New Zealand Ministry of Health Contact/Coordinator Joe McDonald Senior Advisor Quality, Improvement...

New Zealand Ministry of HealthNew Zealand Ministry of HealthContact/CoordinatorContact/Coordinator

Joe McDonaldJoe McDonaldSenior AdvisorSenior AdvisorQuality, Improvement and InnovationsQuality, Improvement and InnovationsSector Capability and Innovations Sector Capability and Innovations

DirectorateDirectoratePhone (04) 8162571Phone (04) 8162571Cell:021241 4956Cell:021241 4956Email: Joseph_McDonald@moh.govt.nzEmail: Joseph_McDonald@moh.govt.nz

Aim of Programme

• free up staff time in a busy day from unnecessary duplication or tasks so that they are able to increase the amount of time they spend on direct patient care.

Patients judge us on their experience of ward based care

• We know what affects patient dignity, but sometimes fail to maintain it

• We know what good infection control practice is, but sometimes fail to uphold it

• We know what safe medication management is, but still have near misses and incidents

• We know that nutritional management is vital for patients, yet some patients become malnourished

So if we know what should be happening, why don’t we do it?

What is stopping us from delivering the ‘gold standard’ of care?•Split into small groups

•Write on paper provided what you think stops us

•You have 5 minutes

•Feedback to group after 5 minutes

Barriers

RELIABILITY

ERRORS

INTERRUPTIONS

TRAINING CONFUSION

TIME

STAFF

RESOURCES

TARGETS Unable to control

Puts patients at the centre of care and empowers front line staff to make

the necessary changes to improve patient outcomes

Canadian Delegation News Release (Sept 08)

The Productive Ward concentrates on the HOW, not the WHAT

The vast majority of healthcare guidelines concentrate on end standards i.e. the WHAT

We need help with HOW to implement these standards so that they happen 24/7 - even on Sunday night

Direct Care Time

Motion Admin Discussion Handovers InformationRoles

Opportunity to increase safety and reliability of

care

Rol

e T

ime

(e.g

. n

urse

)

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

Drivers

• Ward nurses in acute settings spent an average of just 40% of their time on direct patient care.

• Research showed that three in four nurses said that this was not enough

• 90% of those polled said that patient care suffered as a result.

Basic Principles

• Led by front line staff• Application of industrial/”lean” methods in a clinical

setting• Modular, self directed learning structure• Designed for wards but generic enough to apply wider• Equips all staff with methods to move towards safer,

more dignified, reliable and efficient care

So if we know

What are we moving from and where we are moving to…

Then we can improve

Selected ImpactThe early results in 3a/b :• Direct care time increase from 39% to 57% in three months • Motion reduced from 18% of day to 8% in three months• Interruptions have reduced by 50% • Set placement of dynamaps and commodes is saving

approximately 36 & 75 hrs per year respectively on am shift alone • Recruitment and retention – 4FTE down to now fully staffed • Discernable positive change in staff satisfaction and morale on the

ward

Well Organised Ward

Shift HandoversAdmissions & DischargeManagement

PatientObservations

Ward RoundNursing ProceduresPatient Hygiene

Productive Ward

Executive Leader’s Guide

Knowing How we are Doing

Meals Medicines

Patient Status at a glance

Project Leader’s Guide

Ward Leader’s Guide

To

olk

it

Knowing How We Are Doing Foundation Module

Developing ward based measures to help the team to make informed decisions

• Understand what is happening now• Understand how the ward is performing• Using the KHWD information to drive

improvements on the ward • Using information to help module selection• Showcase achievement

Set of Balanced Measures

Core Objectives

Improve patient experience

Improve efficiency of care

Improve staff wellbeing

Improve patient safety

**Patient satisfactionOverall CarePain ManagementPatient Education

Direct care time**Length Of StayWard cost per Patient episode**Nursing HPPD**Skill Mix

Unplanned absences**Staff satisfactionTurnover

Patient Observations**Falls**Pressure soresInfection Rate

** Magnet Nurse Sensitive Indicators

Safety cross is filled in to allow instant visual communication of ward status: For Example

What is the well organised ward

• The well organised ward is an approach to simplify the workplace and reduce waste by having everything in the right place, at the right time, ready to go.

Well Organised Ward

• SORT– Remove what is not needed

• SET– Right thing in right place

• SHINE– Regularly clean and maintain

• STANDARISE– An agreed consistent process

• SUSTAIN– Implement audits, based in the standards so 5S

becomes everyday routine

Patient Status at a Glance

The use of visual management to show important patient information so that it can be updated

regularly, seen at a glance and used effectively.

The aim is to make patient information clear and easily understandable for all disciplines.

PSAG works towards the 3 second rule.

Tools that are used

• Ward Vision• Activity follow• Video• Photos• Process mapping• Audits

.

It is a one hour detailed recording of activities a member of staff undertakes

It captures the task at hand and the location where it is performed

These pieces of information are recorded every minute during the hour

What is an Activity Follow?

To be able to understand what activities are being undertaken by the staff on the ward

Find out how much time you spend on direct patient care

Where the activities are taking place

How long the activities take

To find out what may be impinging on these activities. i.e. interruptions etc.

Why do it?

Direct Care Time February 2009

39%

18%1%

6%

7%

5%

2%

8%

14%

Direct care

Motion

Admin

Handovers

Medicine Management

Discussion

Personal Hygiene

Patient Flow

Other

Direct Care Time April 09

56%

9%

0%

7%

7%

6%

0%

3% 12% Direct care

Motion

Admin

Handovers

Medicine Management

Discussion

Personal Hygiene

Patient Flow

Other

The ward leader is pivotal

to the implementation, success and

sustainability of the programme

Releasing Time to Care is not easy!

• A project - it is a culture change

• A political tool – particularly in regard to the “not enough resource” agenda

• A cost cutting tool – though as a consequence savings are made

Releasing Time To Care is not:

Everybody, Somebody, Nobody and Anybody.Once upon a time, there were four people:

Their names were Everybody, Somebody, Nobody and Anybody.

Whenever there was an important job to be done, Everybody

was sure that Somebody would do it. Anybody could have done

it, but Nobody did it. When Nobody did it, Everybody got angry

because it was Everybody's job. Everybody thought that

Somebody would do it, but Nobody realised that Nobody would

do it. So consequently Everybody blamed Somebody when

Nobody did what Anybody could have done in the first place.