Steve Jamieson Head of Nursing Department Geraldine Cunningham Head of Learning & Development Royal College of Nursing

Leadership, Innovation and Quality: An example from practice Dr Michael Brown, Chair, Learning Disability Forum

The context Harnessing the knowledge, skills and commitment of the RCN membership to effect change Clear RCN strategic framework to guide and support activity to produce effective outcomes The RCN as a dynamic force to challenge and provide leadership

Death by Indifference Significant failures in safeguarding Serious service and system failures Avoidable deaths Poor practice & care Failure to adhere to legislation In short, indifference

The RCN in Action RCN Congress Resolution 2010 – Liaison Nurses in every general hospital Evidence of the changing demographics of the learning disabled population A differing health profile of people with a learning disability People with learning disabilities are high and frequent users of general hospital services. Different uptake and pattern of general hospital usage Clear legislative and policy frameworks which require equal access to public services, including healthcare, Legal duty for all Public services required to make ‘reasonable adjustments’ to care to comply with DDA legislation To impact on improving patient experience and health outcomes.

A model of Liaison Nursing Practice Learning Disability Liaison Nursing (LDLN) Services have been recommended in policy and are being developed across the United Kingdom. First Mixed Methods research study published in 2010 focussing on outcomes from 4 Liaison Nursing Models. The first study to examine LDLN Services from a range of stakeholder perspective and demonstrates evidence of the impact and outcomes. The LDLN role is complex and multi- dimensional and impacts on (i) clinical care, (ii) education and practice development and (iii) strategic developments.

Taking action to effect change Congress Fringe event – issues identified for members - Education, workforce & leadership in learning disability nursing RCN hosted a UK – wide learning disability summit Key leaders and stakeholders involved Identification of key actions and outcomes Effective use of RCN resources and facilities to take forward the issues

The Frontline Outcomes 1.The RCN as a dynamic force to challenge and provide leadership that can effect change to improve patient care 2.The RCN is a dynamic force that can influence the effective use of the nursing resource 3.The RCN membership has the collective knowledge & skills to effect change 4.The RCN has a sound strategic framework to guide and support activity to produce effective outcomes

Productivity What Nursing Has to Offer Using Lean as part of everyday practice Bolton Improving Health System Maria Sinfield Deputy Director of Nursing

Designed and led by Nurses & Midwives Exemplar Wards Using BICS in daily work Exemplar Wards demonstrate our commitment to provide a clean, safe and efficient environment of care, underpinned by Patient Safety. Uses the BICS principles of standard work, removing variation, removal of waste, improving quality and reducing cost. Patient Outcome Target Measures HSMR reduction i.e. MINAP <85% Defects 50% reduction p.a. Increase patient experience 85% good / 'excellent' on comment cards 10% reduction in cardiac arrests 2% reduction in pressure sore incidence 10% reduction in patient falls 14 wards validated 12 In progress 1 waiting for decision 1 ready for validation 3 wards working towards Model ward status

Awarding of the Exemplar ward status is not a given Structured and Strict process Some wards awarded but with conditions that are then performance monitored time provided to get to 100% appraisal for wards in Q1 Unannounced checks for decontamination assurance Formal Presentation of successful wards to Board of Directors The Validation Process

Performance MeasuresPatient Outcome Measures Exemplar Standard attainment PEAT – excellent KPI’s – above 80% HII’s – above 95% Sickness absence at or below 4.5% 6S compliance above 80% LOS – at peer national average PDD – less 20% variation, 50% improvement pre 9.30 CHC - > 90% achievement of timescales All staff PDP’s and KSF outlines Model Ward Standard attainment 6 months rolling consistency KPI’s above 95% ANNT 100% compliance VIP 100% EWS 100% Sickness Absence below 4% 6S compliance above 100% PDD – 85% PRE 9.30 LOS –below peer national averages All staff qualified in specialty Exemplar HSMR reduction – to be linked to wards i.e. MINAP above 85%, Sentinel audit above national average Defects 50% reduction p.a. Increase patient experience >85% 'good' / 'excellent' on comment cards 10% reduction in cardiac arrests 2% reduction in pressure sore incidence 10% reduction in patient falls and found on floor# Model Ward Standard Attainment 6 months rolling consistency No avoidable HCAI’s No preventable Cardiac arrests No medication errors MIPAP and Sentinel among highest national performance Increase patient experience >99% 'good' / 'excellent' on comment cards 50% in pressure sore incidence 50% reduction in patient falls and found on floor Tools and Techniques 6S BIC’s – A3’s and RIE’s HHI audits Productive ward Audits Trust Initiative /Project Links Essence of Care Compassionate Care 5 million Lives Hygiene Code NHSLA Patients First Safer Clinical Systems SHA Nursing Metrics Productive Ward Advancing Quality What has to be achieved

No avoidable deaths or harm HII/Infection control No Defects % of key quality indicators QFAT No Waste Stock levels Ward budgets attendance Highest Morale Good people management Valuing Staff

Source: LE2.2 New way of Working Commenced Improving Flow and Productivity on Respiratory Wards – D3 and D4

BEFORE DURING AFTER Has it made a difference?

Celebrating Our Success!!

Innovation Geraldine Cunningham Head of RCN Learning and Development Institute

5 Principles of Innovation 1.Innovation starts when people convert problems to ideas 2.Innovation needs a system 3.Passion is the fuel, and pain is the hidden ingredient 4.Co – locating drives effective change 5.Differences should be leveraged Creative Leadership Centre

Finding space for innovation “Men of genius work best when they work least.” - Leonardo da Vinci ( )