The Origins of Transforming Care

Transforming Care
The Origins of Transforming Care
Two initiatives developed independently but sharing
common goals;
• Releasing Time to Care (RTTC)
• Transforming Care at the Bedside (TCAB)
Both aimed to improve care by releasing staff to spend
more time with their patients and were being piloted in
some Trusts in NHS Wales.
The Origins of Transforming Care - TCAB
TCAB spread to Wales in 2008
Introduced as a national development initiative as part of
the 1000 lives campaign
Designed to improve patient safety and outcomes and
experience of care, vitality and retention of nurses and
effectiveness of the entire care team
Pilot sites included;
Conwy & Denbighshire NHS Trust
Hywel Dda NHS Trust.
Abertawe Bro Morgannwg NHS Trust (focussing on
Hospital Acquired Pressure Ulcers)
The Origins of Transforming Care - RTTC
• Key measurable outcome to increase the proportion of
time that nurses spend on direct patient care.
• RTTC gave ward staff the skills they needed to identify
and realise opportunities to improve the system they
work in.
• Great emphasis on sustainability - key in achieving this
was the facilitative approach the programme adopted.
The staff ownership of the improvements is crucial to
retaining them once the facilitator has gone.
• No ‘Enabler’ modules
Transforming Care
Aims to transform the quality and safety of
patient care across Wales by 2012
Underlying principle: To engage staff of all disciplines and at every level
within NHS organisations in improving the experience and outcomes of
care for patients
Specific objectives
To increase the amount of time healthcare professionals
spend in direct / value added patient care to 70%
To reduce adverse events by 50% in locally agreed category
Increase patient satisfaction to at least 95%
Increase staff satisfaction to at least 95%
Managing change
“It’s a terrible thing to look over
your shoulder when you are
trying to lead –
and find no one there.”
- Franklin D Roosevelt
Transforming Care
‘The paperwork is
easy to understand
and quick to
How does TC work?
“Everything I need to
do my job is
Role Time (e.g. nurse)
‘’Handovers are
concise, timely and
provide all the
information I need”
‘We have the
information we need
to solve our own
problems, and find out
if we were successful”
‘It is clear to
everyone who is
responsible for what”
Opportunity to increase
safety and reliability of
I am not interrupted by
people requesting
information or looking
for things
Direct Care
Transforming Care
Typical TC results
What percentage of nursing time on average is
spent directly on patient care?
Before TC
After TC
On a ward of 30 WTE nursing staff, this equates to having
10 extra full time nurses working on the ward!
Headline Welsh Transforming Care results to date
Two wards at Withybush have nurses spending 1/3rd more time with patients.
Up from 46% before TC to 60% in Nov 08 and then 63% in July 09 (and this
has been sustained!)
In Cardiff and Vale over the last 9 months they have increased direct care time;
West 5, Llandough up from 41% to 70%
West 3 Llandough up from 42% to 80%
On a ward at Velindre Cancer Centre, nurses:
are now spending 1/10th more time with pts. Up from 42% to 46%
have reduced the number of interruptions by about 30%
On a mental health ward in Hywel Dda, nurses are now spending over twice as
much time with patients. Up from 42% before TC to 89%*
* The ward team involved feel that the 89% has been skewed by the very demanding case mix when
they took this measurement. They will re-audit again shortly
Transforming Care
Headline Welsh TC results to date (cont.)
36% Reduction
in in-hospital
North Wales
336 days
since last fall
Ward 9
Hywel Dda LHB
Transforming Care
Other typical results
Annual supplies costs reduced by up to £18K per ward
Medicine round time reduced by 63%
Handover time reduced by 50%, but quality increased
Observations reliability score increased by 70%
Meal wastage rate down from 7% to 1% (£10,000 of unnecessary
annual meal requests identified in one ward)
Interruptions reduced from 114 to 64 per shift (per nurse)
Transforming Care
5S - a tool to improve workplace organisation
items disorganised and hard to find
easy to find items & manage stock levels
Saves 5 mins per visit to storeroom x 30 times a day = 2.5hrs per
day or 912 hours per year saving (took 15 hours nurse time to do)
Transforming Care
‘Before’ of commode cleaning process at Withybush
Transforming Care
‘After’ of commode cleaning process at Withybush
Simplifying the process saved 136 miles of walking per year!
Or about an hour a week that’s freed up to spend with patients
Transforming Care
Each organisation across Wales has for Transforming Care.
Executive Sponsor
Project Lead
Lead Facilitator
Team of facilitators across workgroups
Developed roll out plans to include Surgical Wards

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