Download Clinical-management pairing and enhancing the elective caesarean

Clinical-Management Pairing & Enhancing
the Elective Caesarean Section List
Neil Davies & Okiemute Emanuwa, Medway Foundation Trust
Background
The challenges of management clinician relationships are well documented. There is increasing evidence that improved
doctor/manager relationships are associated with successful service improvement and superior patient outcomes. Lord Darzi’s
2008 Next Stage Review, underlines the need for partnerships in clinical and non-clinical leadership to enable quality
improvement.
In 2011, as part of a wider clinical leadership programme, the Kent Surrey and Sussex (KSS) Deanery and the NHS Management
Training Scheme launched a pilot project to develop leadership skills of early career doctors and non-clinical management. This
initiative paired graduate management trainees with Foundation Year 2 (FY2) doctor to undertake a joint project that will
further their learning of leadership skills.
Objectives:
•Support understanding in respective value to the
•Realising benefits of collaboration and role modelling
organisation;
within their organisations;
•Achieving specific learning objectives around
•Encourage collaborative learning at early stage in
leadership and management;
career;
Approach
Elective Caesarean Section Sessions at Medway NHS FT
Stakeholders
Project Drivers
FY2 Doctor
Interest/
experience/
skills/
relationships
Management
Graduate
Clinical Area
Anaesthetics
1.Process mapping concurrent
processes
Specific Issue
At Medway Maritime Hospital, a service improvement focus
Start Time
interest and experience.
Obstetricians
Anecdotal evidence from staff indicated unnecessary
Patient safety
issues/
inefficiencies/
staff morale
Theatre staff
&
practitioners
Obstetric
Theatres
was identified in Obstetric Theatres as an area of mutual
Obstetric
Theatres
Medway
Maritime
Hospital
Midwifery
Phase 1
2. Stakeholder mapping
3. Facilitate a ‘bottom-up’
approach
Nursing
staff
variation and delay in session start-up time for elective
KSS and NHS
Institute
Phase 2
caesarean sections.
Help improve elective C-section sessions
Obstetrics)theatres:)barriers)to)starting)Elective)sessions)on)time)
Dear colleague,
Communication &
We’re a small team looking at how we can ensure elective sessions start on
time in a safe and reliable way. We are currently looking at 2 ways to measure
this: Patient in theatre at 08.45am & Patient ready for procedure
(Anaesthesia complete) at 9am.
The sessions are often late in starting for a variety of reasons. In tackling this
issue together with the teams across the delivery suite, this project will:
·
Engagement
·
·
·
·
Measure start times daily and discussing with the teams to understand
why we start late
Identify those critical barriers to starting on time
Work as a team to address those issues
Feedback to the Trust about external factors to gain support for
changes
Ensure we can support the planning and preparation on the day of
surgery and before
As the December Team of the Month award shows, the wider trust recognises
the great work going on in Obs Theatres and wider maternity services. Your
experiences and opinions are vital to its ongoing success.
Qualitative & Quantitative
Analysis and Results
We would be grateful if you could take the time to consider what factors
you think prevent sessions starting on time. We are very interested to
hear your constructive suggestions for improvement. Attached is a simple
form that can be emailed back to us, or printed and posted back to “Neil
Davies, PMO, Level 1”.
It is important that this work takes into account the opinions and feedback of
all colleagues within your teams. We are always very happy to hear your
ideas or thoughts and don’t hesitate to get in touch. We will be working up in
the delivery suite throughout the week, so please come over, say hello and
tell us what you think.
Between September and
December 2011: Quantifying the
issue
Data Collection
The mean delay in session start
of key stakeholders;
time for elective caesarean section
Self report questionnaires across service area;
lists was 38 minutes per day.
Best wishes,
Neil Davies (ext 8939),
[email protected])
Dr Kiemu Emanuwa
([email protected])
Structured interviews
Name (optional)……………………………
Issues%
affecting%
ability%
to%
start%
lists%
on%time%
%
Obs%&%Gynae%
related%
issues%
Details%
Date:……………………..
Ideas%
/%
Proposals%
%
Hospital%
related,%
but%
external%to%
Obs%&%Gynae%
%
Personal%
issues,%
e.g.%
other%
commitments,%
contractual%
issues,%
etc.%
%
Any%
other%
issues%
Please&email&to&[email protected],&or&post&to&“Neil%
Davies,%
PMO,%
Level%
1”.!!
Prospective survey and “5 Whys” analysis of late starts.
Resource equivalent of
1300 nursing hours in one year.
Session procedure distribution and Delay in session start time, Sept to Dec
Consistent delay in start up & large variation in procedure/turn around times
Causes of delay
Identifying the problem
Initial prospective study
indicated
prima
Causes of delays: All Procedures
Waiting for
surgeon
facie
predominantly
Waiting for
midwife
due to availability of
Diagnostic
required
midwives
Patient
complications
delays
and
14
12
10
8
6
4
2
0
120%
100%
80%
60%
40%
20%
0%
obstetricians at session
Causes for delay: Surgeon delay
root
Causes for delay: Midwife delay
cause
as
attending
multiple
medical
productivity and quality improvement projects have been launched (e.g. cell salvage,
scheduling), complementing work on session start up time.
staff,
particularly
Organic Change
engagement strategy, has led to a wider focus in the service area. A number of additional
patients, and difficulties
for
Continuous evaluation and improvement
Monitoring improvement, development of toolkit to handover to permanent
staff.
performance. The initial analysis, along with the cross-professional stakeholder
midwives
to
Recommendations formalised
Disseminated trough communication channels, primarily at multiple small
group meetings
The joint clinical-management involvement has already contributed to improved
analysis revealed issues
such
Phase 3
Conclusions
start up.
Further
Analysis and consultation with key stakeholders
The ‘bottom-up’ approach to communication and data collection has increased awareness
around
of delays across all professional groups, challenging cultural norms and coinciding with an
afternoon cover.
initial improvement in start up times.
Elective Obs Procedure timings Apr-May 2011
19:00
18:30
18:00
17:30
17:00
16:30
16:00
15:30
15:00
14:30
14:00
13:30
13:00
12:30
12:00
11:30
11:00
10:30
10:00
09:30
09:00
08:30
Time arrived
Patient Arrival Time
Anaesthetic application
Operation time
10-May-12
09-May-12
08-May-12
07-May-12
06-May-12
05-May-12
04-May-12
03-May-12
02-May-12
30-Apr-12
01-May-12
29-Apr-12
28-Apr-12
27-Apr-12
26-Apr-12
25-Apr-12
24-Apr-12
23-Apr-12
22-Apr-12
21-Apr-12
20-Apr-12
19-Apr-12
18-Apr-12
17-Apr-12
16-Apr-12
15-Apr-12
14-Apr-12
13-Apr-12
12-Apr-12
11-Apr-12
10-Apr-12
09-Apr-12
08-Apr-12
07-Apr-12
06-Apr-12
05-Apr-12
04-Apr-12
03-Apr-12
02-Apr-12
08:00
Time to exit theatre
Session procedure distribution April-May 2012; comparative statistical process chart Sept 11 & Apr 12
April/May performance data
evidences a small incremental
improvement in delay
reduction (8min knife to skin)
and less variation in procedure
distribution.
Change can be in part
attributed to increased focus
on session start up through
communication and
engagement of theatre staff.
Delivering Continuous Improvement
•Disseminate and display results & raise awareness of pathways and timings
•Continue engagement of key stakeholders and deliver further service recommendations.
•Maintain prospective data collection, finalise toolkit for handover to enable continuous
improvement.
• Extending management-doctor pairing relationships across the trust through audit
partnerships.