the leeds improvement method · 2019. 4. 10. · showcasing some of the wonderful work we are doing...

wwwleedsthnhsuk

THE LEEDS TEACHING HOSPITALS NHS TRUST STAKEHOLDER MAGAZINE Spring 2018

Using lean methodology in healthcarePages 6-7

Safety huddles improve patient care 5

Transforming End of Life Care Pages 20-21

The Leeds Improvement Method

elcome to the latest issue of CONNECT our new look stakeholder publication keeping key

partners Trust Members and anyone interested in health care within Leeds and the wider City Region up to date on our work and plans for the future

This issue of CONNECT features interactive content showcasing some of the wonderful work we are doing to improve quality across our hospitals and some of the great successes we have achieved

Our ambition is for Leeds Teaching Hospitals to build a culture of continuous improvement across the organisation by treating every patient as an individual delivering the best outcomes the best possible experience and one which is free from avoidable harm

As an organisation we are committed to Quality Improvement (QI) and this is shaped by our strategy which includes our work with staff and patient representatives the prestigious NHS Improvement and Virginia Mason Institute national programme and our collaborative work supported by our partners in the city West Yorkshire the wider Yorkshire and Humber region nationally

Collectively this is The Leeds Improvement Method our organisational approach to improvement - I do hope you enjoy learning more about the great work we are doing

We have some great foundations for our Quality Improvement including

Our partnership work with Virginia Mason Institute and the success of the Leeds Improvement Method value streams

Our Trust-wide quality improvement programmes which have helped spread the knowledge and learning from quality improvement methods

Lots of smaller improvement work within and across our departments bringing about real improvements for our patients

Our Leeds Way values

An introduction to Quality Improvement

Welcome


The Trust signed up to the national Sign Up to Safety Campaign in 2014 pledging to put safety first and reduce avoidable harm

Our Quality Ambitions workshop in 2016 helped us to build on our learning to date and shaped our core principles for enabling continuous Quality Improvement throughout the Trust These principles are

Leadership at all levels to engage and sustain our improvement culture

Engagement and Support to partner with patients and their families for the safest care and for all our staff to be involved in improvements as part of the work they do

Communication to support continual learning and improvement from senior leaders to frontline staff from ward to the Board and throughout the organisation

Overview of Quality Improvement

2 LEEDS TEACHING HOSPITALS NHS TRUST - WWWLEEDSTHNHSUK CONNECT MAGAZINE - SPRING 2017 3

Contents An introduction to Quality Improvement


2-3

4-5

11

Reducing Hospital Acquired Pressure Ulcers

Reducing Avoidable Deterioration

12-13

6-7

8-9

Lean for Leaders and QI training of staff

Value stream case study Elective Orthopaedics 12-13

Reducing Falls

Involving patients carers and the public in quality improvement

14

Improving care for patients with Parkinsonrsquos

Safety Hurddles

15

16-17

18-19

Sit Up Get Dressed Keep Moving

Sepsis

Transforming End of Life Care

Latest News

W

DR LINDA POLLARD CBE DL HONDLL

CHAIR LEEDS TEACHING HOSPITALS NHS TRUST

Empowerment to create a shared purpose and understanding of quality improvement

Infrastructure training and capability for all staff in quality improvement

11

10

22-23

20-21

here are three concepts at the heart of the Leeds Improvement Method Value Waste and Respect for People The Leeds Improvement Method is not

only about the process but also about building on our culture - known as the Leeds Way - so we encourage and empower all staff to identify areas where they can make small changes which would improve the services they deliver for patients

Four work areas known as value streams were chosen for initially developing the Leeds Improvement Method and this has now grown continuously across the Trust

A value stream is a programme of work in a service or project area where we are working with staff to use lean improvement techniques to find solutions for challenges we face

Each value stream includes a number of Rapid Process Improvement Workshops (RPIW) within it looking at different but often linked challenges within the same service area or project The people involved in this work are empowered to eliminate waste and improve the process

Every week different teams from each value stream take part in Report Out a 15 minute presentation of the progress they are making and achievements from the RPIW This meeting is open for all staff to attend enabling everyone to look back on the progress being made and learn from it

At the heart of this work are our staff and hundreds of teams have been directly involved in improvement activity to date

ur methods of Quality Improvement use the Leeds Improvement Method and

the Model for Improvement

The Leeds Improvement Method uses Lean methodology which has strong and well-defined approaches that can help to identify system-level issues for improvement The Model for Improvement often uses similar tools

as those used in Lean to understand the local system Both approaches concentrate on the patients as the focus of the outcomes to be improved

