Improving Care out of hours Update – Aug 2013

1. Improving Care out of hours Update – Aug 2013 • Overview of Phase 1 plan (Completed April – June 2013) • A review of the (2004) Hospital at Night Resource pack and reports from other NHS hospitals exploring their OoH care provision • A Survey Monkey of 170 trainee doctors across CHUFT achieved 65 complete responses (38%) and a high level of verbatim feedback. • 254 hours of Trainee Dr and Non-medical staff job Shadowing across the full range of specialties over a period of 3 days achieving 1700 lines of OOH data activity across the hospital. • Key outcomes • Survey Monkey – Top issues raised • Excessive workload and short staffing • Poor Rota management in relation to filling gaps and staff sickness • Task duplication and undertaking tasks that could be done by a non-medical person • Timely access to diagnostic tests (Pathology and Radiology) • Bleep activity both in terms of appropriateness of bleeping and frequency of interruption to tasks • Lack of team working in terms of cross cover and the upwards escalation of workload • Job shadowing exercise – Top themes with other acute providers • The number of calls in all specialties falls markedly after midnight • A very small proportion of OoH work relates to life threatening situations • Medicine has the highest number of calls and work load throughout the night • A reduction in the multiple clerking and better administration and other types of clinical support to medical staff at night could reduce their workload • Effective and collaborative handover and bleep polices play an essential part in supporting Out of Hours working Important messages from phase 1 1. Creating an effective approach to staffing the Out of Hours is not easy especially where it represents a major departure from current practice. The experience of other Trusts shows there is great importance in investing resources that promote staff engagement, team building and leadership development. 2. Whilst the job shadowing and survey monkey evidence provides a strong source of energy for action, many of the issues highlighted have their roots in the need for changes in work behavioral and staff engagement rather than hard procedural changes. If we do not address these as part of this process we risk transferring the same behavioral issues to any new OOH model. 3. The disjointed nature of specialty handover processes within CHUFT both in terms of their timing and attendance is likely to impede the options around developing multidisciplinary team working and combined handovers. 4. The interface of Out of Hours working with Pathology and Radiology activity has not been included in any detail within the current data collection exercise as seen in some other Trusts although more detailed work in this area would be beneficial as highlighted in previous reports (ECIST 2011) 5. There is energy for change across this hospital from the trainee doctors – some staff spent 45 minutes on filling out the Survey Monkey writing paragraphs of verbatim comments per question. The Trust needs to harness and engage this energy to help generate and own its solutions to OOH working. 6. Don’t take short cuts. Time spent on engagement and getting the model approach right will save time later

2. Improving Care out of hours Update – Aug 2013 • Phase 2 plan July – Sept 2013 • 1. Establish site visits to other similar NHS • providers with different Out of Hours staffing • approaches for the purpose of further • scoping a team structure • 2. Engage a Senior Surgical & Medical • Consultant in site reviews • 3. Engage & collaborate with the Consultant • body re their views on the OoH model using • a survey monkey approach • 4. Determine the Out of Hours local approach • based upon site networking and • local evidence base • 5. Implement solution • Quick wins July – July-Sept 2013 Current update Aug 2013 • 1. Review/reinforce bleep policy- 1. Clinical bleep allocation reviewed • requirements determined. Ie • Cardiology now allocated. • Reviewed policy waiting sign off to • implement • 2. Develop Junior Doctor 2. Small handbook generated for • survival guide Aug 13 intake. Dr Kedgley FY1 & • Mandy Winslet to work with • PGMC on JD Web Page. • 3. Improve Night Technician 3. Additional support for OoH minor • services procedures identified via site manager • Yvonne Goodchild working up • implementation. • 4. Establish a robust Non Urgent 4. Dr Elmes FY1 supporting. Template • Job list & guidance notes developed for piloting • Surg/med wards identified for end Aug Current update Aug 2013 1. July 2013 visited the Hommerton to discuss their Acute Care Team approach. Awaiting visit date to Northampton. H@N pilot sites contacted for networking 2. Consultant involvement from Surgery and Medicine obtained for site visits 3. Consultant Survey monkey being worked up for release Aug 2013 4. Small work shop planned for Aug 2013 to generate local OoH solutions refine and to take to consultant body Sept 2013 5. Recruit key stakeholders to group and complete Implementation plan for execution end of Sept 2013 July 13 Aug 13 Sept 13 Oct 13 Produce OoH scoping report from Shadowing & survey monkey start Implementation of OoH Model Complete site reviews and generate CHUFT solution IMPLEMENT 4 QUICK WINS Co-ordinate all actions with existing projects