Case Study Archive – All

The NHS South West Quality and Patient Safety Improvement Programme

Project overview: The project is a regional collaboration of South West hospital NHS trusts to improve patient outcomes by using a best practice model for improvement to implement a series of care bundles.

The project focused on five workstreams: • Critical Care • General Ward • Leadership • Medicines Management • Peri-operative.

TST Safer Care

 

Devon Access and Referral Team

Project overview: DART (Devon Access & Referral Team) was set up in April 2010 as a NHS Devon wide referral management service with the aim to support the quality and consistency of Devon referrals, ensuring the patient has a smooth pathway into the correct service.

Devon Dart Scheme

 

Inpatient to Community Services

Project overview: A review and rationalisation of inpatient and community mental health services for adults across Devon.

DPT Community Services

 

Improving Asthma Management in Bristol

Project overview: To improve asthma management in Bristol through: • Improving healthcare professionals and patients’ knowledge of asthma • Improving patient access to advice and asthma medication reviews • More cost-effective prescribing • Better management of inhaler devices and improved patients’ use of inhalers • Targeting resources at areas of high risk e.g. areas of deprivation, ethnic minority groups.

NHS Bristol Asthma

 

My Way to Health

Project overview: During 2009 and into 2010, the Primary Care Trust has been working with local people with a learning disability to improve access to all health services, but also to focus on improving discharge planning from local acute hospitals. There are 2,189 people with a learning disability in  Cornwall.

NHS COIS My Way

 

Telehealth

Project overview: The Telehealth service in Cornwall was initially a Whole System Demonstrator and was the largest trial of Assistive Technology of its kind in the world. The system allows patients to take daily biometric readings, such as blood pressure and pulse oximetry, at home. These are then transmitted to a clinician for monitoring. Appropriate action can then be quickly taken if there are signs of deterioration or a change in the patient’s condition. The project is being nationally evaluated with the results due in Spring 2011.

NHS COIS Teleheath

 

Developing the clinical service line for stroke care for Plymouth

Project overview: It was recognised that there was a need for fundamental improvements to the Stroke Pathway in the Plymouth Health Community. This was a strategic aim of NHS Plymouth, but was also a high level target initiative following the publication of the National Stroke Strategy in December 2007, and the independent review into stroke services commissioned by the SHA in July 2008.

A clinical service line for stroke was agreed as a concept in January 2009 and formally launched in April 2009, to coordinate the development of stroke services with the two healthcare providers Plymouth Hospitals NHS Trust and Plymouth Primary Care Trust provider arm.

NHS Plymouth S Care

 

Somerset Community COPD Service

Project overview: Research by the NHS Institute for Innovation and Improvement showed a potential 20 per cent reduction in emergency admissions for people with chronic obstructive pulmonary disease when comprehensive community services were in place. NHS Somerset redesigned community COPD services with full involvement from patients, carers and professionals. The service is the first in the country to deliver a comprehensive community COPD service designed around the needs of the patient and delivered through a partnership between the public and private sector.

NHS Somerset COPD

 

Intravenous Antibiotics Service

Project overview: The Intravenous Antibiotics Service was the first community based IV service in the South West when it was launched. Initially, a few patients were being seen by the Intermediate Care Team if capacity was available. The Primary Care Trust was aware that other areas of the country had established IV services through separate specialist teams and wanted to provide a robust service embedded within community nursing. This will enable community nurses to provide holistic care to their patients, including Intravenous Antibiotic therapy as an additional treatment option to support patients to remain in their own homes.

NHS South Glos IVT

 

Transforming the role of the Community Matron through the implementation of the Virtual Ward

Project overview: An opportunity was identified to refocus the role of the Community Matrons in NHS Swindon in order to:

  • Provide more intensive multi-disciplinary care management of specifically identified high intensity users
  • Improve the quality and consistency of care for these patients
  • Reduce readmission to hospital where appropriate
  • Develop the virtual ward concept using the community matrons as the orchestrator of care.

The very high intensive user project was launched to pilot an integrated model of care across primary care and the Community Matrons. The project was led by the Practice Based Commissioning GP across one of the three localities. The project was launched in January 2010 and the implementation was phased over three months with plans to roll out across all three integrated teams within nine months.