They also recognise that improvement works best when people are at the point of care those engaged directly in the work are empowered to test changes and use local feedback data to make improvements


The Leeds Improvement Method The Leeds Improvement Method

T

O

We are one of five Trusts in the UK to be working with NHS Improvement and the Virginia Mason Institute on an improvement programme to improve the efficiency and flow of our services with patient and staff experience embedded at the centre of this work We are building on this programme to develop our own method which we call the Leeds Improvement Method


Methodology

You shouldnrsquot assume that what works well in one place is going to work everywhere improvements might need additional adaptation and testing in a different location Again and again wersquove seen in practice that itrsquos not as important to choose one method or the other itrsquos most important to empower people at the point of care to make changes

DR ANNA WINFIELD PATIENT SAFETY MANAGER EXPLAINS

Watch the video

CONNECT MAGAZINE - SPRING 2018 7

ean for Leaders is a six-month programme run by our Kaizen Promotion Team It provides formal training and certification in lean methodology for colleagues in a leadership role enabling

them to undertake improvement (Kaizen) projects in their workplace (Genba) Almost 150 members of staff have received Lean for Leaders training with another 100 due to start this year This is contributing to a sustainable and lasting culture change across the Trust as well as improving patient care and healthcare processes

In addition we also offer training for colleagues in QI related to our work with our QI collaboratives This training provides staff with the skills to understand how to interpret whether change has made an improvement in data and the psychology behind behaviour change and QI

Lean for Leaders and QI

Showcasing our work to Baroness

Dido Harding

Lean for Leaders

Our ambition is to scale up the implementation of the Leeds Improvement Method to ensure that by 2020 every member of staff has experienced it Baroness Dido Harding visited the Trust to hear more about the Quality Improvement work taking place in our hospitals

6 LEEDS TEACHING HOSPITALS NHS TRUST - WWWLEEDSTHNHSUK

LLean for Leaders and QI training of staff Lean for Leaders and QI training of staff

Case study Chemotherapy Day Case UnitDr Phil Wood Clinical Director for Oncology worked with the chemotherapy day case unit as part of his work on the Lean for Leaders course

The Chair of NHS Improvement Baroness Dido Harding met the team on the Chemotherapy Day unit to hear about the difference this work and many other projects are making across the Trust

Phil and the chemotherapy day case team have undertaken a number of pieces of work to improve the patientsrsquo experience and reduce waiting in the department This included observing and mapping the patient journey to identify the amount of time patients wait for their treatment or for tests and their results

This has resulted in a new approach to scheduling appointments including the introduction of an electronic scheduling system There is also a new process to identify urgent chemotherapy bloods to speed up results in pathology

Philrsquos work with the team has also made a real difference to patients by reducing the waiting time for patients and increasing capacity in the chemotherapy day case unit by 20 for each working day This has enabled the team to include one extra treatment a day and it has reduced the waiting time for bloods by at least 30 minutes Patients are also booked in earlier with all their appointments arranged beforehand so have notice and can plan around them

his value stream was split into five Rapid Process Improvement Workshops (RPIWs) which

use tools and techniques to create continuous improvement and cut down on waste This work led by the multi-disciplinary team at Chapel Allerton Hospital has made real improvements to the patient experience as well as increasing the efficiency of the service and reducing costs

RPIW 1 The first RPIW focussed on looking at the way patients are scheduled on theatre lists when requiring an elective hip or knee procedure

Theatre lists in the elective orthopaedics service go through a variety of changes from the point at which they are created up to the actual day of surgery This can have a negative impact on the patient experience including longer waiting times

Instead of sending surgery admission letters through the post three weeks before surgery the team provide the majority of patients with a date for their surgery during their initial clinic appointment As a result fewer patients cancel their appointment meaning better theatre utilisation This has improved efficiency for the scheduling team who now spend only 10 of their time rescheduling cancelled appointments compared with 80 previously

RPIW 2The focus of this RPIW was inventory including how stock rooms are managed and how theatres are set up with the appropriate supplies

Theatre stock rooms are now organised with an aisle for each type of surgery for example hips knees and elbows with the most used kit nearest the actual operating theatre


Value stream case study Elective Orthopaedics Value stream case study Elective Orthopaedics

TThe team have also used colour coding and labelling to make items easy to find and they identified 150 items that were no longer in use saving around pound500k

The team sorted re-arranged and simplified the loan kit corridor making it easier to identify the kit they required and seeing a reduction in defects

