Releasing Time to Care:Implementation with the

Southern HSC Trust

Kay CarrollLead Nurse , Southern HSC Trust

Sharon KennedyWard Manager, Southern HSC Trust

Implementation stages

• Regional Launch 1 October 2008• All 5 Trusts participating in the pilot stage• Project Leads training 29/30 October • Familiarisation event in each Pilot Trust • Ward based staff training

– 28th Nov,26th Jan, 12th Feb, 12th March 2009• Evaluation of pilots March 09• Rollout to other ward?

Releasing Time To care The Productive Ward

Releasing time to care - is a systematic and inclusive approach to improving the reliability, safety and efficiency of the care that you deliver.

Releasing Time To care The Productive Ward

Executive LeadJoy Youart

Acting Director Acute Services Directorate

Project Leads

Jacqueline MortonHead of Reform

Glynis HenryAssistant DirectorNursing Workforce

Development & Training Nursing Governance

Key roles

• Senior management team and Trust Board• Steering Group• Executive Leader• Project leads• Ward Leader• Ward team• Support from other areas e.g. Finance,

Information and Estates

Expectations of Executive leader• To influence and work with staff on the wards and to influence

and communicate with senior management team colleagues and Trusts Board members

• Ensuring there is senior management team / Board sign up and understanding of the Productive Ward

• Selling the benefits of PW to the organisation• Clarifying the challenges for the organisation • Ensuring the Board understands that PW is focused on improving

the quality of care, not an opportunity to reduce costs• Ensuring that senior colleagues understand the need to be

visible on wards, supporting the staff

Expectations of Project Leader• Responsible for the successful planning and implementation of

the Productive Ward • Project management – overseeing implementation• Managing expectations• Support to Executive Leader and Ward Manager• Stakeholder management• Communication and visible involvement• Tracking progress• Enabling ward staff• Securing resource• Reflection and learning from the process• Being enthusiastic, credible & empathic

Expectations of Ward leader

• Understanding the basic principles of PW• Understanding the benefits PW can bring to your ward• Ensuring staff attendance at all training sessions• Leading your staff in the implementation of PW in your

ward• Addressing emerging issues• Working closely with your Project leader• Regular communications with all ward staff including

shift staff• Being a point of contact for other interested wards

Introduction to Releasing time to care

• Two information sessions for staff.• Meeting with Medical staff.• Dissemination of information to other members

of MDT.• Communication Board in MDT room.

LEAN PHILOSOPHIES

• Elimination of Waste.

• Respect for people.

Lean Methodologies . 6S

Visual Management.

Process Flow analysis.

SMED.

Standard Operating Procedures.

Releasing Time To care The Productive Ward

Knowing How Your Doing

–Developing Ward based measures to help your team make informed decisions

ONLY

33 %OF NURSES TIME

WAS SPENT ON

DIRECT NURSING CARE N.H.S INSTITUTE FOR INNOVATION & IMPROVEMENT AVERAGE 40%

Measures Board

1. Infection control issues.• Hand Hygiene audits.• Commode Audits.• Environmental audits.• C Difficile• MRSA / MSSA bacteraemia.

Measures Board

Complaints.• No of complaints.• Reason for complaint.• Profession indicated.

• Length of stay.• EDD recorded.

Measures Board

HUMAN RESOURCE ISSUES• Sickness and Absenteeism rates.

• Nurse Bank and agency use and costs.

• Display of a nursing dashboard in public area including Infection control, ALOS, complaints, sickness and absenteeism. Measures include the C DIFF infection rate which is supported by the hand hygiene audits scores. This allows the team track progress and to identify areas that may require a focus and improvement;

Releasing Time To care The Productive Ward

Well organised ward.

–Making Ward areas work for your team instead of hindering them in the delivery of care

Ward 1 South

REORGANISATION OF STOCK

• 76% reduction in the number of steps taken to set up a catheterisation trolley

• 234 steps reduced to 61 steps• 4:46 minutes reduced to 2:16 minutes

Cash Savings

CASH SAVINGS £2080

Excess pharmacyreturned £1200

Excess TSSUreturned £880

Releasing Time To care The Productive Ward

Patient Status at a Glance

The ward team develops visual patient information that improves communication, patient experience and patient flow

PATIENT STATUS AT A GLANCE

• Patients name• Name of consultant.• EDD.• Infection control status.• Outliers. • MDT Referral.• Dietary options.

Releasing Time To care The Productive Ward

Meals

The ward team reduce the time spent physically delivering meals and allow more to assist with feeding and ensuring proactive nutritional assessment for ward patients

Releasing Time To care The Productive Ward

Meals• Establish new membership.

• Engage with catering, Portering domestic dieteticians and communication team.

• Baseline data. Audio video meals Patient survey.

Implement “ 10 a day “

Roll out Feedback to SMT.

Develop Roll out programme.

Ward Managers Half day workshop May 09. Two day residential June/ Sept. LEAN methodology/ Releasing time to care.

Training Programme for Trainers for Southern Trust commenced Sept 09.

CHALLENGES:• C --- Complex• H --- Huge.• A --- Achieved.• L ---Learning.• L --- Longevity• E --- Engagement.• N --- Negotiation.• G --- Gains• E ---- Evidence• S --- Success/ support.

The Way Forward

Releasing Time to Care is not a project … it focuses on improving ward processes and environments to help nurses and therapists spend more time on patient care thereby improving safety and efficiency.