Communities of Practice November 2014 Sheffield complete slide set

Seven Day Services Transformational Improvement Programme: Community of Practice

Thursday 13th November 2014

Improving health outcomes across England by providing improvement and change expertise

Welcome, we will be starting shortly

Agenda

2:00 Participants join 2:10 Welcome and introductions Rachel Chapman and Jodie Mazur

2:15 Seven Day Services Transformational Improvement Programme Marie Tarplee

2:30 Sheffield Early Adopter Team Dr Andrew Gibson, Ruth Brown and Paul Harriman

3:50 Summary and next steps Marie Tarplee

4:00 Close


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Agenda






4:00 Close

Seven Day Services

Transformational

Improvement

Programme

Marie Tarplee

Senior Improvement Manager

7 Day Services

Seven Day Services: The Context • Over the last ten years a growing body of evidence of poor

patient outcomes for patients admitted at weekends.

• The 5 day service model no longer meets justifiable patient and public expectations.

• Dec 2012 NHS England Everyone Counts ( 2012/13: Planning for patients).

• Sir Bruce Keogh Review and Forum Findings December 2013.

• Aligned with NHS England’s “Call for Action” united approach to fundamentally changing how we deliver health and care services: “Doing nothing is not an option”.

• Five Year Forward View ( NHSE October 2014)

NHS Director promises

seven-day service by

2017

‘unstoppable movement’

Sir Bruce Keogh

The Sunday Times

Seven Day Services: The Challenge

Taking on the challenge

“Stakeholders are finding it difficult to ‘see outside their

own front door’ due to operational pressures and

cost reduction”

“There are numerous plans and strategies in place but

little positive action and achievement”

“Competition between Trusts and lack of trust

between us is one hurdle”.

“Everyone thinks that the CCG’s should be driving the agenda as they have the legitimate power but in some areas leaders are questioning whether they have the courage to be radical”

“Patients want 7 day services but react when we need to close, relocate services to offer a 7 day service"

“We were slow to realise that it is not about additional funding or simply adding to acute workforce, we were not thinking laterally across the whole health economy”

So what are we to do?

Spread what we know works

Develop models to take us further

Enroll every provider &

commissioner

Build a momentum for change

Engage the public & patients

Commission the best

See local change happen at scale

& pace.

“How can we take on

the extraordinary

challenge of integrating services into a seamless,

consistent, high

quality seven

day service?”

Fiona Carey,

Cancer & Patient Representative

National Clinical Standards:

1. Patient Experience 2. Time to first consultant review 3. Multi-disciplinary Team (MDT) review 4. Shift handovers 5. Diagnostics 6. Intervention / key services 7. Mental health 8. On-going review 9. Transfer to community, primary and social care 10. Quality improvement

Delivering the Standards - Three Year plan

• Local contracts should include an Action Plan to deliver the

clinical standards within the Service Development and Improvement Plan Section.

Year 1

2014/15

• Those clinical standards which will have the greatest impact should move into the national quality requirements section of the NHS standard contract.

Year 2

2015/16

• All clinical standards should be incorporated into the national quality requirements section of the NHS standard contract with appropriate contractual sanctions in place for non-compliance, as is the case with other high priority service requirements.

Year 3

2016/17

NHS Improving Quality

7 Day Services Improvement Programme • The next 3 to 5 years, dedicated support, dedicated investment

• Signpost evidence from the diagnostic service reviews for 24/7 provisions across England including Interventional Radiology, Endoscopy and Scientific services to ensure providers and networks have plans in place to implement evidence based seven day diagnostics services and models.

• Start the drive for spread: engaging every commissioner and provider in moving towards the provision of services that are delivered in a way that meets NHS England’s Seven Day Services clinical standards.

NHS Improving Quality

7 Day Services Improvement Programme

• Support organisations to understand their baseline position – self assessment

tool, build on the evidence, measure outcomes.

• Start to identify the top interventions which will make the biggest difference to supporting delivery of local seven day services across the whole system.

• Supporting learning networks, communities of interest, building capability and capacity, communication & engagement.

