The Pulse September / October 2009 - NHS Lanarkshire

thePulse
10 SPECIAL FEATURE
SEPTEMBER/OCTOBER 2009
SPECIAL FEATURE thePulse 11
IMPROVING patient care is at the heart of everything
we do across NHS Lanarkshire. There is a range of
initiatives which are all designed to make sure we
are providing the best possible service.
The Lean programme, 18 Weeks and the Patient
Safety Initiative are just three of the projects looking at
how we deliver care.
Our diagram on the right shows how they all share
the aim of improving care and, over the next few
editions, The Pulse will look at each project in turn and
will highlight some of the work already undertaken.
As you can see from the diagram, understanding how
they all fit together is child’s play!
This edition examines the role of Leading Better Care
and explores some of the work that has been going on
in wards in Lanarkshire...
Taking the next steps
LEADING Better Care and Releasing Time
to Care are now rolling out in mental
health and community care.
Work began in Lockhart Hospital in
May. Staff at Lockhart have already identified
that they have similar process and
environmental concerns as those of
Hairmyres, and through the use of tools
and modular process work, changes are
already proving successful.
Environmental changes have included
improved shelving and cupboard de-cluttering.
A great improvement has been the
reorganisation of moving and handling
equipment, allowing for an improved
access and maintenance regime.
The first process module of patient
observations has now been completed,
introducing a standard operating
procedure that includes qualitative steps.
Have your say...
Staff are enjoying the experience and
are excited to see their improving
outcomes.
Work is now also under way within
mental health services.
Following consultation with the Mental
Health Collaborative and Mental Health
Facilitators, Releasing Time to Care
Mental Health has now begun within the
three acute sites. This programme links
very closely with other initiatives
currently under way within mental health.
Work is already under way with facilitators
and senior charge nurses from the
six wards attending a four-day modular
training course which is being delivered
over several months.
The first three modules, Knowing How
We Are Doing, Well Organised Ward and
Patient Status at a Glance, have started.
Elderly
ward
first to
improve
We asked the frontline staff on ward 15 at
Hairmyres Hospital how they have found the
Releasing Time to Care experience…
Morale was lifted and
you can now spend
more time with the patients”
Ellen McDonald, clinical support worker, ward 15, Hairmyres
This has given my staff
a chance to voice their
concerns, raise any issues
and actually see action
being taken. Our
pharmacist has said that
our ward is now a pleasure
to come into”
Margaret Gibney, charge nurse, ward 15, Hairmyres
HAIRMYRES Hospital began
its implementation of Leading
Better Care in December last
year in ward 15.
The first step for staff in the
care of the elderly ward was to see
photos and watch a video
recording of their ward to look at
how they worked.
Karen Morrow, practice scholar,
said: “The great thing about the
initial part of the exercise is that
while you are working, you don’t
always see what is in front of you
and even if you do, you may not
have the time to do anything
about it.
“But even sitting down and
having the opportunity to discuss
how you work can identify
small changes that can save a lot
of time.
“It is vital to ensure that every
member of staff on the ward
is able to have input into raising
concerns and identifying
solutions.
“This means that by working as
team, they can find the best
solutions to problems.”
One of the key elements of the
programme was to make sure
that all staff were aware of the
changes and were told what was
happening and when. Over a
12-week period, the group
worked with many tools, such as
route by walking about (RBWA),
spaghetti diagrams, process
and value stream mapping,
3Cs (concern, cause and
counter measure) and 5S (sort,
set, shine, standarise and
sustain) to identify concerns
and frustrations on the ward.
Karen added: “Staff were then
able to organise their own ward,
providing them with an
improved ‘fit for purpose’ area
that not only reduced their
amount of motion in any
one procedure, but also enabled
them to want to make decisions
that affect their daily
working routines.”
One key improvement
involved escorting patients to
X-ray, which had been identified
as a four-hour process.
Not only did this affect the
patient’s experience, but it
meant that the ward was short of
a member of staff throughout
this process.
By working together with
portering and medical, ward
and X-ray staff, this is now a
streamlined 40-minute process.
LEADING THE WAY: divisional nurse
director Joan James (centre) visited
staff at Hairmyres to see how they had
implemented Leading Better Care
It is
vital to
ensure every
member of
staff on the
ward is able
to have input
into raising
concerns and
identifying
solutions”
We are working in a
much more organised
ward, which saves a lot of
time” Kate Blake, staff nurse, ward 15, Hairmyres
Real benefits for all
LEADING Better Care is
one of the initiatives NHS
Lanarkshire is using to
improve patient care.
The project includes
reviewing the role of the
senior charge nurse and
Releasing Time to Care.
Work has been
ongoing within different
sites and results are
already showing that
staff and patients have
seen real improvements
in how care is delivered.
Initial evaluation has
also demonstrated that
implementing Releasing
Time to Care has improved
staff morale.
Releasing Time to Care
is about making sure that
patient care is:
q safe
q effective
q patient-centred
q timely
q efficient
q equitable.
And it makes sure that
senior charge nurses are
“guardians of quality”.
Using the productive
ward programme it makes
sure that the ward is
organised to free up staff
so they can spend as
much time as possible
with patients.
Early indicators show
that both staff and patients
are seeing the benefits of
the programme.
Leading Better Care is
being led by a steering
group with four separate
sub-groups delivering
elements of the
programme.
The sub groups are
education, data to
improve quality,
implementation and
communication.