NHS Swindon V Wards

 

Neighbourhood Teams

Project overview: Neighbourhood Teams are a new way of delivering community based health services in Wiltshire. The 11 multi-disciplinary teams consist of nursing, therapy and support staff, co-located with social care staff, who together provide care for patients and service users, seven days a week. By providing modern, responsive, accessible health and care for patients – normally in their own homes and certainly within their community areas – the teams have reduced inpatient hospital stays and enabled many people to maintain their independence and to enjoy a better quality of life for longer.

NHS Wiltshire Teams

 

Colorectal – faster diagnosis and access to treatment for bowel cancer patients

Project overview: Bowel cancer is the third most common cause of cancer related death in the UK. Around 100 new cases of bowel cancer are diagnosed each day in the UK and the vast majority present on a symptomatic basis. The importance of symptoms or collection of symptoms can be difficult to assess and the scheme sought to deliver faster access to treatment for patients with suspected bowel cancer and to improve the speed and accuracy of bowel cancer diagnosis.

RBCHFT Colorectal

 

Enhanced Recovery Innovation Site

Project overview: Torbay Hospital – working in collaboration with its health communities and other local NHS services – has become an Innovation site for the Department of Health’s Enhanced Recovery Partnership Programme. The programme is designed to extend learning and best practice from the few hospitals which already offer enhanced recovery, or are introducing it, to other NHS hospitals. As an innovation site, Torbay Hospital is helping build evidence on how effective enhanced recovery methods can be, helping patients to get better sooner after surgery.

SDHFT Enhanced Rec

 

Reablement – Contract Monitoring QIPP

The Somerset Clinical Commissioning Group (SCCG) led the review and redesign of reablement services over the last two years to help improve outcomes for patients.  We worked with local authority colleagues to lead a joint programme to review existing services and implement a redesigned service model based on systems thinking methodology.  We also worked with a range of stakeholders from the NHS, adult social care providers, and independent and voluntary sector organisations.  The programme has been discussed and supported by the Somerset Health and Wellbeing Board.

Compass Disability was commissioned to bring together focus groups and develop a questionnaire giving people the opportunity to feedback their experiences of reablement services.  They held extensive stakeholder events with representatives from NHS, adult social care providers, independent and voluntary sector organisations and undertook a ‘deep dive’ exercise to understand what was happening in existing systems.

A pilot integrating health and social care teams at one GP surgery has been in place for 18 months.  It has been rolled out to 15 practices in the Taunton and Area GP Federation with plans to phase in the service across the whole of Somerset.

A clear message from the service users was: “I want to maintain my independence:  help me to find the solutions to do the things that matter to me”.  The key difference with this model is that we are asking patients what they feel is important to them and what goals they want to achieve.  The teams have flexibility to find solutions centred on these goals.  This is a fundamental shift from the ‘one size fits all’ approach often seen in existing services.

Outcomes:

Improved patient experience and quality of life as care delivered in a more appropriate setting; 1{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} reduction in emergency admissions 7{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} reduction in readmissions

Contact details and further information

Ann Anderson

Director for Clinical Commissioning Development

Ann.anderson@somersetccg.nhs.uk

01935 384190

 

Reducing falls in elderly care and across the hospital – Brighton and Sussex University Hospitals NHS Trust

The project aimed to reduce inpatient falls across eight elderly care and acute medical wards. Nationally over 200,000 falls are reported each year in the NHS and are a major issue in a range of health and social care settings, both NHS and non-NHS.

The initiative has focussed on what happens to patients for the first few days in hospital. With an increasing national focus on dementia and frailty the team believes that reducing falls will become a major challenge in delivering compassionate care.  The cost of failing to address the issue in terms of cost and reputation is an additional driver.

 Outcomes:

In the eight wards covered by the initial phase, falls were reduced by 32{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} in twelve months.  Following this success a trust-wide initiative replicated the activity, achieving a reduction across the trust of 17{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b}. The original eight wards, with minimal additional input, are still improving at a faster rate than the rest of the trust and have reduced their rate by a further 31{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b}.  These results indicate that a focus on the behaviour and habits of individual practitioners is the way to make change sustainable and continuous.