As a result there has been a 37 reduction in sterilisation costs by reducing the number of theatre trays required and number of tools on each tray Theatre tray set up time has reduced by 80 down from 49 minutes to just 9 minutes

The Elective Orthopaedics team have been using the Leeds Improvement Method to make significant improvement in the care of patients undergoing total hip and knee replacements

Value stream case studyElective Orthopaedics

This has ensured that the right amount of stock is in the right place at the right time saving money for the Trust and creating a safer more organised and calmer work environment

RPIW 3The third RPIW focussed on improving pre-assessment for patients This was built upon the team identifying that they were having re-assess 66 of patients before they came in for an operation

The pre-assessment process involves patients moving around the department to see different members of the team before a procedure This vital part of the patient journey has now been streamlined so that patients remain in one place and the staff members come to them

The team have also introduced an admissions clerk to the pre-assessment clinic which has improved the patient experience and provided support to the nursing staff The clerk checks booking forms and works with consultants to ensure they are filled in fully and clearly enabling patients to move through the pre-assessment process faster

Prior to the work 55 of booking forms had many defects ranging from missing information or difficulties in reading what had been written This has dropped to less than 7 of surgical booking forms returned to the clinician during clinic Those that are returned are now due to minor quality defects such as not ticking a single box

Patients now spend less time in the department reducing the re-assessment rate significantly and therefore freeing up staff to see other patients The team have actively involved a patient in this work and this has been built upon in other work streams

RPIW 4 The mobilisation of patients who have had hip or knee replacements is a vitally important aspect of their post-surgery recovery The aim of this RPIW was to mobilise patients on the day of surgery and this included standardisation of post-operative analgesia eMeds an electronic system for medication was a key element of the success

The biggest achievement was a reduction in time spent in recovery from 17 hours to 4 hours enabling the recovery ward to close if appropriate and those nurses to work on the ward therefore creating a large saving and improved staffing levels This has also had a real impact on ward metrics for example in reducing falls

RPIW 5The latest workshop is looking at turnaround time in theatres from when the wound is closed to when the next patient enters the anaesthetic room

Waiting can make patients feel anxious so the team wanted to improve the amount of time this takes therefore improving the patient experience

There are a number of variables that can affect this including safety checks the type and number of trays and complexity of set up These processes must be done correctly to ensure that quality care is delivered safely every time

The original turnaround time was 14 minutes and this has now been improved to nine minutes This has ensured that the changeover process between patients is efficient lean and timely

To achieve this the turnaround process was standardised allocating specific tasks to each member of the team This included the introduction of a lsquoskin closure sequencersquo which details exactly what each person should be doing and at what time Anaesthetic equipment was stored in a different place in each theatre so the team standardised this so it was in an identical agreed location meaning that staff could be working in any theatre and they would always be able to find and return it

Watch the video

Overall productivity in the department has increased by over 14 and The Leeds Improvement Method has been a significant contributor in this achievement Some of this work has now spread to other sub specialties including upper limb foot and ankle and soft tissue knee

he bundle was developed by the multidisciplinary teams on each of the pilot wards allowing the team to establish which interventions worked and led to

the most reductions in falls These ways of working were embedded into daily ward practice and the bundle is now being used on wards across the Trust

The reducing falls bundle includes

Safety Huddles

Cohorting of patients at risk

Post-fall review

Appropriate footwear

Structured approach to toileting

The introduction of safety huddles has enabled ward staff to discuss those patients who may be at risk of a fall and implement the appropriate intervention to support them This could be moving the patients into a lsquofalls bayrsquo where they can be closely monitored and supported if they want to leave their bed

The Reducing Falls Quality Improvement Collaborative launched in August 2014 with an ambition to reduce falls throughout the Trust An lsquointervention bundlersquo was created following frontline staff testing their own ideas that focused on reducing falls

Reducing Falls

T

Reducing Falls

By May 2016 pilot wards had achieved a 50 falls reduction and other wards that have implemented this work are also seeing a more consistent reduction in falls which shows the difference this work has made The falls prevention group now meets every quarter to review falls data and drive forward this work

Ambitions for 201819 include further work to improve the care of patients with delirium and ensure that the measurement of lying and standing blood pressure is reliably recorded


Making Quality CountThe first lsquoMaking Quality Countrsquo workshops have been held attended by members of the public patients relatives and patient leaders The purpose was to collaborate and work together to share how everyone can get involved with the Quality Improvement work taking place across the Trust

