A presentation by Annette Bartley

1. Point of Care Hospital Pathways programmeAims & Measures Annette Bartley RGN BA (hon) MSc MPH Faculty member

2. The Reality in Practice

3. Getting to Goal Will Ideas Execution

4. Transitions Williams Bridge ‘ Transitional Management Change is situational and can happen quickly Transition is psychological and is much slower * Adapted from the Transition Process by William Bridges

6. More than a change

8. Improve relatives experience so they can have confidence in the quality of care their loved one’s receive

9. Demonstrate that the well being of staff is important not just for its own sake but for the sake of patients

13. Improving the patients pathway of careGenerating light…not heat! Create a sense of urgency Frontline engagement Partnership with patients and families Build reliable processes Reduce harm, waste and variation Measurement for Improvement

14. NHS Forth Valley Improvement requires Clear Aims Measurement & Action

15. Improvement begins withA clear Aim, Measurement & Action

16. Aim Measure Action The Improvement Guide, API

18. Measurable

19. Achievable

20. Realistic

22. “In God we trust. All others bring data.” W. E. Deming

23. S+P=0 S=Structure The environment in which health care is provided P=Process The method by which health care is provided O=Outcome The consequence of the health care provided Avedis Donabedian Physician

24. Three Types of Measures Outcome Measures: Voice of the customer or patient. How is the system performing? What is the result? Process Measures: Voice of the workings of the system. Are the parts/steps in the system performing as planned? Balancing Measures: Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures? (e.g. unanticipated consequences, other factors influencing outcome)

25. Measurement Guidelines A few key measures that clarify a team’s aim and make it tangible should be reported, and studied by the team, each month Be careful about over-doing process measures for monthly reports Make use of available data bases to develop the measures Integrate data collection for measures into the daily routine Plot data on the key measures each month during the life of the project

28. Outcome measures will most likely lag behind process measures.

30. Key Aims Increase the amount of time nurses spend in direct/value added care to 70% Reduce hospital acquired pressure ulcers by 50% Reduce in hospital patient falls by 50% Increase patient satisfaction >95% Increase staff satisfaction >95%

31. Measures Outcome Percentage of time nurses spend in direct/value added care Incidence of Hospital acquired pressure ulcers Falls rate/ Incidence Patient satisfaction score >95% Staff satisfaction/ well being score >95%

32. Measures Process Percentage compliance with risk assessment /falls & pressure ulcer Percent compliance with SKIN bundle /Intentional Rounding Balancing Length of Stay Complaints Staff turnover /Sickness rates Budget implication

33. Visual Measurement

35. Engaging Heart & Minds ‘If you want to build a ship do not gather men together and assign tasks. Instead teach them the longing for the wide endless sea’ (Saint Exupery, Little Prince)

36. You are this Hospital. You are what people see when they arrive here. Yours are the eyes they look into when they’re frightened and lonely. Yours are the voices people hear when they are in the lifts and when they try to sleep and when they try to forget their problems. You are what they hear on their way to appointments that could affect their destinies and what they hear after they leave those appointments. Yours are the comments people hear when you think they can’t. Yours is the intelligence and caring that people hope they’ll find here. If you’re noisy, so is the hospital. If you’re rude, so is the hospital. And if you’re wonderful – so is the hospital. No visitors, no patients can ever know the real you, the you that you know is there — unless you let them see it. All they can know is what they see and hear and experience. And so I have a stake in your attitude and in the collective attitudes of everyone who works at Cooley Dickinson Hospital. We are judged by your performance. It is judged by the care you give, the attention you pay and the courtesies you extend. Thank you for all you are doing. CEO Cooley Dickinson Healthcare Org