JOAN JAMES DIVISIONAL NURSE DIRECTOR ACUTE

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JOAN JAMESDIVISIONAL NURSE DIRECTOR (ACUTE)
Appendix 4
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ROLE

• Professional Opinion.
• Governance.
• Horizon Scanning.
• Developing Implementing.
• Listening

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CHALLENGE

• Patient Safety/Clinical Care.
• Professional Standards.
• Senior Charge Nurses/Team Leaders.

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Practice Development in Emergency Care

• Gillian Corbett
• Nurse Consultant

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Aims

• Give an overview of the practice development I
  have been involved in
• Discuss the leadership challenges
• What I would and wouldnt do again if I had to
  start all over again tomorrow

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Emergency Care In Context
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the transformation to a butterfly cannot happen
whilst remaining in the cocoon
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New Nursing Roles
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International Recognition and Publication
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Walk the Walk
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Navigation

• Not everyone can make the whole journey in one
  day.
• Recognise the blind spots in others and help
  overcome them.
• If people dont experience success often they
  have no idea what it takes to get from where they
  are to where they want to go.
• Identify attainable goals, giving confidence,
  which will lead to progress.
• John C. Maxwell

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Leadership Challenges

• You may have to fight the battle more than once
  in order to win it

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Reflection What would I do differently?
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Until you spread your wings, youll have no idea
how far you can fly.
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Take Home Messages

• There are no impossible problems. Time,
  thought, and a positive attitude can solve just
  about anything.
• No one ever achieves alone what he can when
  partnering with others. And anybody who doesnt
  recognise that falls incredibly short of her
  potential.
• Recognise a problem before it becomes an
  emergency.

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Finally..
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Peter McCrossan

• Associate Director for Allied Health Professions
  and Professional Lead for Podiatry

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Associate Director for Allied Health Professions

• Responsible for providing professional and
  clinical leadership for all AHP staff across NHS
  Lanarkshire.
• The AHP professions within NHS Lanarkshire
  comprise of 9 professions
• Audiology,
• Nutrition and Dietetics,
• Occupational Therapy,
• Orthoptics,
• Physiotherapy,
• Podiatry,
• Prosthetics and Orthotics,
• Radiography
• Speech and Language Therapy.

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My Journey

• Nursing Assistant Hartwood Hospital (Student)
• Chiropodist Lanarkshire and Glasgow Royal
  Infirmary
• Podiatrist
• Podiatric Manager
• Lanarkshire Health Board - Podiatry Adviser
• Chair of the Allied Health Professions Advisory
  Committee
• Associate Director for Allied Health Professions

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Current Leadership Challenges

• Allied Health Professions - Professional
  Structures
• Rehabilitation and Bone Health Strategies
• AHP Service Reviews

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Allied Health Professions

• Mr Robbie Rooney - NHS Lanarkshire
• Orthotic Service Manager
• from Surgical appliances to an Orthotic Service

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from Surgical appliances to an Orthotic Service

• By Robbie Rooney

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Introduction

• Current services
• Issues with current service
• How do we fix it?
• What are the challenges?
• What would I do differently if I was starting
  again tomorrow?

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Current service

• Surgical appliance service
• Provides orthotic devices
• Surgical footwear
• Calipers, splints, braces
• Insoles
• Who provides the service?
• Orthotist- HPC registered AHP specialist in the
  design and prescription of orthotics. (Dual
  qualification in prosthetics and orthotics)

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Issues within current service

• Scottish Government report (2005) described
  services as
• Cinderella service
• Fragmented
• Poor profile within hospitals
• Lack of local accountability within health boards
• Why?
• Lack of clinical management
• No defined budget
• Lack of defined clinical team

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How do we fix it?

• Service has to be clinically led
• Service has to be clinically focused
  (historically admin driven
• Service should be able to govern itself
  (budgetary control)
• Standards and protocols
• Integration into wider NHS

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What are the challenges?

• Showing the value of a good orthotic service
• Outcomes how do we show value?
• Changing perceptions of the service (external)
• Changing orthotists outlook to communication and
  team work (internal)

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What would I do differently if I was starting
again tomorrow?

• See the bigger picture!!
• Accept that I dont have a magic wand!!
• Dont assume everyone is reasonable as yourself!!

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Leadership In Lanarkshire

• Anne Armstrong

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Divisional Nurse Director Community Primary
Care

• Strategic and operational delivery of effective
  nursing services and practice within Community
  Health Partnerships
• Lead the delivery of significant Board wide
  multi-professional issues

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Route Map To Current Position

• Nurse Training And Education
• Clinical Leadership Experience
• Theory Into Practice
• National Profile

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Challenges

• Healthcare Associated Infection
• Child Protection
• Service Modernisation / Improving Core Care

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Co-Presenter

• Janette Barrie, Nurse Consultant Long Term
  Conditions.