There have been opportunities for those who have attended these sessions to receive training so that they can get involved in our QI collaboratives Training patients carers and the public alongside staff in QI is a new development and the team are now planning to progressing this further

ur Patient Experience team work closely with patients carers and the public to make improvements to our services and they are now collaborating with our

Quality team This included supporting a workshop which was aimed at better understanding how patients with Parkinsonrsquos disease would like to be supported to manage their medicines The team explored a number of options with the patients and carers present which has influenced how this work continues to be taken forward in the Trust

ur commitment is to reduce by all avoidable pressure ulcers by by 50 using the lsquoStop the Pressurersquo initiative

This framework has been widely tested and implemented in a range of acute hospitals

Our Pressure Ulcer Collaborative was launched by the Tissue Viability team on Worldwide Stop The Pressure Day and included a collaboration with colleagues from Leeds Community Healthcare NHS Trust The collaborative brings together teams from a number of pilot wards to reduce avoidable pressure damage in these areas

Following successful testing of the SSKIN Bundle within a number of areas scale up started and this has seen fantastic results with a reduction in the incidence of all hospital acquired pressure ulcers by 4 inr 201617 Incidence of all hospital acquired pressure ulcers per 1000 bed days has also reduced by 5

Similarly with other QI projects the achievements of teams are widely celebrated Recent achievements include some wards celebrating over 400 days without a pressure ulcer which highlights how this work is making real progress in improving patient care



O O


A key aim of all quality improvement initiatives is to ensure that they are fully patient centred

Pressure ulcers can be painful affect quality of life lengthen hospital stay and may even be life threatening It is estimated that 80-95 of all pressure ulcers are avoidable


As part of this initiative we are testing a range of interventions that sit under a SSKIN acronym

Surface - appropriate mattresscushionSkin InspectionKeep MovingIncontinenceMoistureNutritionHydration

The Deteriorating Patient Collaborative launched in August 2014 with an ambition to reduce avoidable deterioration and improve patient safety

n lsquoIntervention bundlersquo was created based on frontline staff testing their own interventions focusing on improving the care of deteriorating patients The

bundle was developed by the multidisciplinary teams on each of the pilot wards allowing the team to establish which interventions worked and led to the most reductions in avoidable deterioration These ways of working were then embedded into daily ward practice

The Deteriorating Patient intervention bundle includes

Safety huddles a short ward based meeting

lsquoOBS made easyrsquo - 11 ward training for new staff on NEWS (National Early Warning Score)

Post lsquo2222rsquo call debrief allowing ward staff to share learning from cardiac arrests

Stickers to identify patients with a high NEWS or to prompt decision making regarding escalation of care

Wards across the Trust have implemented it into their day-to-day working with fantastic achievements including reducing the number of Cardiac Arrests across the Trust by 25

A key element of this work has been to celebrate the achievement of our teams through displaying the number of days they have gone without 2222 calls and awarding certificates to each team when they reach a milestone Many of the wards proudly display their achievements on noticeboards enabling patients visitors and staff to see the great progress they are making every day

This work is overseen by the deteriorating patient faculty group a multidisciplinary team who support the ward teams and help to make their ideas happen The faculty includes staff ranging from nurses and doctors through to pharmacists data analysts and resuscitation officers who meet weekly to share learning and ideas on how to progress the work further



Reducing Avoidable Deterioration Reducing Avoidable Deterioration

A

Patient lift area

Key achievements in 20172018 include

25 reduction in cardiac arrest calls across the whole Trust and 32 at St Jamesrsquos Hospital

The rate of cardiac arrests per 1000 admissions at SJUH is now 25 lower than the national average

Trust wide we have had 31 less cardiac arrests than 2015 (108 people) and 7 (19 people) less than 2016

87 less cardiac arrests annually across the Trust compared to 2015

Ambitions for 201819 include completing the scale up and spread of the bundle across the Trust and seeing further reductions in the number of 2222 calls

n 2016 following feedback from patients and carers the Parkinsonrsquos Quality Improvement Collaborative was formed Carers and people with Parkinsonrsquos are active members of

this Collaborative Faculty as well as a multidisciplinary team of staff members

Ideas for improvement were developed and tested by teams on pilot wards and supported by members of the Faculty The aim is that all people with Parkinsonrsquos receive timely administration of medication and holistic care

The three primary drivers identified to achieve this are

Identifying and promptly administering Parkinsonrsquos medications

Improving culture teamwork and accountability

Identifying and promptly managing patients with swallowing difficulties

Significant improvements have already improved the patient experience Working with carers our collaborative and front-line teams have seen a reduction in omitted Parkinsonrsquos medications from 15 to less than 4 and a reduction in the delay in patients receiving their first dose of medication after admission from over 7 hours to 67 minutes

