How to write an award-winning storyboard Dr Alan Willson presentation

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Title: How to write an award-winning storyboard Dr Alan Willson

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How to write an award-winning storyboard Dr
Alan Willson
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Purpose of NHS Wales Awards

Recognise achievement
Provide learning material to support the training
and development of NHS staff
Stimulate and encourage an evaluative approach to
implementing better ideas in service delivery

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Model for Improvement
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The Judging Criteria
with examples from shortlisted storyboards

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1. Storyboard Title

Gynaecological Cancer Rehabilitation Scheme for
the Prevention of Lymphoedema and Incontinence
86 Gynaecological Cancer Rehabilitation Scheme
for the Prevention of Lymphoedema and
Incontinence
Contact Card for Relatives Following Bereavement
149 Contact Card for Relatives Following
Bereavement

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2. Brief Outline of Context

Where this improvement work was done
What sort of unit/department
Which staff/client groups were involved

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2. Brief Outline of Context

This community service for disabled children and
their families is based in an NHS Trust
Childrens Centre and brings together specialist
social workers, local authority occupational
therapy staff, a specialist teacher, care
coordinators, community learning disability
nurses, special school nurses and Diana nurses in
an integrated team.
0031 Developing a Childrens Integrated
Disability Service (CIDS)
A multi agency Task Team was established in 2000
to review historical Day Care Services provided
at Cam Cyntaf Day Centre, Glanrhyd Hospital and
Tyr Ardd Social Care Day Centre in the
community. The client groups included 170
individuals with severe and enduring mental
health to those with mild to moderate mental
health problems.
0152 Integrated mental Health Day Opportunities
Service Continued

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2. Brief Outline of Context

AMBU Health Board is one of the largest in Wales
employing around 300 midwives. It serves a
population of 600,000 with an annual birth rate
of about 6,380. The maternity services are based
in 3 separate sites and midwives provide care in
a variety of settings including consultant led
units, midwife led birth centres, the community
and home.
0114 Flexible Retirement Everyones a Winner!

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3. Brief Outline of Problem

Statement of problem
How they set out to tackle it
How it affected patient/client care

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3. Brief Outline of Problem

Parent Education for pregnant women has
traditionally been organised in weekly sessions.
Before the 1990s it was during the day and only
for women. Midwives and Service Commissioners
realised that the take-up for the session was not
optimum and that with many women now working,
holding the information programme in the day is
not always convenient. The drop out rate becomes
high as the sessions progress and continuity of
midwife is not available depending on available
rotas. Parent Education has since been offered
for couples in six weekly evening sessions and is
very popular, with demand outstripping supply,
but again the drop out rate is high.
0160 Streamlining the Parent Education Programme
Bringing It into the 21st Century.
Continued

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3. Brief Outline of Problem

Pressure Ulcers cost the National Health Service
2.4 Billion a year (Bennett et al 2004). Nice
Guidelines have pointed out that Hospital audits
have shown hospitals to range between 10-14
incidence of hospital acquired Pressure Ulcers.
Incidence rates within the Department have shown
to be at 4.2. Target for the 1000 Lives campaign
was to reduce Pressure Ulcer Incidence by 50 per
1000 bed days.
0106 Pressure Ulcer Prevention Zero Tolerance
The Sister and staff identified a problem in the
provision of key services to patients around
Electrocardiograph (ECG) Phlebotomy Podiatry
and Therapies which was part time, nine to five,
Monday to Friday, leaving a significant gap in
care for patients, the rest of the time. The
above was observed to significantly hamper
patients progress and delay discharge from
hospital.
0125 The Flexible and Sustainable Workforce

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4. Assessment of Problem and Analysis of its
Causes

Quantified problem
Staff involvement
Assessment of the cause of the problem
Solutions/changes needed to make improvements

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4. Assessment of Problem and Analysis of its
Causes