In 2012 the trust was shortlisted for the BMJ Safety /Improvement Award.

Information, tools and techniques used:

The first phase, which took a conventional approach to service improvement (training, action plans, guidelines, meetings etc) was abandoned after 9 months as no improvements had been made.  Phase 2 focussed on the concepts of emergent design, followership and imitation, producing outstanding results.

Over the past 3 years the team has moved from a position of thinking that safety is a product of resilient processes to thinking that safety is something that emerges out of imitating safe behaviours.

Contact details and further information:

Mark Renshaw, Deputy Chief of Safety, Brighton and Sussex University Hospitals NHS Trust: Mark.Renshaw@bsuh.nhs.uk

Paula Tucker, Head of Nursing Patient Safety, Brighton and Sussex University Hospitals NHS Trust: Paula.tucker@bsuh.nhs.uk

 

Improving hip fracture pathways – South Devon Health Services (primary and acute care) and social care.

This very successful project aimed to reduce time from A&E to theatre and improve pain control for hip fracture patients. It reviewed and revised the patient pathway through the system from paramedic through A&E, radiology, theatre, ward and discharge, including social care.

Outcomes:

There have been a number of significant improvements including extremely positive patient feedback.  The team has recorded impressive reductions in, for example, pain score on movement from severe (2.75) to mild (0.5); median time to theatre (48 hours to 19 hours) and an increase in the percentage of patients treated on the day of injury (3{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} to 33{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b}).  Although cost reduction was not a primary aim, the programme has led to a reduction of 1,800 bed days per year, saving an estimated £326,000.  There is also some evidence of reduced post-discharge dependency and therefore a reduced social care cost.

Other intended and unintended benefits have included improvements in staff morale; theatre and ward productivity; a reduced backlog on trauma board; and the development of a screening tool for malnutrition.  However, the programme team believe that the most significant change is cultural.

Information, tools and techniques used:

A small multidisciplinary team of anaesthetists, nurses, surgeons, and a clinical systems engineer worked together, with other professionals drawn in as required to help.  The project applied Lean Thinking and Enhanced Recovery principles, involving all professional groups and patients in the redesign. The team developed an innovative technique of clinical process simulation during which the process of care was simulated by the professionals involved from injury (with a paramedic) to ward. This technique has been used for another Trust’s team and could be offered to others who are interested.

Timescale:

Approximately a year was spent defining and analysing the problem with testing of ideas for change and building the will for change. The change in process occurred in November 2010 and is sustained with regular team review of success and issues to fix; they are proud of what has been achieved and striving to improve still further.

Contact details and further information

Andrew Fordyce: andrew.fordyce@nhs.net

 

Patient Access Centre – Torbay, Devon

This programme’s purpose was to replace a hospital’s complex and inconsistent system for outpatient bookings with a call centre, using a single telephone number for all outpatient bookings.

A review found that bookings were being made by over 300 staff with over 70 phone numbers in use across the trust. In some departments, it was only possible to book an appointment between certain times and on occasion there was nobody was available to cover bookings during annual leave. The lack of consistency across the trust meant that the patient experience was confusing and navigating between specialties was difficult.

The team worked with stakeholders to interpret the review findings and to co-design a more streamlined booking system.  A new bookings process was then introduced alongside call centre technology and, after a trial period, all booking staff moved into one building.  The service has since been gradually refined to enable staff to work across specialities.

Outcomes:

Outpatient bookings are now handled by 30 full time employees.  Patient experience is much improved and savings of £1.2 million have been achieved.

Information, tools and techniques used:

The creation of a Patient Access Centre was a Process Redesign in Administrative and Managerial services project (PRAM).  The project team drew on principles from a number of change tools, using a lean systems approach and being guided by principles from the DEMAIC (Define, Enthuse, Measure, Analyse, Improve, Control) model of change.

To govern the overall project management, the team drew on principles from PRINCE 2. To embed the change, the team drew on Kurt Lewin’s ‘unfreeze, change and refreeze’ thinking.  The principles of Kubler Ross’ change curve were also instrumental in the team’s approach.  

