Nottingham University Hospital NHS Trust Productive Ward: Releasing Time to Care

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Nottingham University Hospital NHS Trust -
Productive Ward Releasing Time to Care
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Productive ward turns this into -


INDIRECT NURSING TIME
NURSING CARE
DIRECT NURSING TIME
25 - 40 direct time spent with patients
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To this80


INDIRECT NURSING TIME
NURSING CARE


DIRECT NURSING TIME



and both patients and staff benefit
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Basic Principles

• Application of industrial / lean methods
• Modular, self directed learning structure
• Entirely ward / departmental focused
• Equips ward leaders and teams with methods /
  tools

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The Productive ward consists of 3 foundation 8
process modules




















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Performance Information








Evidence


Open and transparent






Strengths and weaknesses



Vehicle for change





Tracks improvements


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Achievements


Implemented across 51 wards (out of 96) ED


MRSA reduced by 68 and C Difficile by 50










Direct Nursing Care increased by 60





45 of wards have reduced falls







Staff Measures





Improving Absence and Survey Results




85 of in-patients are satisfied






500 - 3000 saving per ward (procurement)
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Case for change


It enables staff to apply a standard set of tools
which transform wards, leading to calmer and
more dignified environments Time is released to
make care more reliable and safer - patients get
better quickly.









































Removing wasteful resources
Making ward areas work for staff
Information to make decisions
Reducing Motion Time
Reviewing processes


Releases time to care for patients
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Cycle of continuous improvements




Staff feel empowered to make changes



Staff are more satisfied at work

Patients are navigated appropriately



Staff are able to correct issues - getting it
right, first time



Patients feel safer and happier
There is less waste in the system
Problems are identified earlier
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Where next?


Complete Roll Out




Summer 2010
-
Supporting projects


-
Rostering
Procurement
-
-

Lorenzo

The Productive Hospital




Problems are identified earlier
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Lincolnshire Partnership NHS Foundation Trust -
Delivering Lean HR Productivity
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Drivers for Change - Why?

Authorised as a Foundation Trust - 1st October
2007

Initial focus on developing a workforce plan to
support the long term financial model
Need to ensure workforce is deployed effectively
and efficiently with the appropriate skills to
meet the needs of patients


Now key focus is on quality and patient experience
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LPFT - Approach

Project across whole Trust - All services, Whole
Workforce

Service user and carer involvement


Three Phases
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Baseline analysis
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Identify opportunities, implement, set targets
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Evaluation and roll-out
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Tools

Observations


Activity analysis and capacity models



Caseload management tools




Mental Health Productive Ward

Productive Leader



New technology

Estates Strategy
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Sample of Case Review - Recovery


















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Messages from Review

1 in 3 well




1 in 3 seen monthly or longer





1 hr in 3 on face-to-face contact




1 in 2 long-term engagement (2 yrs)





Caseloads range 16 - 42



Non-clinical work not defined



KEY AREAS FOR CHANGE
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Case sample profile

• April 2007
• 10 (Red) New Referral/Relapse
• 47 (Amber) Active Treatment
• 43 (Green) Recovered

• April 2008
• 21 (Red )New Referral/Relapse
• 42 (Amber) Active Treatment
• 10 (Yellow) Social Inclusion Needs
• 15 (Green) Recovered
• 12 (Blue) Continued Care

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Learning Outcomes from both studies

Communication


Staff engagement on what matters to them











Leadership




Skills gaps and development needs








Information requirements





Variance in performance





Quality metrics







Equipping staff with tools
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A Local Health Community (LHC) Approach to
Workforce Development Planning

• Sue Hepworth
• (Nottinghamshire LHC Workforce Lead)

Jackie Hewlett-Davies (Derbyshire LHC Workforce
Lead)
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Our Challenge

To produce an integrated East Midlands Workforce
Plan to inform learning and development
requirements, and manage any identified risks to
service delivery, in order to produce a
workforce to deliver high quality services to
meet the needs of the local population.
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Response

5 County LHC Workforce Teams

LHC Workforce Boards as the Accountable Body for
Local MPET Resource


East Midlands LHC Workforce Leads Partnership
Forum
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Purpose of LHC Workforce Teams

Act as the link between NHS East Midlands / East
MidlandsHealthcare Workforce Deanery and Health
and Social Care employers




Ensure local, regional and national initiatives
are understood and implemented

• Robust partnership working
• Integrated Workforce Development Plans
• Evidence-based investment plans for education
  and training

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Benefits
Whole System approach to workforce development
planning
1.





Alignment of education investment to meet current
and future service needs
2.





Strategic approach to improving quality and
capacity of Practice Learning, and promoting
Interprofessional Practice Learning
3.


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Benefits (cont.)
4.
Supporting routes from education into careers in
Health and Social Care through widening
participation opportunities








Maximising use of resources and reducing
duplication
5.


Building capacity and capability of the Health
and Social Care workforce in workforce
development planning
6.


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Results Achieved

East Midlands Skills Academy for Health




Raised the profile of Skills for Life






East Midlands Framework for Assistant
Practitioner role




Developed the role of Health and Social Care
Ambassadors, and NHS Careers Taskforce




Learning and placements for 14 - 19 Society
Health and Development Diploma





Increased the number of Apprenticeships

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A Local Health Community Approach to Workforce
Development Planning Supports the Principles of













Co-production







Subsidiarity





Clinical ownership and leadership






System alignment




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NHS Leicester City Dis-solution Scheme
dissolving the barriers to employment solutions
for disabled people

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Dis-solution Scheme

Aims to address under-representation of disabled
workforce within the trust
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Offering work placements




Providing training, mentoring, building
confidence and identifying suitable employment
opportunities





Providing post-placement support





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Key Features



Partnership with LCIL







Senior Management Teams commitment and support






Pre, during and post-placement support for both
trust staff and disabled people










Ongoing evaluation




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Benefits



To increase the workforce representation of
disabled employees








To help disabled people make informed career
decisions/ job choices








To identify and reduce barriers that are
preventing disabled people from gaining
employment within the trust














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Benefits (cont.)



A workforce with a better understanding of
disability and improving patient care








Increased disclosure of disabilities











Change of culture







Tackling social exclusion by giving disabled
people a chance to improve their employability





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Future



We hope that the scheme will become integral to
tackling under-representation in the workforce.


































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NSR Challenge to Workforce

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Workforce Planning for Quality

Quality patient care is dependent upon robust
service planning underpinned by effective
workforce development planning which informs
educational and modernisation investment NHS
East Midlands Workforce Development Plan 2008 -
2011
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NHS East Midlands From Evidence to
Excellence Five Local Health Community Clinical
Visions







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Challenge and Opportunity

Workforce plans that




Are developed along care pathways


Transcend organisational boundaries



Demonstrate proper clinical engagement


Have clarity and transparency


Align with financial plans
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Workforce modelling using a system dynamic
approach









Maternity and newborn



Long Term Conditions





Trauma




Stroke



Primary Angioplasty (PPCI)
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Quality and Workforce

Delivery of effective and efficient care and
experiences for patients







Strategic Workforce Planning







Making it happen through

Trauma




Pathway based organisational and leadership
development





Robust change management programmes