Delivering the Productivity Challenge workshop. 18 th November, 10.15am-11.45am NHS Employers Conference ACC Liverpool

Transcription

1 Delivering the Productivity Challenge workshop 18 th November, 10.15am-11.45am NHS Employers Conference ACC Liverpool

2 Agenda 1. Welcome 2. Productive Care and QIPP National Workstream 3. The Productives Series 4. Cost and Quality benefits case studies 5. Temporary Staffing strategies approaches to reduce agency costs 6. What can I do? Where can I get support?

3 The Productive Care QIPP prize? To support greater (clinical) staff productivity in provider organisations in a way that delivers real cash savings necessary for QIPP Contributing c. 1.4bn to the NHS challenge but potentially much more Improving the quality of care Positively improving the experience and unleashing the energy of tens of thousands of NHS staff. and therefore the experience of patients Building capacity, capability and leadership through delivering This equates to having an extra 255 full-time nurses.while an equivalent level of service improvement without the programme would cost an estimated 7.5 million a year Nursing Management July 2009

4 No. of wards/operating theatres/cs Productive Care Programme Scope 100% productive approaches across key clinical settings. Evidence based interventions. Accelerated scale and pace of adoption. Strong link to workforce and the wqipp programme o Productive Ward o Productive Mental Health o Productive Operating Theatre o Productive Community Services P Ward P Metal Health Ward TPOT P Community Services / / / / / /13

5 National Activity Research - Top Tips CQUIN exemplars 100% Productive Ward defining implemented Productive Ward mobilising campaign Work with Professional bodies, unions, Monitor, Quality accounts Developing professional narratives Widespread engagement activity and peer to peer learning

6 The Productive Series Lynn Callard NHS Institute for Innovation and Improvement

7 The Productive Series Copyright NHS Institute for Innovation and Improvement 2009

8 Principles of The Productive Series Team performance and leadership Safe and reliable care Patient s experience & outcomes Cost effective care Copyright NHS Institute for Innovation and Improvement 2009

9 Putting patients and the public first - White Paper, July 2010 Copyright NHS Institute for Innovation and Improvement 2009

10 Copyright NHS Institute for Innovation and Improvement 2009

11 Variability of uptake by SHA 50% Sept 2010 Average Lowest Uptake Highest Uptake 0% 34% 67% 100% Copyright NHS Institute for Innovation and Improvement 2009

12 Evidence and Impact

13 Rampton Hospital positive impact for staff Copyright NHS Institute for Innovation and Improvement 2009

14 Portsmouth Hospitals NHS Trust Re-admissions reduced by 2.7% (575 patients) in General Medicine Re-admissions reduced by 2.4% (200 patients) in General Surgery The average patient admission cost is 1,316, so this improvement translates to a 131,575 benefit 127,488 attributable to The Productive Ward Copyright NHS Institute for Innovation and Improvement 2009

15 The potential of The Productives Can help you meet the challenges of: Quality and safety of care Efficiency and reduction of waste Improving staff well- being We are committed to making sure that every NHS patient will be receiving productive care by March 2013 Copyright NHS Institute for Innovation and Improvement 2009

16 Productive Community Services (PCS) The Coventry Experience Julia Williams Assistant Director/ Programme Lead

17 Topics Covered. Coventry & Strategic Fit Why Productive Community Services? Progress to date Benefits/findings from the modules Challenges/considerations Revised Project Plan Staff and Patient Feedback

18 COVENTRY

19 Why the Productive Community Services Productivity Quality Capability Long term culture change Programme?

20 Well Organised Working Environment?

21 Well Organised Working Environment (WOWE) Organised Accessible Minimum / maximum levels of stock sustained Store room disorganised Cluttered Excess of equipment/not available

22 WOWE Impact Measures Identified 5 items collected from the store room Time saved: 28 seconds x 5 staff =140secs / 60 = 2.3 mins a day x 6.5 days = 15 min per week x 52 = 780 / 60 = 13hrs per year 13 x mid band x 13 = 237 per year Cost excess/waste stock items Current cost approximately for stores 1000

23 Before and After

24 5 S A place for everything and everything in it s place!

