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West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Conflicts of Interest None to declare.

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Presentation on theme: "West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Conflicts of Interest None to declare."— Presentation transcript:

1 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Conflicts of Interest None to declare

2 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Samantha Jones, Chief Executive Dr Mike van der Watt, Medical Director

3 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Onion “ A way of enabling staff to solve issues”

4 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust How it all started.. Overheated hospital: –Daily “silver command” –Inability to maintain a safe A+E –Staff left accepting “this is how it is around here” No direct daily interaction between management and staff

5 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Stop the clock….. Cancel all non-urgent meeting (clinicians and managers) for a week Executive and senior clinicians met daily with one question “What needs to be done to improve patient safety”

6 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Onion grew bigger and bigger! 08.15 AM Every day Board to Ward Visibility of exec Quality & Safety No blame Assurance Listening, Support “collectively, as a team, we all know everything we need to know” Elderly Care Physician

7 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Surgery Nursing Workforce Sitrep Ward RN to Bed Day RN to Bed Night Rag Rating Overall Rag Rating Green - Staffing numbers are as expected on the rota and ward is assessed as being safely staffed taking into consideration workload and patient acuity. Staffing numbers are not as expected but safe according to current workload DayNight Beckett SACH #### GG Amber - Staffing numbers are not as expected and minor adjustments need to be made to bring staffing to a reasonable level given workload and acuity or staffing numbers are as expected but given workload and acuity additional staff are required De La Mare SACH 1 : 71 : 9GG Letchmore 1 : 7 GG Red - Staffing levels inadequate to cope with current patient needs Flaunden 1 : 81 : 9GG Ridge 1 : 81 : 10GG Cleves 1 : 81 : 7GG Langley 1 : 51 : 8GG Number of Specials signed off by Head Nurse1 Langley-Surge #### GG Number of additional shifts signed off by Head Nurse0 Comments/Actions Taken - Surg Areas and Becket ward closed Daily Nursing “Sit-rep” at Onion

8 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Any issues of patient safety or experience today? Gathering information …. evidence vs layers Rapid response time (bring it back tomorrow?) Multidisciplinary forum Solutions, not problems Spreading success and learning “Impressed at so many people, a sight to behold, fired up to make the hospital work better” Junior Doctor R oot C ause Analysis

9 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust I mprovements & O utcomes Making services flow for our patients: Review of nursing roles + establishment Supervisory band 7 Prescribing in Discharge Lounge 77% increase in use of discharge lounge since May Integrated discharge team Enhanced Therapy services Rapid review & change based on evidence and fact “Onion has sorted something in 3 days that I haven’t been able to sort in 3 years”

10 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Onion’s measure of success is patient experience and safety I mprovements & O utcomes “ Consultant ward rounds at weekends a massive help; saves lives” Junior Doctor Sustaining 95% performance on A&E Increase in EDD in a single day Board & ward rounds re-scheduled Reduction in cancelled operations Reduction in use of escalation areas Up to 40% of ‘take’ patients to Ambulatory Care Reduction in delayed discharges Removed delays in death certificates

11 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust C ulture C hange Improving Care through Culture Change… N o issue too big or too small or off-limits “Hello. My name is Dr Kate Granger. How are you feeling today?” Locally: “I am a person not a number”

12 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust I mprovements & O utcomes Looking after our patients’ experience: “ the standard you walk past …….is the standard you accept” Learning from patient stories Visiting times Portering practice Availability of hot meals in A+E New wheelchairs & more repairs Lines of responsibility made clear

13 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust I mprovements & O utcomes Team working Multidisciplinary clinical team Board to ward External partners Feeling part of the hospital team Similar to “Schwartz Rounds” where staff connect and support Renewed energy/optimism/belief New language – ‘onion-ising’

14 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Does it really have an effect? Crude mortality down 20% HSMR 101 (110) SHMI105 (107) 14

15 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust 15 ONION

16 West Hertfordshire Hospitals NHS Trust West Hertfordshire Hospitals NHS Trust Onion is compelling and highly replicable Powerful ingredients: People Passionate commitment to putting the patient first and Doing tomorrows work today CEO: “I want to lead an organisation that knows what it does well, knows what it doesn’t do well & above all, isn’t afraid of saying things aren’t right and wants to deal with those areas and improve.” So, what is Onion?


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