This work won a national award at the Parkinsonrsquos Excellence Network for excellence in Parkinsonrsquos care

To share their learning the faculty have established an educational masterclass and video for hospital and community-based staff and they have supported carers and staff members to present this work at regional national and international conferences

They have also conducted a patient experience event with patients and carers to discuss how they can develop a patient-centred approached to medication administration The aim is to further involve patients and carers and to pilot novel interventions for self-medication administration in the near future

The work of the Parkinsonrsquos Quality Improvement Collaborative is now being rolled out across all adult wards within the Trust so all patients with Parkinsonrsquos receive high-quality and safe care as inpatients

I



T

afety huddles are multi-professional team meetings supported by senior clinicians and take place at a regular time each day for 5 to 15 minutes Team

members can confidently speak up and jointly act on any safety concerns they have about patients allowing wards to continually learn and improve

Certificates are awarded to celebrate and recognise when teams achieve significant milestones and these are proudly displayed on the ward Team ownership of ward data is another crucial ingredient monitoring days between falls etc

Teamwork and safety climate surveys of multidisciplinary staff were completed allowing staff to reflect on areas for celebration and improvement Safety huddles allow staff to feel empowered and more confident to speak up about patient safety concerns This includes non-clinical staff such as housekeepers who reported increased job satisfaction and a sense of feeling part of the wider multi-disciplinary team

Paul Tobin a Porter at St Jamesrsquos Hospital and his colleagues have introduced portering patient safety huddles - the first of their kind in the UK - which build upon the portering teamrsquos unique access to every ward and clinical area in the Trust

Paul won lsquoUK Operational Support Worker of the Yearrsquo for his role in leading this work and since then the huddles have continued twice weekly The portersrsquo regular contact with staff and patients means they are in an ideal position to propose changes that make a lasting difference to patientsrsquo comfort and safety

S

Safety Hurddles

As a result of issues raised by porters a number of positive actions have been taken to improve patient safety and experience An example is their work with the blood bank to reinforce the correct procedure for ordering blood products and the interventions put in place regarding missing items on transportation have resulted in a dramatic reduction in the number of return visits that porters are required to make

In partnership with Yorkshire and Humber Improvement Academy and supported by The Health Foundation safety huddles have been established across our wards

Safety Huddles


91 of wards in Leeds are huddling and 45 of wards have achieved a statistically significant reduction in patient safety incidents eg falls

Leeds is now seeing organisation level impact of safety huddles with a significant reduction in cardiac arrests of 25 and a 30 reduction in falls

Leeds has supported the scale up and spread of huddles across the region to over 150 frontline teams including acute trusts mental health trusts the community and Yorkshire ambulance service

This work has been showcased at national conferences and it was shortlisted for the Royal College of Physicians Excellence in Patient Safety Award 2017

Ambitions for 201819 include providing further support to areas to sustain and enhance huddles across the Trust

Improving care for patients withParkinsonrsquos

There are approximately 1500 patients with Parkinsonrsquos in the Leeds Teaching Hospitals catchment area and around 30-40 inpatients in the Trust with Parkinsonrsquos at any time

Watch the video

Itrsquos fantastic to be recognized with an award and itrsquos really a testament to what can happen when hospital staff across all specialisms and teams work together for the benefit of patients

DR JANE ALTY CONSULTANT NEUROLOGIST

eams from Acute Medicine were selected and their idea was lsquoSit Up Get Dressed Keep Movingrsquo which is a campaign that aims to prevent deconditioning by

encouraging patients to wear their own clothing and stay mobile in hospital

The multidisciplinary team were inspired by a national campaign called lsquoEnd PJ paralysisrsquo and organised a flashmob to raise awareness across the Trust (pictured below)

PJ paralysis affects every patient in hospital irrespective of their age No matter how old a patient is they will lose muscle strength during their stay albeit at different levels so the multidisciplinary team on each ward are being encouraged to help patients be as mobile as possible

For every 10 days of bed-rest in hospital the equivalent of 10 years of muscle ageing occurs in people over 80-years old so