The group agreed to redo the audit by
Developing an audit tool to record the patients
body temperature through out the care pathway.
To ensure consistency only one method of
recording temperature
Tympanic thermometers were the best method chosen
by the team.
This audit identified that the problem started
when the patient was admitted to the Day Surgery
unit, by the time they changed and walked to the
anaesthetic room 77 patients arrived hypothermic
and transferred to operating room hypothermic.
Forced warm air blankets improved the patients
body temperature, but they still remained
hypothermic when transferred to recovery room 88
transferred from operating theatre to recovery
were hypothermic. The audit identified that the
impact of transferring patients from the ward to
the anaesthetic room reflected on the outcome of
the patients recovery and discharge home.
0008 Reducing Harm Risks of Hypothermia to
Surgical Patients Under General Anaesthetic
Continued

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4. Assessment of Problem and Analysis of its
Causes

We established that there were tremendous
examples of positively evaluated work supporting
the most vulnerable in the community. Their main
limitations however were that
They were too small to have a critical mass of
resource to meet user need
They were too restrictive in terms of exclusion
criteria to allow those in need to access them
They were too restrictive in terms of who could
refer patients to the service
They were often age or disease discriminatory
Joined up working particularly with respect to
integration with services providing personal care
provision were missing
There was no clear line of horizontal
accountability that crossed traditional barriers,
rather each component was accountable in a
vertical manner through different lines of
management.
The combined skill mix of the interagency
partners was integral to crossing these
barriers. A co-located integrated
inter-disciplinary team sharing an electronic
patient record that could cross the interfaces of
primary, secondary and
intermediate care were the principal components
used to tackle these problems
to enhance patient care and satisfaction.
0122 The C.E.L.T.I.C. Experience, An
All-inclusive Seamless Intermediate Care Service
Continued

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4. Assessment of Problem and Analysis of its
Causes

According to The Department of Health (DoH)
(2000) 6 million people in the United Kingdom
suffer with urinary incontinence. The earlier
local study highlighted the reluctance to seek
help for incontinence and with the increasing
number of referrals to the District Nursing
service for incontinence assessment the idea of
setting up a clinic was conceived. Discussions
then followed between the District Nurse and
Continence Advisor. The concept was presented to
the head of District Nursing and to General
Practitioners from two rural practices. The
proposal was accepted and accommodation to run a
clinic was secured at a GP Surgery. Plans were
then drawn up to take the venture forward.
0084 Proactive Approach to Continence Care in a
Rural Community
Up to 10 of patients are readmitted as
emergencies within 3 months of their initial
acute admission because of further stone
formation or stone migration. In the UK,
Metabolic assessment of urinary stone formers is
rarely undertaken in the form of urine, blood and
stone analysis to identify those at risk of
recurrent stone disease despite this being part
of the European and American Urological
Guidelines. No other Urological Centre in Wales
currently runs a metabolic stone clinic.
0077 The Metabolic Stone Clinic Benchmark
Prevention for High Risk Patients

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5. Strategy for Change

How the proposed change was implemented
Clear client or staff group described
Explain how they disseminated the results of
analysis and plans for change to the groups
involved with/affected by the planned change
Include a timetable for change

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5. Strategy for Change

The Practice News Letter and Health Promotion
board displayed in the practice informed the
practice population of problems associated with
urinary incontinence and the ease of access to
the clinic (March 2005). The GPs and practice
staff were made aware that the clinic would
commence in July 2005, held on a monthly basis
and would accept male and female clients of any
age group. Develop protocol and referral forms
for the clinic by July 2005. Develop Audit Tool
for use on an annual basis. Collate evidence to
support effectiveness of the clinic. Disseminate
experience and findings to colleagues at
Carmarthenshire NHS Trust Professional Group
Meetings. Attend and present annual report at the
GP Professional Group meeting.
0084 Proactive Approach to Continence Care in a
Rural Community

