building and strengthening leadership
TRANSCRIPT
Building and Strengthening
Leadership
Chair: Bronagh Scott, NHS England London Region
Leadership in Action Shelley Dolan, The Royal Marsden Hospital NHS Foundation Trust,
and London Cancer Alliance
Leading Integrated Community Teams Rachel Street, Amanda Mayo & Tracy Stocker, Bromley Healthcare
Community Interest Company
Monday 9 February 2015
Twitter: #transformLDN
Leadership in Action
Dr Shelley Dolan
Chief Nurse, The Royal Marsden Hospital NHS Foundation Trust, and
Clinical Director, London Cancer Alliance
The Royal Marsden
Transforming community and general
practice nursing in London – the art of the
possible
Building and Strengthening Leadership
Dr Shelley Dolan, Chief Nurse, The Royal Marsden
& Clinical Director, London Cancer Alliance
The Royal Marsden
Objectives: Leadership in Action
– The context of The Royal Marsden & SMCS
– Input and Transformation over 4 years
– Specific improvements
– Clinical leadership change models
– New clinical leaders: Nurse Consultant / Darzi Fellow
– New educational models
– The evidence: Safety, Quality and Patient Experience
The Royal Marsden OSC - November 2013 5 5 5
Our mission
To continue to make a national and global contribution to cancer research and treatment so that more people are cured, and quality of life is improved for those living with cancer
The Royal Marsden Staff open meeting - November 2014 6
SMCS became part of The Royal Marsden 1st April 2011
The Royal Marsden
What is the Problem?
• Increase in demand and activity
• Patient population
• High rates of organisational change
• Short term relationships
• Pressures to see more patients
• Long shifts / issues with IT
• Reported problems with patient experience across London
The Royal Marsden
Patients’ experiences are a mix of the ‘what’ (T) and the ‘how’ (R)
– Respect for values, preferences, and expressed needs (R)
– Coordination and integration of care (T)
– Information, communication, and education (T+R)
– Physical comfort (T)
– Emotional support (R)
– Welcoming the involvement of family and friends (T + R)
– Transition and continuity (T)
– Access (T)
Transactional (T) and relational (R) dimensions of care
Low relational High
tran
sact
ion
al
High
The Royal Marsden
The combination of transactional (T) and relational (R) dimensions is
often difficult
High
High Low
T
R
Efficient and impersonal
Efficient and warm
Chaotic and rude, indifferent
Chaotic and warm
T
The Royal Marsden
What do we mean by Quality Care: Personalised Care?
(Professor Jessica Corner, Dr. Jocelyn Cornwell)
The Royal Marsden
Staff Engagement and care The evidence
• Quality of staff experience precedes quality of patient experience (Maben et al 2012
• Analysis of national staff & patient experience surveys: the two sets of experience are related (Raleigh
et al 2010)
• Management & quality of HR practice linked to mortality and other quality measures (West et al (2009)
• National impetus – Out of Hospital care - however
• 2012 It felt that Community Nurses had been forgotten, much concentration nationally on HVs but not Community Nurses.
The Royal Marsden
Community Nursing profile grows across London.
– Involved in the successful bid for education across all three LETBs for Community Nursing £360,000
– lobbied to improve the profile of School Nurses across London
– Successfully provided Health visiting response to extend 6 day services (fully funded)
– Excellent communication with Chief Nurses across London supporting each other in leading new services.
– The Chief Nurse NHS E (London) focused, supportive and has invested in raising the profile and awareness of community nurses.
The Royal Marsden
At The Royal Marsden SMCS Investment in the Community – all supported by Commissioners
– Locality Teams
– Nurse Leads
– Quality & Safety CNS
– Nurse Consultant CRISIS
– DARZI Nurse Fellow
– Education for new nurses to the Community
The Royal Marsden
Building a Leadership team: Community Rapid and
Intensive Support Integrated Service (CRISIS) Nurse
Consultant CRISIS Team
– Greater integration of the Community teams associated with the prevention of the avoidable attendance and admission of people to hospital and the provision of intensive discharge support for people at home and within intermediate care bedded facilities.
– These teams will be incorporated within the Community Rapid and Intensive Support Integrated Service (CRISIS) and be the focus for unplanned and intensive care.
– A Nurse Consultant will commence in March 2015 to be the overall clinical lead as well as the professional nursing lead for CRISIS, supported by professional leads for physiotherapy and occupational therapy.