Sit Up Get Dressed

T

Sit Up Get Dressed Keep Moving Sit Up Get Dressed Keep Moving

this campaign could make a real difference to the recovery of older patients

Alison Raycraft Lead Nurse for Older People said ldquoWe are encouraging patients to wear their own clothes and be mobile unless itrsquos for reasons of clinical appropriateness rather than organisational culture One week of bed rest equates to 10 loss in strength and for an older person this may make the difference between dependence and independence and how soon they go home Educating relatives and carers will be just as important as our staff to ensure that they encourage their relative friend or person they care for to get dressed and move aboutrdquo

The campaign is being rolled out on wards enabling more patients to build their strength and enhance their mental wellbeing The aim is to build their confidence and empower them to take greater responsibility therefore becoming active participants in their own health journeyKeep Moving

Staff from across the Trust were invited to submit their ideas for improvement projects to improve the patient experience The campaign called iFactor saw hundreds of suggestions being shared and the top 12 were given a sponsor from the executive team to support their development

epsis responds well to early intervention so our teams have implemented a specially designed lsquotreatment bundlersquo called BUFALO This consists of

three diagnostic and three therapeutic steps - all to be delivered within one hour of the initial diagnosis of Sepsis BUFALO stands for blood cultures urine output fluids antibiotics lactate and oxygen

Wards and departments are equipped with BUFALO bags which contain all the necessary items to take a sample of blood for culture testing and include stickers for patientsrsquo notes (pictured below) An adult screening tool based on NICE guidance also provides indicators for high moderate and low risk stratification

The aim of this work has been to improve the identification and management of red flag sepsis patients and to reduce the mortality rate from red flag sepsis and septic shock

The Emergency Departments at St Jamesrsquos Hospital and Leeds General Infirmary have implemented the sepsis protocols and are now embedding the use of the sepsis screening tool and BUFALO interventions Sepsis has also been incorporated into an e-learning package as part of the Acute Kidney Injury programme

Our Urgent Care team support staff in quickly identifying early indicators of sepsis and administering the correct

antibiotic therapy which ensures the best possible outcome for our patients

Alongside this work a paediatric sepsis screening tool has been launched at Leeds Childrenrsquos Hospital to help improve care for young patients who may be at risk of sepsis The tool was developed to heighten situational awareness in managing children who are diagnosed with sepsis by encouraging prompt treatment and escalation of care It also ensures that we have considered the possibility of sepsis in every child who comes through our doors


Sepsis Sepsis

S

SepsisSepsis is a life threatening condition caused by severe infection and can also be known as septicaemia or blood poisoning The bodyrsquos immune system goes into overdrive setting off a series of reactions including widespread inflammation swelling and blood clotting This can lead to a significant decrease in blood pressure which can mean the blood supply to vital organs is reduced

Early detection and treatment are vital when dealing with Sepsis Our comprehensive measures designed specifically to deal with cases of Sepsis have been shown to reduce mortality and length of hospital stay Sepsis is a real threat to patients in our care but our teams here at Leeds are leading the fight-back and ensuring that more people recover from the condition

DR STUART NUTTALL AampE CONSULTANT

wo work streams have been established - the first focusses on the care of patients with terminal agitation a form of delirium that is characterised by emotional or

physical restlessness and can be found in up to 90 of dying patients

The second work stream looks at improving access to palliative care services in outpatients empowering patients to discuss advanced care planning and express their wishes

Interventions include ward-based role modelling of expert care for patients experiencing agitation educations sessions and the display and presentation of improvement data


Building on the best and transforming

T

Building on the best and transforming End of Life Care Building on the best and transforming End of Life Care

Leeds Teaching Hospitals has been selected as one of 10 acute Trusts across the UK to take part in the national lsquoBuilding on the Bestrsquo programme to improve palliative and end of life care Supported by a partnership between the National Council for Palliative Care Macmillan Cancer Support NHS England and NHS Improving Quality the programme will run for two and a half years

Data has demonstrated statistically significant improvements in the care of dying patients for example more patients are now being assessed for terminal agitation and this is being documented in their medical notes This work was led by the Palliative Care team with engagement from patients and carers and is now being spread to other areas in the Trust

Key achievements in 20172018 include successfully launching a new banner for outpatient areas focusing on advanced care planning statistically significant improvements in the management of patients with terminal agitation and successfully developing a web based resource for outpatient staff to access information and promote exemplary end of life care

End of Life Care

The first ever day-case aortic aneurysm repair in Leeds has been completed Aortic aneurysm repair is undertaken to prevent aortic rupture an event that is nearly always fatal Traditionally this required a major open operation with a 5-10 day post-op hospital recovery