– CCG Development, Service Improvement & large scale change programmes

• Share the learning widely across the health and care communities

7 Day Self Assessment tool

• The national self-assessment toolkit has been developed to enable organisations to baseline provision of seven day services.

• The toolkit will enable you to assess your current level of service provision, using nationally agreed definitions, and help you to understand your local needs and requirements to deliver extended services

• Accessed at:

http://www.7daysat.nhs.uk/

1. Patient Experience – Lack of access to social care across 7 days.

2. Consultant review – NEWS score widely used upon admission, but reduced review of NEWS after admission.

3. MDT – Significant variation, in terms of access to timely complex needs assessment and medicines reconciliation. No area reports having access to patients’ primary and community care records.

4. Shift Handovers – Little electronic recording of clinical data.

5. Diagnostics – Lack of weekend access to Bronchoscopy, Histopathology and MRI.

6. Intervention / key services – The majority of inventions / key services are available across 7 days across the country, variation in urgent radiology.

7. Mental Health – Variation in access across the country, particularly 1 hour standard.

8. On-going review – Lack of an electronic record is hindering achievement

9. Transfer to care – Lack of weekend access to equipment provision, occupational therapy, social services, senior clinical expertise & access to an integrated care record

10. Quality improvement – Good involvement of those who deliver care in the review of patient outcomes, majority of sites give training that is consistent with General Medical Council and Health Education England curriculum recommendations.

7DSAT: Early learning

Seven Top Tips

2. Understand your baseline position – “Don’t jump to solutions before you understand the real problem “

3. Engage, communicate, partner, network , align with the whole system - “You cannot achieve this alone”

4. Keep the focus on patients , safety, quality of care & outcomes

5. Don’t ignore the big challenges 6. If your not measuring– you’re not improving - If you are only measuring you’re not improving, but measure & improve the right thing that adds value

7. Get the messages right - services not working. Share the learning. Think scale & pace

1. Use a systematic Approach

Case studies

www.nhsiq.nhs.uk [email protected]

http://www.nhsiq.nhs.uk/

mailto:[email protected]

Thank you

[email protected]

07917 233248

www.nhsiq.nhs.uk

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4:00 Close

Sheffield Led 7 Day Services Community of Practice

Webinar 13 November 2014

Version 3 13 August 2014

Ruth Brown Operations Director Combined Community & Acute Group [email protected]

Presenting Today Dr Andrew Gibson Deputy Medical Director [email protected]

Paul Harriman Assistant Director, Service Improvement [email protected]

The Sheffield Team at the Delivering Services, Seven Days a Week Conference held on

22 July 2014

Dr Andrew Gibson, Deputy Medical Director speaking at the Delivering Services, Seven Days a Week Conference held on 22 July 2014

This afternoon we will talk through …

• Our journey so far

• An overview of our approach, model and results

• Our next steps

• Our approach to measurement and tests of change

The Starting Point……

• In 2010, a Geriatric Medicine Consultant analysed 23 sets of notes

• All 23 patients had avoidable delays in discharge

• 2259 bed days used, could have been 515

• Highlighted the discharge opportunities missed

The Big Room (Oobeya)

PDSA Cycle

The Big Room in action

Physiotherapist gives an

account of the test of change

to get a patient home on the day

they

were discharged by the GSM

consultant

Senior

registrar

General

Manager

For

Medicine GSM

Matron

Service

Improvement

Social

Services

Manager

Community

Services

manager Physiotherap

ist

Secretary

Discharge

Liaison

Development of the Frailty Unit

• Medical Assessment Unit (MAU) to Frailty Unit

• In April 2012 all Geriatric & Stroke Medicine Consultants changed their job plans enabling earlier senior review

• In May 2012, the Frailty Unit become a physical entity supported by a Front Door Response Team


• During this time, adult Community Services had merged with STHFT as part of ‘Transforming Community Services’

• Hospital and community teams at the interface were brought together and we began to understand each others worlds

• Single Front Door Response Team including therapy, managed within Community Services


• Assessment delays within hospital became more obvious

• The Big Room considered data and impact of standard method of discharge

• PDSA Testing – started with 1 patient, repeated with 3, then whole week

Frailty Unit Results in 2012

• 34% increase of patients discharged on the day of admission or following day

• No increase in the population of patients being readmitted

• Length of stay reduced by 4 days

• This model is now embedded

“Discharge to Assess”

