Dr Helen Horton (GP at Distington Surgery and GP Lead for Commissioning & Clinical Lead for Health Pathways at NHS North Cumbria CCG), explains to us what Community Health Pathways is, and how it's benefitting both clinicians and patients in North Cumbria.

Teach it forward! If you would like to know more about the Community Health Pathways work, please contact: helen.horton7@nhs.net 


Throughout October in CLIC we are shining a spotlight on improvement – helping you learn and connect with others across health and care to make a difference.

This week we're focusing in particular on the safety of the people who use our services, which should be absolutely central to any improvement we make...

 

5S workplace organisation

Unorganised and chaotic workplaces result in huge amounts of waste, and can significantly hinder staff and patient/service user experiences. The 5S approach is a structured process which involves five key steps to create an ideal work environment for you and your team: sort, simplify, sweep, standardise, sustain.

Safety is considered at all of the five key steps to ensure that people and the work area are safe.

By applying the 5S approach to your workplace you can:

  • Reduce time spent on searching for things/information
  • Make better use of time
  • Identify issues/problems before they happen
  • Provide a foundation for future improvements
  • Take control of your work environment so that it is properly set up to support you
  • Put a system in place to ensure that everyone understands the standards set as a team and that those standards are not only maintained but continually improved
  • Support your team to take responsibility and ownership of their working environment, creating feelings of empowerment in their roles

Here's a couple of useful 5S videos:

 

Find out more about 5S in our toolkit...

 

After Action Review (AAR)

AAR is a discussion that supports continuous improvement, prompting us to reflect on how successful we were at achieving our aim by comparing what actually happened with what was intended.

It can be used at key stages or after completing a task, event, activity or project, and helps us to recognise when something needs improving.

AAR is simple to use - it doesn't require a lot of equipment or advance preparation and can be held almost anywhere. Importantly, it's really inclusive so everyone can join in and it doesn't judge success or failure!

Find out more about AAR in our toolkit...

 

Improvement Story: Community Health Pathways

Dr Helen Horton (GP at Distington Surgery and GP Lead for Commissioning & Clinical Lead for Health Pathways at NHS North Cumbria CCG), explains to us what Community Health Pathways is, and how it's benefitting both clinicians and patients in North Cumbria.

Teach it forward! If you would like to know more about the Community Health Pathways work, please contact: Helen.Horton@northcumbriaccg.nhs.uk 

 

Involving Patients in their Safety 

Paula Smith (pictured right) has been a Nurse within Cumbria for over 30 years, and has a background in Medical Nursing, Infection Prevention and Quality Assurance & Improvement. Her career has taken her across acute care, primary care, community, mental health, commissioning, and working alongside Public Health, Local Authority, NHS England & NHS Improvement as well as working closely with care homes. Throughout her career she has always been passionate about patient safety, and empowering the voice of local patients. 

The NHS Patient Safety Strategy (2019) required each NHS organisation to appoint a Patient Safety Specialist, and Paula Smith has taken up this role within NHS North Cumbria CCG.

The document said: "Too often in healthcare we have sought to blame individuals, and individuals have not felt safe to admit errors and learn from them or act to prevent recurrence. The willingness to support the development of this strategy, however, has amply demonstrated people’s desire to make the NHS safer." 

A key goal of the Patient Safety Specialist role is to enable patients and their carers to be partners in their own safety, as well as in the safety of the organisation. So while in Don Berwick’s 2013 report into patient safety the plea for “patients and their carers to be present, powerful and involved” is an important call to action, we must be mindful of the fact that it spoke to a system which for 70 years has been both paternalistic and hierarchical. 

The Patient Safety Specialists are leading the way towards changing this culture within healthcare services by involving patients in their own safety. Paula is currently a member of a national task group that is looking at how The Framework for Involving Patients in Patient Safety (2021) can be put into practice at a local level in order to make a positive difference.

"Patients should have a greater expectation of how they can be involved in their own care and ensure it is safe. However, patients are not always sure what they should look out for or what they can do to help" - The Framework provides guidance on how the NHS can involve people in their own safety, as well as improving patient safety in partnership with staff. It also describes how we can help maximise the things that go right and minimise the things that go wrong for patients. 

The framework is divided into two parts. The first describes how organisations should support patients, their families and carers to be directly involved in their own or their loved one’s safety; and the second part describes how organisations should support Patient Safety Partners to be involved in wider governance and leadership of safety activities.

Approaches to involving patients in their own safety can include: 

  • Encouraging patients to ask questions 
  • Information campaigns such as those encouraging people to be vigilant about staff, visitors and patients cleaning their hands
  • Individual involvement in incident investigation
  • Ensuring individuals have enough information to participate in decision-making about their care
  • Training individuals in how to be involved in their own safety, e.g. in self-medication

Part B is about how Patient Safety Partners become involved in organisational safety. It relates to the role that patients and other lay people can play in supporting and contributing to a healthcare organisation’s governance and management processes for patient safety. 