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Integrated Care Management in Lanarkshire

• Proactive, Planned and Coordinated
  

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Care management
A proactive approach focused on high risk
patients with a combination of medical, nursing,
pharmacological and social care needs delivered
by suitably trained and competent professionals

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Prompts

• National Policy clear framework SGHD
• Ageing population
• Increase in LTC at all ages more so in the over
  65s
• Local strategy for LTCs

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Where did we start?

• Evidence What works, what doesnt work
• Different models and approaches National and
  International
• Learning from experience of others
• Acknowledging the needs and wishes of our
  population

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Supporting Infrastructure

• Tools to identify at risk groups
• Recruit Practices and Care Managers
• Local Authority support
• Access to information Practice managers GPs on
  board
• Local interagency knowledge sharing groups
• Directory of Services
• Shared protocols and pathways
• Prepared practitioners (highly skilled)
  confident competent

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What does it involve?

• Proactively finding those at risk of readmission
• Full assessment medical, nursing, pharmaceutical
  and social care needs
• Develop personalised holistic care plans
• Involve patients and carers as partners
• Maintain highly visible lead role
• Secure services/ treatments modalities
• Teach pt/ carers monitor condition
• Maintain contact throughout hospital admissions
• Cross boundary working / Interagency communication

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Benefits

• Better outcomes for individuals, their families,
  carers and communities preferred place of care
• Improved access to services
• Reduction in the use of unplanned care
• Improved concordance with medication
• Improved partnership working
• Reduction in the number of professionals involved
  in the individuals care
• Greater continuity of support / care /
  involvement
• More control in the package of care / support
  provided
• Improved and speedier decision making
• Empowerment of individual and their carer through
  active participation in the process

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Pilot sites

• Coatbridge 44,983
• High risk younger old with chronic heart and
  lung disease
• Clydesdale 87,893
• Mental health alcohol issues amongst men
• East Kilbride 57,844
• High risk oldest old females in East Kilbride
• 3 Practices / 5 Care Managers

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The Model
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Baseline Findings

• Over 400 people identified 65 with SPARRA risk
  score of gt 50
• 306 cases reviewed using local data and
  multi-agency knowledge sharing groups
• 36 had died, 13 have moved to long term care,
  11 changed practice and 29 had conditions which
  had fully stabilised

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Integrated Care Management Programme

• 63 patients fully assessed
• 38 patients entered into programme
• Further 25 patients were assessed but not
  accepted into programme
• 20 patients declined 11 no longer met the
  criteria, 3 refused, 6 not specified.

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Findings

• 91 of Coatbridge patients reviewed fell within
  highest categories of deprivation
• 59 admissions recorded 21 patients2.8 admission
  per patient.
• 45/49 admissions justified unavoidable (10
  unknown)
• 17 patients had no hospital admissions
• Patients screened but not accepted LoS increased
  from 8 to 15 days.
• Patients accepted LoS fell from 10.3 days to
  8.9 days
• Focus group analysis suggest quality of care has
  improved and patient satisfaction has increased

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Key Learning Points..

• Invest in the preparation time get supporting
  infrastructure in place
• Must communicate and engage widely GPs,
  Hospital Consultants, Healthcare Staff,
  Specialist Nurses and Partner Agencies
• Support Care Managers high profile
• Timely access to information on services
  available to enable early interventions
• Shared protocols and pathways giving care
  managers access to specialist resources
• People and processes in developing practice are
  just as important as the outcome.
• Communication!

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Turning back the clock
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What would we do differently??

• More baseline information to evidence the impact
  of proactive, planned and coordinated nursing
  care in the community
• Instinctively know its right prove it!
• Publicise pilot more often throughout
• Capture feedback from patients and carers Care
  Managers have got heart warming stories to share.
  
• Demonstrate the fantastic job Care Managers and
  the Community Nursing Team do!

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Why??

• 
  

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Frontline Clinical Leadership

• An overview of current developments
• Margot Russell Practice Development Specialist,
  Clinical Leadership Quality

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Themes of CLQ
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Elements of Clinical Leadership
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Quick summary of each component

• Clinical Leadership programme - runs annually
  for 9 months for those in formal NMAHP clinical
  leadership positions or who aspire to be.
  Validated both at degree and Masters level. Only
  NHS Programme in the UK to offer a Post Graduate
  Certificate in Clinical Leadership
• Clinical Leadership Active Learning sets-
  Bimonthly facilitated learning sets for those who
  have completed the clinical leadership programme
  and wish to continue to develop their learning
  through peer networks.

