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The Journey -

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.  We 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   Annual value of savings made 2012/13           £311,000 (Gross) Recurrent 2013/14           £1,659,000 (Gross) Recurrent  

Patient setting

In-patient          X Out-patient Community base     X
Mental health Chronic illness Cross-systems        X

 

Clinical area

Staying healthy Maternity/Newborn Children and young people Acute care    X
Planned care Mental health Long-term conditions   X End of life
 

Information, tools and techniques used 

Project Management Board jointly with Local Authority with Project Manager  

Geography

County wide Somerset Project being rolled out Somerset wide.  Population 550,000  

Timescale

2008 and ongoing April 2012 to March 2013  

Contact details and further information

Ann Anderson Director for Clinical Commissioning Development Ann.anderson@somersetccg.nhs.uk 01935 384190 [post_title] => Reablement - Contract Monitoring QIPP [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => reablement-contract-monitoring-qipp [to_ping] => [pinged] => [post_modified] => 2015-03-24 13:27:31 [post_modified_gmt] => 2015-03-24 13:27:31 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.tvhkt.org.uk/?post_type=improvement-science&p=3711 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 3434 [post_author] => 8 [post_date] => 2013-01-16 16:51:31 [post_date_gmt] => 2013-01-16 16:51:31 [post_content] =>

The journey -

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.  

Patient setting

In-patient   X Out-patient Community based
Mental health Chronic illness Cross-systems
 

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care   X
Planned care Mental health Long-term conditions End of life
 

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.  

Geography

Brighton and Sussex University Hospitals NHS Trust.  

Timescale

Phase 1 started in June 2009 and the project is still ongoing.  

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

[post_title] => Reducing falls in elderly care and across the hospital [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => reducing-falls-in-elderly-care-and-across-the-hospital [to_ping] => [pinged] => [post_modified] => 2015-03-24 13:27:31 [post_modified_gmt] => 2015-03-24 13:27:31 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3434 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 3432 [post_author] => 8 [post_date] => 2013-01-16 16:45:42 [post_date_gmt] => 2013-01-16 16:45:42 [post_content] =>

The journey -

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 and behavioural.  

Patient setting

In-patient   X Out-patient Community based
Mental health Chronic illness Cross-systems   X
 

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care   X
Planned care Mental health Long-term conditions End of life
 

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.  

Geography

This programme involves South Devon Health Services (primary and acute care) and social care. Interest from many other health systems has generated visits from clinical teams across the UK  

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 [post_title] => Improving hip fracture pathways [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => improving-hip-fracture-pathways [to_ping] => [pinged] => [post_modified] => 2015-03-24 13:27:31 [post_modified_gmt] => 2015-03-24 13:27:31 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3432 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 3430 [post_author] => 8 [post_date] => 2013-01-16 16:37:16 [post_date_gmt] => 2013-01-16 16:37:16 [post_content] =>

The journey -

The purpose of the programme is to improve patient flows, making emergency pathways more efficient and reducing length of stay and number of beds whilst also making care safe, effective and a good experience for patients and staff. By better matching capacity to demand the trust aimed to make sure that patients who didn’t need to be admitted to the hospital could be managed on an ambulatory pathway or a short stay pathway; and that inpatients were swiftly signposted to the right specialty with a clinical management plan and pathway of care that would facilitate an appropriate length of stay.

Outcomes

Key achievements of the Programme include: Rapid Assessment in place in A&E where feasible; average length of stay reduced by 0.6 days; a 28 per cent decrease in length of stay over 14 days; 5 pathways embedded in ambulatory and short stay with another 7 at various stages of roll out; 45 patients case managed at home through a ‘virtual ward’ at any one time; a 3 per cent increase in discharges taking place before 2pm; and monthly levels of patients being seen and treated within four hours at 97 per cent.

Patient setting

In-patient           X Out-patient Community based
Mental health Chronic illness Cross-systems       X
 

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care        X
Planned care Mental health Long-term conditions End of life
 

Information, tools and techniques used

Several change management tools and models have been used, most notably some principles of PRINCE2 methodology and a Sarah Fraser model for sustainability.  Lean methodology has also informed the programme and a performance dashboard was developed according to IST specifications. The Emergency Care Programme has also benefited from clear communication strategies within divisions and large-scale direct engagement with staff.

 

Geography

This programme took place in the three main acute sites of East Kent Hospitals University NHS Foundation Trust: Kent and Canterbury Hospital (Canterbury); William Harvey Hospital (Ashford); and the Queen Elizabeth the Queen Mother Hospital (Margate).  

Timescale

The programme started in June 2010.  For the first 18 months, the programme focused primarily on developing the right systems and processes, identifying clinical leaders to facilitate the change and engaging staff.  It is now being refreshed to recognise current achievements and look ahead at the challenges that remain. With systems and processes in place, greater focus is being placed on the cultural aspects of embedding change in the organisation.  

