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Simon Rattenbury Head of Laboratory Service Microbiology Seven Day Services supporting Improved Outcomes in Prevention and Early Diagnosis - Presentation from seven day services in diagnostics event on 4 March 2013 #7dayDiagnostics
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The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Simon Rattenbury
Head of Laboratory Service
Microbiology
Seven Day Services supporting
Improved Outcomes in Prevention
and Early Diagnosis 4th March
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
RFH Founded in 1828 Royal Charter 1837
Clinical Instruction for Women
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
• ~600 beds Reduced from 1200.
• 700,000 patients a year from all over the world.
• Employ around 4,600 people and have a turnover of about £450m.
• Major A&E.
• All branches of surgery and medicine
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
What am I Going to Cover
• Scientists / Pathology & its Role
• What was the need & why consider 24/7?
• What was the clinical need?
• The outline planning of the 24/7 case?
• What the key points/take home message?
• What did it deliver / measure success today?
(time, Money, efficiency etc)
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Why 24/7 Why Microbiology
• Patients aren't ill 9 to 5:
– Better patient outcomes
– Fit with patients care pathways
– Antibiotic Stewardship
– The new system of working was developed over
several years. It involved changes to staff roles,
training and contractual arrangements and was a
major restructuring exercise
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
The 63 heroes who saved our son: Revealed in the heart-tugging story of a critically ill baby and the astonishing army of NHS staff needed to save one life
To save one life: 7 doctors, 9 consultants, 18 nurses, 5
support staff, 22 scientists, 1 professor and 1 receptionist
6
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Pathology Challenge
• Organise services around the patient/users,
– not disciplines, staff groups, hospital labs
• Transform structures and practices
Reduce variability
Provide evidence of progress
• No change is not an option
• Take ownership and drive the agenda
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Vision of 24/7
Providing an
integrated service
end to end
Increasing productivity
& delivering continuous
improvement
Providing quality
services at
competitive prices
Pathology
Services enabling
better NHS care
Better patient outcomes
& commitment to a
quality 24/7
A Department
employees are proud
to be part of
Providing a Service for the
Future
Delivering “end-to-end” Pathology
Service
Transforming the
existing path
operating model
Developing
scientific & clinical
knowledge
Target Markets:
Core pathology services in chosen geographies
Specialist reference services nationally & internationally
Innovation R&D
PATIENT
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Improvement Cycle
User
Satisfaction
Pathology
Modernisation
Pathology Service
Improvement
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Current Service Provision
Departments philosophy
Molecular Rapid Microbiology
• Chlamydia/GC
• TB
• MRSA
• Enteric Panel Real time
• 16s RNA sequencing
• Fungal 18ITs Sequencing
• Typical & Atypical respiratory
• C difficile toxin
• MALDI ToF
Patient
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
The Past
• Staff turnover………..high
• Staff cover at weekend and out of hours was
on a voluntary rather than a contractual basis.
• Reliance on high cost locum staff and high
turnover meant the training and staff
experience was variable and at times services
had to be withdrawn due to lack of staff
available to perform the work
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
The Past
• 2000 all new contracts were changed to 24/7
working including bank holidays
• Staff titles were changed to ‘Health Care
Scientists’ in an attempt to remove glass
ceilings and introduce equality and to gain
greater job satisfaction
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
The Past• Two on call systems were in operation (routine and
High Secure Pathology Unit) plus additional staffing for
– Blood cultures
– MRSA
– C difficile
– Resistant Gram negative screening
• Shift Rota was complex and time consuming
• Required at least 2 .5 days to prepare but was not EWTD compliant
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
The Past
• 2004 Introduction of more support grades and
Health Care Scientists
• Band re-profile 6 to 5
• AP
• MLA
• No A&C grades
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Staff grade 07/08 08/09 2011/13
8 6 5 5
7 BS 10 13 8
7 CS 6 4 4
6 BS 15 13 14
5 BS 0 0 3
4 AP 2 2 6
3 MLA 1 1 2
2 MLA 2 8 8
A&C 4 3 3 0
A&C 2 2 0 0
Totals 50 49 47
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Year 06/07 07/08 08/09 11/12 12/13
approx
Workload 250,000 300,000 350,000 500,000 600,000
Staffing 50 50 49 47 47
Workload & Staffing
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
• Major change
• Negative and some positive impacts on staff
• Time, effort and strong communication to
work through the issues with staff.
