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JOAN JAMES DIVISIONAL NURSE DIRECTOR ACUTE

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Title: JOAN JAMES DIVISIONAL NURSE DIRECTOR ACUTE


1
JOAN JAMESDIVISIONAL NURSE DIRECTOR (ACUTE)
Appendix 4
2
ROLE
  • Professional Opinion.
  • Governance.
  • Horizon Scanning.
  • Developing Implementing.
  • Listening

3
CHALLENGE
  • Patient Safety/Clinical Care.
  • Professional Standards.
  • Senior Charge Nurses/Team Leaders.

4
Practice Development in Emergency Care
  • Gillian Corbett
  • Nurse Consultant

5
Aims
  • Give an overview of the practice development I
    have been involved in
  • Discuss the leadership challenges
  • What I would and wouldnt do again if I had to
    start all over again tomorrow

6
Emergency Care In Context
7
the transformation to a butterfly cannot happen
whilst remaining in the cocoon
8
New Nursing Roles
9
International Recognition and Publication
10
Walk the Walk
11
Navigation
  • Not everyone can make the whole journey in one
    day.
  • Recognise the blind spots in others and help
    overcome them.
  • If people dont experience success often they
    have no idea what it takes to get from where they
    are to where they want to go.
  • Identify attainable goals, giving confidence,
    which will lead to progress.
  • John C. Maxwell

12
Leadership Challenges
  • You may have to fight the battle more than once
    in order to win it

13
Reflection What would I do differently?
14
Until you spread your wings, youll have no idea
how far you can fly.
15
Take Home Messages
  • There are no impossible problems. Time,
    thought, and a positive attitude can solve just
    about anything.
  • No one ever achieves alone what he can when
    partnering with others. And anybody who doesnt
    recognise that falls incredibly short of her
    potential.
  • Recognise a problem before it becomes an
    emergency.

16
Finally..
17
Peter McCrossan
  • Associate Director for Allied Health Professions
    and Professional Lead for Podiatry

18
Associate Director for Allied Health Professions
  • Responsible for providing professional and
    clinical leadership for all AHP staff across NHS
    Lanarkshire.
  • The AHP professions within NHS Lanarkshire
    comprise of 9 professions
  • Audiology,
  • Nutrition and Dietetics,
  • Occupational Therapy,
  • Orthoptics,
  • Physiotherapy,
  • Podiatry,
  • Prosthetics and Orthotics,
  • Radiography
  • Speech and Language Therapy.

19
My Journey
  • Nursing Assistant Hartwood Hospital (Student)
  • Chiropodist Lanarkshire and Glasgow Royal
    Infirmary
  • Podiatrist
  • Podiatric Manager
  • Lanarkshire Health Board - Podiatry Adviser
  • Chair of the Allied Health Professions Advisory
    Committee
  • Associate Director for Allied Health Professions

20
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21
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22
Current Leadership Challenges
  • Allied Health Professions - Professional
    Structures
  • Rehabilitation and Bone Health Strategies
  • AHP Service Reviews

23
Allied Health Professions
  • Mr Robbie Rooney - NHS Lanarkshire
  • Orthotic Service Manager
  • from Surgical appliances to an Orthotic Service

24
from Surgical appliances to an Orthotic Service
  • By Robbie Rooney

25
Introduction
  • Current services
  • Issues with current service
  • How do we fix it?
  • What are the challenges?
  • What would I do differently if I was starting
    again tomorrow?

26
Current service
  • Surgical appliance service
  • Provides orthotic devices
  • Surgical footwear
  • Calipers, splints, braces
  • Insoles
  • Who provides the service?
  • Orthotist- HPC registered AHP specialist in the
    design and prescription of orthotics. (Dual
    qualification in prosthetics and orthotics)

27
Issues within current service
  • Scottish Government report (2005) described
    services as
  • Cinderella service
  • Fragmented
  • Poor profile within hospitals
  • Lack of local accountability within health boards
  • Why?
  • Lack of clinical management
  • No defined budget
  • Lack of defined clinical team

28
How do we fix it?
  • Service has to be clinically led
  • Service has to be clinically focused
    (historically admin driven
  • Service should be able to govern itself
    (budgetary control)
  • Standards and protocols
  • Integration into wider NHS

29
What are the challenges?
  • Showing the value of a good orthotic service
  • Outcomes how do we show value?
  • Changing perceptions of the service (external)
  • Changing orthotists outlook to communication and
    team work (internal)

30
What would I do differently if I was starting
again tomorrow?
  • See the bigger picture!!
  • Accept that I dont have a magic wand!!
  • Dont assume everyone is reasonable as yourself!!

