Engaging Local
Clinical Leadership
Clare Thomas, Senior Nurse
Professional Practice
Debbie Waywell, Quality & Safety
Matron
your hospitals, your health, our priority
About us
• 4 site acute NHS FT
• Elective orthopaedic
surgery
• Hot site
• Day case/
outpatient/rehab
• Town centre
outpatients site
• Population c300,000;
758 inpatient beds
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How things were….
• Good track record of safety improvement
• Limited mechanism for sharing innovation
across the Trust
 Professional Development Days
 Quality Improvement Teams
 Ward level Quality Accounts
• Needed to be able to spread and share best
practice across the Trust – the ward leader role
is pivotal in this
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Our aims
• To achieve harm free care for at least 95% of our patients
•
Wanted to achieve this through the sharing of best practice via our
secondary driver which is local clinical leadership
• Focus on harm in its entirety rather than 4 harms individually
• The promotion of cross divisional working (avoid those silos!)
• Develop the role of clinical ward leaders
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“The pessimist complains about the wind. The
optimist expects it to change. The leader adjusts the
sails.”
your hospitals, your health, our (John
priority Maxwell)
How did we begin?
• Ward leaders were asked to self nominate to
participate in a harm free care project .
• 1st cohort selected to ensure members from
across the Trust with a proven track record of
improvement
• Orthopaedic ward; medical assessment unit;
surgical ward; CoE ward; ENT/ urology ward
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And…
• Launched on Nurses Day
(May 12) at Professional
Development event
• Ward leaders of selected
wards facilitated
breakaway workshops for
“Harm Free Care”
• This photo shows our first
Harm Free Collaborative
meeting
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Collaborative Working Group
• Fortnightly Collaborative group meetings
• Improvement model (PDSA) established
• Each ward asked to identify a SMART objective
•
•
•
•
Improving patient access to nutrition
Implementing a safety huddle
Intentional Rounding pilot
Introducing an additional hot drinks round
• Each objective was to be small scale and easily
adopted, adapted or discarded
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Preparatory Work
• Each ward collected baseline data on harm for
every patient on discharge, transfer or death
• Completed for a period of two weeks
• Only collecting data concerning that ward stay
• Data collection tool derived from Safety
Thermometer
• Each Ward Leader prepared own team
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WWL Data Set
• All patients on discharge/ transfer or
death
• Ward stay only
• LOS
% of patients
• Falls – harm
suffering harm
• HAPU
• HA MRSA bacteraemia
• HA Cdiff
• Other HAI
• HA VTE
• Weight loss
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Improving patient access to nutrition
•
PLAN
 Improve access to nutrition postoperatively and out of hours
•
DO
 Patients surveyed as to preferred food pre-op
 Liaising with catering enabled provision of toasters and ambient food products on the
ward
 Snack trolley provided in between scheduled mealtimes
•
STUDY
 Led to easier availability of ambient snack products 24 hours a day
 Improved access to and timings of snack trolleys in line with ward requirements
•
ACT
 Other wards have now developed plans to improve availability of nutrition
 Planned study days for all levels of staff to highlight nutrition
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Implementing a Safety Huddle
• PLAN
 Devise a “Safety Huddle” checklist to raise awareness of risk to patients with
regard to 4 harms
• DO
 Incidents and complaints analysed to identify greatest risks
 Baseline dataset used to compile checklist
 Checklist to be used daily by shift leader during handover
• STUDY
 Issues identified with unit caseload and suitability of checklist
 Established handover format already embedded
• ACT
 Ongoing development of checklist via further PDSA cycles
 Additional elements to be included of risk not covered by 4 harms
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Intentional Rounding (IR)
•
•
•
•
PLAN
 Devise a Tool to incorporate 4 P`s (Personal needs;
Possessions; Position; Pain) to address 4 harms
DO
 Tool formulated in line with current research
 Guidance criteria written for staff
 Trialled on two HFW – one surgery and one CoE for 24h period
STUDY
 Identified issues about suitability of a universal IR tool ( not one IR
fits all) .
 Felt that some wards already doing IR although not in same format
 Perceived to increase nursing activity from initial data
ACT
 Each ward adapting local IR other wards also trialling and feed
back awaited.
 One ward using as a learning tool for student nurses
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Introducing an Additional Hot Drinks
Round
•
PLAN
 to improve hydration in elderly care patients
•
DO
 One extra drinks round per day for two patients as a small scale change.
•
STUDY
 Patient 1 demonstrated an improvement in hydration as recorded on input
output chart.
 Patient 2 refused extra hot drink offered; no evidence of improved
hydration.
•
ACT




Other areas implementing same change as additional PDSA cycle
Extra kitchen equipment required for additional drinks round
Issues identified with inadequate supplies of hot water
Time considerations for extra hot drinks round
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Challenges faced
• Time involved in implementing change
• Keeping the change small scale
• Gathering data and understanding measurement
tools
• Demonstrating evidence
• Involving patient to improve experience
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Harm Free Ward Data
% Patients Receiving Harm Free Care (Ward 6)
% Patients Receiving Harm Free Care (Orrell)
105
100
105
100
95
90
95
90
85
80
85
80
75
70
75
70
65
60
65
60
1
2
3
4
5
6
7
8
1
9
2
%Patients Receiving Harm Free Care (Standish)
3
4
5
6
7
8
9
10
11
12
11
12
%Patients Receiving Harm Free Care (Swinley)
100
100
95
95
90
90
85
85
80
80
75
75
70
70
65
65
60
60
1
2
3
4
5
6
7
8
9
10
11
12
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1
2
3
4
5
6
7
8
9
10
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The way forward……
• Forthcoming Quality Improvement Day and Delivering
Quality Care workshop
• Ongoing PDSA cycles
• Harm Free Ward leaders visits to neighbouring Trusts
• Display poster for “days since” harm
• Second cohort of Harm Free Wards
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…and patients were satisfied
• I was in Wrightington Hospital for eight
days after a hip replacement.
• Meals were chicken dinner one day, steak
the next with all the trimmings, and
delicious puddings to follow.
(letter to Wigan Observer, 30 August 2011)
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Thankyou!
• Any tools or information described in this
webex is available for sharing
• Clare.thomas@wwl.nhs.uk
• Deborah.waywell@wwl.nhs.uk
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