• Major concern for staff was reduction in pay;
managed by providing pay protection for up to
one year, variable lengths
Introduction of 24/7
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
• The benefits to staff
– self roster
– working hours 37.5hrs
– Improved staff safety.
• New ways of working and career development
– new roles to emerge e.g. the associate practitioner role.
• Continuity of staffing
– Provide better quality services and reduce the pressures that
had previously been experienced
Introduction of 24/7
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
• Addition of three bands 5
• Gradual introduction of band 4 to be trained as
Associate Practitioners.
• Budget
– Funding for pay protection was required Overall
the remaining staffing changes were managed
within the existing budget by re-profiling the skill
mix.
Introduction of 24/7
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
• Unions
• Consultation
• Committee
• Staff questions
• HR A4C pay rates
• Reserve lists
• Multidisciplinary HSPU training
• Three monthly and weekly rota
• Went live 1st Aug 2009
Challenges
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Challenges• Terms and conditions
• Working practices - consultants
• - technical
• Culture - professional
• - Management» - “siteism”
• Corporate identity
• Changing job roles
• Ownership / territory
• Takeover mentality
• Disaffected staff
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Staff View
STAFF
FOCUS
HEALTH AND SAFETY
LOW SICKNESS RATES
CPD
A4C/KSF
TRAINING
INDUCTION
RECRUITMENT AND
RETENTION
WORKING
CONDITIONS
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
What’s Needed
• Management Support
• Resources
• Team Building
• Organisational / Personal Development
• Vision / Plan
• Leadership
• Resolve
• Time
• Stability
• Communication
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
In Transition: Key Objectives
• Keep the system safe in transition
• Drive sustainable innovation and service excellence
• Modernise planning to deliver a patient centred approach that embraces patient pathways
• Enable service transformation– Move general services closer to patients’ homes– Centralise specialist services to leverage
expertise and drive economies of scale– Integrate across health and social care
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
• Have clear and measurable goals and realistic timeframes when planning the changes.
• Engage staff early in the change process and gain as much agreement with the project goals as possible.
• Ensure that all meetings have minutes taken and they are distributed to all staff
• Ensure negotiations with staff are reasonable and managed well
• Skill changes provide positive training and development opportunities for all staff and enable flexible rosters
