Transforming Care at the Bedside: Implementation with the South Eastern HSC Trust

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Transforming Care at the BedsideImplementation
with the South Eastern HSC Trust
Dr Bob Brown Asst Director of Nursing, South
Eastern HSC Trust Yvonne Millar Ward Manager,
South Eastern HSC Trust
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Ideal care means

• Something different to everyone.but
• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient Centered
• Perceive patients not as hosts in our systems,
  but as guests in their lives (Don Berwick, IHI
  President and CEO)

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We all have two jobs

• To do our work and to improve our work
• (NI HSC Safety Forum)

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TCAB Background

• Introduced in 2003 by the IHI
• Funded in the USA by the Robert Wood Johnson
  Foundation
• Currently over 80 participating hospitals in the
  US
• Integrated into Wales 1000 lives campaign
• The beginning in Northern Ireland

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TCAB What is it?
Monthly meetings Daily improvement Drumbeat
approach PDSA
Safety Reliability

• Transformational
• Leadership

Vitality Teamwork
Value added Care Processes (Lean principles)
Patient Family Centred Care
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Key People Involved

• Pedro Delgado NI Lead HSC Safety Forum
• Brenda Carson Patient Safety Manager
• Bob Brown Assistant Director of Nursing
  (Learning and Development) and MHSOP
• Yvonne Millar Ward Manager Ward 19
• Peter Johnston Charge Nurse Ward 19
• Medical Staff Grade, Pharmacist, AHP Staff SW
• Ward 19, Trauma and Orthopaedics Staff

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Implementation Process

• Strategic intent corporate and professional
• Engage front line staff from vision to action
• Ask what ifcreate the idealised design
• Brainstorm/Snorkel
• Triage ideas and prioritise where to start
• Develop rapid cycle tests of change/test your
  hypothesis
• Keep testing
• Adapt, Adopt, Abandon
• Spread TCAB Café and roll out

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This is not a PROJECT

• Its strategically important for the South Eastern
  HSC Trust as it will
• contribute towards
• Providing best care for patients statutory duty
  of quality from Department of Health (DHSSPSNI)
• Imperative to increase effectiveness and
  efficiency through improved flow and improved
  patient care
• Continuous Improvement framework, not only
  releasing time to care
• Cost Effective currently evaluating impact of
  falls
• Engagement of multidisciplinary team in
  reliability and design
• Aligned with Regional priorities including
  patient experience standards, PfA targets

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Key Themes in TCAB

• Safe and Reliable Care
• Patient Centred Care
• Value Added Care
• Vitality and Teamwork

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Safe and Reliable Care

• Aim - Reducing Harm
• Target - Reduce Inpatient Falls by 25
• - 95 Compliance of Medicines
• Reconciliation
• Method - Create Early Detection and Response
• Systems / Development of
  Falls Risk
• Assessement Form / Development of
  Medicines Reconciliation Form

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Safe and Reliable Care
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Safe and Reliable Care
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Safe and Reliable Care
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Safe and Reliable Care
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Safe and Reliable Care
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Safe and Reliable Care
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Patient Centred Care

• Aim - Continuity of Care With a Holistic Approach
• Target - 95 Patient Satisfaction
• Method - Welcome to Ward 19 Leaflets
• Discharge Satisfaction Survey
• Ward 19 Pledge
• Value Added Activities at Bedside

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Patient Centred Care
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Patient Centred Care
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Patient Centred Care
Flat out staff in ward 19 rock
Staff very helpful and caring even when they were
very busy
Wonderful nursing care from all staff - couldn't
have made it without them - the care and
understanding I received throughout my long
illness
Communication to treatment were exceptionally
good and I would like to express my thanks to all
from the top to the bottom for the courtesy and
kindness I received
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Value Added Care

• Aim - All Care Processes are Free of Waste and
• Promote Continous Flow
• Target - Nurses to Spend 70 of Their Time in
• Direct Patient Care
• Method - Improve Work Environment Through
• Physical Space Design
• Improved Work Flow in Medication

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Value Added Care
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Value Added Care
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Vitality and Teamwork

• Aim - To Create a Supportive Dynamic Learning
• Environment while continually Striving for
• Excellence
• Target - 95 Staff Satisfaction
• Method - Supervision
• Learning Sets
• Build Capability of Staff
• Staff Satisfaction Questionnaires
• Baseline survey team culture

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