Timescale:

The project started in January 2010 and took approximately 18 months to complete.

Contact details and further information:

Nick Debney, Torbay Hospital. Email: nick.debney@nhs.net

 

Enhanced Recovery Programme, Royal Berkshire NHS Foundation Trust

Whilst ERP is a national programme, senior leaders of NHS trusts have also been instrumental in driving forward ERP. Programme objectives have been set differently in different trusts.  In the case of Royal Berkshire NHS Foundation Trust, ERP has focused on patients as well as NHS staff, in particular giving them information to help them prepare for surgery, give them the right expectations and support them throughout their hospital stay. Information packs and patient diaries have been central to this. The trust has also developed education packages for nurses and established education sessions for staff.

Outcomes:

In Royal Berkshire hospital, length of stay has reduced from ten to six days for colorectal surgery, from five to two days for hysterectomies, from four to two days for prostatectomies and from seven to under five days for hip and knee surgery; all with no significant change in readmission rates.

Information, tools and techniques used:

Clinically led since its inception, the ERP programme at the Royal Berkshire NHS Foundation Trust uses Plan Do Study Act (PDSA) cycles to drive local implementation and improvements.

Timescale:

An enhanced recovery programme started for colorectal surgery in 2005/06 but lapsed two years later. Following the national launch of ERP, the hospital’s own programme was re-launched in 2010.  The programme is still on-going.

Contact details and further information:

Sarah Cherrill, Enhanced Recovery Nurse, Royal Berkshire Hospital.  sarah.cherrill@royalberkshire.nhs.uk

 

Safe, Supportive and Therapeutic Care

Safe, Supportive and Therapeutic Care aimed to improve safety and care within acute inpatient mental health units by minimising risk while maximising therapeutic benefit. A secondary but related objective was to reduce length of stay in acute inpatient units.

Strands of work covered three key areas: clinical skills and interventions; policies, procedures and systems; and environmental security. Specific activities included a thorough review of clinical evidence and of policy and procedures; staff training and a ligature audit to identify and remove any environmental elements contributing to increased risk of patient suicide.

Outcomes:

The programme has achieved a wide range of improvements, including better clinical risk assessment and collaborative and patient focused care plans. Each acute inpatient environment has been assessed using an accredited ligature audit tool with high risk ligature points being addressed first and processes identified to modify medium and low risk points.

The programme has created a stronger identity and culture within Acute Care, as well as greater clarity among the different professions (psychology, nursing, occupational therapy and medical) about their role and contribution to providing high quality care.  There is now greater consistency of care across acute units and the programme has also achieved its overarching aim, which was to minimise risk while maximising the therapeutic benefit of inpatient care.

Information, tools and techniques used:

Whilst some general principles of change management underpinned the programme, it did not follow a formal change model. Different change management processes included a ligature audit which used a validated tool to assess environments as well as consulting nationally in order to learn from good practice elsewhere. The review of risk policy, training and redesign of risk tools was informed by a full consultation within the trust.

Geography:

The programme was run across the six acute inpatient units and six crisis teams working in the community across the Sussex Partnership NHS Foundation Trust.

Timescale:

The programme was initiated in March 2010, and by April 2012 most of its key elements had been implemented.

Contact details and further information:

Theresa Dorey, Nurse Consultant/Professional Lead, Acute Care. theresa.Dorey@sussexpartnership. nhs.uk

COPD Monitor

The solution featured here is Message Dynamics’ ‘COPD Monitor’ which uses interactive voice technology to monitor patients’ wellbeing.  It is designed to improve patients’ quality of life, improve disease management, reduce admissions and reduce costs.

Outcomes:

The COPD monitor phone calls patients twice a week to record their state of health. Between September 2011 and February 2012, almost 1,500 calls were completed (a response rate of 91 per cent). Of these, 13 per cent generated an alert which starts an automatic escalation process. An initial follow up call by the unit’s nurses resolved 80 per cent of issues and the remaining 20 per cent required home visits. These home visits prevented nearly forty emergency admissions (representing a saving of at least £80,000). The investment in this project by the SHA has been £48,775. However, excluding this initial development cost the cost of  delivering this service is £375 – ie 25p per call. The return on investment ratio of this pilot is in excess of 200:1.