Endovascular aneurysm repair (EVAR) has revolutionised this by using image guidance to re-line the aorta from the inside Recent technological advancements now allow the whole operation to be completed through tiny incisions in each groin resulting in much speedier patient recovery Enhanced recovery not only benefits patients physically and mentally but it also reduces the pressure for hospital beds

Having performed EVAR as a one night stay the pioneering Leeds Vascular Radiology and Vascular Surgery teams have now pushed the boundary to complete the operation as a day-case for the first time

The patient Mr Peter Ashton was warmly welcomed on the day by the staff on L27 before going to Radiology theatres to have the operation completed by Dr Walker and his team by 11am He made a rapid recovery and was discharged ahead of time at 4pm He has gone on make a full recovery and praised the care and support he got from the entire Vascular team with a special mention for Jodi Lancaster the Aortic coordinator

Dr Christopher Tufton the Minister for Health in Jamaica and members from the Chain of Hope childrenrsquos charity visit the Trust to find out about nursing retention as well as how care is provided in Leeds

The group visited the Adult Critical Care areas at St Jamesrsquos and met with the team to hear about the post-registration education available for Registered Nurses in Adult Critical Care settings The Minister was pleased to see how many male nurses there were in employment - in Jamaica male nurses are underrepresented in the industry He went on to discuss some of the challenges Jamaica is facing with nursing retention and post-registration skills development and education and explained that he was keen to explore avenues for future co-operation between the Trust and hospitals in Jamaica to improve this

In the afternoon the Minister and colleagues went to Leeds Childrenrsquos Hospital to visit the Neonatal and Paediatric Intensive Care areas They heard from some of the clinical staff who have been involved in the charityrsquos work in Jamaica Minister Tufton shared the news that a new Childrenrsquos Hospital is being built in Jamaica and he was very interested in hearing about our work here and in exploring potential collaborations with our paediatric teams in the future


Work has begun on the new Maggies Yorkshire centre being built on the St Jamesrsquos Hospital site

The centre has been funded through generous donations to the charity and some of the key donors were invited to attend the groundbreaking ceremony As well as the official cutting of the ground where the centre will be built Harriet a patient shared her excellent experiences of receiving care at Leeds Cancer Centre and how a Maggies based in Leeds would make a real difference to her and her family Harriet said that Maggies Yorkshire would lsquoscoop us all up when we need it the mostrsquo

The teams at Leeds Cancer Centre provide fantastic care and treatment for patients with a cancer diagnosis Getting the clinical care right is just one part of it and for many patients the emotional aspects of going through cancer treatment are just as difficult to manage as the physical effects

The Trust is supported by some fantastic charities to help patients through difficult times including The Leeds Hospital Charitable Foundation Yorkshire Cancer Research Macmillan and many others as well as the services provided at the Sir Robert Ogden Macmillan Centre The Maggies Yorkshire centre will complement this work and take it even further

Work begins on new Maggies Yorkshire centre

Latest News

Latest New

s

Latest News

From left Paul Walker Consultant Vascular Radiologist Peter Ashton a couple of hours after aortic aneurysm repair Venogopal Shankar Consultant Vascular Surgeon and Jane Haigh L27 Ward Sister

First day case aortic aneurysm repair

Jamaican Minister visits the Trust

Elective caesarean surgery list improves patient experience

The theatres team have recently launched a new way of working which means that elective caesarean section surgery lists are now available Before at St Jamesrsquos and LGI Before the daily lists included both elective and emergency sections which has meant women coming in for elective surgery may find themselves waiting longer than expected whilst fasting due to unplanned emergencies

Now thanks to this dedicated list elective patients are enjoying a streamlined service This has also had the effect of increasing the number of electives that can be planned for a given day whilst patients can benefit from the care of a dedicated team of anaesthetists ODPs theatre staff midwives and obstetricians

This has come about through a great deal of work from many staff at both St Jamesrsquos and LGI and these first lists were put on thanks to staff volunteering their time to make it work

wwwleedsthnhsuk

Follow our social media pages to find out our latest news

Leeds Teaching Hospitals NHS Trust

LTHTrust

We are rated as a Good Trust by the Care Quality Commission (CQC)

Visit wwwleedsthnhsukcqc to read the report

PATIENT-CENTRED | FAIR | COLLABORATIVE | ACCOUNTABLE | EMPOWERED

At the Leeds Teaching Hospitals NHS Trust we have defined the values that we believe are at the heart of the care we provide - The Leeds Way You can read about how we developed them and find out how we live them at

wwwleedsthnhsukvalues

elcome to the latest issue of CONNECT our new look stakeholder publication keeping key

partners Trust Members and anyone interested in health care within Leeds and the wider City Region up to date on our work and plans for the future

