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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: [email protected]: [email protected]
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.
