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 multidimensional 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
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
The Validation Process
• 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
What has to be achieved
Performance Measures
Patient Outcome Measures
Exemplar Standard attainment
Exemplar
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
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
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
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
Trust Initiative /Project Links
6S
BIC’s – A3’s and RIE’s
HHI audits
Productive ward Audits
Essence of Care
5 million Lives
NHSLA
Safer Clinical Systems
Productive Ward
Advancing Quality
Compassionate Care
Hygiene Code
Patients First
SHA Nursing Metrics
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
Improving Flow and Productivity on Respiratory Wards – D3 and D4
C u m u la t iv e D is c h a r g e s a n d D e a t h s D 3 & D 4 ; T r e n d fr o m A p r il 2 0 0 9
C u m u la t iv e D is c h a rg e s / D e a t h s
1800
1600
1400
1200
1000
800
600
400
200
0
May
Ju n e
C is c h a r g e s
/ D e a th s
p e r A v a ila b le
B e d
A p r il
J u ly
A ugust
S e p te m b e r
O c to b e r
C u m u l a t i ve 2 0 0 8 - 2 0 0 9
M e a s u rin g
New way of Working
Commenced
9
Nov ember
Dec ember
Ja n u a ry
February
Marc h
C u m u l a t i ve 2 0 0 9 - 2 0 1 0
F lo w : R e s p ir a to r y W a r d
D 3 &
D 4 , P a tie n t D is c h a r g e s p e r B e d
D a y
8
7
6
5
4
3
A p r il
M a y
J u n e
J u ly
A u g u st
S e p te m b e r
2 0 0 8 -2 0 0 9
Source: LE2.2
O c to b e r
N o v e m b e r
2 0 0 9 -2 0 1 0
D e ce m b e r
J a n u a ry
F e b ru a ry
M a rch
Has it made a difference?
BEFORE
DURING
AFTER
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
(1452-1519)