Top Tips
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
• Develop key baseline measures and track the measures to demonstrate the improvements to all stakeholders…Win/Win
• Be prepared to modify original plans where possible so that staff are involved and are part of the decision making
• Allowing staff to design the shift and rosters system worked well
• Recognition of staff in their staff review
Top Tips
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Types
of Shift
Time Staff numbers
HCS MLA
Early 8.00 am to 4.30 pm 1 1
Core 9.00 am to 5.30 pm 15 7
Late 11.30 am to 8.00pm 2 2
Nights 8.00pm to 8.00am
7.30pm to 7.30am
1
1
0
0
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Night Person Night Person 2
19:30 Hand over Hand over
20:30 Blood Cultures Start final put up of all left
21:30 over samples
22:30 Fluids Help with follow up
23:30 "
00:30 Follow up of both benches
Lunch
01:30 Urines
Lunch "
02:30 Any urgent samples PLUS "
03:30 Help on urines "
04:30 " "
05:30 Make sure all samples "
06:30 are booked in plus blood "
07:30 cultures put on analyses "
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital MICROBIOLOGY WEEKEND ROTA (Prepared by ABhamra)
Sections Sat 21.04.12 Sun 22.04.12 SECTION
LEADER
RECEPTION
Sat only sorted
Taufiq am –please note reception / spa done
on night shift + tristel
® kumar (V) >2
Taufiq am –please note reception / spa done
on night shift + tristel
® kumar >1
SPA
Urines Put up Komal < 1 pm
Taufiq pm;♣♣♣♣Sarah>4
Taufiq pm
♣♣♣♣Sarah
Waste collection / autoclave ® kumar (V) (minimal) priority<2 ® kumar ( minimal) <1
Stool Put up
&CDT( 12.30)
Michelle + Stool Put up ( priority for CDT)
+ Sub SF/APW/Acetamide
+ OCP Prep / Crypto stain
+ Send TDM levels @ 10 am and 3 pm
♦♦♦♦Michelle + Stool Put up ( priority for CDT)
+ Sub SF/APW/Acetamide
+ OCP Prep / Crypto stain
+ Send TDM levels @ 10 am and 3 pm
BLOOD CULTURES
+ report TDM
+ GUM
Maria ( No Maldi) + IQC Oxidase / Nephelometer
+ GC Screen / Read & record AST
+Sub ATCC Ctrls
+ Report TDM
Maria( No Maldi) + IQC Oxidase / Nephelometer
+ GC Screen / Read & record AST
Sub ATCC Ctrls (if applicable)
+ Report TDM
FLUIDS NW+FU
RESPIRATORY NW+FU
Includes reporting on Sunday
RESPIRATORY NW Putup
*Owen( No Maldi)
*Owen
Komal >2pm
*Owen( No Maldi)
Rizalea ( V)
Rizalea( V)
MRSA CULTURE & PCR Mohammed
+ CDT PCR if required
Mohammed
+ CDT PCR if required
HVS
Kanti 9-1
Read the NW only and complete the FU
CLOSED
RNOH & MALDI ♣♣♣♣Sarah<4 ( RNOH Maldi only) ♣♣♣♣Sarah( RNOH Maldi only/ SPA
URINES NIGHT Jasim CLOSED
WOUNDS/ E.N.T/ACIN
NIGHT NIGHT
ENTERICS Komal only to Screen for Salm/
Shi < 11-45
Komal start to finish + reporting
SEROLOGY CLOSED CLOSED
VIPER CLOSED CLOSED
Computing CLOSED Owen
Night staff Lucy
• Wounds / ENT
• Leave reporting for Sun night if