An unanticipated benefit is that patients like talking to a computer; they do not feel they are wasting people’s time and patients report feeling less isolated. Clinicians are also noting that patients are becoming better equipped to understand and manage their own conditions.

Information, tools and techniques used:

SBRIs start with a ‘problem space’ which can be defined quite closely to respond to a specific issue.  Prince project management underpins the thinking of the programme management team and helps provide a balance between process, structure and outcome foci.

Timescale:

SBRI was launched in July 2010 and companies were given six weeks to bid. Sixty-nine companies from the UK and overseas responded in September 2010 and in November, Message Dynamics was one of four companies that received funding to take their proposal to a ‘proof of concept’ (POC) by February 2011. The product was adopted in September 2011 and is now offered to all patients referred to the specialist COPD service at Heatherwood and Wexham Park Hospital.

Contact details and further information:

Duncan Goodes: Duncan.Goodes@southernhealth.nhs.uk

 

Reducing spend and increasing efficiency in MSK services – East Sussex

This programme aimed to improve quality, reduce spend and increase efficiency in musculoskeletal (MSK) services in East Sussex. Data on efficiency and spend in MSK services were presented to 70 participants at an event called Shaping the Future, where a number of key issues and possible solutions were identified.  These included high rates of fractures and falls admissions, high rates of arthroscopy and of elective admissions, fragmented MSK services and variation in referral rates.

The programme has since focussed on pursuing solutions to these issues, including peer-review by GPs of referrals, agreeing surgical policies for arthroscopy and eight further orthopaedic procedures and introducing physiotherapy triage as an alternative to orthopaedic referral.  To achieve change in systems and results, it has been necessary to influence culture and behaviour and seek consensus across a number of systems. Alongside this, an integrated MSK service has been procured in Hastings and Rother and commissioning of a similar service is being considered for the remainder of East Sussex in conjunction with other local commissioners.

Outcomes:

Savings achieved in arthroscopy totalled £1.8million in 2010/11 and a further £600K in 2011/12 Interim outcomes for physiotherapy triage are encouraging, and there is increased interest in MSK from a primary care perspective.  A service specification and business case has been agreed for a Falls and Fracture Liaison service for East Sussex and work is underway to implement Shared Decision Making – critical to ensuring that patients are fully aware and have the option to participate in decisions about their care, particularly where more than one treatment option may be available.

Information, tools and techniques used:

The programme has used a range of national and regional best practice tweaked for local use. The project drew on a number of sources: the Framework for Musculoskeletal Services, National Institute of Clinical Excellence, surgical policies from other PCT areas, data from the NHS Atlas of Variation and the South East Public Health observatory.

Contact details and further information:

Fiona Streeter, Service Development Team Leader, East Sussex: fiona.streeter@nhs.net

Sussex Dementia Partnership

The Sussex Dementia Partnership is a clinically-led collaboration between the health and social care commissioners and providers of Sussex involved in Dementia care. It aims to transform dementia services in line with the National Dementia Strategy (NDS) in order to improve the experience of people with dementia and their carers.

Dementia is a significant and increasing financial burden in Sussex. There are different commissioning and provider arrangements for dementia across Brighton & Hove, East Sussex and West Sussex. Evidence suggests that working collaboratively across organisational and geographical boundaries to implement the dementia transformation programme with a QIPP (quality, innovation, productivity and prevention) focus could enable Sussex to meet future challenges against a backdrop of financial constraint, and this has led to the formation of the Partnership.

The vision of the programme is to achieve improvements in the following areas:

  • The experience of people with dementia and their carers
  • Early diagnosis of dementia and access to information and support
  • Numbers of people treated (within existing resources) in order to meet significant demographic increases over the next 10 years
  • Improved care in the general hospitals, plus reductions in inappropriate admissions and length of stay
  • Improved care in care homes
  • Access to dementia crisis support at home services
  • Reduced inappropriate use of anti-psychotic medication
  • Reduced unwarranted variation in services across Sussex

Outcomes:

There has been significant progress in delivering the NDS. A full Memory Assessment Service with Dementia Advisors has started in West Sussex and procurement is also underway in the other localities meaning that full coverage will be achieved by April 2013.

