Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk

1. ‘Breaking the Cycle’ or ‘perfect weeks’:
social movements improving emergency
flow & patient safety in acute hospitals
Nye Harries & Diane Fuller
Emergency Care Intensive Support Team (ECIST)

3. .

4. Building a social movement
Social movements
start with:
• A compelling story
• A commitment
• A structure
• A strategy
• A set of measured actions
& outcomes

5. Social movements – 6 features:

6. A compelling story #1

7. • 48% of people over 85 die within one year of hospital admission
Imminence of death among hospital inpatients: Prevalent cohort study
David Clark, Matthew Armstrong, Ananda Allan, Fiona Graham, Andrew Carnon and Christopher Isles, published online 17 March 2014 Palliat Med
• 10 days in a hospital bed (acute or community) leads to the
equivalent of 10 years ageing in the muscles of people
over 80
Gill et al (2004). studiedthe associationbetweenbed rest and functional decline over 18 months. They found a relationship between theamount of time spent in bed rest and the
magnitude of functional decline in instrumental activitiesof daily living,mobility, physical activity, and social activity.
Kortebein P, SymonsTB, Ferrando A, et al. Functional impact of 10 daysof bed rest in healthy older adults. J Gerontol A Biol Sci Med Sci. 2008;63:1076–1081.
If you had 1000 days left to live
how many would you chose to
spend in hospital?
A compelling story #2

9. .

10. Example commitments from ‘Breaking the cycle’ weeks
• Cancelling all non urgent meetings &
reducing email traffic
• Consultants standingdown non-clinical
SPAs
• Two senior medical reviews a day on every
ward, every day
• Increased visibility of senior staff
• Deploying Liaison Officers to wards
• Introducing Internal Professional Standards
• Move to a ‘go and see’ approach (rather
than office based)
• Permission from executives for front line
staff to get on and do things that prevent
patient delays (no matter how small)

11. The Patient Flow Bundle - SAFER
S- Senior Review: all patients will have a consultant review before midday.
A- All patients will have an Expected Discharge Date (that patients are made aware of)
based on the medically fit for discharge status agreed by clinical teams.
F- Flow of patients will commence at the earlier opportunity (by 10am) from assessment
units to inpatient wards. Wards (that routinely have patients transferred from assessment
units) are expected to ‘pull’ the first (and correct) patient to their ward before 10am.
E– Early discharge: a third of our patients will be discharged from base inpatient wards
before midday. TTOs (medication to take home) for planned discharges should be prescribed
and with pharmacy by 3pm the day prior to discharge wherever possible to do so.
R– Review: a weekly, systematic review of patients with extended lengths of stay
(e.g. > 14 days) to identify the issues and actions required to facilitate discharge.
This will be led by clinical leaders supported by operational managers who will
help remove constraints that lead to unnecessary patient delays.

13. Breaking Free for Our Patients:
A Perfect Week (July 2015)
It’s all about ‘the Buzzzzzz’
.

14. UHCW: impact of ‘Breaking the Cycle’
week
• 120 more patients were discharged during the BtC week compared to a poor
performing week
• 20 more patients were discharged before 12 noon each day compared to a
poor performing week
• 313 patients with LoS >14 days are in our hospitals now compared to 430
before
• 60 patients waited more than four hours in ED over this week compared to
584 six weeks ago
• We now have16 medical outliers. On a bad week, we had 160.

15. What led to our performance improvement?
• Created a ‘Buzz’
• Which resulted in much better Engagement –
there’s a sense of ‘being in it together’
• Care bundle promotes the correct actions which
were delivered.
• Pride became important again and we’ve
recovered a sense of ‘we can do it’.

16. Tuesday14th April 2015
System’s Flow Event
Summary & Feedback

17. Headline numbers

18. Results: 4 hours
 Week ending Sun 15 performance 88.79%
 Week ending Sun 22 performance 96.23%
 Drop in number of expected patients diverting to ED due to better
bed availability in GP Unit
 Reduction in Medical outlier numbers (23 at end of April vs. average
of 40 - 60 through Jan/ Feb)

19. Feedback - Was Onwards Together worthwhile?
 Yes! Overwhelmingly positive response.
 “Very valuable exercise, we need to re-run it”
 “My suggestion would be that onwards together
become a regular programme and we find ways to
engage every member of staff into the ideas &
philosophy of improving flow.”
 “It would be great if the model for Onwards together
becomes business as usual. We need to maintain the
pace and responsiveness.”

20. So what next for a ‘social movement’…
..for NHS emergency care ? …in the rest of the NHS ?