“Discharge to assess as soon as the acute episode is complete in order to plan post-acute care in the person’s own home”

Imison. C. et al. (2012)

Older People and Emergency bed use: exploring variation The Kings Fund

“Discharge to Assess” Concept on a Base Ward

• In 2013, we chose RH6 to test “Discharge to Assess” based on local learning from Frailty Unit

• RH6 has 28 beds and is an elderly medical ward, part of the Geriatric Medicine and Stroke Directorate

• Patients have a wide range of medical conditions most with complex social problems and care needs

The Hospital Perspective

• Patients were waiting an average of 10 days to go home after their acute episode

• Medical patients were being treated on other wards eg surgery

• Impact on flow, cancelled elective care

• Assessments were undertaken in hospital environment

The Hospital Perspective

• Equipment delivery would take between 48 hours – 5 days

• Referrals for on going services had to be booked several days in advance

• Discharge for complex patients did not regularly take place at a weekend

• Hospital staff did not know or have trust in the Community staff or services

The Community Perspective • Provide rapid support for patients in their own home

(admission avoidance or hospital discharge)

• All patients in their own bed had to be seen within 2 hours if urgent or 24 hours if routine

• The service was available 7 days a week 8am – 10pm

• Generic assessment in place, supported by core skills training with Sheffield Hallam University

The Community Perspective Following the merger of Community Services with the hospital (and a period of settling in!) it became apparent that:

• the waiting time for patients into the intermediate care service was often over 10 days

• there was a need to build confidence and relationships with hospital based colleagues

• the discharge pathways were complex

The Big Room (Oobeya)

Testing Discharge to Assess on a Base Ward

• To support the testing, real time working was crucial for Community services

• Big Room principles allowed rapid, small ‘tests of change’

• Most patients assessed as needing lower levels of care than predicted by ward staff. Staff confidence increased.

• New processes were quickly adopted as routine for RH6 ward

The Big Room – Benefits • Patient Focus

• Development of a no blame culture

• Able to challenge historic practice and mind sets

• Reviewing expectations

• Understand each others language

• PDSA - Staff empowered to test

Sheffield’s Right First Time Programme

• Sheffield health and social care partnership

• Working together since 2011 to provide high quality, safe and effective care in the most appropriate setting

• Transitional care project

• Senior weekly meeting to understand and escalate any flow issues; CEO level sponsorship

October 2013

• Discharge to Assess was implemented on RH6 in October 2013

• It was already well embedded on the Frailty Unit

• The Community Intermediate Care Service aligned with the LA Short Term Intervention Team to create Active Recovery

• The results……..

RH6: Discharge count increased by 34%

RH6: Mean LoS reduced by 30%

RH6: Falls count reduced by 30%

Intermediate Care Results • We combined health and social care to form a new rapid

response service called Active Recovery

• Reduced the length of stay from 12 weeks to 6 weeks

• In September 2014, 100% of patients were seen at home within 24 hours

• 99% of patients were seen within 24 hours on the hospital discharge pathway (reduced from an average of 10 days)

The Discharge to Assess model • Proportionate assessment process in hospital

• Patients leave hospital as soon as they no longer need acute care

• All patients receive the same responsive service

• Transfer of care from the hospital to Active Recovery is within 24 hours, so discharge can be planned on same day or planned for next morning

The Discharge to Assess model

• Broader range of Community Services considered to meet the patients needs

• Single point of access – health and social care

• Discharged patients can be met at home

• Increase in community capacity via Active Recovery

Challenges • Major culture change - challenging historic practice

• Building confidence and trust

• Transport and admin systems

• Capacity to work real time

• 7 day working

• Expectations – Patient and Carers, Commissioners and Management

Benefits • Improved patient experience

• Reduced length of stay, falls and geriatric medical outliers

• Increased discharge rate

• Increased trust between hospital and community staff

• Removal of processes that don’t add value

• Joint core skills training rolled out to hospital therapists in provided by Sheffield Hallam University

