Transcript Document

Overview & Update
of the PW initiative in Ireland
Mark White, National Lead PW
Director NMPD HSE-SE
RCSI Masterclass
Thurs 6th November 2014
What is Productive Ward: RTC?
“It is a ward-based Quality improvement
programme that enables and empowers
ward teams to improve the safety, quality
and delivery of care, with a focus on
releasing more time to care”
Productive Ward Aims:
• To increase the proportion of time nurses
spend in direct patient care
• To improve experience for staff and for
patients
• To make structural changes to the use of ward
spaces to improve efficiency in terms of time
effort and money
(NNRU & NHSI 2010).
Productive Ward Module ‘House’
Quality improvement activities that include:
• improving clinical leadership by equipping ward leaders with methods to
lead and help their staff to deliver safer, more dignified care
• empowering ward-based teams to take ownership and control of wardbased processes
• developing stronger, more confident front-line leaders
• creating a ward based culture of measurement and improvement
• applying lean/improvement methods and tools in a ward setting
• encouraging an entire patient focus with all of the changes/improvements
• improving team-manager relationships through collaborative working and
corporate engagement
PW in Ireland 2001-2014
• Standalone Clinical Programme, (cross-programme initiative)
• Expression of interest to engage with PW initiative in Autumn
2011
• Phase 1 sites identified x 17 hospitals (24 wards)
• MI Training December 2011- implementation started Jan 2012
• Phase 2 sites (same process, refined) commenced
implementation Jan 2013 (9 hospitals; 20 wards)
• Phase 3 sites commenced January 2014 (8 Hospitals; 46
wards)
Productive Ward Phase 1-3
HSE West Phase 3
• Portiuncla Hospital
HSE NE Phase 2
HSE DNE Phase 3
•UL Maternity Hospital
• National Orthopaedic Cappagh
•UL Dorradoyle
•St Josephs, Raheny
•Merlin Park Hospital
• Our Lady’s Navan
HSE DNE
•Cavan General Hospital
HSE West Phase 2
•OLOL Drogheda
• Nenagh General Hospital
•Beaumont Hospital
•UCHG
•Connolly Hospital
HSE West
HSE DML Phase 2
•Letterkenny General Hospital
• National Rehab Hospital
•Sligo General Hospital
•Peamount Hospital
•Our Lady’s Manorhamilton
•Roscommon County Hospital
HSE DML
•Ennis General Hospital
• St. Vincent’s University Hospital
•St Johns Hospital Limerick
• Coombe University Hospital
•Midlands Regional Hospital Portlaois
HSE South Phase 3
•Midlands Regional Hospital Tullamore
• Merrymount Hospice
HSE South (SE)
•University Hospital Waterford
HSE South
•South Infirmary/Victoria
University Hospital
•Cork University Maternity
Hospital
•SthTipp General Hospital
HSE South Phase 2
• Mercy University Hospital
•Macroom Comm Hospital
HSE South (SE) Phase 3
•St Lukes Hospital Kilkenny
Total to Date...