Roles for Patient Safety Partners include:

  • Membership of safety and quality committees 
  • Involvement in patient safety improvement projects
  • Working with organisational boards to consider how to improve safety 
  • Involvement in staff patient safety training
  • Participation in investigation oversight groups

For more information of please contact: Paula.Smith@northcumbriaccg.nhs.uk 

Or visit: www.england.nhs.uk/wp-content/uploads/2021/06/B0435-framework-for-involving-patients-in-patient-safety.pdf


Brought to you by CLIC in collaboration with North Cumbria Knowledge and Library Services, this Lunch & Learn session on 7th October 2021 saw Karen Kirk (Programme Manager, NHS North Cumbria CCG) and Sarah Fowler (Organisational Development / Workforce Training Team Manager, Cumbria County Council) deliver a presentation on 'Supporting leaders to navigate new ways of working'.

Due to the COVID-19 pandemic, we have become used to flexible working arrangements and for team leaders navigating a way forward and back into work might be a challenge. The aim of this session was to support leaders in focusing on having helpful conversations with staff, and to signpost to some helpful resources for decision making. 

 

 

Upcoming LUNCH & LEARN...

We need to talk about climate change… │ 12 November 2021, 1:00 - 1:30pm │ Online with MS Teams

The best thing you can do in your workplace to fight climate change is to talk about it. In this short presentation, Anna Foster (Trust Lead for Strategy and Sustainability, CNTW) will describe the series of ‘climate conversations’ held earlier this year at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust to raise awareness of sustainable healthcare and their Green Plan, empowering colleagues to raise these issues within their own teams. 

No need to book! Find out more & get the MS Teams link here...


If you would like to present and share your innovations/improvements across a wider platform, please get in touch with us at: info@theclic.org.uk / 01768 245480

After attending our Leading Sustainable Change Programme, Julie McColm (Beech C Ward Manager, Cumberland Infirmary, North Cumbria Integrated Care NHS Foundation Trust), created an Improvement Wall in order to improve both patient care and her team's audit results. A great example of visual control!

Teach it forward! If you would like to know more about the work Julie and her team have been doing, please contact: Julie.McColm@ncic.nhs.uk 


Throughout October in CLIC we are shining a spotlight on improvement – helping you learn and connect with others across health and care to make a difference.

‘Not every change is an improvement but every improvement is a change; you can’t do anything better unless you can manage to do it differently’ - Eliezer Yudkowsky.

Sometimes working in health and care can feel like constant change… and not always for the better. When improving services you need to consider what you are trying to achieve, how you will know if a change is an improvement and what changes you can make that will result in improvement.    

Measuring for improvement does not have to be complicated, can be applied to small scale changes, and can show: 

  • How well the current process is performing
  • If we have reached an aim
  • If the changes have resulted in improvement
  • If the change has been sustained

There are 7 steps to good measurement as shown in the diagram. Working through each of these systematically enables us to gather data that helps us make better decisions about how to improve our services.

Find out more about measuring for improvement in our toolkit...

 

Spaghetti Diagrams

Spaghetti diagrams are one of the simplest forms of data collection

They are hand or computer drawn diagrams showing the movements in a process. The movements could be information, materials/equipment or people, and drawing these out in a visual way helps us to identify where waste and inefficiencies are happening.

Repeating the spaghetti diagram after a change has been made can really help to demonstrate the improvement.

Find out more about spaghetti diagrams in our toolkit...

 

Plan, Do, Study, Act (PDSA) - every improvement is an experiment

PDSA (sometimes known as PDCA) is a key tool in any improvement work, and provides a framework for developing, testing and implementing change. It can be used to test out any planned improvement or change in the way we work on a small scale, in small steps.

A fundamental part of the PDSA cycle is gathering information and data to enable you to measure whether the change has resulted in an improvement.

Multiple and simultaneous PDSA cycles may be used when the planned change is complex or if further improvements are required. 

Here's a useful video giving an overview of PDS(C)A:

Find out more about PDSA in our toolkit... 

 

5 Whys

When gathering data, you learn about the area you are aiming to improve and gain a greater understanding of the problem. Data can help to assess if you have a problem, but it won’t necessarily explain why the problem exists. 

The idea of using 5 whys is to simply ask why something is done as it is. To the response, another why is then asked. This continues until you drill down to a full understanding of the reason for an action or process.

Moving into 'fix-it' mode too quickly might mean dealing with symptoms but leaving the underlying problem unresolved, so you can use the 5 Whys to ensure that the cause of the problem is being addressed.


Find out more about 5 Whys in our toolkit...

 

OGIM (Objectives, Goals, Initiatives, Metrics)

OGIM can be used at all levels of an organisation, giving structure to developing an annual plan that is linked and aligned to the organisation's vision and strategies. It is visual and simple to understand.

A particularly important part of an OGIM is the 'metrics', or your data/measurement. Displaying this for the whole team to see allow you to keep check on your progress, and ultimately keep the work on track.

Find out more about 5 Whys in our toolkit...

 

Improvement Story: Beech C Improvement Wall

After attending our Leading Sustainable Change Programme, Julie McColm (Beech C Ward Manager, Cumberland Infirmary, North Cumbria Integrated Care NHS Foundation Trust), created an Improvement Wall in order to improve both patient care and her team's audit results. A great example of visual control!

If you would like to know more about the work Julie and her team have been doing, please contact: Julie.McColm@ncic.nhs.uk