The right staff, right skills, right place, at the right time to provide high quality care, improved outcomes and a better experience for all within planned care.
Greater demand across our planned care service saw the service become more reactive and task focussed.Staff started to feel unsupported and not in control of their work. Nurses were leaving the service and the service was struggling to find experienced staff to replace them leading to an over-reliance on bank/agency.
Working with the staff, over 3 weeks, a series of workshops reviewed patients and their outcomes. Live studies were conducted to understand the day-to-day frustrations. What was found:
- Only 31% of a clinician’s time is spent face-to-face with patients
- 16% of their time is spent on data entry and manual record-keeping
- 14% of their time is spent travelling
- 10% of care delivered by our qualified nurses could be delivered by an unqualified nurse
- Focus on discharge planning and self-care was limited
A staff-led transformation programme was started, focusing on:
- Improve the quality of care patients receive by reducing clinical variation
- Improve the workplace environment – staff feeling positive and enthusiastic about what they do, the care they provide and the leadership in their teams
- Introduce innovative approaches to planning and recording care, using technology to release time back for patient care
- Up-skill our staff to maximise both clinical and leadership capability
- Improve data quality and access to relevant information, giving visibility of nursing outcomes and empowering staff to further improve
- Develop improved clinical pathways, promoting self-care and independence
Staff came together in workshops during the design phase to design, pilot and iterate new ways of working. They identified and designed the following:
- A new planning process and tool within SystmOne so staff are; allocated visits within their working hours, see the right patients at the right time, have efficient travel routes
- Standardise record keeping, reducing duplication and improving electronic referral processes to specialist services
- New care plans reflecting the care delivered and a new acuity model
- Developed training plans based on the new training requirements for each banding to support staff to operate at the top of their license
- Weekly reviews of caseloads to ensure the care provided is promoting self-care and maximising independence
These new ways of working were rolled out across 8 operational hubs, with the right leadership in place to support staff and embed the changes through the implementation phase.
The results:
- 34 HCSWs trained, assessed and now delivering insulins with 10% of additional clinical activity now completed by HCSWs
- Over 9000 inactive patients discharged from SystmOne with a further 6,000 patients reviewed in newly set-up board rounds to ensure they have the right care delivered by the right person to maximise their independence
- 35% reduction in time taken to fill out holistic assessment with over 300 clinical hours released annually through paperwork reduction
- A new planning tool rolled out across all teams reducing the time taken to plan and improving the visibility of our workload
Submitted by LPT - Leicester Partnership Rachel Dawar