25 Knowing How We Are Doing Care Plan Audit Patient Facing Time Patient Satisfaction Unplanned Absence This module gives us control of our own performance 25

26 PALLIATIVE BOARD Review of patients Progress Updating of patient Information Easily assessable Consultant NHS Number Other Comments PSAAG Easy to review Aids MDT working Effective efficient handover meetings Info available to all team members We have found this to be very successful DIABETIC BOARD Patient s type of Insulin Frequency given Hba1c due date( any other Diabetic review date NHS Number Other Comments 26

27 Managing Caseload & Staffing Yearly Planner (MCAS) Predictability for forthcoming week Planning for future training/ annual leave easily recognisable Clarity of training accessed Ensures all staff have equal opportunities Staffing levels maintained 27

28 Planning Our Workload (POW) Teams able to plan their day/ week Able to meet the needs and demands of the patients Able to reduce travel times, duplication and improve efficiency Fair work allocation 28

29 Planning Our Workload (POW) Teams able to map out staff routes & patient/ client locality Able to reduce points of mapping by 50% Able to reduce travel times, duplication and improve efficiency 29

30 Working Better with our Key Care Partners 14% of referrals over 4 week period inappropriate equating to mins/wk 21hrs/yr potential costing 380 /yr. Another DN team had 47% inappropriate referrals potential costing 6390/yr. Currently using the new DN referral form Plan further roll out to more GP s

31 Agreeing The Care Plan with the Patient Practice questioned by team members for most appropriate approach on first visit Use of SMART goals essential to involve patient Use of a reliability audit to ensure sustainability Evidence based input into new proposed documentation

32 Why are SMART Goals and Actions Important? They are measurable, realistic and achievable and allow the patients to truly understand their problems It enables the patient to be more compliant and to take control of their own health issues It involves patients in their own care It gives the patients something back that they may have lost- control 32

33 Standard Care Procedures Impact Measures Identified Quality of care ensured through challenges between practice and procedures Evidence based practice Audits to monitor and address variations Care delivered in a more consistent and standardised way

34 Challenges/ Considerations Community Field Based Teams Clinic Based Services Independent Practitioners Office Based Teams * WOWE KHWAD PSAAG MCAS POW WBKCP ACPWTP SCP PI PP WOWE KHWAD PSAAG * MCAS * WBKCP POW * SCP PI PP WOWE KHWAD PSAAG * MCAS* WBKCP* POW ACPWTP SCP* PI PP WOWE KHWAD *

35 PILOT ROLL OUT Half Day Introductory Workshop for all Clinical Leaders and Managers Well Organised Working Environment (WOWE) Knowing How We Are Doing (KHWAD) Patient Status At A Glance (PSAAG) Managing Caseload and Staffing (MCAS) Weeks 1,3,5,7,9 Weeks 2,4,6,8,10 Weeks 11,13,15,17,19 Weeks 12,14,16,18,20 Weeks 21,23,25,27,29 Weeks 22,24,26,28,30 Weeks 31,33,35,37,39 Weeks 32,34,36,38,40 Prepare Prepare Prepare Prepare 90 minute coaching session each 2 weeks followed by implementation of activities within teams before the next session. Assess Workplace activity Assess Workplace activity Assess Workplace activity Assess Workplace activity Workplace activity Workplace activity Workplace activity Workplace activity Plan Plan Plan Plan Workplace activity Workplace activity Workplace activity Workplace activity Treat Treat Treat Treat Workplace activity Workplace activity Workplace activity Workplace activity Evaluate Evaluate Evaluate Evaluate Clinical Leader facilitates own team through remaining modules of PCS House Planning Our Workload Working Better With Our Key Care Partners Standard Care Procedures Agreeing the Care Plan With The Patient Perfect Intervention Patient Perspective 35

36 Dressings easier to find, you can see when stores need to be ordered, so we are not left with nothing Patient current status at a glance very useful Keeps all staff up to date Phone book vital tool in the workplace - life easier and saves time looking for numbers all day 36

37 PATIENT FEEDBACK Mrs A is following her goals with positive effect and is enjoying undertaking them as it gives her something to aim for. Her legs are improving and are less painful with reduced exudate. Mrs A fully understands why we have set goals with her and feels they are both attainable and realistic. Mr B feels that personalised goal setting gives him structure and involvement in his own care and the healing of his wound. He understands why it is important and how it can enhance his life. Mr B has changed his diet and is more compliant and as a result his Diabetes has become more stable and his blood sugars are now within normal range. Furthermore he has lost weight, states that he feels better and his mobility has improved greatly. His wound has greatly improved and is expected to improve further. 37

38 PCS has a had a positive impact as a whole and over time will improve the way we work and the care we provide. Thank You Contact details: julia.williams@coventrypct.nhs.uk 38

39 The Productive Ward Project at Salford Royal NHS Foundation Trust Kate Clayton Project Lead

40 Drivers for the Project Do nurses have enough time for direct patient care? 73% No Does lack of time with patients have an adverse effect on patient care? 89% Yes Does lack of time with patients have an adverse effect on morale? 93% Yes Are you frustrated at working on the ward and ability to do your best? 89% Yes Source :National survey conducted by The Nursing Times on behalf of the Institute for Innovation and Improvement 2005

41 Research study from National Nursing Research Unit The Productive Ward programme: has huge perceived value and it is easy to identify local evidence of impact SRFT identified easy wins has been framed and communicated in ways that connect with staffs need and will for change Cemented the other collaboratives together thrives where local communication and leadership are strong SRFT already has a change and quality mentality has huge potential for on-going spread The nursing staff recognised how PW could be applied to all aspects of the ward, implemented the modules quickly and simultaneously Source: King s College London, June 2009

42 Results from SRFT Biggest value and impact has been from WOW module. Financial and De cluttering Communicated as a nurse led project, nurses identifying and finding solutions for their wards issues Good ideas and practise has been spread effectively

43 Financial success Reduction of 20 wards pharmacy budget = 47,400 Reduction in Stock = 58,127 Return of stock and supplies = 30,293. Reduction in food waste from 37% to 31%

44 Other Successes Handover bedside handover, reduction in time Medicines- better storage, less interruptions, rationalisation of stock WOW de cluttering, easier to find things PSAG Symbols, ward clerk update sheets

45 Ward Direct Care Time/ Direct Visual Time original activity % original activity time (mins) new activity % new activity time (mins) increase in time (mins) % increase in time B C G ICU SHDU B L J B G K C L L SCBU SAU L L B H B ASU B Overall % increase in time as a Trust average is %. Average (mean) % increase in time %

46 SRFT Survey Results Of 100 of SRFT ward staff surveyed: 88% say they have been involved in the project 90% say the project has made a difference to their ward Well Organised Ward Easier to find stock and supplies (93%) Relieved frustration of searching for stock (89%) Relieved stress (84%)

47 Handover, Meals, Ward Round More time: to spend with patients (100%) to involve patients in their care & choices (100%) to talk to their patients (83%)

48 Staff Development Find it easier to access training (56%) More time to work on link subjects (70%) Reducing Stress and Staff Frustration: Easier to leave shift on time (75%) Feel less rushed (80%) Happier at work (80%)

49 Return on Investment (ongoing) Return of stock (drugs, supplies, equipment) (so far) 30, Cost saving ideas (so far) 58,127 Reduction in pharmacy budget 46,300 (B Renal Unit 1,703.70)

50 What could be improved? More involvement of all ward team staff Someone else to do the activity follows To be given time out to do the project Given time to implement changes instead of things being fitted into the day when able

51 What has been the best thing? The ward is more organised It has encouraged teamwork Allowed the ward staff to take ownership Better communication Thank you for making a difference I feel Productive Ward has made us a better team

52 Sustainability The wards which have just launched need support from their Matron and Lead nurse to make progress. Maintain the activity follows Project will be a SCAPE competency Operational responsibility for the maintenance of Productive Ward will rest with the lead nurses

53 Reduction of Agency Costs DH Workforce/QIPP Shirley Chipperfield DH Temporary Staffing Lead

54 Project Aim: To support NHS organisations in making the most efficient use of temporary staffing with the intention of reducing agency spend by 500million by 2013/14. Key Areas of Delivery: 1. Promotion of Good Practice (volume) 2. Development of Metrics (volume and price) 3. Contract Management for Agency Staff (price) 4. Support Tools (volume)

55 Promotion of Good Practice Launch NHS Employers Briefing No. 72 Flexible Workforce: strategic planning to reduce costs and improve quality Flexible Workforce Checklist and Flow Chart Good practice Case Studies NHS Employers Website Policy and good practice for Employers & Employees Interactive web discussion following conference Agency Workers Regulations (Oct 2011)

56 Development of Metrics Information Collection & Benchmarking Each SHA has Agency Savings goal to achieve DH QIPP teams monitoring savings projections Develop use of DH Efficiency Improvement Metric Compare total cost of staff v agency usage to understand value for money. Promote local benchmarking between FT s and build on existing work (e.win North West) to include HES, ESR and agency data. Auditing of agency invoices

57 Contract Management for Agency Staff How much does your Trust spend on agency? what is the level of non-national framework spend? 1.9 billon estimated spend on agency/non-nhs staff in 2008/ million through Buying Solutions (PASA) national frameworks and 1.4 billon spend not through national frameworks.

58 Contract Management for Agency Staff Trusts need to take ownership of procurement contracts for agency staff to better reflect their local needs and to drive down price. Evidence from NHS Scotland shows a 15% ( 6m) saving on current national medical locum contract rates (54 agencies reduced to 5 and limited use of escalation pay rate). Evidence from London Procurement Programme Nursing hourly rates reduced (estimate 8-12m savings) Migration pack to assist Trusts move from off-framework back to framework.

59 Support Tools and Next Steps... Efficiency Improvement Metric To identify Trusts/FTs to be pilots for agency benchmarking (5 identified) E-rostering and Use of Technology Extend use of E-rostering (case study: centralised E- rostering North Tees & Hartlepool FT) Implementation Programme 2010/2011 to promote good practice and support Trusts/FTs with commercial management of regional/local agency procurement contracts (3 identified) NHS Employers to promote findings from pilots and disseminate good practice.

60 Remit! Reduce Bank and Agency Spend. Esther Blakey Trust Nursing Resource Manager North Tees & Hartlepool NHS Foundation Trust

61 Assess where we are now? Bank Office (June 2009) Bank office paper based Requests through telephone / Inability to determine if request within budget Inability to determine if resources available from another area No reason for requests recorded No authorised requester list available 257 bank staff however still unable to cover shifts therefore utilising Agency

62 Actions Introduction of e-bank module across all areas utilising the Trust e-rostering system Ensure all budgets vs templates were balanced Requests only accepted if requested through e-bank module Requests only by senior staff (band 5+ / take charge) Ability to request shifts only if vacant duty available Give reason for requests (for future analysis) Specials extra to basic ward requirement (when no ward vacant duty present) Review bank staff availability and work record (<6months) Review Trust float

63 Trust Float (August 2009) 1. HCA Float required to cover the following shifts (both sites): 24hrs / 7 days a week Band 2 = 14 x nights = 14 x Early = 14 x Late 2. Actual Cover by Float: 6 x nights on one site only Remaining shifts covered with Bank /Agency = 8 x Nights = 28 x Days Due to minimal bank availability mainly covered with Agency

64 Requests Cadet s 26/ 9/ N/ T w/ day Float s cancelled 10/ 10/ 09 H/ P w/ day Floats cancelled 277 3/ 10/ Bank & Agency Weekly Statistics September June unf unded beds opened capacit y management issue 12/ 12/ Agency request s require GM approval 1/ 2/ 10 unf unded beds closed 21/ 1/ 10 Ext ra beds f or wint er pressures closed 3/ 4/ / 9 / 09 Specials assessment form introduced 3/ 10 10/ 1 17/ 1 24/ 1 31/ 1 7/ 11/ 14/ 11 21/ 11 28/ 1 5/ 12 12/ 1 19/ 1 26/ 1 2/ 1/ 1 9/ 1/ 1 16/ 1/ / 09 0/ 09 0/ 09 0/ 09 0/ / 09 / 09 1/ 09 / 09 2/ 09 2/ 09 2/ / 1 30/ 1 6/ 2/ / 10 / / 2 20/ 2 27/ 2 / 10 / 10 / 10 6/ 3/ 10 13/ 3 20/ 3 27/ 3 / 10 / 10 / 10 3/ 4/ 10 10/ 4 / 10 17/ 4 24/ 4 1/ 5/ 1 8/ 5/ / 10 / / 5 22/ 5 29/ 5 5/ 6/ / 10 / 10 / Bank Fill Agency Fill Total Requests Specials request s W/B Bank Fill Agency Fill Total Requests

65 2 nd Review and Actions Recruitment drive for bank staff Introduction of Modern Apprentiship scheme (60 over 6 months) Reduction of float shifts to nights and weekends only Specials assessment form introduced Agency requests requiring GM approval Centralised rostering to ensure all staff hours utilised and expensive shifts covered first i.e weekends and nights Prioritisation of shifts to be covered i.e. specials, short term sickness Bank only booked if ward area over budgeted headroom for AL / sickness etc

66 Requests Bank & Agency Weekly Statistics April present Capacity Issues 3/11/10 DEEP/ NEEP level 3 4/11/10 DEEP / NEEP level 2 5/11/10 DEEP / NEEP level 1 Extra beds opened: 9 N/Tees / 4/ 10/ 4 17/ 4 24/ 4 1/ 5/ 8/ 5/ 15/ 5 22/ 5 29/ 5 5/ 6/ 12/ 6 19/ 6 26/ 6 3/ 7/ 10/ 7 17/ 7 24/ 7 31/ 7 7/ 8/ 14/ 8 21/ 8 28/ 8 4/ 9/ 11/ 9 18/ 9 25/ 9 2/ 10 9/ 10 16/ 1 23/ 1 30/ 1 6/ 11 13/ 1 20/ 1 27/ 1 4/ 12 11/ 1 18/ 1 25/ 1 1/ 1/ 1 8/ 1/ 15/ 1 22/ 1 29/ 1 5/ 2/ 12/ 2 19/ 2 26/ 2 5/ 3/ 12/ 3 19/ 3 26/ 3 10 / 10 / 10 / / 10 / 10 / / 10 / 10 / / 10 / 10 / 10 / / 10 / 10 / / 10 / 10 / 10 / 10 / 10 0/ 10 0/ 10 0/ 10 / 10 1/ 10 1/ 10 1/ 10 / 10 2/ 10 2/ 10 2/ / 11 / 11 / / 11 / 11 / / 11 / 11 / 11 Bank Fill Agency Fill Tot al Request s Specials request s W/B Bank Fill Agency Fill Total Requests Specials r

67 B&A Monthly Expenditure Comparison 2008 v 2009 v April M ay June July August September October November December January February M arch

68 What can you do next? Check where you are up to with the Productives? Contact Is your trust following excellent practice around agency staffing? Contact

69 Please feedback your thoughts. Please help us shape our programme to meet your needs by taking a few minutes to complete the session evaluation form.