helen bevan 18 th march 2010. copyright ©: nhs institute for innovation and improvement 2008-2009...

Helen Bevan18th March 2010

The “Productive” (Releasing Time) Series

Direct Care Time

Motion Admin Discussion Handovers InformationRoles

Opportunity to increase safety and reliability of care

Total Time

“Everything I need to do my job is conveniently

located” ‘The paperwork is easy to understand and quick to complete’

I am not interrupted by people requesting

information or looking for things

‘’Handovers are concise, timely and provide all

the information I need”

‘It is clear to everyone who is responsible for

what”

‘We have the information we need to solve our own

problems, and find out if we were successful”

The focus is on direct patient care

What we are learning from Releasing Time to Care

How much energy can be unleashed by encouraging front line teams to question how they work and providing simple tools and skills to do this

Energy focus

Imagination, engagement, participation, moving and mobilising

The “anatomy

” of change

Effectiveness and efficiency

Metrics and measurements;

technical systems and process

design, clinical pathways,

evidence based medicine

Improving healthcare

The “physiology”

of change

Commitment of the people

Control of the processes

Alienated Ascendant

Apathetic Anarchic

Source: Wickens

Where we are trying to get to…

Lean organisation alignment

Building on a strong foundation:The Productive Ward - the evidence

Research study from NHS London

• Releasing Time to Care has been a significant catalyst for change

• It has resulted in measurable, positive impacts.• 13 percentage points increase in median Direct Care Time• 7 percentage points increase in median Patient Satisfaction Scores• 23 percentage points increase in median Patient Observations

Source: NHS London 2009

This equates to having an extra 255 full‑time nurses….while an equivalent level of service improvement without the programme would cost an estimated £7.5 million a year

Nursing Management July 2009

‘Putting frontline staff in control’

22 January 2009

Modular Structure:Module Box Set

Basic principles

The Productives concentrate on the HOW, not the WHAT

• The vast majority of all healthcare guidance concentrates on end standards (i.e. the WHAT)

• Our staff need help with HOW to implement these standards, so they happen 24/7 – even on a Sunday night!

Critical factors for success with any Productive

Leadership at Executive level √

Aligned with strategic direction √

Governance of the programme √

Continuous improvement √

Capability and knowledge √

Right people in place √

Source: NHS London Review May 2009

Team Design:The Activity Follow tends to show that, despite the aspiration to have well defined teams, team definition collapses as the shift goes on

Bay 10

Bay 11

Bay 12

Bay 13

Off Ward

Learning to See

Using video in observation:Bringing to the surface custom and practice

Mixed linen in clean disposal room

Learning to See

Patient access areas

Learning to See

Undesirable waste storage

Don’t forget, we live in a 3D world…..

STANDARDISE

SUSTAIN

10 point module checklist

NO. TASK WHEN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62

1 SLUICE TEAM AUDIT

2 LINEN CUPBOARD TEAM AUDIT

3 NURSING STATION TEAM AUDIT

4 TREATMENT ROOM TEAM AUDIT

5 PERFORMANCE BOARD TEAM AUDIT

6 PATIENT STATUS BOARD TEAM AUDIT

7 MEAL ROUND AUDIT

8 OBSERVATION AUDIT

9 MEDICINE ROUND AUDIT

10 HANDOVER AUDIT

11 ADMISSION AUDIT

12 AUDIT SYSTEM AUDIT

13 TREATMENT ROOM MANAGER AUDIT

14 PATIENT STATUS BOARD MANAGEMENT AUDIT

15 NURSING STATION MANAGER AUDIT

16 PERFORMANCE BOARD MANAGEMENT AUDIT

17 SLUICE - MANAGER AUDIT

18 LINEN CUPBOARD MANAGER AUDIT

AUDIT PLANNER (EXAMPLE)WEEK

VISIT PYRAMID AUDIT SUITABILITY COLOUR CODE

Example Audit Planner Table:

Audit Planner in detail:

Visualisation is a key principle used in:•The Well Organised Ward•Patient Status at a Glance•Knowing How we are Doing

With visualisation, we aim to be able to find the status of someone, something, or some process in three seconds

Visualisation

Visualisation: Visualisation and the 3 second ruleFloor markings and photographs detail location, number and contents of trolleys that should be

stored in this room

An example: NHS Yorkshire and Humberside

Examples of reach and impact in the NHS in Y&H are as follows:

• All 36 NHS healthcare provider organisations in Yorkshire and Humber are implementing one or more of the Productive programmes

• In four hospital systems, over 97% roll out of the Productive Ward or Productive Mental Health Ward to their front line team/wards (Sheffield, Hull & Airedale, RDASH - MH),

• Another hospital system has achieved over 75% roll out (Leeds).

• Two organisations have adapted Productive Ward for their Community Health teams- Kirklees 44 teams and Doncaster two teams

• Every provider organisation in Yorkshire and the Humber can provide examples of how the Productive methodology has resulted in improvements in the quality and productivity of care.

Sheffield Teaching Hospitals

• A five hospital system• 100 wards (approx)• Went “live” January 2008• Local adoption, first group May 2008 last group

March 2010

Local adoption

• currently 97 areas working on programme• 1st outpatient area started September 08 • 10 outpatient areas now working on the programme• labour and delivery started January 09 • remaining maternity wards started March 2010• both day surgery units started Sept 09

Successes

– Direct care time increased by 32% (4.5 hours per nurse per shift)

– Time spent walking / looking for equipment has reduced from 130 minutes (over 2 hours) to 25 minutes

– Time spent on nursing documentation has reduced from 127 minutes to 82 minutes

Successes• No more looking for keys – digital locks for drug cupboard

• Short term sickness reduced from 10% to 1% and sustained

• Reduction in falls

• Handover reduced by 30 minutes per nurse per shift – 3 hours per day

• Ward round reduced from 60 – 90 minutes to 20 – 40 minutes

•Some areas using Productive Community Hospital Modules for patient flow:

-Outpatients-Labour and delivery-Emergency admission

•Day case / short stay areas started Productive Ward foundation modules will combine with productive theatre process modules

•Adapted activity follow to reflect workload

•Productive Community Services encompass staff working cross boundary

•Medical Records using Productive Ward methods and combining it with Productive Leader methods

Combining

Director of Finance – “What actual cost savings have been made?”

Director of Quality – “How much time has this module actually saved?”

Director of HR – “What skills have the team actually improved?”

Chief Executive – “How much more efficient have the team become by

doing this programme?

The Productives Module Impact Framework

helps answer the following questions:

The Productives Module Impact Framework:

(i) can help you analyse qualitative and quantitative impact data (inc financial)

(ii) can aggregate impact data across an organisation and across all Productive programmes

(iii) can create impact reports at organisational and regional level at the touch of a button

Impact Areas

1: Staff experience and wellbeing 2: Process improvements

4: Financial impacts

3: Knowledge and skills

Learning from the Productivesso far…

• Energy can be unleashed by encouraging front-line teams to question how they work and by providing simple tools and skills to help them do this

• It is possible to achieve virtually universal take up

• Excitement can be created and then steered, rather than forcefully “over-designing” a programme

• Modules are leadership methods rather than improvement tools

helen bevan 18 th march 2010. copyright ©: nhs institute for innovation and improvement 2008-2009...

copyright nhs institute

nhs london

control slide

direct patient care

physiology of change

median direct care time

time nurses

reliability of care

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