31
Leadership In Lanarkshire
  • Anne Armstrong

32
Divisional Nurse Director Community Primary
Care
  • Strategic and operational delivery of effective
    nursing services and practice within Community
    Health Partnerships
  • Lead the delivery of significant Board wide
    multi-professional issues

33
Route Map To Current Position
  • Nurse Training And Education
  • Clinical Leadership Experience
  • Theory Into Practice
  • National Profile

34
Challenges
  • Healthcare Associated Infection
  • Child Protection
  • Service Modernisation / Improving Core Care

35
Co-Presenter
  • Janette Barrie, Nurse Consultant Long Term
    Conditions.

36
Integrated Care Management in Lanarkshire
  • Proactive, Planned and Coordinated

37
Care management
A proactive approach focused on high risk
patients with a combination of medical, nursing,
pharmacological and social care needs delivered
by suitably trained and competent professionals

38
Prompts
  • National Policy clear framework SGHD
  • Ageing population
  • Increase in LTC at all ages more so in the over
    65s
  • Local strategy for LTCs

39
Where did we start?
  • Evidence What works, what doesnt work
  • Different models and approaches National and
    International
  • Learning from experience of others
  • Acknowledging the needs and wishes of our
    population

40
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41
Supporting Infrastructure
  • Tools to identify at risk groups
  • Recruit Practices and Care Managers
  • Local Authority support
  • Access to information Practice managers GPs on
    board
  • Local interagency knowledge sharing groups
  • Directory of Services
  • Shared protocols and pathways
  • Prepared practitioners (highly skilled)
    confident competent

42
What does it involve?
  • Proactively finding those at risk of readmission
  • Full assessment medical, nursing, pharmaceutical
    and social care needs
  • Develop personalised holistic care plans
  • Involve patients and carers as partners
  • Maintain highly visible lead role
  • Secure services/ treatments modalities
  • Teach pt/ carers monitor condition
  • Maintain contact throughout hospital admissions
  • Cross boundary working / Interagency communication

43
Benefits
  • Better outcomes for individuals, their families,
    carers and communities preferred place of care
  • Improved access to services
  • Reduction in the use of unplanned care
  • Improved concordance with medication
  • Improved partnership working
  • Reduction in the number of professionals involved
    in the individuals care
  • Greater continuity of support / care /
    involvement
  • More control in the package of care / support
    provided
  • Improved and speedier decision making
  • Empowerment of individual and their carer through
    active participation in the process

44
Pilot sites
  • Coatbridge 44,983
  • High risk younger old with chronic heart and
    lung disease
  • Clydesdale 87,893
  • Mental health alcohol issues amongst men
  • East Kilbride 57,844
  • High risk oldest old females in East Kilbride
  • 3 Practices / 5 Care Managers

45
The Model
46
Baseline Findings
  • Over 400 people identified 65 with SPARRA risk
    score of gt 50
  • 306 cases reviewed using local data and
    multi-agency knowledge sharing groups
  • 36 had died, 13 have moved to long term care,
    11 changed practice and 29 had conditions which
    had fully stabilised

47
Integrated Care Management Programme
  • 63 patients fully assessed
  • 38 patients entered into programme
  • Further 25 patients were assessed but not
    accepted into programme
  • 20 patients declined 11 no longer met the
    criteria, 3 refused, 6 not specified.

48
Findings
  • 91 of Coatbridge patients reviewed fell within
    highest categories of deprivation
  • 59 admissions recorded 21 patients2.8 admission
    per patient.
  • 45/49 admissions justified unavoidable (10
    unknown)
  • 17 patients had no hospital admissions
  • Patients screened but not accepted LoS increased
    from 8 to 15 days.
  • Patients accepted LoS fell from 10.3 days to
    8.9 days
  • Focus group analysis suggest quality of care has
    improved and patient satisfaction has increased

49
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50
Key Learning Points..
  • Invest in the preparation time get supporting
    infrastructure in place
  • Must communicate and engage widely GPs,
    Hospital Consultants, Healthcare Staff,
    Specialist Nurses and Partner Agencies
  • Support Care Managers high profile
  • Timely access to information on services
    available to enable early interventions
  • Shared protocols and pathways giving care
    managers access to specialist resources
  • People and processes in developing practice are
    just as important as the outcome.
  • Communication!

51
Turning back the clock
52
What would we do differently??
  • More baseline information to evidence the impact
    of proactive, planned and coordinated nursing
    care in the community
  • Instinctively know its right prove it!
  • Publicise pilot more often throughout
  • Capture feedback from patients and carers Care
    Managers have got heart warming stories to share.
  • Demonstrate the fantastic job Care Managers and
    the Community Nursing Team do!

53
Why??


54
Frontline Clinical Leadership
  • An overview of current developments
  • Margot Russell Practice Development Specialist,
    Clinical Leadership Quality

55
Themes of CLQ
56
Elements of Clinical Leadership
57
Quick summary of each component
  • Clinical Leadership programme - runs annually
    for 9 months for those in formal NMAHP clinical
    leadership positions or who aspire to be.
    Validated both at degree and Masters level. Only
    NHS Programme in the UK to offer a Post Graduate
    Certificate in Clinical Leadership
  • Clinical Leadership Active Learning sets-
    Bimonthly facilitated learning sets for those who
    have completed the clinical leadership programme
    and wish to continue to develop their learning
    through peer networks.