Contact details and further information

Karen Miles, Associate Director of Operations, East Kent Hospitals University Hospitals NHS Foundation Trust: kmiles1@nhs.net [post_title] => Emergency Care Quality Improvement Programme [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => emergency-care-quality-improvement-programme [to_ping] => [pinged] => [post_modified] => 2015-03-24 13:27:32 [post_modified_gmt] => 2015-03-24 13:27:32 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3430 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 3429 [post_author] => 8 [post_date] => 2013-01-16 16:31:35 [post_date_gmt] => 2013-01-16 16:31:35 [post_content] =>

The journey -

From 2008 to 2009, two acute trusts in NHS South West took part in the Orthopaedic Rapid Improvement Programme led by the NHS Institute. Interest in the programme was much more widespread than this: another 15 acute trusts in the region applied to the programme but were not selected as pilot sites. As a result, the SHA decided to work with the NHS Institute to spread the learning from the Orthopaedic Rapid Improvement Programme, in particular from the two pilots in the region, and build on the desire for improvement. For these reasons, the SHA and NHS Institute designed a programme of three events focused on good practice in the commissioning and delivery of orthopaedic surgery. They brought together commissioners, nurses, managers, physiotherapists, surgeons and anaesthetists to build relationships and common understanding of best practice, and foster a more collaborative culture.  

Outcomes

The Collaborative Commissioning events were seen to create more conversation, networking and collaboration across organisational and professional boundaries – for example, service providers started working with their commissioners to solve issues; and teams from local trusts worked alongside independent sector treatment centres. Following the events, improvements were also seen in about a third of the elements of the pathways. The divergence between the best and worst providers initially increased, suggesting that the better ones responded faster to put learning from the events into practice, but performance has since converged. The region is now estimated to be saving about 250 to 280 beds a year for orthopaedic pathways, compared to a national average of about 50.  

Patient setting

In-patient   X Out-patient Community based
Mental health Chronic illness Cross-systems
 

Clinical area

Staying healthy Maternity and newborn Children and young people Acute care X
Planned care  X Mental health Long-term conditions End of life
 

Information, tools and techniques used

In designing the programme of events, the SHA was aware (not least from the Darzi white paper) that a particular challenge to address was a lack of collaboration and common understanding in the commissioning process. The events were themselves developed collaboratively. They were workshop based and open to the 14 PCTs and all providers of fractured neck of femur and hip and knee surgery (including the independent sector) in the south west.  

Geography

Across the south west of England  

Timescale

Over a period of six months from spring 2009.  

Contact details and further information

Sasha Karakusevic sasha.karakusevic@nhs.net led the design of the events; Deborah Thompson deborah.thompson@institute.nhs.uk headed the orthopaedic Rapid Improvement Programme team.

[post_title] => Collaborative Commissioning events [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => collaborative-commissioning-events [to_ping] => [pinged] => [post_modified] => 2015-03-24 13:27:32 [post_modified_gmt] => 2015-03-24 13:27:32 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3429 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 5 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 3711 [post_author] => 8 [post_date] => 2013-03-27 15:11:05 [post_date_gmt] => 2013-03-27 15:11:05 [post_content] =>

The Journey -

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.  We 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   Annual value of savings made 2012/13           £311,000 (Gross) Recurrent 2013/14           £1,659,000 (Gross) Recurrent  

Patient setting

In-patient          X Out-patient Community base     X
Mental health Chronic illness Cross-systems        X

 

Clinical area

Staying healthy Maternity/Newborn Children and young people Acute care    X
Planned care Mental health Long-term conditions   X End of life
 

Information, tools and techniques used 

Project Management Board jointly with Local Authority with Project Manager  

Geography

County wide Somerset Project being rolled out Somerset wide.  Population 550,000  

Timescale

2008 and ongoing April 2012 to March 2013  

Contact details and further information

Ann Anderson Director for Clinical Commissioning Development Ann.anderson@somersetccg.nhs.uk 01935 384190 [post_title] => Reablement - Contract Monitoring QIPP [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => reablement-contract-monitoring-qipp [to_ping] => [pinged] => [post_modified] => 2015-03-24 13:27:31 [post_modified_gmt] => 2015-03-24 13:27:31 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.tvhkt.org.uk/?post_type=improvement-science&p=3711 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 22 [max_num_pages] => 5 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => 1 [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => 1 [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => [is_privacy_policy] => [is_404] => [is_embed] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_favicon] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => e73e8a33783bd06f1ef4ed61bb8bc842 [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) ) [1] => derp )

Category: Acute care

Reablement – Contract Monitoring QIPP

The Journey – 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 […]

Posted on Mar 27th Cat: , , , , , Comments: Comments are off for this post

Reducing falls in elderly care and across the hospital

The journey – 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 […]

Posted on Jan 16th Cat: , , Tags: Comments: Comments are off for this post

Improving hip fracture pathways

The journey – 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 […]

Posted on Jan 16th Cat: , , , Comments: Comments are off for this post

Emergency Care Quality Improvement Programme

The journey – The purpose of the programme is to improve patient flows, making emergency pathways more efficient and reducing length of stay and number of beds whilst also making care safe, effective and a good experience for patients and staff. By better matching capacity to demand the trust aimed to make sure that patients […]

Posted on Jan 16th Cat: , , , Tags: Comments: Comments are off for this post

Collaborative Commissioning events

The journey – From 2008 to 2009, two acute trusts in NHS South West took part in the Orthopaedic Rapid Improvement Programme led by the NHS Institute. Interest in the programme was much more widespread than this: another 15 acute trusts in the region applied to the programme but were not selected as pilot sites. […]

Posted on Jan 16th Cat: , , , Tags: Comments: Comments are off for this post