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5. Strategy for Change

Formation of steering group consisting of
Consultants, GPs, nurse advisors, modernisation
manager, Nurse directors from Trust and LHB and
patient representatives 2005/6.
Appointment of chronic disease co-ordinator and 8
specialist nurses, 1 physiotherapist 2
administratorsJanuary 2006
Co-ordination of top up, clinical assessment
skills training for specialist nurses March
2006
Personalised visits to Carmarthenshire GP
surgeries, secondary care medical and elderly
care teams, AE, medical admission units,
CCU/intensive care teams, district nursing teams
and newly appointed admission avoidance
teams/services informing them of the chronic
disease service June 2006
Identify link nurses in each GP surgery October
2006.
Baseline review of medical emergency admission
rates and QoF data 2005/2006
Update needs analysis regarding current service
and training needs in primary and secondary care
October 06- Mar 07
Produce evidence based diagnostic and treatment
algorithms June 2006
Update Heart failure and Diabetic components of
Carmarthenshire CHD Diabetic tool kits,
designed to facilitate standardised management
for CHD and Diabetic patients throughout
Carmarthenshire November 2007.
Introduction of Heart Save heart failure
training course 2006/7
Introduction of XPERT diabetic patient training
course 2006/7
Development introduction of integrated COPD
care pathway 2006/7
Introduction of COPD telehealth pilot 2007/8
Develop standardised clerking and communication
documentation for the service January 2008
Establish patient focus groups to evaluate and
inform service development November 2007
Develop test service satisfaction
questionnaires
0146 Chronic Disease - Continuums of
Care Continued

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5. Strategy for Change

Medical staff are often resistant to change which
is dictated to them but will often support change
when there is strong evidence of its benefit or
previous personal involvement with critical
incidents. Nursing and Operating Department
Practitioners are heavily influenced by medical
leadership so it was essential to have medical
support in all areas.
Time was spent talking to all members of the
teams in small groups and answering the queries
before we embarked on implementation. Each
consultant was also sent written information at
least a week prior to implementation. After a
months pilot (using the model for improvement
and small steps of change) with the introduction
of the checklist in Llandough Hospital, we made
minor changes and moved on to main theatres at
UHW starting the checklist in a new theatre each
week. We started with the most enthusiastic teams
and then rolled out rapidly in order to get round
all the theatres. We planned to have the
checklist in place in all surgical theatres by
August 2009 and to use the final six months to
improve compliance and focus on poor performing
areas.
During the first six months other specialities
such as radiology, podiatry, dermatology and
cardiology were contacted and encouraged to alter
the checklist for their clinical use but maintain
the core standards set out by the NPSA. Their
ownership is important for sustainability of the
project.
0174 World Health Organisation (WHO) Surgical
Safety Checklist A Successful Strategy for
Implementation

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6. Measurement of improvement

Details of how the effects of the planned changes
were measured

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6. Measurement of improvement

Client evaluations, capturing both quantitative
and qualitative information are completed.
Standardized outcome measures are used pre and
post intervention (SF36).
Formal research is currently being undertaken by
Cardiff University to understand the
effectiveness of the Programme
Jobcentre Plus tracking of clients to measure
return to work outcomes (30 return to work)
Postal survey to 500 discharged clients to
measure customer satisfaction (25 response rate
to date)
NLIAH Case Study of the effectiveness of the CMP
Partnership Steering Group
The cost effectiveness of delivering the course
compared to one to one interventions has been
analysed.
Article published in OT News (October 2008)
0132 Positive Partnership Working The NHS and
Jobcentre Plus Working Together to Support
Citizens living with Long Term Conditions to
Return to Work.
Continued

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6. Measurement of improvement

Collated a directory of each GP link nurse,
outlining their method of systematic GP follow up
Medical emergency admission rates from the Trust
and QoF data from each GP surgery was provided
monthly to the LHB, and compared quarterly
against the previous years data
Staff questionnaires issued to primary and
secondary care, ascertained their local
management and training needs
Evaluation questionnaire regarding the education
programmes
Patient focus groups and user satisfaction
questionnaires
Comparatives of quality of life scores Minnesota
QoL questionnaire
Comparatives in application of evidence based
prescribing
Referral waiting times for diagnostic
echocardiograms
0146 Chronic Disease - Continuums of Care

