Transcript Slide 1

“Time to Make a Difference”
Evelyn Barker
Chief Operating Officer
Trust Board
10th April 2014
Local Context
 High occupancy levels
 High and sustained escalation
 Crowding in Emergency Department and Assessment Unit
 Elderly population – high admissions
 Counter productive patient placement
 Challenging 4 hour performance across the Trust
 Cancellation of patient operations due to bed pressures
Objectives for the week
To rapidly get the Trust back on the ‘front foot’
To improve patient experience, safety, quality
and flow throughout the Trust
To urgently recalibrate the system
To reduce overall bed occupancy
To accelerate and improve discharge processes
To use the week to accelerate and embed
known good practice
To engage staff and improve the working
To reduce high escalation levels
To improve operational performance
Some of our commitments
 To cancel all non urgent
meetings and reduce email
 Consultants to stand down
all non clinical SPAs
 There will be 2 ward/board
rounds a day on every
ward across both sites
 Increased visibility of
senior staff
 We will deploy Liaison
Officers to wards
 Introduction of Internal
Professional Standards
 We will move to “Go and
How has it worked ?
 The Trust has been run as a
controlled critical incident for 8
 Command & Control structures
in place
 Daily ‘wash up’ meetings to
gather intelligence
 We listened, shared our
experiences and thanked our
staff daily for their input
The Outcomes?
 New ways of working introduced
 Improved staff morale and ‘can do’ attitude, with a
‘licence’ to test new ideas
 Patient discharges earlier in the day
 Fewer patient bed moves early evening
 Reduced outliers
 A ‘sense of calm’ on the wards
 Similar level of emergency patient admissions as
expected, but 111 more patients discharged than
admitted - over the first 4 days!
 Reduced our bed base by closing 50 contingency
 Improved patient flow through hospital, with improved
performance against the 4 hour standard
How do we sustain the momentum?
 Focus on improved good practice, such as
single clerking, improved handover
 Maintain the new triage & assessment
processes for medical and surgical
 Early morning discharges and ‘pull’ from EAU
to specialty wards
 Implement Internal Professional Standards
 Implement SAFER Flow Bundle
 Repeat the concept before winter
S - Senior Review, all patients will have a Consultant Review before 12
A - All patients will have an Estimated Discharge Date (that patients are
made aware of) based on the medically ‘suitable for discharge’ status
agreed by the clinical teams
F - Flow of patients will commence at the earliest opportunity from
assessment units (EAU & SAU) to inpatient wards. Receiving wards
from assessment units will commence before 10am daily
E – Early discharge, 30% of our patients will be discharged from base
inpatient wards before 11am. TTO’s for planned discharges should be
prescribed and with pharmacy by 3pm the day prior to discharge
R – Review, a weekly systematic review of patients with extended
lengths of stay ( > 7 days) to identify the issues and actions required to
facilitate discharge. This will be led by senior leaders within the Trust.
Key Learning
• Planning and preparation were key
• Telling the compelling story of why we were
implementing the “Time to Make a Difference” week
• High level endorsement and visible support
• Clear structure and success measures
• Staff engagement - regular communications set the
drumbeat and created a ‘buzz’
• A sense of community spirit
• Ownership - all staff taking personal responsibility