A perennial challenge of hospital improvement projects is bringing together clinicians and managers in a way that empowers everyone. Traditional improvement strategies often focus on centrally-driven and monitored programmes which can leave shop-floor staff feeling like they are not involved, despite them having the greatest knowledge to enable change. Management teams, on the other hand, feel like their clinical colleagues are not engaged with these projects.
This article suggests a way to overcome this challenge starting from clear, shared data that makes an everyday impact:
- use simple, meaningful performance data that engages frontline staff;
- create forums that integrate clinical and management teams; and
- ensure consistent messaging and interaction across teams that reinforces the interdependency of all areas of a hospital and every patient being cared for.
Simple and engaging data
The business intelligence department of a hospital trust has many answers. But who’s asking the questions? More often than not, questions are posed by central transformation teams, the Trust executive or consultancies seeking to understand root-causes of issues before deploying teams of people to ‘do improvement’. So, what about the staff who lead key patient-facing services? What data do they need to bring improvement to their own work?
Providing ward teams, emergency department colleagues and others with the sight of consistent, simple, meaningful performance data, which they can understand in the context of their work, is a great place to start. This enables frontline staff to actively identify trends, make evidenced-based improvement plans, monitor progress and target any centrally-provided support.
Create integrated forums
In addition to providing simple data, setting up working groups that bring together clinical and management teams provides a crucial forum for establishing the rhythm of reviewing local-level performance data.
Having a mix of clinical and management staff in the room also cultivates a positive “can do” atmosphere. The variety of perspectives and seniority complement each other, bringing together on-the-ground understanding with a bigger picture view, allowing the group to rapidly unpick issues, agree appropriate solutions and influence outside the room, to successfully embed changes.
Develop an ‘every patient counts’ narrative
Data and meetings can only take us so far: they are only effective tools when staff feel motivated to improve against agreed metrics. Take, for instance, discharge lounge utilisation. This key indicator, as determined by the management team, is simple (number of patients per day per ward). But for a member of nursing staff on a ward, the motivation to increase this number is damped by practical challenges. Sending a patient to the discharge lounge actually increases ward staff workload: if a nurse in charge of a 24-bedded ward sends three patients to the discharge lounge in the morning, they will remain responsible for care until each patient is discharged. This means that this nurse has 27 patients in their care for the majority of their shift.
However, if the Trust were able to openly discuss these issues under the guiding mindset that every patient counts, not just those being cared for directly, staff might feel comfortable in developing new solutions. Some leading Trusts have had success in sharing staff stories to highlight the importance of thinking about the impact for patients outside each individual department. In this example, effective utilisation of the discharge lounge is key to reducing the number of ambulances queuing at the front door of the hospital. This can mean the difference between life and death for a patient who is waiting to be treated in their own home by the ambulance crew.
In summary, when pursuing a culture of locally-driven improvement across management and clinical teams, Trust leaders need to consider several factors:
Real-life improvements: urgent and emergency care
Working with trusts who have shifted the focus to the three priorities above, we have seen impressive results. Take this example of a Trust in the south east of England. The team developed simple ward performance dashboards, created regular supportive forums that brought together both clinical and management staff, and introduced clinical coaching and cross-team workshops. As a result, the Trust achieved an 16% reduction in average length of stay across supported wards and doubled the number of pre-noon discharges. Culturally, things also improved: all staff pulled together and there was a buzz of excitement as local improvement projects started seeing and feeling the results.
How did they do it?
The first step was to streamline and simplify the performance data received by clinical areas. This helped clinical teams to review trends regularly and make their own evidence-based decisions on their next steps.
Secondly, clinical coaching and cross-team meetings helped clinical areas to build their awareness of all patients across the hospital pathway, rather than only the needs of patients in their direct care. This shift provided fresh motivation to improve against their performance metrics, enabling clinical teams to take ownership of driving improvement.
Finally, a refreshed governance structure brought clinical and management staff into the room together, embedding the belief that reviewing and acting on performance data was a priority across all clinical areas.
As one ward sister reflected: “This project has helped me look at the Trust-wide picture rather than just my own area – I now think of the patients waiting on trolleys in ED and feel motivated to do my bit.”
Over a decade of experience
2020 Delivery has over a decade of experience and expertise in supporting acute trusts to improve flow, with benefits to A&E performance, quality of care and staff engagement. To find out about our experience in Urgent Care, or our transformation expertise, please get in touch.
Author: Tess Moseley-Roberts