NHS South East Workshop. 17th March 2015
Dr Rob Haigh
Deputy Medical Director and Chief of Medicine
Western Sussex Hospital NHS Foundation Trust
To outline why the trust proposes to
improve safety, clinical outcomes and
patient experience, regardless of the
time of day or day of the week
To demonstrate that “one size does not
fit all” when selling the dream of
consistent care across the whole week
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…. has widespread national support, including all
main professional bodies
consistent care across seven days will bridge
current major service gaps
… evidence shows that targeted changes, including
increased consultant-present care, improves safety,
clinical outcomes and the experience of patients
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5
Dr Foster HSMR by Day of Admission
80
85
90
95
100
105
110
115
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
WSHFT
Acuity weekend admissions is higher
Mean NEWS 2.26 vs. 2.0 for weekday admissions
• Most wards managed by Band 5 nurse at weekend.
• Typically 20% of the weekday numbers of junior
doctors on duty at weekend.
• Weekend AMU consultant cover restricted
• Majority of existing in-patients fail to see a
consultant from Friday to Monday.
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L i v e d i s c h a r g e s p e r d a y ( n o n - e l e c t i v e )
-
2 , 0 0 0
4 , 0 0 0
6 , 0 0 0
8 , 0 0 0
1 0 , 0 0 0
1 2 , 0 0 0
W S H F T S R H W o r t h i n g
All staff will contribute to 7 day working; in return, the Trust will
make clear commitments to staff, with respect to working
patterns, rest and work-life balance. Many staff already
routinely work to a 7 day model.
There will be new investment to support 7 day working, BUT
we will identify opportunities for role extension, the avoidance
of waste and duplication, service redesign and innovation.
We will implement a pragmatic and gradual solution, beginning
in Medicine, which is identified as the area of highest risk.
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Executive (COO)
Deputy MD and Deputy DoN
Consultants : Acute Medicine, Gen. Surgery, CD for Imaging, Chiefs of Service.
Medical Matrons x2
Head of Medicines Management
Head of Therapies
Senior HR business partner
FT Governor and Staff side
PMO
(W+C, junior doctors)
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Keogh standard Lead(s)
1. Patient experience Medical Matrons – Katrina and Lisa 2. Time to first consultant review Joe Wileman and Pauline Whitehouse
3. MDT review Saffron Mawby and Nicky Sullivan 4. Shift handovers Joe Wileman and Pauline Whitehouse 5. Diagnostics Hatef Mansoubi and Saffron Mawby
6. Intervention/key services Rob Haigh
8. On-going review Rob Haigh and Saffron Mawby
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7 day intranet page–information about programme, a
short questionnaire/feedback mechanism, a video
montage and details about getting involved. Content
builds, as we progress.
Engage with different staff groups through existing
mechanisms. e.g. Employee Partnership Forum,
Medical Staff Committee, board of governors etc
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Initial gap analysis prepared against each standard.
Definition of what consultant model could look like
i.e. delivering consultant present care - by division
Priority focus on Medicine – ensuring greater
consultant presence in AMU, & ramping up
supporting services (radiology & pathology)
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Learning from other Trusts that are succeeding, prepared
OBC, on-going work on consultant model.
Additional investment is significant (£2m+ based on the
experience of other Trusts),
Identify opportunities for more effective and efficient working,
linked to learning from Virginia Mason.
Pragmatic view on Keogh’s aspiration for consultant-led ward
rounds on every ward, every day - unlikely to be feasible in the
medium term.
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Ultimately, the Keogh standards require 7 day collaboration between all of the health, social and community services. We are keen to host a joint role on behalf of the LHE –supported by the Coastal Cabinet.
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Aspect of service
All coverage is per site on both Saturday and Sunday, unless otherwise stated
Consultant model
• AMU: 8am-8pm consultant cover • AMU ‘hub’ consultant outreach to specialty wards on a selected patient basis
Nursing model
• Band 6 day shifts on every ward • Diabetes, Alcohol liaison and Resp Specialist Nurses – morning cover • Palliative and EOLC specialist nursing
Diagnostics • Radiology: 9am-6pm consultant and radiographer cover for investigations and reporting; sonographer cover 3 hours
• Endoscopy: 1 PA Sat planned list, to include emergency scoping requirements (plus 24/7 GI bleed rota)
• Phlebotomy extension • Echo for planned and urgent activity and on-call technician
Pharmacy • Senior pharmacist and medicines reconciliation technician on each AMU – whole daytime • Targeted senior pharmacist support to wards • Additional dispensary support
Therapies • OT and Physiotherapy (in line with consultant model) • Dietetics – on-call weekend & bank holiday coverage • SALT – Dysphagia on-call service
Other support
• Additional roles to supplement junior doctors • Administration, portering, transport, revised management rotas • Additional hospital social workers, community equipment and continuing care provision
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Mon Tues Wed Thur Fri Sat Sun
OPD Y Y Y Y No No
PTWR & rolling new patient review
Y Y Y Y PTWR’s only
PTWR’s only
Unselected Take
Y Y Y Y Yes Yes
Endoscopy Y Y Y Y No No
CEPOD Theatre
Y Y Y Y Yes Yes
Elective Theatre
Y Y Y Y No No
SpA Y Y Y Y No No
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Mon Tues Wed Thur Fri Sat Sun
OPD Y Less ? Y Less ? Yes Yes
PTWR & rolling new patient review
Y Y Y Y Yes Yes
Unselected Take
Y Y Y Y Y Y
Endos’y Y Y Less Y Yes ? Elective Theatre
Y Less Y Y Yes Yes
SpA No Y No Y ? ?
Makes every weekend day like every other day
Activity outline to mirror profile of weekend
emergency admissions
Optimises use of expensive resources
Financially beneficial
Supports RTT and planned care
It’s what many patients want
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We electronically surveyed 1000 patients & directly
interviewed 60 of these.
Feedback linked to the day of the week and time of the patient’s
admission.
Our emergency patients tell us that we communicate
less well in the evening and at weekends (and
especially weekend evenings)
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Changing how we work, to deliver consistent care across 7 days will improve safety, quality & clinical outcomes. We all share this responsibility.
Although some changes will require additional investment and recruitment, innovation/working differently, and standardisation provide the basis of our developments
There are great opportunities for role extension & service redesign – PA’s, Resident On Call Consultants, SSP’s,
Engage at every opportunity … staff, esp. consultants, may be
increasingly concerned about what 7 day working means for them.
There is no hidden plan & staff will not be expected to do more hours or be put under undue pressure
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