The quality of care in general hospitals has improved notably; Older People’s Mental Health Liaison services have been extended across Sussex and the innovation of a Dementia Shared Care Ward is being spread to other hospitals. All four acute trusts have developed dementia strategies and are making progress in delivering improvements in education, environment and person-centred care. A Sussex wide dementia acute audit has provided the system with valuable information about the dementia profile in the hospitals and preventative approaches to admission.

In care homes, a Sussex-wide service has been developed to focus on medication review and non-pharmacological approaches to challenging behaviour. This has led to quality improvements and reductions in anti-psychotic prescribing. Achievements have also been made in dementia crisis support services at home.

Finally, work is in progress to improve services for people with dementia at end of life, to increase carer support and to provide education for the system in relation to reducing anti-psychotic prescribing.

Information, tools and techniques used:

The National Dementia Strategy was published in February 2009 and there was widespread belief that the strategy could not be implemented effectively by individual organisations in isolation. The concept of a partnership approach was initiated by CEOs and senior clinicians within Sussex, with the Director of Social Care and Partnerships South East acting as a catalyst to bring the different parts of the system together. The principles of the Academy for Large Scale Change model were utilised, focusing on mobilising, spreading and sustaining change. Whole system modelling was undertaken to understand the impact of implementing the NDS on demand and resources.

Contact details and further information:

Contact Charlotte Clow, Sussex Dementia Partnership. Email charlotte.clow@nhs.net

 

Rapid Assessment & Consultant Evaluation (RACE)

This programme established a new admissions unit, the Rapid Assessment & Consultant Evaluation (RACE) ward.  Here medical patients with geriatric needs (frailty, multiple co-morbidities, advanced age dementia) referred to hospital as emergencies, are assessed and cared for by a consultant-led multidisciplinary (MDT) team, including doctors, nurses, physiotherapists, occupational therapists and community support staff.

All patients receive comprehensive geriatric assessment (CGA) within 24 hours of admission and there is a daily multidisciplinary meeting attended by the ward team and representatives from Poole Intermediate Care Service, Poole Social Services and Dorset Social Services to facilitate discharge planning.

GPs can also refer patients to the daily emergency clinic held on the ward to access rapid diagnostics and CGA without admission to hospital.

The aim of the unit is rapid comprehensive assessment of older patients with complex needs. This facilitates early supported discharge and avoids unnecessary hospital stays which can be detrimental to older patients. The trust benefits from a reduced length of stay for older patients with concomitant savings.

Outcomes:

Within 3 months of the establishment of the RACE ward marked improvements were recorded. Patient discharge within 48 hours increased from 20{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} to 40{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b}, and average length of stay decreased from 19 to 13 days. The quality of patient care also improved as a result of comprehensive geriatric assessment at the front door.

Information, tools and techniques used:

The original impetus for the change was managerial, but the change was driven bottom up: planned, led and implemented by clinicians.

Contact details and further information:

Prem Fade, Department Director: Prem.Fade@poole.nhs.uk

 

Reablement programme, Somerset

The Reablement programme helps patients or their carers to be experts in their own care and maintain independence for as long as possible.  By giving tailored solutions that don’t foster dependence and supporting people to remain in their own homes, it ultimately aims to reduce health inequalities and build a cost-effective service that meets demand.

The programme takes a systems approach. This has meant taking a long hard look at the way that services are delivered and has led to fundamental changes in service provision, rather than simply ‘doing the wrong things righter’, as one programme manager put it.

Listening to patients and collaborating across professional and organisational boundaries are both central to what makes the reablement programme work. In Somerset, the PCT and the county council jointly reviewed all their services that might be termed ‘reablement’. They worked in partnership with private and voluntary sector organisations and the new CCG to deliver better, more coordinated services.

Outcomes:

In Somerset, the reablement programme has led to an increase in collaboration across the healthcare sector and made significant changes in how patients are assessed and what services are provided. An example is a patient with a history of sciatic pain who had a fall. Previously, he would have been hospitalised, but his GP contacted the reablement team, who quickly established that he would prefer to be at home. The team devised a personal support package that enabled him to gradually increase his mobility without being admitted to hospital.