necessary
Jasim: urine start to finish
Paul
• Night duties
• Read TVs/BVs and Record + Sub LIMs
• Help Lucy with + reporting
Lucy
• Wounds / ENT
• Leave FU on bench with instruction
Jasim
• Night duties
• Help Lucy with FU + reporting
• Read TVs/BVs and Record + Sub LIMs
HSPU Day
Night
Maria
Jasim
Maria
Lucy
Sickness Andrew Andrew
Early
Late
No colour= Core
Night
Over time /
Xtra hours
Team
leader:
Owen
Please ensure
relevant plates
for closed
sections are
placed in the
fridge
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
MICROBIOLOGY WEEKLY ROTA (Ed 23 March 2012) Rota Prepared by:A.Bhamra
Sections / Section-leaders Monday 23/04/12 Tuesday24/04/12 Wednesday 25/04/12 Thursday26/04/12 Friday 27/04/12
Deputy Rota Maker + weekly overdues Rajita Monica am Victoria Rajita Rajita Rajita Chris , Angela
Judith Shaila
Fitzroy 8-9
Chris Angela
Judith Shaila
Fitzroy 8-9
Chris AngelaJudith
Shaila, θAudrey pm
Fitzroy 8-9
Yonas Angela
Judith Andrew
Fitzroy 8-9;Rita
Chris Angela
Judith Andrew
Fitzroy 8-9 Rita
: SL Rajita
Victoria 0n tuesday
Ward Duties Jenny closed Yonas closed Yonas
URINE/ GU MED : Section leader Owen
rine Phx + Urine NW +AP
Urine NW & FU +Microscopy
•Maferim<11.30
Temitayo
Saroj ♥Komal>4.30
•Maferim<11.30
Temitayo
Saroj γRizalea<4.30
•Maferim<11.30
Temitayo
Dr Lakshi
Saroj♥ Komal>4.30
Temitayo
Dr Lakshi
Saroj⊗Kanti >4.30
Temitayo
Dr Lakshi
Saroj ⊗Kanti >4.30
HVS+ GC+ settle plate < 4
+ MALDI SPOTTING GC ONLY
Alan Vicky Alan Alan Alan
SWAB CULTURE: Section leader Kanti
read / report Kanti, ♥Komal Kanti ♥Komal Kanti, ♥Komal ⊗Kanti,Komal ⊗Kanti,Komal
follow-up < 3 Kanti, ♥Komal Kanti ♥Komal ♦Vicky >11 ♦Vicky >11 ♦Vicky >11
up (SPA) ↓Samer >10 Andrew
•Maferim>11.30
Dr Anna pm
JennyChika>4.30
•Maferim>11.30
↓Samer >10 Andrew
♦Vicky <11 Jenny
•Maferim>11.30
Andrew↓Samer >10
♦Vicky <11
↓Samer >10
Shaila°Mod >2
♦Vicky <11
↓Samer >10
Shaila°Mod >2 HAI : Section leader Gemma
(am/pm)
+ MALDI SPOTTING culture) +transferx2 runs
Kumar/ωMonica brief
ωMonica am
Kumar
θAudrey am/2 pm
Kumar
θAudrey am/2 pm
Kumar
θAudrey am/2 pm
Kumar
θAudrey am/2 pm MYCOLOGY: Section leader Rebecca
Shanti ♠Shanti koh Dr Daniel=dopsx2 * Rebecca/Shanti
↓Samer 9-10 ↓Samer 9-10 ↓Samer 9-10 ↓Samer 9-10 ↓Samer 9-10
(Tues & Fri)
(Mon & Thu) Rebecca/Shanti+koh Rebecca/Shanti+koh
BLOOD / FLUID: Section leader : Monica Victoria 0n Tuesday pm
+ MALDI SPOTTING Sirilaksmi Sirilaksmi Sirilaksmi Sirilaksmi Sirilaksmi Fluids + MALDI SPOTTING Harry Emma Monica am /Dr Anna
am Victoria ♠Shanti +koh
Emma
Anna Emma Anna Emma
<2 Sini /Mohammed Sini /Mohammed Sini/ Mohammed+caf °Mohammed °Mohammed
Main Lab cover 1-2 Kanti/Komal Purnima/Gemma Harry Sirilaksmi Anna Sirilaksmi Rajita Audrey
RESPIRATORY / TB: Section leader Kanti