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Senior Charge Nurse developments

• Senior Charge Nurse / Team leader Performance
  Objectives- developed over past 12 months and
  recently roll out across whole organisation for
  NM clinical leaders to identify key deliverable
  to work towards and assist in providing evidence
  for KSF. Assists in bringing a degree of
  consistency and clarity to the role. Being
  reviewed for AHPs currently. Links to Scottish
  Patient Safety programme, CQI, HEAT, Better
  Together
• Review of the Senior Charge Nurse role- Part of
  the national development phase of the refocused
  national role framework for Senior charge nurses.
  Centred around safe effective patient care,
  improving the patients experience, managing the
  performance of the team and contributing to the
  organisations objectives. Links to Scottish
  Patient Safety programme, Better Together, HEAT

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Improving quality

• Releasing Time to Care / Organised ward-
  initiative , based on Lean methodologies, looking
  at reorganisation of systems and processes within
  clinical areas in order to release nursing time
  back to clinical care, thus releasing the SCN to
  undertake the refocused role. Links to National
  pilot of Releasing Time to Care
• Clinical Quality Indicators- Part of the
  national development phase of clinical quality
  indicators. Provides readily accessible
  information for the SCN regarding the compliance
  to best practice within the clinical area. Links
  the refocused role, scn objectives and the
  organised ward initiatives as a means to identify
  continuous quality improvement. Links to Scottish
  Patient Safety programme, NHS QIS standards,
  Better Together, National work programmes from
  CNO directorate

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Improving Quality 2

• Food Fluid Nutrition- Links to the Clinical
  quality indicators and senior charge Nurse
  objectives. Assist the organisation in improving
  nutrition and hydration care from strategic plans
  to clinical practice. Links to Organised ward
  initiative, SCN objectives and national work from
  CNO directorate, NHS QIS standards.
• Medicines management- commenced work
  commissioned by PD Board looking at systems and
  processes across NHS Lanarkshire. Areas of risk
  and improvements and are being identified. Links
  to Scottish Patient Safety Programme, SCN
  objectives, CQI Organised Ward initiatives

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Improving Quality 3

• Non medical prescribing- reviewing systems and
  process in place to access, support and maintain
  NMAHP prescribes to ensure maximum benefit for
  both patient and organisation. Links to National
  work, SCN objectives and Scottish Patient Safety
  programme
• Cleanliness Champion programme-
  interprofessional learning sets to support those
  undertaking the programme. Since the introduction
  of CC coordinators the completion rates of the
  programme in NHS Lanarkshire have more than
  doubled. Currently undertaking impact evaluation
  study to examine impact on clinical practice.
  Links to SCN objectives, HAI work, HEAT, Scottish
  Patient Safety programme, Organised ward
  initiative

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Improving Quality 4

• Integrated Care Pathways (ICP)- Recent addition
  to the team. Examining and reviewing current
  ICPs currently in use within the organisation,
  structures supporting their use, development of
  further / new ICP where a need exists. Current
  focus on mental health ICP development. Links to
  CQI, Rights Relationships Recovery, SPSP

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Challenges

• Keeping all the issues on the agenda moving at
  the required pace
• Ensuring that there is strong linkage between
  programmes of work within the team and out with
  the team
• Managing expectations - ensuring that that the
  work streams are phased into the clinical areas
  without overwhelming the practitioners

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Reflections what would I do differently

• Clinical Engagement work harder to ensure that
  at all levels of the organisation were aware of
  the work programmes and were fully on board with
  what was being proposed
• Have an organisational strategy / framework where
  this work sits at the outset
• Proactive engagement with partner institutions at
  an earlier stage in development.

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Celebrating Lanarkshire 2008

• Conference Reflection and Evaluation

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Celebrating Lanarkshire 2008Reflection

• What have I done today, what have I learned from
  today and how will today make a difference?
• Certificates of Attendance
• Reflection in action on action -
• Thank You

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Celebrating Lanarkshire 2008Evaluation (1)

• Please dont leave here until you have
  completed your evaluation formit really does
  help with future planninghence why year on year
  the Conference has been different in content and
  style.

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Celebrating Lanarkshire 2008Evaluation (2)

• In addition to a conference report being
  prepared and placed on the PDC web-site, your
  views will be considered alongside the recently
  published Critical Review of Celebrating
  Lanarkshire and NMAHP Symposiaan evaluative
  piece of work commissioned in 2008 to provide an
  evidence base for the future of Celebrating
  Lanarkshire.

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Celebrating Lanarkshire 2008Evaluation (3)

• Tell at least 5 other NMAHPs about today and
  get each of them to commit to tell at least 5
  othersnever underestimate the power of the word
  of mouth!

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Celebrating Lanarkshire 2008

• Conference Close

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Celebrating Lanarkshire 2008

• Thank you, Goodbye and Safe Journey