The Royal Marsden
The world of the Nurse Consultant In the hospital
– Prevention of avoidable admission via A&E & AMU/CDU
– Intensive supportive discharge via A&E, AMU, CDU & Inpatient Wards
– Community Nursing Liaison Service (In -reach) at SGH & St Helier’s Hospital, 5 - 7 days per week
In the community
– Prevention of avoidable attendance at A&E – Provision of intensive support for people going to
intermediate care beds rather than going to hospital & intensive supportive discharge to home or intermediate care beds
With Social Care – Facilitating the integration agenda
The Royal Marsden
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The Royal Marsden School Nurses New to the Community Programme
The Royal Marsden
Dedicated programme devised by education experts and community experts
The Royal Marsden
Nurses New to the Community Development
Programme
– The Royal Marsden School has worked with SMCS to develop a structured programme to aid qualified nurses new to working in the community
– An 8 day programme addresses key clinical and professional issues, plus negotiated time for the group to identify their own learning needs to be met on the programme
The Royal Marsden
Nurses New to the Community Development
Programme
– In class, students presented a potential change in community practice which could improve patient care and considered how this could be implemented
– All students undertook the class presentation - and others offered an optional written review of the change for degree level academic credit through St George's, University of London
The Royal Marsden
Nurses New to the Community Development
Programme
– Community colleagues and managers attended the presentations to support the students and consider how the changes could be taken forward – bringing theory and practice together
– Two programmes ran in February (N 14) and September 2014 (N 9) with a new course due in March 2015
The Royal Marsden
The SMCS community nursing service has, over the past three years, markedly improved its KPI performance…
2012/13
41%
8%
51%
2013/14
64%4%
32%
2014/15 (to Q3)
96%
2%2%
The Royal Marsden
How likely are you to recommend this service to friends and family if they needed similar care or treatment?
The Royal Marsden Staff open meeting - November 2014 23
Conclusion
Investment in:
• Clinical Leadership
• Nurse Consultant
• Darzi Fellow
• Locality leads
• Safety & Quality CNS
• Education for nurses new to the Community
• Improved staff and patient experience
• Improved Safety, quality & productivity metrics.
Leading Integrated Community
Teams
Rachel Street, Assistant Director
Amanda Mayo, Head of Nursing
Tracy Stocker, Operations Manager for the Integrated Teams
Bromley Healthcare Community Interest Company
Bromley Healthcare CIC
Leading Integrated
Community Teams
The Challenge
From:
four District Nursing Teams (18+ caseloads)
one Community Physiotherapy Team
one Community Occupational Therapy Team; and
one Community Matron team
To:
Six multidisciplinary locality based integrated
Community Teams
And pilot social care and mental health integration
The Approach
Staff buy in and
engagement
Listen…..…really listen
“if you don’t tell me, how
will I know?”
The small stuff matters
Driven by front line staff….
• Six Geographically Based Teams
• Team Leader, Community Matrons,
Therapists, District Nurses and Community
Staff Nurses, HCA’s and Phlebotomists
• Each Team is supported by a team
coordinator and admin support
• The Willows running an extended pilot with
a CPN (Oxleas)and a Social Care Manager
(LBB)
Patient focused coordinated care….
“Prior to our first multi-disciplinary meeting I had the usual reservations about whether the whole thing
might collapse at the outset. However our first whiteboard meeting went very well and it became
immediately apparent that this way of working had enormous benefits for patients. It was a joy
to pull together clinical experience from across professions and to work together in developing care
plans for our most complex patients.
It’s what nursing and caring for patients in the community is all about.” Betty, Integrated
Community Team Leader
Critical Learning Points
• Don’t forget the small things
• Team Leader role is not easy
• Remember the existing pressures
• There are some quick wins, but true integration
takes time and culture change
• Leadership at ALL levels is key
Still a long way to go
• Using technology – EMIS – building the system
and templates to support integrated working
• Wider Integration
• Social Services
• Mental Health
• Baseline of core skills
• On-going leadership development
Integrated Community Team Staffing Structure
Team Coordinator
Community Matron
District Nurses
Physiotherapists
Occupational
Therapists
Community Nurses
Healthcare Assistants
Team Coordinator
Community Matron
District Nurses
Physiotherapists
Occupational
Therapists
Community Nurses
Healthcare Assistants
Team Coordinator
Community Matron
District Nurses
Physiotherapists
Occupational
Therapists
Community Nurses
Healthcare Assistants
Team Coordinator
Community Matron
District Nurses
Physiotherapists
Occupational
Therapists
Community Nurses
Healthcare Assistants
Team Coordinator
Community Matron
District Nurses
Physiotherapists
Occupational
Therapists
Community Nurses
Healthcare Assistants
Team Coordinator
Community Matron
District Nurses
Physiotherapists
Occupational
Therapists
Community Nurses
Healthcare Assistants
Team Leader Beckenham Beacon
Integrated Community
Team Leader
Team Leader Addington Road
Integrated Community
Team Leader
Team Leader Princes Plain
Integrated Community
Team Leader
Team Leader Chislehurst Road
Integrated Community
Team Leader
Team Leader St Pauls Cray
Integrated Community
Team Leader
Team Leader The Willows
Integrated Community
Team Leader
Jane Parker Integrated Community Teams Service
Lead (Nursing)
Debbie Bristow Integrated Community Teams Service
Lead (Therapy)
Tracy Stocker
Operations Manager
Rachel Street
Assistant Director of Operations
Janet Ettridge
Director of Operations
Amanda Mayo Head of Nursing
Marie-Louise Muir Practice Educator
Jo Walls Head of AHPs
Quality Team
Operations
Monday 9 February 2015
Twitter: #transformLDN
Transforming community and
general practice nursing in
London – the art of the possible A partnership between NHS England, NHS Health Education North Central
and East London, NHS Health Education North West London, and
NHS Health Education South London.