+ MALDI SPOTTING Manpreet Manpreet Manpreetam Victoria Manpreet ManpreetDr Anna am RNOH Tissues + MALDI SPOTTING Anna /Rachel Anna Rachel Rajita Rachel Rajita Rachel Rajita Rachel
Xpert-CepheidPCR) Rizalea/Chika+ind -AL γRizalea&Chika<4.3 Rizalea Chika Harry Chika Harry Chika ENTERICS / IQC: Section leader : Purnima Gemma ( Wed)
+ CDT/HP transfer 4-4.15 Purnima Gemma Purnima Gemma Gemma Purnima Gemma Purnima Gemma
H.pylori prep only( Mon & Thu) ◊ Michelle ◊ Michelle
Stool/CDT /OCP prep &CDT assay ◊ Michelle Yonas Michelle ◊ Michelle Michelle IQC am (all day Wednesday) Ω Rajita am till 7pm θAudrey pm Harry θAudrey pm θAudrey pm
SEROLOGY: Section leader Rajita( Purnima on Tuesday)
/ TDM (if closed) Rita Rita Rita Night(Paul) Night(Sini)
MLA Serology prep + send aways
i DS2 on Mon/Thu only
Fitzroy 9 -4.30Kristine
+H.Pylori DS2
Fitzroy9 -4.30
Kristine
Fitzroy 9 -4.30
Kristine
Fitzroy9 -4.3Kristine
+H.Pylori DS2
Fitzroy 9 -4.30
Kristine
MOLECULAR (VIPER): Section leader Victoria( Mon-Wed),Gemma( Thu-Fri)
Chlamydia Viper / CDT & HPYL via DS2 Night( Sarah) Night( Sarah) Night( Sarah) Jenny Jenny
CT/GC Transfer results Night( Sarah) Night( Sarah) Night( Sarah) Night( Lucy) Night( Lucy)
MOLECULAR (Other): Section leader Victoria( Mon-Wed),Gemma( Thu-Fri)
Molecular (16s & others) / Atypical PCR ↑Damion Kevin ↑Damion Kevin Damion Kevin Damion Kevin Damion Kevin am
( half day 2 staff ) Anna Rob Rizalea Rob Rizalea Rob
Other Activities + R&D Rebecca=maldi sort
ΩRajita 7pm =Audit
writMonica pm =caf sort
Victoria =Eucast plan
Monica am =caf sort
+dops for Dr Daniel-
see Amrat
Monica =caf sort
Maria pm= audit ‘f’ std
Sini= audit –see mk
Abh= Rota
Rebecca/♣Owen maldi sort ,Abh= Rota
Monica =strep phx
Maria till 7= audit
: ↑ Damion =CoSurv Owen↑Damion pm Owen ICE+CoSurv Owen/Maria am ♣Owen +CoSurv MEDIA / WASH-UP: Section leader Adrain
Media stock Tues / delivery Weds Taufiq Taufiq Taufiq Taufiq Taufiq
Registrars office /Enquiries Kelly, Valeria Kelly, Valeria Kelly, Valeria Kelly, Valeria Kelly, Valeria SR,Abh,Mk am,AL Abh Mk AL Abh,Mk am AL SR,Mk AL Mk AL
Lucy Sarah Paul Sarah Paul Sarah Paul Lucy Sini Lucy
LEAVE (Med) = Medical (S) = Study (E) = Emergency (O) = off duty due to 24/7
(L) = Annual / Time-In-Lieu Leave
(MP) = M/Paternity (MT) = Meeting Francis @georgeds,Fenella rfh –virology,
Catherine r&d @ rfh,Ingrid@Barts,Manar @
Over time Kristine Mon 9-
Thu/Fri 9-11.30,Judith tue 9-
L:Yonas,Dallas,Audrey
GinaPaulO:TomMaria,
Owen,Jasim , Mk pm
S:VickyRob MP AntheaMT:Michelle/Ab
ccrp1-2,Sini & Abh
12.15-12.30, Sam/Abh
12-12.15
L:Dallas, Gina
O:,Michelle,
Tom,Lucy,Maria,
Jasim Rajita MP: AntheaSHarry,Manar
Alan,EmmaSamantha
RobMT:Yonas/Abh
ccrp 12-1,Monica
pm,SR,AL10.30-11
L:Dallas,Gina,
RebeccaO:TomLucy,
Purnima,Jasim,
MK pm,Monica pm S: Maria, Manpreet
pm MP: Anthea
MT:SR
L:Dallas,Gina, O:
Maferima,Tom,Sarah
