Leading Better Care
Sharing Good Practice
NHS Board: NHS Lothian
Ward / department / team: Community Children’s Nursing Team
Details of Improvement:
What was the particular problem that this case study is about?
Historically the Community Children’s Nursing (CCN) service had been provided by two
independent teams based in two different localities within two acute hospitals in Lothian. The
service is now managed as a Pan Lothian service but continues to have two bases.
This change in service provision highlighted the importance of a streamlined CCN service to meet
the needs of both the young people/families/carers and the staff, involved with this change.
How was this identified?
It was identified by the Clinical Nurse Manager (CNM) and team members, through team
meetings and away days that both teams worked in a slightly different way albeit with the same
philosophy of care to young people and their families/carers. There was a mutual understanding
that this new Pan Lothian CCN service required to be equitable, efficient and effective in its
service provision. The CCN service review in line with “Modernising Nursing in the Community”
supported this.
What were the implemented improvements (what tools/techniques did you use)?
The team implemented the Releasing Time to Care (RTTC) – Productive Community Services
programme within the service. Team facilitators were identified to oversee the programme, with
each team member having the opportunity to lead on modules within the programme. RTTC
progress meetings are held every two weeks and have been prioritised in the teams work diaries
with the understanding that all on duty have to attend as workload allows. These meetings have
allowed and encouraged engagement amongst the team, with everyone equally listened to.
Throughout the Foundation Modules of the programme, both bases have been streamlined to
replicate each other.
Some examples include
 replicating store cupboards and the offices as much as possible across the two bases,
 shared CCN documentation,
 Daily Patient Safety at a Glance (PSAG) meeting with telephone liaison across the two
bases at the end of these meetings. This allows both bases to have an understanding of
any children that require a rapid intervention.
 Staff availability tracker in cooperating annual leave and study leave. The team have
developed “Golden Rules” in relation to this.
 Meeting reliability audit sheets ensuring meetings are held to time and remain focussed
What is the situation now?
The team have completed the Foundation Modules of this programme and are progressing
through the Planning and Delivery modules. Following the publication of the recent CCN service
review, it was evident that the RTTC modules would enhance the findings of the review.
How is the change sustainable?
By continuing with the twice weekly progress RTTC meetings, we can ensure that the team will
share a clear common goal, remaining focussed on the benefits of the programme within the CCN
team
Monthly audits of direct patient facing time and staff wellbeing questionnaires will ensure that the
service is effective and efficient and will identify any areas for development.
Measurable outcomes
What are the patient benefits?
By approaching our service through the RTTC programme, we hope to improve our service so
that the young people and their families/carers will receive an efficient, effective and equitable
Pan Lothian CCN service.
Examples of these are
 Improved telephone management – decreasing answer phone use for families.
 Flexible working patterns – introduction of core hours of CCN service with the provision to
extend in exceptional circumstances.
 Further development of all geographical areas being staffed with the appropriate skill mix,
ensuring the prompt delivery of effective care.
 Re-organisation of supplies and equipment reduced time spent on this aspect, thereby
creating more time for patient centred care.
 Implementation of PSAG meetings ensuring that the whole team have knowledge of the
more vulnerable children and their families/carers across the Lothian’s.
What are the staff benefits?
The CCN team have developed a cohesive approach to service provision by getting to know each
other and interacting with each other, while working through the RTTC process.
Examples of this are
 All decisions made as a team and discussed openly
 Good team working and shared philosophy of care – a sense of unity within the team
 Integration of skill mix to geographical areas
 Moving from 2 off duties to one shared off duty
 The implementation of a staff availability tracker
 The implementation of the PSAG board across two bases, informing each team member
of children requiring rapid intervention
What are the organisational benefits?
An improved staff well being leading to an efficient, equitable and effective CCN Pan Lothian
service, as a result of the improvements.
.
How did staff feel before the improvement/during the improvement and after the
improvement?
Before – anxiety regarding the joining up of the two independent teams in relation to team
dynamics and differing work patterns.
During – every team member fully supports the RTTC philosophy and, subsequently, there has
been successful effective change within the provision of the CCN service.
After – The team have embraced the RTTC philosophy and will continue to do so. The results of
the RTTC programme, so far, have supported team cohesion, change in working practice and
subsequently a more accessible service for the young people and their families/carers.
What are the lessons learnt and what would you do differently next time?
Lessons learnt - Change is difficult however, if the whole team are listened to and involved in the
processes, change becomes easier. Strong team facilitators are the driving force in keeping the
team informed and motivated which enables the team to make sense of RTTC.
What would we do differently – in the early implementation of the programme, the modules
booklets were followed to the letter, however, more recently we have adapted the essence of the
module booklets to meet our team needs with the support of the RTTC facilitator.
What plans are there to spread the improvement?
Our service has been in an exceptional situation in that two historically different CCN teams in two
distinct geographical areas have been joined together. The RTTC programme has eased and
enhanced this process by successful team working. We plan on creating a digital story which will
demonstrate the implementation of the programme to highlight the clear benefit this has made to
individual team members, the team and the organisation. This, in turn, will benefit the young
people and their families/carers that require the services of the Pan Lothian CCN Service.
Contact information for case study
Sally Thompson, Community Children’s Nurse (Case Manager) – 01506 524382
Leigh Combe, Community Children’s Staff Nurse – 0131 536 0371
Christine Thompson, Community Children’s Nurse (Case Manager) – 0131 536 0371