This issue of CONNECT features interactive content showcasing some of the wonderful work we are doing to improve quality across our hospitals and some of the great successes we have achieved

Our ambition is for Leeds Teaching Hospitals to build a culture of continuous improvement across the organisation by treating every patient as an individual delivering the best outcomes the best possible experience and one which is free from avoidable harm

As an organisation we are committed to Quality Improvement (QI) and this is shaped by our strategy which includes our work with staff and patient representatives the prestigious NHS Improvement and Virginia Mason Institute national programme and our collaborative work supported by our partners in the city West Yorkshire the wider Yorkshire and Humber region nationally

Collectively this is The Leeds Improvement Method our organisational approach to improvement - I do hope you enjoy learning more about the great work we are doing

We have some great foundations for our Quality Improvement including

Our partnership work with Virginia Mason Institute and the success of the Leeds Improvement Method value streams

Our Trust-wide quality improvement programmes which have helped spread the knowledge and learning from quality improvement methods

Lots of smaller improvement work within and across our departments bringing about real improvements for our patients

Our Leeds Way values


Welcome


The Trust signed up to the national Sign Up to Safety Campaign in 2014 pledging to put safety first and reduce avoidable harm

Our Quality Ambitions workshop in 2016 helped us to build on our learning to date and shaped our core principles for enabling continuous Quality Improvement throughout the Trust These principles are

Leadership at all levels to engage and sustain our improvement culture

Engagement and Support to partner with patients and their families for the safest care and for all our staff to be involved in improvements as part of the work they do

Communication to support continual learning and improvement from senior leaders to frontline staff from ward to the Board and throughout the organisation

Overview of Quality Improvement


Contents An introduction to Quality Improvement


2-3

4-5

11



12-13

6-7

8-9

Lean for Leaders and QI training of staff

Value stream case study Elective Orthopaedics 12-13

Reducing Falls


14


Safety Hurddles

15

16-17

18-19

Sit Up Get Dressed Keep Moving

Sepsis

Transforming End of Life Care

Latest News

W

DR LINDA POLLARD CBE DL HONDLL

CHAIR LEEDS TEACHING HOSPITALS NHS TRUST

Empowerment to create a shared purpose and understanding of quality improvement

Infrastructure training and capability for all staff in quality improvement

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Methodology



Watch the video







Dido Harding

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Safety Huddles


Post-fall review





Reducing Falls

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Safety Hurddles



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Methodology



Watch the video







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Watch the video





Safety Huddles


Post-fall review





Reducing Falls

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Patient lift area



















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Safety Hurddles



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Sit Up Get Dressed

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End of Life Care














Latest News

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Dido Harding

Lean for Leaders




































Watch the video





Safety Huddles


Post-fall review





Reducing Falls

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Reducing Falls















O O





















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Patient lift area



















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Safety Hurddles



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Sit Up Get Dressed

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End of Life Care














Latest News

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Latest News








wwwleedsthnhsuk



LTHTrust

































Watch the video





Safety Huddles


Post-fall review





Reducing Falls

T

Reducing Falls















O O





















A

Patient lift area



















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S

Safety Hurddles



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Watch the video









Sit Up Get Dressed

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Sepsis Sepsis

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T





End of Life Care














Latest News

Latest New

s

Latest News








wwwleedsthnhsuk



LTHTrust









Safety Huddles


Post-fall review





Reducing Falls

T

Reducing Falls















O O





















A

Patient lift area



















I



T







S

Safety Hurddles



Safety Huddles









Watch the video









Sit Up Get Dressed

T















Sepsis Sepsis

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T





End of Life Care














Latest News

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s

Latest News








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LTHTrust




















A

Patient lift area



















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Safety Hurddles



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Watch the video









Sit Up Get Dressed

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Sepsis Sepsis

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End of Life Care














Latest News

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Latest News








wwwleedsthnhsuk



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Safety Hurddles



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Sit Up Get Dressed

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Sepsis Sepsis

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End of Life Care














Latest News

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Latest News








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Sit Up Get Dressed

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Sepsis Sepsis

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End of Life Care














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Latest News








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Sepsis Sepsis

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End of Life Care














Latest News

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Latest News








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End of Life Care














Latest News

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Latest News

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Latest News








wwwleedsthnhsuk



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wwwleedsthnhsuk



LTHTrust






the leeds improvement method · 2019. 4. 10. · showcasing some of the wonderful work we are doing...

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