58
Senior Charge Nurse developments
  • Senior Charge Nurse / Team leader Performance
    Objectives- developed over past 12 months and
    recently roll out across whole organisation for
    NM clinical leaders to identify key deliverable
    to work towards and assist in providing evidence
    for KSF. Assists in bringing a degree of
    consistency and clarity to the role. Being
    reviewed for AHPs currently. Links to Scottish
    Patient Safety programme, CQI, HEAT, Better
    Together
  • Review of the Senior Charge Nurse role- Part of
    the national development phase of the refocused
    national role framework for Senior charge nurses.
    Centred around safe effective patient care,
    improving the patients experience, managing the
    performance of the team and contributing to the
    organisations objectives. Links to Scottish
    Patient Safety programme, Better Together, HEAT

59
Improving quality
  • Releasing Time to Care / Organised ward-
    initiative , based on Lean methodologies, looking
    at reorganisation of systems and processes within
    clinical areas in order to release nursing time
    back to clinical care, thus releasing the SCN to
    undertake the refocused role. Links to National
    pilot of Releasing Time to Care
  • Clinical Quality Indicators- Part of the
    national development phase of clinical quality
    indicators. Provides readily accessible
    information for the SCN regarding the compliance
    to best practice within the clinical area. Links
    the refocused role, scn objectives and the
    organised ward initiatives as a means to identify
    continuous quality improvement. Links to Scottish
    Patient Safety programme, NHS QIS standards,
    Better Together, National work programmes from
    CNO directorate

60
Improving Quality 2
  • Food Fluid Nutrition- Links to the Clinical
    quality indicators and senior charge Nurse
    objectives. Assist the organisation in improving
    nutrition and hydration care from strategic plans
    to clinical practice. Links to Organised ward
    initiative, SCN objectives and national work from
    CNO directorate, NHS QIS standards.
  • Medicines management- commenced work
    commissioned by PD Board looking at systems and
    processes across NHS Lanarkshire. Areas of risk
    and improvements and are being identified. Links
    to Scottish Patient Safety Programme, SCN
    objectives, CQI Organised Ward initiatives

61
Improving Quality 3
  • Non medical prescribing- reviewing systems and
    process in place to access, support and maintain
    NMAHP prescribes to ensure maximum benefit for
    both patient and organisation. Links to National
    work, SCN objectives and Scottish Patient Safety
    programme
  • Cleanliness Champion programme-
    interprofessional learning sets to support those
    undertaking the programme. Since the introduction
    of CC coordinators the completion rates of the
    programme in NHS Lanarkshire have more than
    doubled. Currently undertaking impact evaluation
    study to examine impact on clinical practice.
    Links to SCN objectives, HAI work, HEAT, Scottish
    Patient Safety programme, Organised ward
    initiative

62
Improving Quality 4
  • Integrated Care Pathways (ICP)- Recent addition
    to the team. Examining and reviewing current
    ICPs currently in use within the organisation,
    structures supporting their use, development of
    further / new ICP where a need exists. Current
    focus on mental health ICP development. Links to
    CQI, Rights Relationships Recovery, SPSP

63
Challenges
  • Keeping all the issues on the agenda moving at
    the required pace
  • Ensuring that there is strong linkage between
    programmes of work within the team and out with
    the team
  • Managing expectations - ensuring that that the
    work streams are phased into the clinical areas
    without overwhelming the practitioners

64
Reflections what would I do differently
  • Clinical Engagement work harder to ensure that
    at all levels of the organisation were aware of
    the work programmes and were fully on board with
    what was being proposed
  • Have an organisational strategy / framework where
    this work sits at the outset
  • Proactive engagement with partner institutions at
    an earlier stage in development.

65
Celebrating Lanarkshire 2008
  • Conference Reflection and Evaluation

66
Celebrating Lanarkshire 2008Reflection
  • What have I done today, what have I learned from
    today and how will today make a difference?
  • Certificates of Attendance
  • Reflection in action on action -
  • Thank You

67
Celebrating Lanarkshire 2008Evaluation (1)
  • Please dont leave here until you have
    completed your evaluation formit really does
    help with future planninghence why year on year
    the Conference has been different in content and
    style.

68
Celebrating Lanarkshire 2008Evaluation (2)
  • In addition to a conference report being
    prepared and placed on the PDC web-site, your
    views will be considered alongside the recently
    published Critical Review of Celebrating
    Lanarkshire and NMAHP Symposiaan evaluative
    piece of work commissioned in 2008 to provide an
    evidence base for the future of Celebrating
    Lanarkshire.

69
Celebrating Lanarkshire 2008Evaluation (3)
  • Tell at least 5 other NMAHPs about today and
    get each of them to commit to tell at least 5
    othersnever underestimate the power of the word
    of mouth!

70
Celebrating Lanarkshire 2008
  • Conference Close

71
Celebrating Lanarkshire 2008
  • Thank you, Goodbye and Safe Journey
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