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7. Effects of Changes

Statement of the effects of the change
How far these changes resolve the problem that
triggered the work
How this improved patient/client care
The problems encountered with the process of
changes or with the changes

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7. Effects of Changes

Our first months data showed a compliance of
between 60-70 and four months later this data
has improved to approximately 90 compliance at
UHW main theatres.
Llandough Hospital data was not as good with as
low as 15 compliance initially but after
focusing on the problem of surgical engagement
this improved to approximately 80 four months
later.
Data for completion for all emergency procedures
was not as good, initially only achieving
approximately 50 compliance initially. This has
improved but we need to focus on emergencies that
are undertaken outside the designated CEPOD
theatre (theatre 7).
0174 World Health Organisation (WHO) Surgical
Safety Checklist A Successful Strategy for
Implementation
Continued

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7. Effects of Changes

Results from the trial of using the Forced warm
air gowns. On admission 60 patients arrived
hypothermic and forced warm air gowns were
immediately applied. All patients transferred
from the day Surgery were normothermic and the
temperature was maintained until the patient was
fully recovered and discharged. This had an
impact on the outcome of the patients recovery
Length of stay reduced in recovery
Analgesia reduced to oral on the ward
Reduced readmissions (improving pain control,
nausea etc)
Discharge time reduced from 8pm to 2pm
Patient satisfaction (10 day post operative
phone call.)
Infection control single use
Easy access to limbs- Velcro
The group agreed that the best way forward was to
introduce across Powys operating theatre, no
cloth gowns are used for any patients under going
surgery. We are continuously auditing to ensure
that patient temperature is maintained. We may
have had a saving of 240 per month, but most
important we reduced harm and saved lives.
0008 Reducing Harm Risks of Hypothermia to
Surgical Patients Under General Anaesthetic

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8. Lessons learnt

Statement of lessons learnt from the work
What would be done differently next time

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8. Lessons learnt

The team has met certain challenges along their
journey, which with determination and robust
planning these were overcome.
These have included staff shortages, but through
innovative planning all areas were able to send
their staff for education and training.
There is no doubt that a recognised forum that
met regularly to make decisions was important.
Being able to accept failures, address them and
move on was also essential in maintaining the
momentum of change.
Start small but aim big.
Capture the enthusiasm of the frontline staff as
well as the patients and their carers. There is
no better way of improving morale than through
successful initiatives driven by the staff
themselves.
0106 Pressure Ulcer Prevention Zero Tolerance
Continued

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8. Lessons learnt

Strong involvement and support from the MDT is
essential.
Patients have numerous appointments during a
cancer diagnosis, try to coordinate with other
members of the team or check appointments on the
IPM system.
Not all suspected gynaecology cancers are
actually diagnosed with cancer, 27 enrolled on
the scheme were eventually cancer free. This
decreased activity is enabling the service to
embark on a skin cancer lymphoedema prevention
scheme as well.
Increasing capacity demands on the lymphoedema
service the 6 week scheme could be condensed into
one morning or afternoon session.
With the Welsh Assembly Government Lymphoedema
Strategy being published in December 2009 and
prevention being one of the key aims this scheme
could be replicated throughout Wales.
86 Gynaecological Cancer Rehabilitation Scheme
for the Prevention of Lymphoedema and
Incontinence

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9. Message for Others

Statement of the main message they would like to
convey to others, based on the experience
described

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9. Message for Others

Creating a specialised service within existing
resources can reduce demands on services a whole.
Clients who have been chaotic and presented with
high levels of risk can be active participants in
their care and have a positive impact on their
peers.
Working with high risk can be done without worry
when decisions are supported by management and
made as a group.
0183 Taith The Therapeutic Day Service
Improving service delivery in the NHS is not
always about additional financial investment, it
needs the team to have the conviction to critique
their own service, be open-minded enough to
change and be effective motivators and
communicators.
There is a wealth of specialist skill mix within
the NHS and dont be afraid to benchmark new
ideas that work outside the UK and above all-
enjoy what you do.
0077 The Metabolic Stone Clinic Benchmark
Prevention for High Risk Patients