Ultimately, the programme has delivered a number of real gains in service quality, patient outcomes, productivity and staff motivation. This includes significant reductions in hospital readmissions and the cost of social care.

Information, tools and techniques used:

The programme used Vanguard Consulting’s change methodology for systems thinking.

Timescale:

The Somerset Reablement programme started in spring 2010 with a pilot in Taunton. From January 2012 Reablement was mainstreamed in Taunton and rolled out in another large federation in Somerset.

Contact details:

Ann Anderson ann.anderson@somersetccg.nhs.uk and Sue Glanfield Susan.glanfield@somerset.nhs.uk were both members of the project team.

Community response and reablement service (Bracknell Forest)

The community response and reablement service programme, undertaken by Bracknell and Ascot CCG commissioners jointly with Bracknell Forest Council, pursued an alternative to hospital-based intermediate care.  It worked across health and social care in areas where the lead commissioner for the service is the local authority via a Section 75 agreement.

The core purpose of the programme was to set up a joint service for the provision of bed based reablement. Some beds in a community hospital were decommissioned and a formal application was made by the clinical commissioning group (CCG) to invest in more local bedded reablement in a social care setting.  The change happened concurrently with a continued shift in patient flow.  Previously almost all acute non-elective admissions to hospital were to one district general hospital (DGH).  Now admissions are split between 3 neighbouring acute hospital trusts.

Outcomes:

A number of outcomes have been recorded in relation to the performance of the health and social care system.  These include minimal delayed transfers of care and an encouraging rise in admissions directly from home to the new service via GP referral.  People using the service report high satisfaction with the service.

Information, tools and techniques used:

No specific change management methodology was used.  Instead the programme took a pragmatic approach to engaging with stakeholders with a common purpose.

Geography:

The programme involved local community health services provided by Berkshire Healthcare NHS FT, the CCG for Bracknell Forest and Ascot; Bracknell Forest local authority and three acute hospitals.

Timescale:

The programme started in July 2012 and is still on-going.

Contact details and further information:

Mira Haynes, Chief Officer: Older People and Long Term Conditions, Bracknell Forest Council –  mira.haynes@bracknell-forest.gov.uk

Mary Purnell, Assistant Director of Commissioning, NHS Berkshire East – Mary.purnell@berkshire.nhs.uk

Enhancing Quality and Recovery Programme – Kent, Surrey and Sussex

Enhancing Quality and Recovery is a clinically-led rapid quality improvement programme which triangulates clinically robust data to drive quality improvements in clinical interventions, patient reported outcomes and patient experience.  The programme uses accurate benchmarking of clinical practice to identify variation and then supports clinicians to innovate and improve patient outcomes. It recognises best practice and promotes a collaborative approach whereby learning is shared within and between different Trusts.

The EQ programme aims to streamline care and improve accountability through reliable and directly comparable information on clinical quality; and to rapidly spread and adopt evidence-based improvements to multiple settings.

Outcomes:

In the first year over 25,000 patients were tracked by the programme. Quality improvement scores show a 15 per cent improvement for heart failure and pneumonia patients, eight per cent for hip & knee and five per cent for heart attack. More granular improvements were demonstrated such as a 20 per cent increase in the number of patients with pneumonia receiving their antibiotics within six hours of arriving in the hospital.

Individual Trusts are able to compare their quality performance within their Trust (at ward and clinician level), against other Trusts across this region, with trusts in the North West and with hospitals in the United States in order to improve their quality of care.

Information, tools and techniques used:

The EQ programme uses the PDSA (Plan Do Study Act) rapid quality improvement methodology, recommended by the IHI (Institute for Healthcare Improvement) and the NHS Institute for Innovation and Improvement.  The team has also used some of the principles of the MSP and Prince 2 programme management tools, adapted to suit their own purposes.

Contact details and further information:

Kay MacKay, Director, Enhancing Quality and Recovery Programme: kay.mackay1@nhs.net

Further information at: http://www.enhancingqualitycollaborative.nhs.uk

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