Lessons Learnt

• This takes time, but the results are worth it

• The culture change required must not be underestimated

• Use shared values as a starting point – Patients First

• Ensure senior leadership manages Executive and commissioner expectations

Take time to make sure you understand each other

#NOF

Lessons Learnt

Our Next Steps

• Roll out of Discharge to Access across the Trust, increasing Community capacity ready for winter

• Focus of the Big Room is now ‘7 day working’

• Better Care Fund

• Merger of Community Services, Geriatric Stroke Medicine and all hospital AHP services on 1 October

7-day services - Our Approach to Measurement and Tests of Change

Topics • Measurements

• Types

• Data sources

• Example

• 7-day tests of change • Understanding the current problem

• The tests

• What we have learned and results

• What about costs

Measurements

• Various types • Measurements for Diagnosis

• Measurements for Improvement

• Measurements for Performance

• System level measures • Demand

• Supply

• Time

• WIP

Data sources • Patient events are recorded within our PAS

system.

• All data is extracted daily into SQL tables

• Relevant one for this is our Inpatient transaction table

• One line per episode with 180 fields per episode

• Data extracted into Access and then Excel to create admission and discharge pivot tables

• Also need midnight bed occupancy table

Example: Discharge Table ShortDayName (All)

Registered Practice Code (All)

AdmissionGroupWLAP (All)

Intended Management Description (All)

Hospital (All)

Admission Method Description (All)

EpisodeTypeDescription (All)

Consultant Surname (All)

Disch Day (All)

SpellLOS (All)

AgeOnAdmission2 (All)

AgeOnAdmission (All)

Specialty Description2 (All)

Specialty Description CARE OF THE ELDERLY

Discharge Destination Description (All)

Ward on Discharge (All)

Discharge Destination Description2 (All)

Count of Casenote Number Disch Day2

Discharge Date Weekday Weekend Grand Total

28/03/2011 22 22

29/03/2011 18 18

30/03/2011 18 18

31/03/2011 21 21

01/04/2011 16 16

02/04/2011 11 11

03/04/2011 6 6

04/04/2011 20 20

05/04/2011 27 27

06/04/2011 19 19

07/04/2011 25 25

08/04/2011 18 18

09/04/2011 12 12

10/04/2011 5 5

11/04/2011 31 31

12/04/2011 20 20

13/04/2011 16 16

14/04/2011 19 19

15/04/2011 17 17

16/04/2011 11 11

17/04/2011 7 7

18/04/2011 21 21

19/04/2011 18 18

Data plotted onto Control chart

What should we measure?

• DO NOT use the average for weekdays and the average for weekends and ratio them.

• If a patient should be discharge with equal probability on any day of the week

Then

Probability of discharge = 1/7= 0.143

So

Probability of discharge on a weekday = 5 x 0.143 = 0.71

Calculate the ratio for a specialty Count of Casenote Number Disch Day2

Discharge Date Weekday Weekend Grand Total Ratio

<28/03/2011

28/03/2011 - 03/04/2011 95 17 112 0.848

04/04/2011 - 10/04/2011 109 17 126 0.865

11/04/2011 - 17/04/2011 103 18 121 0.851

18/04/2011 - 24/04/2011 108 21 129 0.837

25/04/2011 - 01/05/2011 81 7 88 0.920

02/05/2011 - 08/05/2011 86 17 103 0.835

09/05/2011 - 15/05/2011 110 20 130 0.846

16/05/2011 - 22/05/2011 110 14 124 0.887

23/05/2011 - 29/05/2011 96 11 107 0.897

30/05/2011 - 05/06/2011 81 17 98 0.827

06/06/2011 - 12/06/2011 106 18 124 0.855

13/06/2011 - 19/06/2011 109 10 119 0.916

20/06/2011 - 26/06/2011 100 14 114 0.877

27/06/2011 - 03/07/2011 99 14 113 0.876

04/07/2011 - 10/07/2011 110 10 120 0.917

11/07/2011 - 17/07/2011 111 19 130 0.854

18/07/2011 - 24/07/2011 85 14 99 0.859

25/07/2011 - 31/07/2011 83 12 95 0.874

01/08/2011 - 07/08/2011 95 11 106 0.896

08/08/2011 - 14/08/2011 82 6 88 0.932

Plot that ratio on a chart

7-day tests of change

• Big Room

• What is the problem • Equality of discharge opportunity

• What is the cause of the problem • Weekends are different to weekdays

• What is different about the weekend?

