Releasing time to care
Teams across the Trust are redesigning and streamlining the way they manage and work as part of the NHS Institute for Innovation and Improvement’s ‘Productive series’.
Around 80% of trusts have already signed up to the programme that is designed to develop ways to increase the amount of direct care time given to patients. The ‘Productive mental health ward: releasing time to care’ focuses on wards that provide mental health services and is designed to release more time for care by improving the effectiveness, safety and reliability of mental health wards
The Trust currently has nine wards enrolled on the programme including all adult inpatient wards and also the Chantry Unit, Castle Lodge, Enfield Down and the Elmdale ward.
The key to the success of the programme is that improvements are driven by staff themselves, by giving them the power to ask difficult questions about practice and to make positive changes to the way they work. The process promotes a continuous improvement culture leading to real savings in materials, reducing waste and vastly improving staff morale.
As part of the scheme teams attend workshops and network meetings where they can share knowledge and listen to new ways to develop services to free time to spend with people who use the service.
Head of nursing George Smith, who is leading the programme for the Trust, said, "I believe the key to success of the productive series is the way that it empowers frontline staff. Wards involved in the scheme are demonstrating how it can lead to real and sustainable change. It requires them to constantly measure how they are performing and seek improvements, and that can only benefit people who sue our services."
Here we look at how Castle Lodge and the Elmdale ward are already benefiting from the programme.
Castle Lodge, has been part of the programme since November 2009 and has already started to see the benefits.
It is a 12-bed inpatient rehabilitation unit for people with enduring mental health problems and it has recently undergone a number of renovations. These changes have included a new kitchen and clinic and revamped seating areas.
Ways in which the ward has been streamlined to become more efficient include having all information available to hand reducing the time spent chasing different information. This has been made easier through the effective use of RiO and other technology such as projectors, which enable staff to share information in a team meeting.
All these transofromations have helped staff feel empowered and enthused to make challenging changes to the way they work. These changes have and will continue to help achieve significant and lasting improvements – predominately in the extra time that they give to patients, as well as improving the quality of care.
The deputy unit manager at Castle Lodge Pam Hammerton said, "It has been hard work getting the programme started and has taken a real team effort, but we are already starting to see the benefits with more time freed up to spend with service users. Staff have been assigned different responsibilities which means areas of the ward are well maintained and as efficient as possible. We are looking forward to seeing even more benefits from the programme which will ultimately improve the quality of care we provide."
Staff on the Elmdale ward in Halifax have recently completed the foundation stage of the programme and are progressing to the next level.
The Elmdale ward at The Dales Unit at Calderdale Royal Hospital is a 24 bed unit for adults who are experiencing mental distress. Staff there have been looking to increase the amount of time spent caring for individuals by making small but effective changes to their everyday tasks focusing on quality and productivity.
Elmdale’s productive ward vision is to provide a safe and supportive environment that promotes and enhances recovery. Their vision is to have an enthusiastic, approachable, motivated and professional team working in collaboration with service users in an environment that is well organised and efficient. Elmdale are committed to reviewing working practices to enable them to ‘release time to care’.
‘Activity follows’, where a routine activity is monitored from start to finish, have been carried out to look at how much time is spent doing daily tasks such as administration and shift handovers. Areas where tasks are unproductive have been targeted and more lean methods have been applied. The use of a notice board to display information has also been used to enable staff to see at a glance where other members of the team are without having to chase each other around the ward. This fits in with the programmes ‘Five S rule’ which advises staff to sort, set, shine, standardise and sustain.
All staff on the ward are being encouraged to view a presentation make them aware of the aims of the programme and to see how they can start applying the methodology to everyday tasks. By seeing information such as admission rates, incidents and absences staff are constantly aware of the impact they have on the team and how absences are actually ‘days lost’ for the ward.
Now that the Elmdale ward has completed the foundation stage of the programme they are concentrating on the first process module. They have opted for the meal times module, which looks at everything involved in meal times for service users. This includes the environment in which they eat, what they think of the food and time spent doing tasks associated with meal times.
Staff have found that by making simple changes to be more organised an increased amount of quality time is available to spend with service users. Although it is a working progress and they are only on their first process module, the Elmdale ward is already seeing the benefits of the programme and continuing assessments and audits will be completed to enable the team to continue comparing data.