Victoria,Jasim, MP:
Anthea MT:Monica 10-11.30 & 1-2
L:Dallas,Gina,Jasim
Kevin pm, SR,Chika
O: Maferima,Tom,
Sarah,Victoria,Paul, MP: Anthea
S: Manpreet pm
Night Training Late shift Early HCS 1.5hrs Dr Rita Oladele: observer from ECCMID in dept for I month
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Sections / Section-leaders Monday 23/04/12 Tuesday24/04/12 Wednesday 25/04/12
Thursday26/04/12 Friday 27/04/12
Deputy Rota Maker + weekly overdues Rajita Monica am Victoria Rajita Rajita Rajita
RECEPTION: SL RajitaMonica am Victoria 0n tuesday
Ward Duties
Chris , Angela Judith ShailaFitzroy 8-9
Chris AngelaJudith ShailaFitzroy 8-9
Chris AngelaJudith Shaila, θAudrey pm
Fitzroy 8-9
Yonas AngelaJudith AndrewFitzroy 8-9;Rita
Chris AngelaJudith AndrewFitzroy 8-9 Rita
Jenny closed Yonas closed Yonas
URINE/ GU MED : Section leader Owen
Urine Phx + Urine NW +APUrine NW & FU +Microscopy
•Maferim<11.30 Temitayo
Saroj ♥Komal>4.30
•Maferim<11.30 Temitayo
Saroj γRizalea<4.30
•Maferim<11.30 Temitayo
Dr Lakshi
Saroj♥ Komal>4.30
TemitayoDr LakshiSaroj⊗Kanti >4.30
Temitayo Dr LakshiSaroj ⊗Kanti >4.30
GU MED HVS+ GC+ settle plate < 4 + MALDI SPOTTING GC ONLY
Alan Vicky Alan Alan Alan
SWAB CULTURE: Section leader Kanti
Wounds / Ent read / report Kanti, ♥Komal Kanti ♥Komal Kanti, ♥Komal ⊗Kanti,Komal ⊗Kanti,Komal
Wounds / Ent follow-up < 3 Kanti, ♥Komal Kanti ♥Komal ♦Vicky >11 ♦Vicky >11 ♦Vicky >11
Swab put-up (SPA) ↓Samer >10 Andrew
•Maferim>11.30Dr Anna pm
JennyChika>4.30•Maferim>11.30↓Samer >10 Andrew
♦Vicky <11 Jenny
•Maferim>11.30Andrew↓Samer >10
♦Vicky <11↓Samer >10Shaila°Mod >2
♦Vicky <11↓Samer >10Shaila°Mod >2
HAI : Section leader Gemma
ACP MRSA (am/pm)+ MALDI SPOTTING
HAI (MRSA culture) +transferx2 runs
Kumar/ωMonica briefωMonica am
KumarθAudrey am/2 pm
KumarθAudrey am/2 pm
KumarθAudrey am/2 pm
KumarθAudrey am/2 pm
MYCOLOGY: Section leader Rebecca
Mycology (Tues & Fri)MLA 1 HPLC (Mon & Thu)
Shanti ♠Shanti koh Dr Daniel=dopsx2 * Rebecca/Shanti
↓Samer 9-10 ↓Samer 9-10 ↓Samer 9-10 ↓Samer 9-10 ↓Samer 9-10
Rebecca/Shanti+koh Rebecca/Shanti+koh
BLOOD / FLUID: Section leader : Monica Victoria 0n Tuesday pm
Blood culture + MALDI SPOTTING Sirilaksmi Sirilaksmi Sirilaksmi Sirilaksmi Sirilaksmi
Fluids + MALDI SPOTTING Harry Emma Monica am /Dr Anna am Victoria
♠Shanti +kohEmma
Anna Emma Anna Emma
MALDI LAB <2 Sini /Mohammed Sini /Mohammed Sini/ Mohammed+caf °Mohammed °Mohammed
The Royal National
Throat, Nose and
Ear Hospital
The Royal Free
Hospital
Summary
• To ensure that workforce planning, training, &
education drive sustainable innovations
• To deliver a capable and flexible workforce
now and in the future.
• An aim to improve the quality of care and the
experience of patients and staff at all levels
and enable them to embrace change and
improvement.”