Seven Day Services Improvement Programme
Birmingham, Sandwell and Solihull Collaborative
Professor Matthew Cooke
Deputy Medical Director (Strategy & transformation)
Heart of England NHS FT
‘7 day services is only part of a whole system
transformation’
• Optimising hospital flow, including discharge to ensure front
end emergency care capacity.
• Flow is a whole system issue.
• Where are the bottle necks?
Improving health outcomes across England by providing improvement and change expertise
How we are addressing it:
Perfect Week, including with community
SAFER care bundle
Monitoring systems, including Jonah
Feedback mechanisms
Gap analysis
Discharge hub 7/7
Access to community facilities 7/7
Improving health outcomes across England by providing improvement and change expertise
Perfect Week, including with community
• The perfect week methodology is a way of resetting a
broken system relying on a mixture of social movement
theory, multiple rapid improvement methodology and
strong leadership and support mechanisms.
• It has been developed to help solve poor flow in hospitals
resulting in overcrowding in emergency departments. One
week of intense improvement activity can improve flow
across the whole hospital resulting in safer, higher quality
care and it can then be sustained.
Improving health outcomes across England by providing improvement and change expertise
S - Senior Review, all patients have a Daily Consultant Review
, sick and discharge patients seen before 10am
A - All patients a Planned Discharge Date
F - Flow , every ward should have a min. of 1 bed available
from 9am to enable emergency assessment and theatre
services to flow safely.
E – Early discharge, 50% of our patients will be discharged
from base inpatient wards before midday.
R – Review, a weekly systematic review of patients with
extended lengths of stay ( > 14 days
Improving health outcomes across England by providing improvement and change expertise
• Monitoring systems, including Jonah
• Feedback mechanisms
Improving health outcomes across England by providing improvement and change expertise
Gap analysis
Therapies
Nursing
Senior Medical
Junior Medical
Clinical support
Non-clinical support
Improving health outcomes across England by providing improvement and change expertise
• Discharge hub 7/7
• Access to community facilities 7/7
Improving health outcomes across England by providing improvement and change expertise
Mortality rates – same by day of week
Improving health outcomes across England by providing improvement and change expertise
Discharge rates still
reduced at weekend
Discharges by day of discharge
14000
12000
10000
8000
6000
4000
2000
0
Mon
Tue
Wed
Thur
Fri
Sat
Sun
Day of Discharge
25%
% discharged at Weekend - Monday 4th June to Sunday 27th May (Nonelec Only)
20%
15%
10%
5%
Improving health outcomes across England by providing improvement and change expertise
0%
242526272829303132333435363738394041424344454647484950515253 1 2 3 4 5 6 7 8 9 101112131415161718192021
LOS of stay varies but……
Average LOS by day of admission
2.5
2.5
2.4
2.4
2.3
2.3
2.2
2.2
2.1
2.1
2.0
2.0
Mon
Tue
Wed
Thur
Fri
Day of Admission
Improving health outcomes across England by providing improvement and change expertise
Sat
Sun
Reducing variation
• By day
• By team
• By individual
It is not a seven day services programme
Improving health outcomes across England by providing improvement and change expertise
Questions ?
Improving health outcomes across England by providing improvement and change expertise
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Birmingham, Sandwell and Solihull Collaborative