Helen Bevan 18 th March 2010. Copyright ©: NHS Institute for Innovation and Improvement 2008-2009...
-
Upload
brian-dickerson -
Category
Documents
-
view
220 -
download
0
Transcript of Helen Bevan 18 th March 2010. Copyright ©: NHS Institute for Innovation and Improvement 2008-2009...
Helen Bevan18th March 2010
Copyright ©: NHS Institute for Innovation and Improvement 2008-2009 – All rights reserved
The “Productive” (Releasing Time) Series
© Copyright NHS Institute for Innovation and Improvement 2009
Direct Care Time
Motion Admin Discussion Handovers InformationRoles
Opportunity to increase safety and reliability of care
Ro
le T
ime
(e
.g.
nu
rse
)
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”
The focus is on direct patient care
© Copyright NHS Institute for Innovation and Improvement 2009
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
© Copyright NHS Institute for Innovation and Improvement 2009
Energy focus
Imagination, engagement, participation, moving and mobilising
The “anatomy
” of change
Effectiveness and efficiency
focus
Metrics and measurements;
technical systems and process
design, clinical pathways,
evidence based medicine
Improving healthcare
The “physiology”
of change
© Copyright NHS Institute for Innovation and Improvement 2009
LOW
HIGH
HIGH
Commitment of the people
Control of the processes
Alienated Ascendant
Apathetic Anarchic
Source: Wickens
Where we are trying to get to…
Lean organisation alignment
© Copyright NHS Institute for Innovation and Improvement 2009
Building on a strong foundation: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
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
© Copyright NHS Institute for Innovation and Improvement 2009
‘Putting frontline staff in control’
© Copyright NHS Institute for Innovation and Improvement 2009
22 January 2009
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
Modular Structure:Module Box Set
© Copyright NHS Institute for Innovation and Improvement 2009
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!
© Copyright NHS Institute for Innovation and Improvement 2009
Critical factors for success with any Productive
Leadership at Executive level √
Aligned with strategic direction √
Governance of the programme √
Continuous improvement √
Capability and knowledge √
Right people in place √
Source: NHS London Review May 2009
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
Team Design:The Activity Follow tends to show that, despite the aspiration to have well defined teams, team definition collapses as the shift goes on
Bay 10
Bay 11
Bay 6
Bay 12
Bay 9
Bay 13
NS
Re
d T
ea
m
Bay 5
Bay 4
Bay 3
Bay 1
Off Ward
© Copyright NHS Institute for Innovation and Improvement 2009
Learning to See
Using video in observation:Bringing to the surface custom and practice
Mixed linen in clean disposal room
© Copyright NHS Institute for Innovation and Improvement 2009
Learning to See
Using video in observation:Bringing to the surface custom and practice
Patient access areas
© Copyright NHS Institute for Innovation and Improvement 2009
Learning to See
Using video in observation:Bringing to the surface custom and practice
Undesirable waste storage
© Copyright NHS Institute for Innovation and Improvement 2009
SORT
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
SET
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
Don’t forget, we live in a 3D world…..
© Copyright NHS Institute for Innovation and Improvement 2009
SHINE
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
STANDARDISE
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
SUSTAIN
© Copyright NHS Institute for Innovation and Improvement 2009
10 point module checklist
© Copyright NHS Institute for Innovation and Improvement 2009
NO. TASK WHEN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62
1 SLUICE TEAM AUDIT
2 LINEN CUPBOARD TEAM AUDIT
3 NURSING STATION TEAM AUDIT
4 TREATMENT ROOM TEAM AUDIT
5 PERFORMANCE BOARD TEAM AUDIT
6 PATIENT STATUS BOARD TEAM AUDIT
7 MEAL ROUND AUDIT
8 OBSERVATION AUDIT
9 MEDICINE ROUND AUDIT
10 HANDOVER AUDIT
11 ADMISSION AUDIT
12 AUDIT SYSTEM AUDIT
13 TREATMENT ROOM MANAGER AUDIT
14 PATIENT STATUS BOARD MANAGEMENT AUDIT
15 NURSING STATION MANAGER AUDIT
16 PERFORMANCE BOARD MANAGEMENT AUDIT
17 SLUICE - MANAGER AUDIT
18 LINEN CUPBOARD MANAGER AUDIT
19
20
© Copyright NHS Institute for Innovation and Improvement 2008
Au
dit
to
be
com
ple
ted
by
War
d L
ead
er u
nle
ss
visi
t sc
hed
ule
d f
or
that
day
Au
dit
to
be
com
ple
ted
by
team
or
wa
rd le
ad
er u
nle
ss v
isit
sch
edu
led
fo
r th
e d
ay
AUDIT PLANNER (EXAMPLE)WEEK
VISIT PYRAMID AUDIT SUITABILITY COLOUR CODE
