diagnosis]

• “…Open the tunnel for transfers! We wait hours for transport and it costs a fortune…”

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Partnership working – Integrating systems

• “If taking to next level need instruction of what community and social care should be providing and what networks should be providing”

• “…biggest challenge will be working alongside council and other health services. It’s a flow issue – all linked –more concerned that we will never get flow..”

• “…Community MDTs, prevention agenda, not just about UHS it’s about changing substantially across health care system.”

• “No social services all weekend except a senior ‘I think’. Delays discharges-6 medically fit patients on ward today. If Social Services were 7 days, the patients would get shifted along. Need social services-7 days a week, same as we do-would facilitate transfers..”

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UHS Patient survey Wendy Keating & Juliane Goetz, March 2016

The good...

• Everybody was so kind, so good • Emergency care is brilliant • Really good ward, happy to help, more staff to help the doctors, more

human than a few years ago • Treated ok, Dr very good, tablets too late 11 pm • We didn't have a truly representative experience due to the doctors

strike, but we have no complaints • Need more consultants at the weekends, a lot falls to junior doctors so

they dont get things done till Monday, although they are brilliant

• I don't think things can be improved • Meals are late, care is good

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The bad....

• Too noisy to sleep • Ward temparture needs regulating, too hot at night • Catering should be improved • Better comms would be helpful, politer food assistants would be

helpful • Was queuing in ED, but taken to AMU quickly • 4 months ago my family was turned away when about to give birth and

taken to another hospital, there should always be doctors available • There could be more nurses, ...they are trying to do too many things • 1 nurse should only look after 6 patients not more • There are more agency staff on duty during the weekend • I will never return to this hospital, waiting ages for equipment delivery

and ambulance refused to take my wheelchair

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UHS seven day services patient survey

• 52 patient questionnaires completed • Average rating of all departments by day of the week:

– Monday to Friday – core hours 4.31 (of 5) – Monday to Friday – out of hours 4.29 – The weekend 4.27

• Urgent and emergency care a priority – Yes = 47 – Blank = 4 – Not Sure = 1

• Good explanation of tests and care: 26 patients (50%) • Good explanation of medication

– Yes = 41 – I don't need one = 6

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Next steps

• UHS Collaboration with other early implementer in region

• UHS Collaboration with other trusts’ 7DS clinical leads (regional) to work on 7DS

• Community collaboration – Seven day community discharge planning

– Patient pathways to continue 7 days a week

– Primary care signposting for urgent care

– Mental health services to provide a 7 day service

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Thank you

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7 Day Hospitals – Information

Questions

Please write your question in the chat box to ‘all participants’.

www.england.nhs.uk

• Let us know if you have any work you would like to share

• or if there are other topics you are interested in

Email: [email protected]

Twitter: #7dayservices

Thank you for joining the National Webinar the

links to the recording will be sent out shortly

7 Day Hospitals – For more information

mailto:[email protected]





www.england.nhs.uk

Future webinars:

Seven Day Self-Assessment: Preparation for March

2017 Survey • 9th March 2017 - 15:00 – 16:00

• 13th March 2017 - 12:30 – 13:30

• 17th March 2017 - 10:30 – 11:30

Next National 7 Day Service Webinar:

Consultant Job Planning to support Seven Day

Services

• 4TH April 2017 - 13:00 – 14:00

For more information or details of how to register email: england.si-

[email protected]

7 Day Hospitals – Future

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tips to engage stakeholders in 7 day services

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