Hospital Sites = 34
Wards = 90
Bed Numbers= 1970
National Results – Macro view
Hospital Site
Ward
DPC-time
T1
DPC-time
T2
Increase or
Decrease
Coombe
Our Lady's Ward
46%
59%
↑
National Rehabilitation Hospital
St. Patrick's Ward
59%
49%
↑
Peamount Healthcare
ARRU - Age Related Rehab Unit
37%
51%
↑
St. Vincent's University Hosp - SVUH
St. Anne's Ward
42%
49%
↑
56%
63%
↑
St. Vincent's University Hosp - SVUH
St. Patrick's Ward
MRH-Tullamore
Medical 2
54%
54%
↔
Beaumont Hospital
Adams McConnell Ward
33%
39%
↑
Our Lady's Hospital Navan
Male Medical Ward
35%
55%
↑
Mercy University Hospital
St. Catherine's Ward
56%
53%
↓
Elective Level 1 South Ward
38%
42%
↑
47%
45%
↓
34%
44%
↑
(SIVUH) Cork
(SIVUH) Cork
ENNIS - MWRH
Obs 1 Level 1
Surgical Day Ward
Galway University Hospital
St. Anne's Medical Ward
48%
30%
↓
Galway University Hospital
St. Michael's Ward
45%
30%
↓
Roscommon Hospital
St. Colman's Ward
Stroke and Medical Rehabilitation
Unit
34%
60%
↑
53%
47%
↓
Letterkenny General Hospital
WARD RESULTS – The Micro view
ST. PATRICK’S WARD -SVUH
Direct care: 52% Jan 2012 → 63% Jan 2013
Staff Nurses increased time spent in direct patient care by 11%
Length of stay: 37.8 days Jan 2013 → 18.3 days Aug 2013
Length of stay on St. Patrick’s Ward has reduced by 19.5 days
Well organised ward results:
Sourcing enteral feeding supplies: 106.9 hrs per annum saving
Restocking MOU supplies: 28hrs per annum saving
CPAP/BIPAP retrieval: 9.84 hrs per annum saving
Restocking linen trolley: 71 hours per annum saving
Restocking IV fluids: 32.76 hours per annum saving
Stock returns March 2012: €7,663
Total time saving from these improvements alone =
248.5 hours per year
WARD RESULTS – The Micro View
ST. ANNE’S WARD -SVUH
Direct care: 42% Pre-implementation → 49% Post-implementation
Staff Nurses increased time spent in direct patient care by 7%
Well organised ward results:
Stock spend: €11,700 Jan 2013 → €7,219.98 Aug 2013
Stock spend reduced by €4,481 when compared to the start of the year
Drug rounds: 1hr 20 min Pre-implementation → 24mins Post- implementation
Drug rounds reduced by 56 minutes = 6.5 hours per week
Retrieving equipment for central line dressings:
98 footsteps (15 mins) Pre-implementation
↓
= 400 minutes saved per month
17 footsteps (5 mins) Post- implementation
Before Productive Ward
ST. PATRICK’S WARD SVUH
After Productive Ward
ST. PATRICK’S WARD SVUH
Before Productive Ward
ST. PATRICK’S WARD SVUH
After Productive Ward
ST. PATRICK’S WARD SVUH
Before Productive Ward
ST. PATRICK’S WARD SVUH
After Productive Ward
ST. PATRICK’S WARD SVUH
After Productive Ward
ST. PATRICK’S WARD SVUH
Success……..
Our Lessons
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•
•
•
•
•
•
Fertile Ground, Start small
Right supports/structures/investments
Corporate buy-in and engagement (long-term)
Measurement, reporting, monitoring
Freedom, autonomy, Finance
Promotion, Marketing Celebration
Acknowledging its not a silver bullet
The future….
PW
PW
Productive
Hospital
Site
PW
PW
PW
Productive
Hospital
Site
PW
PW
PW
Hospital
Group
PW
implementation
Lead
Productive
Hospital
Site
PW
PW
PW
PW
Supporting QI Journey & Learning
http://www.hseland.ie/iqx/en-gb/home.aspx
The Research/Evaluation Foci
Phase 1 Sites:
Phase 2 Sites:
Person/Patient
Centeredness
Staff/Work
Engagement
Patient /Family
Experience
Context/Work
Environment
Implementation/Facilitati
on Impact
Improvement Data
Financial tracking &
Impact
The Research/Evaluation Methods
& Instrumentation
Phase 1 Sites:
Person-centered Practice
Index
Context Assessment
Index
Focus Groups &
Interviews
Person-centred climate
Questionnaire
Patient Experience
Questionnaire
Phase 2 Sites:
Utrecht Work
Engagement Scale
(UWES 17)
Ward-team interviews
context/impact factors
Monthly Improvement
Reports
Evaluation Results
Publications….
Thank you