Example Audit Planner Table:
© Copyright NHS Institute for Innovation and Improvement 2009
Audit Planner in detail:
© Copyright NHS Institute for Innovation and Improvement 2009
Visualisation is a key principle used in:•The Well Organised Ward•Patient Status at a Glance•Knowing How we are Doing
With visualisation, we aim to be able to find the status of someone, something, or some process in three seconds
Visualisation
© Copyright NHS Institute for Innovation and Improvement 2009Visualisation and the 3 second rule
© Copyright NHS Institute for Innovation and Improvement 2009
Visualisation: Visualisation and the 3 second ruleFloor markings and photographs detail location, number and contents of trolleys that should be
stored in this room
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
38
An example: NHS Yorkshire and Humberside
© Copyright NHS Institute for Innovation and Improvement 2009
Examples of reach and impact in the NHS in Y&H are as follows:
• All 36 NHS healthcare provider organisations in Yorkshire and Humber are implementing one or more of the Productive programmes
• In four hospital systems, over 97% roll out of the Productive Ward or Productive Mental Health Ward to their front line team/wards (Sheffield, Hull & Airedale, RDASH - MH),
• Another hospital system has achieved over 75% roll out (Leeds).
• Two organisations have adapted Productive Ward for their Community Health teams- Kirklees 44 teams and Doncaster two teams
• Every provider organisation in Yorkshire and the Humber can provide examples of how the Productive methodology has resulted in improvements in the quality and productivity of care.
© Copyright NHS Institute for Innovation and Improvement 2009
Sheffield Teaching Hospitals
• A five hospital system• 100 wards (approx)• Went “live” January 2008• Local adoption, first group May 2008 last group
March 2010
© Copyright NHS Institute for Innovation and Improvement 2009
Local adoption
• currently 97 areas working on programme• 1st outpatient area started September 08 • 10 outpatient areas now working on the programme• labour and delivery started January 09 • remaining maternity wards started March 2010• both day surgery units started Sept 09
© Copyright NHS Institute for Innovation and Improvement 2009© Copyright NHS Institute for Innovation and Improvement 2009
Successes
– Direct care time increased by 32% (4.5 hours per nurse per shift)
– Time spent walking / looking for equipment has reduced from 130 minutes (over 2 hours) to 25 minutes
– Time spent on nursing documentation has reduced from 127 minutes to 82 minutes
© Copyright NHS Institute for Innovation and Improvement 2009
Successes• No more looking for keys – digital locks for drug cupboard
keys
• Short term sickness reduced from 10% to 1% and sustained
• Reduction in falls
• Handover reduced by 30 minutes per nurse per shift – 3 hours per day
• Ward round reduced from 60 – 90 minutes to 20 – 40 minutes
© Copyright NHS Institute for Innovation and Improvement 2009
•Some areas using Productive Community Hospital Modules for patient flow:
-Outpatients-Labour and delivery-Emergency admission
•Day case / short stay areas started Productive Ward foundation modules will combine with productive theatre process modules
•Adapted activity follow to reflect workload
•Productive Community Services encompass staff working cross boundary
•Medical Records using Productive Ward methods and combining it with Productive Leader methods
Combining
© Copyright NHS Institute for Innovation and Improvement 2009
Director of Finance – “What actual cost savings have been made?”
Director of Quality – “How much time has this module actually saved?”
Director of HR – “What skills have the team actually improved?”
Chief Executive – “How much more efficient have the team become by
doing this programme?
The Productives Module Impact Framework
helps answer the following questions:
© Copyright NHS Institute for Innovation and Improvement 2009
The Productives Module Impact Framework:
(i) can help you analyse qualitative and quantitative impact data (inc financial)
(ii) can aggregate impact data across an organisation and across all Productive programmes
(iii) can create impact reports at organisational and regional level at the touch of a button
© Copyright NHS Institute for Innovation and Improvement 2009
Impact Areas
1: Staff experience and wellbeing 2: Process improvements
4: Financial impacts
3: Knowledge and skills
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
© Copyright NHS Institute for Innovation and Improvement 2009
Learning from the Productivesso 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