Identified issues

• No ward nurse coordinator on duty • Reduced OT/Physio presence at weekend • Weekend therapy cover often from different specialty staff with no knowledge of

ward or patient • Lack of up-to-date knowledge of discharge system means it takes longer for a ward

nurse to process the work (as well as taking them away from patient care) • Lack of ward pharmacist • Difficulty in making Anticoagulation appointments • No junior docs on ward (1 on for acute medicine) • More difficult to arrange direct transport • Difficult to access Satellite SPA • Access to offsite beds • Lack of ward admin cover • Lower District Nurse numbers at weekend • More difficult to access GP • Access to imaging • Access to laboratory service • No consultant

Tests of change • Start small • One ward voted to be test-bed with others

watching • What could we change

• Nurse coordinator • OT and PT • Ward clerk • ? Pharmacy • ? junior doc

• Set up 1 weekends test • BUT……

Initial test

• Timing meant we couldn’t start

• So alternate proposed

Project: Older Peoples Care Service Improvement

Cycle: SD1 Date: weekends of 23/24 Aug and 31/1 Sept

Objective; We have noted over the past few years that weekend discharge counts are obviously lower than during the week. As part of the thinking around 7-day services and potential for reducing variation within and between wards we propose to learn how to move towards an equal chance of discharge on any day of the week. The ward teams have already identified resource differences at weekends. This test looks to see if identification of patients who could go home at the weekend enables the wards to prime the weekend discharge teams to affect that discharge.

PLAN

Questions Predictions

1. Will we be able to remind the wards to identify pts for discharge by Friday 1700

1. Yes, in the test Chris Hayden and 1 other will remind the wards on Friday afternoon.

2. Will the wards be able to identify patients who will be ready for discharge weekend

2. Yes

3. Will the weekend discharge team be able to effect those discharges

3. Yes

4. Will focusing on GSM discharges have an impact on other specialties

4. Yes

5. Will Active Recovery be able to take discharges at the weekend

5. Yes previous test have confirmed this

What data will be collected during this time? (Forms to be used) To be measured: Number and time patient identified on Friday Time w/e discharge team start and end the process Time patient leaves NGH Arrival time at home If patient stays at home with appropriate package Patient experience (narrative) Readmission Plot of weekday discharge ratio Who, what , when and where: All NGH GSM base wards, w/e discharge team, Active Recovery, SPA, transport, Chris Hayden Any patient who is capable of being discharged on the weekend who otherwise would have waited until the next normal working day.

DO the Action Plan

What went wrong? What happened that was not part of the plan?

STUDY

Complete analysis of data. Summarize what was learned include results of predictions.

ACT

What decisions were made from what was learned?

What will be the next cycle?

Cycle 2 Plan Project: Older Peoples Care Service Improvement

Cycle: SD2 Date: weekends of 4th/5th Oct

Objective; As part of the thinking around 7-day services and potential for reducing variation within and between wards we propose to learn how to ensure that ward staffing is consistent across the whole week and we move towards an equal chance of discharge on any day of the week. The ward teams have already identified resource differences at weekends. During test cycle SD1 we identified patients on Friday who could leave over the weekend. This led to a partial increase in discharges but it has highlighted that patients admitted at the weekend wait until Monday for a range of assessment/treatments. This test will attempt to staff across the weekend to the same level as during the week so that care appears more equal. Learning from this test will be carried forward to potential repeat tests over the next 8 weeks.

