Health Service Focus

28.08.19

Cultural shift pays off at Britain’s leading orthopaedic hospital

Source: NHE Jul/Aug 19

With the Royal National Orthopaedic Hospital NHS Trust (RNOH) moving from a CQC rating of ‘Requires Improvement’ to ‘Good’, John Bateson, senior improvement advisor, Jonathan Berry, deputy head of operations and Cynthia Rau, theatre business support manager, outline the improvements made at the organisation.

We are now seeing a burgeoning culture of improvement at RNOH, and finding that colleagues feel inspired to identify and make improvements to the care they deliver, the experience of patients and the daily experience of our teams. 

The change is fundamental, and it was clearly seen by the inspectors; after the 2018 CQC visit, the chief inspector of hospitals said: “Staff should be proud of the progress made…there was evidence of positive changes to organisational culture, quality improvement initiatives and innovative research projects.” 

The previous CQC inspection was in 2014 and changes seen by the inspection team were the result of a long-term focus on changing our organisational culture so that we are in a position to make improvements driven by delivery teams. This has been happening across the trust, in clinical and non-clinical settings, often led by the frontline delivery teams. To illustrate what we’ve been doing, we have some examples of the improvement activity in theatres that we think have made a big difference. 

Firstly, we wanted to make sure we had wide buy-in to the improvement work, so back in late 2017 we set out to deliver a ‘perfect week’ in theatres with wide engagement from all staff. Clinical and non-clinical staff collaboratively agreed a number of measures that could determine what a perfect week in theatre should look like. This included ambitious targets on prompt start times, reducing unwarranted cancellations and finish times. Then we concentrated the efforts of the whole trust on running one ideal week in theatres, gathering learning and improvement ideas as we went. 

This has been a whole-team effort with the fundamental involvement of frontline staff. The results have been seen in our data, which we have shared widely to help build confidence and commitment to ongoing improvements: 

  • We set a target for the Booking Fill Rate of 90% and we have seen a 10% improvement and a shift to a median of 94%.
  • Intra-session utilisation now has a median above 87%, which is an 8% improvement.
  • Prompt starts now have a median measure of 72%, which is a 7% improvement, and is moving towards our shared target of 85%. 

The approach led to a series of immediate improvements, including a weekly multidisciplinary forward planning meeting that looks at the situation six weeks, four weeks and two weeks out from surgery; we call it 6-4-2. We have also introduced a daily ‘theatre huddle’, a 20-minute meeting to review the next day’s operating list in detail, to avoid on-the-day cancellations and delayed starts to lists. 

There are also some long-term improvement projects that have been identified, which include the need for a dedicated paediatric admissions nurse to prepare children for surgery on the day and the development of a dedicated Theatres Admissions and Day Case Unit (TADCU) to ease ward pressures. 

The approach has also led to an increased interest in improvement projects; two members of the team are currently undertaking a one-year improvement leadership programme, and staff are now identifying and driving new improvement ideas. 

One of the most exciting aspects of this work is that it has created energy for improvement, and a fund of ideas for the next steps. We are now working harder to understand the root causes for avoidable cancellations on the day of surgery. We are also in the process of developing cancellation avoidance strategies by closely reviewing all cancellations through a working group that includes a consultant surgeon and operational theatre staff. 

We have made a lot of improvements in our service recently, and we think that by all staff working closely together, we have managed to create an atmosphere of continuous positive engagement between front-line staff, both clinical and non-clinical, senior clinicians and senior management.

For more information

Tw: @RNOHnhs

W: www.rnoh.nhs.uk

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

NHS calls on remaining social media companies to clamp down on ‘potentially harmful material’

19/09/2019NHS calls on remaining social media companies to clamp down on ‘potentially harmful material’

The chief executive of the NHS in England has urged remaining social media firms to get tougher on potentially harmful material being posted onli... more >
Plans for new £11.5m Musgrove Park Hospital unit unveiled

19/09/2019Plans for new £11.5m Musgrove Park Hospital unit unveiled

Taunton and Somerset NHS Foundation Trust have unveiled new proposals for the expansion and relocation of units at Musgrove Park Hospital, as par... more >
NHS gambling clinic opens In Leeds

18/09/2019NHS gambling clinic opens In Leeds

National charity GambleAware have opened The NHS Northern Gambling Clinic in Leeds today, the first in the country outside of London. Throug... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

last word

The NHS needs more senior women in leadership

The NHS needs more senior women in leadership

The gender pay gap in the NHS remains a hotly debated topic, especially as the final report from the Gender Pay Gap in Medicine Review approaches. Andrea Hester, deputy director of employment rel... more > more last word articles >

681 149x260 NHE Subscribe button

the scalpel's daily blog

An ageing population means hand care and injury prevention is more important than ever

23/08/2019An ageing population means hand care and injury prevention is more important than ever

Grey Giddins, member of the British Society for Surgery of the Hand, discusses how hand care and injury prevention have become increasingly important given the UK’s ageing population   It’s no secret that the UK’s ageing population presents challenges for the NHS. The fact that we are living longer means greater demand for medical care across a number of healthcare specialisms, one of which is hand surgery. ... more >
read more blog posts from 'the scalpel' >

comment

Peter Kyle MP: It’s time to say thank you this Public Service Day

21/06/2019Peter Kyle MP: It’s time to say thank you this Public Service Day

Taking time to say thank you is one of the hidden pillars of a society. Being on the receiving end of some “thanks” can make communit... more >
Nurses named as least-appreciated public sector workers

13/06/2019Nurses named as least-appreciated public sector workers

Nurses have been named as the most under-appreciated public sector professionals as new research reveals how shockingly under-vauled our NHS, edu... more >
Helpforce to launch training programmes for NHS volunteers

10/06/2019Helpforce to launch training programmes for NHS volunteers

Kay Fawcett OBE, clinical advisor and education lead at Helpforce, and Lynn Twinn, talent development consultant, outline the new national traini... more >
Creating the Cardigan integrated care centre

10/06/2019Creating the Cardigan integrated care centre

Peter Skitt, county director and commissioner for Ceredigion Hywel Dda University Health Board, looks ahead to the new integrated care centre bei... more >
Pay and reward in the NHS needs to be taken seriously

10/06/2019Pay and reward in the NHS needs to be taken seriously

Ben Gershlick, senior economics analyst at the Health Foundation, examines the new pay deal for NHS staff.  More than £50bn is sp... more >

interviews

NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >
Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >