Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff A learning tool to spport all nrsing, midwifery and care staff to identify and address nwarranted variation in practice March 2018
Foreword Dear Colleages, We are delighted to formally present the first Leading Change, Adding Vale (LCAV) learning tool. LCAV is the national framework for nrsing, midwifery and care staff within England. It bilds on the sccess of Compassion in Practice with the 6Cs remaining as the core vales. Following extensive consltation and feedback from the professions, LCAV was developed to spport nrsing, midwifery and care staff to apply eqal importance to qantifying and measring the otcomes of or work as we do to demonstrating the qality and compassion that we are recognised for. We have therefore developed this learning tool to spport all nrsing, midwifery and care staff to identify and address nwarranted variation in practice, no matter what yor role is, or where yo work. Many colleages are doing this already as part of everyday practice, however, mch of this essential work can often remain hidden or misnderstood, as some of it is not easily measred or captred, or shared. LCAV specifically looks at redcing nwarranted variation, where standards of care are not eqal and how we can make sre that by seeing where ineqalities exist and changing them, that everyone can receive the same highest standards of better otcomes, better s and better se of resorces. We recognise that for many, this may be a new way of working and that some of the langage and principles may be nfamiliar. Therefore on behalf of Health Edcation England, NHS England and all LCAV partners, we have worked with E-learning for Healthcare to develop this tool to help explain and de-mystify the approach to identifying and addressing nwarranted variation in practice. We appreciate yor interest and participation in this work and ask that yo encorage colleages to also find ot more abot Leading Change, Adding Vale. By doing so and ptting LCAV in to action we can demonstrate or key contribtion to the transformational work that is happening across the contry, and showcase and share the positive otcomes of the work and the leadership of nrsing, midwifery and care staff within both health and care sectors. Best wishes, Contents Foreword 2 Contents 3 Session Overview 4 Session Introdction 4 Introdction 5 Principles 6 Elements 7 The Three Gaps 8 Unwarranted Variation 9 The Triple Aim 12 The Six Cs 16 The Ten Commitments 17 Conclsions 24 Self Assessment Qestions 25 Session Key Points 28 Session Smmary 28 References 29 Self Assessment Answers 30 Ssan Aitkenhead Director of Nrsing Professional Development NHS England Liz Fenton Depty Chief Nrse Health Edcation England An online version of the e-learning tool can be accessed at https://www.e-lfh.org.k/programmes/leading-change-adding-vale/ 2 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 3
Session Overview Description This docment will explore the Leading Change, Adding Vale (LCAV) framework and spport all nrsing, midwifery and care staff to identify and address nwarranted variation in practice recognising neqal standards of care and changing them. Athors: Liz Fenton, Depty Chief Nrse, Health Edcation England Kate Lievesley, Project Delivery Manager Research and Qality Assrance, NHS England Dration: 40 mintes Introdction First lanched in 2016, Leading Change, Adding Vale (LCAV) is a national framework for nrsing, midwifery and care staff [1]. LCAV is aligned with the NHS Five Year Forward View [2] and positions nrsing, midwifery and care staff as leaders in designing the ftre and sing their inflence to manage the challenges of today. LCAV gives England s nrsing, midwifery and care staff a new opportnity to demonstrate the beneficial otcomes and impact of or work. Nrsing, midwifery and care staff (whatever their role, wherever they work) are invited to take a lead in narrowing the gaps facing those that work in health and care (see later). Session Introdction Learning Objectives By the end of this session yo will be able to: Identify the main elements of the LCAV framework Describe how nrsing, midwifery and care staff can se the LCAV framework to identify and address nwarranted variation and strengthen the qality and otcomes of care Identify and address any examples of nwarranted variation in yor workplace The LCAV framework was lanched in 2016 by Professor Jane Cmmings, the Chief Nrsing Officer for England. 4 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 5
Principles It is important to ensre that we are not complacent and assme that or work and the reslting otcomes are always nderstood and recognised. Why the LCAV framework matters We need to clearly identify or positive contribtion and demonstrate how we add niqe vale to the new system going forward to 2020 and beyond. The LCAV framework positions nrsing, midwifery and care staff as leaders in designing the ftre (reprodced with permission from Science Photo Library) The LCAV framework invites nrsing, midwifery and care staff to se their inflence to manage challenges (reprodced with permission from Science Photo Library) Elements Before we proceed, let s explore the elements of the LCAV framework. The three gaps Unwarranted variation The triple aim The six Cs The ten commitments We will now explore each of these five elements in more detail. Leading Change Health and wellbeing Care and qality Fnding and efficiency UNWARRANTED VARIATION Adding Vale The final element of the LCAV framework is the ten commitments otcomes se of resorces The LCAV framework encorages nrsing, midwifery and care staff to demonstrate the beneficial impact of their work (reprodced with permission from Science Photo Library) 6 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 7
The Three Gaps The FYFV report identifies three gaps which impact on the health and care sector [2]: Health and wellbeing Care and qality Fnding and efficiency Leading Change Adding Vale Unwarranted Variation Overview The term nwarranted variation is sed to describe sitations where there are ineqalities in health and care, patient and staff s and se of resorces that cannot be jstified by reasons of geography, demography or infrastrctre. By identifying and addressing sch ineqalities, everyone can receive the same high standards of care. Health and wellbeing Care and qality Fnding and efficiency Health and wellbeing Withot a greater focs on prevention, health ineqalities will widen and or capacity to pay for new treatments will be compromised by the need to spend billions of ponds on avoidable illness. Qestion: How can yo help to close the health and wellbeing gap? Practise in ways which prevent avoidable illness, protect and promote health, wellbeing and resilience. Qestion: Can yo think of ways to narrow the health and wellbeing gap in yor work and/or workplace? UNWARRANTED VARIATION Care and qality Health needs will go nmet nless we reshape care, harness technology and address variations in qality and safety. Qestion: How can yo help to close the care and qality gap? Practise in ways which provide safe, evidencebased care which maximises choice for individals and poplation health. Qestion: Can yo think of ways to narrow the care and qality gap in yor work and/or workplace? otcomes se of resorces The three gaps are health and wellbeing, care and qality and fnding and efficiency Fnding and efficiency Withot efficiencies, a shortage of resorces will hinder care services and progress. Qestion: How can yo help to close the fnding and efficiency gap? Practise in ways which manage resorces well inclding time, eqipment and referrals. Qestion: Can yo think of ways to narrow the fnding and efficiency gap in yor work and/or workplace? Health and wellbeing Care and qality Fnding and efficiency UNWARRANTED VARIATION otcomes se of resorces The term nwarranted variation is sed to describe ineqalities that cannot be jstified by variations in geography, demography or infrastrctre Abot nwarranted variation Unwarranted variation can occr in many ways, e.g. between geographical areas, specialties or poplation grops. Everyone wold like to think they are offering the best vale they can... bt sometimes that jst isn t the case. The framework specifically looks at redcing nwarranted variation, where standards of care are not eqal and how we can make sre that by seeing where ineqalities exist and changing them, that everyone can receive the same highest standards of better otcomes, better s and better se of resorces. Recognising nwarranted variation Two areas within the same city and with similar demographics had differing rates of diagnosed type 2 diabetes. Frther investigation was reqired and nrsing and care staff were well positioned to compare their practice with areas known to be sccessflly addressing the challenge. This revealed that the more sccessfl areas had edcated practice nrses in the early identification of type 2 diabetes. Those practice nrses then spported their patients with advice on ntrition, hydration and self-management and also become more proficient at recognising the signs of the condition and increased their detection rates. This model was rolled ot within the second area and the positive reslts were dplicated, leading to improved otcomes for both poplations and redced ratings on diabetes measrements. 8 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 9
Unwarranted Variation contined Video Consider this video clip showing how nrses at University College London Hospitals NHS Fondation Trst responded to nwarranted variation. Nrses at UCLH NHS Fondation Trst explain how they developed an exemplar ward programme in response to nwarranted variation Reflection points Take a few moments to reflect on the content of the video clip. Make some notes on the following qestions: What was the natre of the nwarranted variation in this case? How did the staff at UCLH address the nwarranted variation? What were the otcomes of their intervention? Can yo think of any nwarranted variation in yor workplace? University College London Hospitals (UCLH) have developed an Exemplar Ward programme that is designed to spport clinical teams to implement standard processes, redce nwarranted variation and deliver local qality improvement initiatives in their wards and departments. Data packs and monthly trend reports allow staff to view at a glance how their ward is performing, identifying what is being done well and what needs to improve. UCLH are aiming to move from reactive se of information towards a more proactive and preventative approach to its se, ensring that patients receive qality care at all times and that staff work in a cltre that spports and motivates them to engage in continos improvement. Feedback To address nwarranted variation, we need to know where to look, what to change and how to change it. That means nderstanding the differences in how services are provided, the otcomes they achieve and what they cost. The process may start with a conversation with a colleage. We often benchmark orselves against colleages, informally, withot even realising it. They may highlight a new practice that is redcing the nmber of falls which starts s thinking abot or own practice. Or it may start with a conference on infection control that triggers local debate and sets s looking at what we might be doing differently. Care home colleages comparing catheterisation rates in their homes may learn abot improvements in care that lead to redced se of catheters - and redced infections, redced costs and greater comfort for residents. Improving otcomes reqires s to reflect on or practice. It is not easy and we often need spport to make the necessary change. Now we need to measre it too, to demonstrate the vale that we bring. Trning intention into actions In smmary, when faced with nwarranted variation we need to: Take a closer look at what we do Uncover activities that we need to change, add or take away Challenge established practice becase we nderstand that service can be delivered in a better way Strive for high vale care Use the ten commitments to provide focs (see later) 10 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 11
The Triple Aim Overview To meet the triple aim of better otcomes, better and better se of resorces, colleages across the system need to be eqipped with the knowledge and capability to deliver the framework within the context of their roles. LCAV provides a framework to apply the principles of the triple aim to the work that nrsing, midwifery and care staff do. It bilds on the sccessfl Compassion in Practice [3] with the 6Cs remaining as the inherent core vales. However, LCAV was developed to enable nrsing, midwifery and care staff to also apply an eqal importance to qantifying and measring the otcomes of their work as they do to demonstrating the qality and compassion that the professions are recognised for. Leading Change Health and wellbeing Care and qality Fnding and efficiency UNWARRANTED VARIATION Adding Vale otcomes se of resorces The triple aim is focsed on better otcomes, better and better se of resorces Otcomes Let s investigate how addressing nwarranted variation can reslt in better otcomes. Hampshire Hospitals NHS Fondation Trst fond nwarranted variation amongst older people admitted to an acte nit. Staff noticed how some older people lost their independence and raised concerns abot the effects (e.g. prolonged rehabilitation). Nrses, physiotherapists, occpational therapists and doctors received health coaching training from the Health Fondation. The staff work in partnership with patients and families to increase engagement in their care and recovery. Improvements in activities of daily living of patients and self-efficacy have been observed alongside redctions in the length of stay and the need for care home placements. otcomes se of resorces 12 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 13
The Triple Aim contined Experience Next, let s consider how addressing nwarranted variation can lead to better. Staff at James Paget University Hospitals (JPUH) NHS Fondation Trst identified nwarranted variation in the ptake of certain vaccinations. Antenatal inflenza and pertssis vaccinations were available from local GP services bt ptake was poor (below 40%). Maternity staff at JPUH led a pilot offering women the vaccinations at their 20-week anomaly scan appointment. Uptake rates increased (to 76% for inflenza and 80% for pertssis) and feedback confirmed that the pilot was more convenient. This change in provision reslted in a better for patients at no additional cost to the trst. Use of Resorces Now, let s explore how addressing nwarranted variation can encorage better se of resorces. Cornwall Partnership NHS Fondation Trst fond nwarranted variation in spport for vlnerable people with long-term conditions. Working with Age UK and Volnteer Cornwall, nrses co-designed and led a pioneering programme called Living Well. Volnteers visited vlnerable people, establishing new partnerships and engaging with individals to nderstand their goals. The Living Well project now spports 2,500 vlnerable people in three different parts of Cornwall. A recent assessment reported a 40% redction in hospital admissions and care packages by 8%, improving wellbeing by 23% and raising staff morale by 87%. otcomes otcomes se of resorces se of resorces 14 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 15
The Six Cs The six Cs were first introdced in Compassion in Practice [3] and represent the vale base for LCAV. They are central to identifying and addressing nwarranted variation. Care Compassion Competence Commnication Corage Commitment Leading Change Health and wellbeing Care and qality Fnding and efficiency UNWARRANTED VARIATION Adding Vale otcomes se of resorces The six Cs represent or vale base and are central to identifying and addressing nwarranted variation The Ten Commitments The LCAV framework also incldes ten aspirational commitments. These commitments can be applied in any health and care setting by any member of staff. Collectively, they can help s to narrow the three gaps, address nwarranted variation and achieve the triple aim. Leading Change 1 Health and wellbeing Care and qality Fnding and efficiency UNWARRANTED VARIATION Commitment 1 We will promote a cltre where improving the poplation s health is a core component of the practice of all nrsing, midwifery and care staff. The pblic health and prevention roles of nrsing, midwifery and care staff are vital and need to be more visible in leading and providing services which simltaneosly spport personalised care and improve poplation health. We have opportnities throgh pblic trst and individal professional relationships to have significant impact on improving health and redcing health ineqalities practicing in ways which prevent disease, protect health and promote wellbeing and resilience. Adding Vale otcomes se of resorces The ten commitments can be applied in any health and care setting by any staff member An enhanced practice nrsing programme in Harrow transformed their integrated care system to redce the nwarranted variation in the provision of homebased spport to patients with significant healthcare challenges. A nrse-led implementation of a virtal ward allowed practice nrses to provide home-based spport, preventing the need for hospital admissions and for acte healthcare challenges by promoting a positive health cltre (commitment 1). 16 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 17
The Ten Commitments contined 2 Commitment 2 We will increase the visibility of nrsing and midwifery leadership and inpt in prevention. We can demonstrate or role as a vibrant force for change by leading, shaping and implementing innovative and targeted prevention programmes, with the aim of promoting health gain for individals, families and commnities. Health promoting practice with a focs on prevention is essential if we are to create better health otcomes for people (individals, families and commnities). Primary and commnity care nrses and midwives have a role in working with families and commnities to enhance their capability to manage and improve health, especially of babies, children, yong people and families. Respiratory Ftres is an example which demonstrates nrsing leadership in respiratory care. They identified that across Leeds, there was nwarranted variation with regards to respiratory care and it was one of the worst places in the contry for respiratory otcomes. This was identified throgh the NHS Atlas of Variation. Practice nrses established the Leeds Respiratory Network to try and redce variation in respiratory care throgh edcation of healthcare professionals. The network organise evening edcational meetings as well as other respiratory events with national speakers attending. They disseminate information via different forms of social media and blog acconts and disseminate new gidance and resorces to their colleages. Their work is centred on clinical effectiveness and the nrsing leadership in working with patients in primary care is having a preventative fnction and redcing the demand on hospitals and nplanned admissions. Throgh collaboration with nrsing staff and patients, they are improving respiratory care. 3 Commitment 3 We will work with individals, families and commnities to eqip them to make informed choices and manage their own health. People are living longer, bt are at risk of spending their extended years in poor health as a reslt of smoking, poor diet, alcohol consmption and other lifestyle choices. We need to spport people to engage in healthier lifestyles and encorage people to take more responsibility for their own health. Understanding and bilding on strengths that exist in local commnities is vital to bild healthy places. 4 Commitment 4 We will be centred on individals experiencing high vale care. We will ensre that individals are always spported to inflence and direct their own health care decisions, so that they are confident that no decision is taken withot them. We need to encorage people to take more responsibility for their health by focsing on personalised care planning, self-management and behavior change. Person-centred care is central to improving the lives and health of the increasing nmber of children, yong people and adlts who live with long-term conditions. A General Practice Nrse in Drham led a piece of work with nrsing colleages after recognising profond difficlties for their patients to engage in weight management programmes. They also identified that their weight management consltations were not satisfactory according to their CQC preparatory work. In an area of the contry where inpt is needed, weight loss was not being achieved. They developed evening grops (nrse led) for a strctred, evidence based weight loss programme that made the grops more accessible to their poplation and they sed these grops to objectively monitor weight, lifestyle and diet. Flexible sessions in remote areas proved inflential, peer spport was also poplar. They fond better otcomes, s and se of resorces throgh targeting commitment 3 (amongst others). This work has the potential of being rolled ot across other rral practices that may be faced with similar isses especially given concerns over obesity. An example to showcase commitment 4 is work at the Royal Marsden NHS Fondation Trst, where they worked to improve patient throgh a patient and nrse collaborative redesign of the prostate cancer follow-p pathway. Evidence sggested that nmbers of patients being discharged from hospital care following crative treatment for localised prostate cancers were potentially low. Increasing nmbers of referrals led nrses to look at the way in which clinics were held and the way in which patients were being discharged from hospital care despite the sccess of their treatment. Nrse leaders reflected that it is easy to think yo are doing a good job bt yo cannot be sre nless yo ask patients what matters to them. After making changes to the care pathway based on these discssions, the nmber of patients sccessflly discharged from the service rose from 0 to 73 in the first year. Patients were able to move into srvivorship care as a reslt of earlier discharge with appropriate spport. The pathway will contine to be reviewed on a 3 monthly basis inclding interviews with patients, demonstrating commitment 4 we will be centred on individals experiencing high vale care. 18 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 19
The Ten Commitments contined 5 Commitment 5 We will work in partnership with individals, their families, carers and others important to them. We will ensre that individals and their families are at the heart of their care and decisions are made with them by recognising the assets they bring, and working collaboratively as care navigators to signpost easilyaccessible spport systems. We will spport people to live at home by leading the development of integrated health and social care services. We will seek to integrate into or work the crcial roles of carers, volnteers and the local commnity. 6 Commitment 6 We will actively respond to what matters most to or staff and colleages. We have a responsibility to protect or own health in order to practice safely and effectively. Providing an appropriate cltre, terms and conditions will mean we gain the most from or staff. Embedding the key qestion What matters to yo? alongside the delivery of consistent compassionate leadership will help s to meet this commitment. Tommy Whitelaw from the Dementia Carer Voices campaign talks abot the vale of working in partnership Teaching Care Homes was a programme condcted by Care England. Care homes are some of the most established nrse-led services, yet there can be often a lack of nderstanding of this as a professional career pathway. There is often a challenge in the recritment of registered nrses to work in care homes and a need to demonstrate the career options in the sector and bring nrsing colleages together to network and develop a commnity of practice. This is an ongoing piece of work which will create the fondations for a framework of learning; becoming pioneer centres from which the whole sector can learn. A digital platform was lanched (commitment 10) to share learning abot the development and social care nrsing for se across the care sector as well as the NHS. The programme aims to provide excellent edcation and training to preregistration stdents, to encorage and embed a ftre workforce of care nrses. It aims to frther develop existing care home staff and managers. An aim to improve satisfaction with work wold demonstrate that the meeting of commitment 6 and actively responded to what matters most to or staff and colleages. 7 Commitment 7 We will lead and drive research to evidence the impact of what we do. There is lots of evidence based practice which can help s improve or work. However, to demonstrate or positive impact, we need to se robst evalation, from the beginning when we can. We shold rotinely captre and analyse data which measres the impact of or work placing the same importance on qantifying as we do to qality. Rising nmbers of acte admissions and Emergency Department (ED) attendance from care homes, which cold lead to nnecessary distress and avoidable hospital stays were identified in this case stdy. Colleages at Airedale recognised that telemedicine sed sccessflly in prison healthcare cold be applied to spport care homes. The Critical Care Otreach team had skills in assessment and treatment of deteriorating patients and led work to deliver a telemedicine service in 27 local care homes. A 24/7 telemedicine hb was established to spport the staff and carers of frail elderly residents in care homes, sing remote video consltation. Early data showed a redction in avoidable ED attendance (14%) and acte admissions to hospital (5%) from care homes. Residents are triaged throgh the telemedicine system and where possible their isses are addressed by nrses working in the hb. The telemedicine system of assessment is now in almost 500 care homes across the UK. Care home residents can now access remote consltations redcing their need to attend GP srgeries and the need for GPs to visit care homes. This is a significant achievement bt also allows an evalation at scale to demonstrate the vale of this work and an opportnity for nrses to lead and drive research to evidence the impact of what we do (commitment 7). 20 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 21
10 H t The Ten Commitments contined 8 Commitment 8 We will have the right edcation, training and development to enhance or skills, knowledge and nderstanding. Edcation, learning and training are important for the provision of high qality care. This commitment encorages s to spport a cltre of life-long learning and self-reflection. We will also encorage partnership working across health and social care, which provides opportnities to share nderstanding and skills, new career options and new roles. Improving infection control in nrsing care homes (Doncaster and Bassetlaw NHS Fondation Trst). Unwarranted variation in infection prevention and control (IPC) standards in care homes sggested that consideration shold be given to ensring the environment always spported safe care. IPC nrses worked with the care homes and set p a nrsing form for commnication and edcation. The team in Bassetlaw has focsed on having the right edcation, training and development to enhance skills, knowledge and nderstanding (commitment 8). The infection prevention and control nrses have increased the visibility of nrsing and midwifery leadership and inpt in prevention (commitment 2) and have done so while working in partnership with staff in care homes, spporting them to become more knowledgeable leaders and practitioners in the field of infection prevention and control. Improvements were seen in all areas of infection prevention and control. 9 Commitment 9 We will have the right staff in the right places and at the right time. Or staffing mst be safe, sstainable, efficient and able to provide competent and compassionate care to or patients and people we care for. workforce planning and management of staff resorces is needed to improve qality of care, staff prodctivity and financial control. We mst be aware of the differing needs of older and yonger staff and ensre all caring roles are flfilling and ones in which staff are spported, have a positive and want to stay. Commitment 10 We will champion the se of technology and informatics to improve practice, address nwarranted variations and enhance otcomes. Technology has helped transform care and or roles in providing it. We need to contine to be at the forefront of innovation, enabling individals to access information, se diagnostic tests, record their own health data and live more independently and safely in their own homes. Technology can enhance or clinical decision making by providing access to the relevant information at the point of care and enable s to reach ot to commnities in sparsely poplated areas. The ESTHER model of care is based on a real person who became nwell with serios heart failre and was admitted to hospital. There were delays in diagnosis, treatment and care planning. Overall the that Esther had was not good and somehow typical of a lot of patients and service sers. The health and social care staff involved in Esther s care recognised that there was a different way of doing things that wold lead to better otcomes, higher qality care and efficiency. This work has shown that evidence based work has allow care staff to lead on the care and the care plans, and ensring patient/resident care was optimal bt the new element of this process was that care staff worked to ensre residents wishes (e.g. in terms of spport wanted) were listened to and represented and this practice improves otcomes and s. It has led to more personal care, better mood among the residents and staff time is saved, not having to ask each other or the resident the same qestions over and over again. Qality of care has improved alongside this throgh the approach. Releasing nrsing time while providing safer care is a case stdy which exemplifies how technology can spport health and social care. The practice of docmenting patient information on paper often reslted in a fragmented approach to the recording, visibility and access of information and ease of escalation of patients at risk of deterioration. The project was led by nrses and midwives who acted as local champions deciding on areas for implementation and leading the introdction of bedside vital signs monitors. Patient safety is an essential element of patient care. Throgh the introdction of the electronic system for the recording of National Early Warning Scores (NEWS) at Imperial College Healthcare NHS Trst, the Exective Nrse Director and Nrse Informatics Lead have actively responded to what matters most to or staff and colleages (commitment 6) ensring consistency in the delivery of safe patient care and redcing the time of completing paper records. This provides a good example of how it is possible to champion the se of technology and informatics to improve practice, address nwarranted variations and enhance otcomes (commitment 10). 22 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 23
Conclsions As we near the end of this session, take the opportnity to reflect on the following key qestions. Firstly, is there nwarranted variation where yo work? Secondly, is there something yo do every day that makes yo think we cold do this differently? Finally, how can yo show yor great work and share it with colleages arond the contry? Qestions and Answers Key qestions to consider Next steps Visit the LCAV website [4] and download a copy of the framework. Explore the case stdies and think abot the work yo are doing that the LCAV team wold love to hear abot. If yo wold like to discss the framework, or to hear more, contact the LCAV team via: england.leading-change@nhs.net 24 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 25
Self Assessment Qestions Self Assessment Qestions contined 1. Which of the following statements on the Leading Change, Adding Vale (LCAV) framework are tre? (please tick) c The LCAV framework was first lanched in 2016 c The LCAV framework is aimed exclsively at hospital nrses c The LCAV framework is aligned to the Five Year Forward View 3. Consider the prpose of each element of the LCAV framework. (match the description to the element) Element Unwarranted variation Description Impact on the health and care sector and reslt in nwarranted variation. 2. Consider the five main elements of the LCAV framework. (Nmber the five boxes below the diagram) 1 - The six Cs 2 - The ten commitments 3 - The three gaps 4 - Unwarranted variation 5 - The triple aim Leading Change Adding Vale The ten commitments The three gaps The six Cs The triple aim Ineqalities that cannot be jstified by differences in geography, demography or infrastrctre. Achieved throgh better otcomes, better s and better se of resorces. Represent or vale base and help s to identify and address nwarranted variation. Ten aspirational statements that can help s to narrow the three gaps. 4. Which one of the following does not represent an example of the six Cs? (please tick) c Care c Corage c Commitment c Creativity c Compassion c Competence c Commnication Answers on page 30... 26 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 27
Session Key Points Leading Change, Adding Vale (LCAV) is a national framework for nrsing, midwifery and care staff It spports nrsing, midwifery and care staff to take a lead in promoting health and wellbeing, improving care and qality, and sing resorces efficiently It encorages nrsing, midwifery and care staff to identify and address nwarranted variation, measring the impact of their work and sing the ten commitments Consider if there is nwarranted variation or something that makes yo think we cold do this differently where yo work Contact the LCAV team to show the great work yo do and share it with colleages arond the contry References 1. Leading Change, Adding Vale: A Framework for Nrsing, Midwifery and Care Staff. London: NHS England, 2016. 2. NHS England. Five Year Forward View. London: NHS England, 2014. 3. Department of Health. Compassion In Practice: Nrsing Midwifery and Care Staff Or Vision and Strategy. London: Department of Health, 2012. 4. Leading Change, Adding Vale. https://www.england.nhs.k/leadingchange/ Session Smmary Learning Objectives Having completed this session yo will now be able to: Identify the main elements of the LCAV framework Describe how nrsing, midwifery and care staff can se the LCAV framework to identify and address nwarranted variation and strengthen the qality and otcomes of care Identify and address any examples of nwarranted variation in yor workplace Frther Reading Refer to the following text for additional information: NHS England. Leading Change, Adding Vale: A Framework for Nrsing, Midwifery and Care Staff. London: NHS England, 2016. NHS England. Five Year Forward View. London: NHS England, 2014. Department of Health. Compassion In Practice: Nrsing Midwifery and Care Staff Or Vision and Strategy. London: Department of Health, 2012. Next Steps Having completed this session yo may now wish to: Visit the LCAV programme webpage. Think abot the work yo are doing that the LCAV team wold love to hear abot Contact the LCAV team via: england.leading-change@nhs.net and reqest yor Leading Change, Adding Vale badge! 28 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 29
Self Assessment Answers 1. Which of the following statements on the Leading Change, Adding Vale (LCAV) framework are tre? (please tick) c The LCAV framework was first lanched in 2016 c The LCAV framework is aimed exclsively at hospital nrses c The LCAV framework is aligned to the Five Year Forward View 2. Consider the five main elements of the LCAV framework. (Nmber the five boxes below the diagram) 1 - The six Cs 2 - The ten commitments 3 - The three gaps 4 - Unwarranted variation 5 - The triple aim 3 4 2 5 1 3. Consider the prpose of each element of the LCAV framework. (match the description to the element) Element Unwarranted variation The ten commitments The three gaps The six Cs The triple aim Description Impact on the health and care sector and reslt in nwarranted variation. Ineqalities that cannot be jstified by differences in geography, demography or infrastrctre. Achieved throgh better otcomes, better s and better se of resorces. Represent or vale base and help s to identify and address nwarranted variation. Ten aspirational statements that can help s to narrow the three gaps. 4. Which one of the following does not represent an example of the six Cs? (please tick) c Care c Corage c Commitment c Creativity c Compassion c Competence c Commnication 30 Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff March 2018 31
Leading Change, Adding Vale: A framework for nrsing, midwifery and care staff NHS March 2018. NHS England Pblications Gateway Reference: 05247