PLAN

Questions Predictions

1. Will we be able to provide additional nurse, therapist, admin, pharmacy and medical staff cover

1. No. We will struggle to be able to provide all staff groups. Pharmacy and junior doctors are main risk

2. Will the wards be able to discharge patients over the weekend

2. Yes

3. Will we be able to reduce the number of patients who remain unassessed on Monday morning

3. Yes

4. Will we be able to prevent the additional staff being removed from the ward to cover shortfalls elsewhere

4. No. Staff (nursing) shortfall elsewhere will see the additional staff input removed

5. Will patients require consultant input over the weekend

5. No, lack of direct consultant input is not likely to be an issue at this stage

6. Will transport be an issue 6. No, we predict that Arriva, Event or City taxi options will allow us to discharge

What data will be collected during this time? (Forms to be used) To be measured: Number of admissions and discharges over the weekend (existing data sets) List of identified defects and successes (Helen et all to create and keep a list) Unassessed therapy workload on Monday morning (OT/Physio to count on Monday morning) Any patient carer/comment Any AR issues Who, what , when and where: RH6 staff on daytime period over the weekend 4/5 Oct

DO the Action Plan

STUDY

ACT

Now upto 7 cycles

• What have we learned? • Not having one of the key staff causes a problem

• Ideally need staff from existing ward team

• Lack of ward-based Junior doctor is an issue

• Lack of ward-based pharmacy is an issue

• No identified need for a consultant

• Removal of staff on Friday compromises weekend discharges

• Reduced Monday morning batches

• Admit and discharge within the weekend

• Cycle 2 - 7 discharged, 1 admit & discharge

• Cycle 3 - 3 discharged, OT not from base ward only 1 PT pt for Mon am

• Cycle 4 - 3 discharged but could have been 8 (no staff for Sat)

• Cycle 5 - 4 discharged (but 16 others in week)

• Cycle 6 - 3 discharged, the only ones who could

• Cycle 7 – 4 discharged, no OT on Sunday

What about the cost?

• Cost is a balance measure

• So far about £900 per weekend (equivalent of 3 nights stay)

• No additional patients, just earlier

• Will reduce total ward capacity allowing reallocation of resources

5-day system example Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun LoS

1 1 1 1 4

1 1 1 1 4

1 1 1 1 1 1 6

1 1 1 1 1 1 6

1 1 1 1 1 1 6

1 1 1 1 1 1 6

1 1 1 1 1 5

1 1 1 1 4

1 1 1 1 4

1 1 1 1 1 1 6

1 1 1 1 1 1 6

1 1 1 1 1 1 6

1 1 1 1 1 1 6

1 1 1 1 1 5

1 1 1 1 4

1 1 1 1 4

1 1 1 1 1 1 6

1 1 1 1 1 1 6

1 1 1 1 1 1 6

1 1 1 1 1 1 6

1 1 1 1 1 5

1 1 1 1 5.29 mean

1 1 1 1

1 1 1 1 1 1

1 1 1 1 1 1

1 1 1 1 1

1 1 1 1

1 1 1

WIP per night 6 6 6 6 4 4 5 6 6 6 6 4 4 5 6 6 6 6 4 4 5

WIP per night x 60 360 360 360 360 240 240 300 360 360 360 360 240 240 300 360 360 360 360 240 240 300

max WIP 360

mean WIP 317

Util with 360 beds 100% 100% 100% 100% 67% 67% 83% 100% 100% 100% 100% 67% 67% 83% 100% 100% 100% 100% 67% 67% 83%

mean util 88%

0

1

2

3

4

5

6

7

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

LoS

7-day system example Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun LoS

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4

1 1 1 1 4 mean

1 1 1 1

1 1 1 1

1 1 1 1

1 1 1 1

1 1 1 1

1 1 1

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240

mean WIP 240

Util 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

• Initial ’5-day’ system required 360 beds

• Redesigned ‘7-day’ system requires 240 beds

• Same number of patients being admitted

• Which was better for the patient?

Thank you!

Andrew Gibson [email protected]

Ruth Brown

[email protected]

Paul Harriman [email protected]




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4:00 Close

Next Community of Practice: Led by County Durham and Darlington Early Adopter

• “Preparing for the implementation of 7 day services”

• Wednesday 14th January 2015 11:30-13:00

www.nhsiq.nhs.uk

[email protected] #nhs7dayservices

Seven Day Services Transformational Improvement Programme

http://www.nhsiq.nhs.uk/


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Communities of Practice November 2014 Sheffield complete slide set

Healthcare

Transcript of Communities of Practice November 2014 Sheffield complete slide set