Respiratory CHANGE

The four Brearley wing respiratory wards at the Northern General Hospital (Brearley 1-4) have for the past two years been involved in improvement work as outlined on this page. The work started back in 2013 when the Clinical Director, a senior consultant, the service manager and a Service Improvement coach visited Bolton hospital and decided to test out the concept of doing some ward improvement work ensuring the work actively involved the staff at the front line.

Assessment
 
Initially ward meetings were held open to all staff from the wards to ask what were their opinions, what did they do well and what could we do better. This initial discussion identified some processes that could be improved. Supported by SI coaches, the teams on the wards began to collect 5Ps data to understand the ward systems. This included data on outcomes, length of stay, patient types and demographics, incidents as well as feedback from staff and patient stories. Ward processes such as ward rounds were timed and studied.
 
Diagnosis

The wards set up a CHANGE room displaying all this data and invited all staff to comment on the data. Weekly meetings on Fridays were scheduled with an open invite to all ward staff. Coached by the SI team, at the next few meetings themes for
improvement were generated, aims written, and the processes mapped in question were mapped. This generated lots of ideas for improvement which were then tested using PDSA cycles and time series measurement.

Treatment

Many ideas and improvements to processes have been tested as listed on the table below.

Results

The CHANGE room still continues meeting fortnightly with new tests of change introduced on an on - going basis. The multiple improvements have also triggered system level improvements, with a sustained reduction in length of stay (See charts below) and reduced HSMR mortality seen over the past months.

 

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