often fire fighting, affecting staff morale and teamwork. Assessment of problem and analysis of its causes: All staff we
World class healthcare for Wales Transforming Care on St Arvan’s ward: Teamwork and Patient Centred Care Lisa Henry, NLIAH and Aneurin Bevan Health Board
Context and Problem Context: The improvement was conducted on St Arvan’s Ward, Chepstow Hospital, part of Aneurin Bevan Health Board, Wales, UK. St Arvan’s is a busy 22 bed Sub Acute medical ward, with 28 staff led by a Ward Sister, with 10 Registered Nurses and 17 Health Care Support Workers.
Effects of Changes Measurement of improvement:
Assessment of problem and analysis of its causes:
An Activity follow was conducted to baseline the Direct Care Time registered nurses spend with patients. This was 40%. This increased to 72% following the improvements. Analysis of the activity follow indicates a significant reduction (20% per shift) in motion and less time working on patent flow (10%). A number of process and outcome measures were used and displayed in the safety cross format. Run charts were produced to identify any changes over time e.g. A reduction in the number of falls on the ward was seen.
All staff were engaged with the improvement work. Volunteers were also sought to champion specific areas of improvement.
Effects of changes:
Baseline measures were collected to identify the cause of the problems. This indicated staff spent a lot of time:
• Registered nurses spend significantly more time in patient bays providing value added care.
• • • •
• Care is provided in a proactive manner and with the hourly patient reviews any changes in a patient condition can be detected rapidly, improving the recognition and rescue of deteriorating patients.
Problem: St Arvan’s management team felt the care provided on the Ward was satisfactory but not cohesive or as effective as it could be. There were pockets of high activity rather than a steady flow. Care was provided in a reactive manner and staff felt that they were very often fire fighting, affecting staff morale and teamwork.
Looking for equipment Working on patient flow Being interrupted to provide information on a patient status Responding to call bells
Strategy for Change Intervention: 3 of the Ward team attended national study sessions run by NLIAH and were trained in the programme’s modules. They engaged their colleagues to make the improvements required in all 5 Transforming Care (TC) modules. For example : • The Releasing Time to Care module: Lean principles and 5s were used to reduce the amount of time nurses spend looking and fetching equipment. • Safety and reliability of care - Intentional Rounding (process of proactively visiting patients every hour to provide care and assess their needs), this significantly reduced the number of call bells used and provided a means to provide proactive care.
Strategy for change: A timetable was designed to conduct each module. Weekly meetings around the measures board were used to communicate issues as they arose; discuss why they had occurred and produce an action plan. These meetings were also used to communicate the next steps. The Multi Disciplinary Team was involved and a newsletter was produced.
We’re
TRANSFORMING CARE!
• Patients use their call bells less frequently, as illustrated by a pre and post audit. • The ward appears calm and organised which aids patient recovery and staff morale has improved. • Staff now feel empowered to take ownership of the ward as well as pride in their place of work.
Lessons Learned Lessons learnt: • Provide more information to staff at the beginning of the process • Undertake more preparation before making any improvements • Obtain all required resources before commencing the programme • It is imperative to keep momentum and motivation of the team
Message for others: It is hard work and will take a lot of time to get this up and running but the improvements in patient care are significant which makes it all worthwhile. This programme puts the ward in control of its own improvement and puts the patient at the centre of the care.
