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• Aim to have all hospitals implementing the NHS Institute ‘Time to Care’ initiative by April 2013. Targeted support is to be focused on 20 Trusts, which would most benefit from intensive support. It will particularly focus on the delivery of care to older people.

• Red tape challenge: The new Nursing Quality Forum will ask frontline nurses to identify which pieces of bureaucracy get in the way of them performing their jobs properly, with the aim of removing them.

• Regular nursing rounds: The Nursing Quality Forum will be encouraging the adoption of this best practice by all hospitals by raising its profile and demonstrating the benefits to frontline nurse leaders. The NHS Institute will look to bring together this programme with the ‘Time to Care’ initiative.

• The Nursing Quality Forum will identify good practice and advise on what is best to implement and, where barriers to adoption and spread exist, will

implementation of this type of programme uses energy and needs dedication. The report highlights that organisational energy is influenced by levels of visible executive support, resources for programme leadership and facilitation and building resilience to times of pressure and change.2 It is perhaps no wonder that Trusts are

failing to devise a spread of the initiative while they are consumed with the cost-saving agenda, which currently applies across the board. It is welcomed, therefore, that ‘targeted support’ to 20 Trusts will be facilitated by the Department of Health. In January last year, the

NHS Institute for Innovation and Improvement undertook a Rapid Impact Assessment of the ProductiveWard,3 reporting that it delivered an increase of 41% in direct patient care time. By investing that time in higher quality of care, the report demonstrates that the following benefits can be delivered: • Better staff satisfaction. • Better patient experience. • Reduced harmevents (such asMRSA, C. difficile, pressure ulcers and falls).


advise on what can be done to remove them (For example, Energising for Excellence initiative).

• The Nursing Quality Forum will look at how to secure greater frontline nursing leadership in the future; exhibit national leadership, to stimulate local action by those delivering care to address problems; and promote the improvements needed across services.

• Local HealthWatch will lead a new patient-led inspection regime to replace the old Patient Environment Action Team inspections. HealthWatch England will make sure independent patient views are incorporated into the design. Inspections will cover consider cleanliness, food, privacy and dignity at a minimum.

• A new ‘friends and family test’ question in the national surveys will ask ‘whether patients, carers and staff would recommend their hospital to their families and friends in their hour of need’.

• Reduced (same diagnosis) re-admissions.

In addition, the productivity, efficiency and financial benefits of the improvements are: • Reduced length of stay (and reduced excess bed day costs per patient).

• Reduced staff sickness and absence. • Stock reduction.

The assessment reports that the ProductiveWard has significant identifiable quality, productivity and efficiency benefits for Trusts. The authors conclude that the programme empowers frontline staff to influence and improve the way they work, which improves morale and enhances the working lives of nurses and other ward based staff. The results of this study, which involved

nine Trusts, suggest that, the Productive Series (if extrapolated across the NHS), could provide many of the answers required by the Nurse Quality Forum.

Regular nursing rounds So what will be done with all this extra time once the red tape and bureaucracy have been swept away? Politicians will expect nurses to undertake regular rounds of their patients, to systematically ensure that they are comfortable, properly fed and hydrated and being treated with the respect and dignity that they deserve. It is suggested that these rounds take place hourly. A new financial incentive will be introduced as part of the NHS Safety Thermometer. These new safety standards include the need to report harms such as pressure ulcers, falls, blood clots and catheter-acquired urinary tract infections. Hospitals could attract incentive payments of up to 0.5% above their contracted income if they use the Safety Thermometer to measure standards of basic care. Unfortunately, it seems that one set of

impediments to spending time with patients will be replaced with a set of reports which need to be made on a variety of other parameters.

‘The Productive Series aims to empower teams to identify areas for improvement on the ward by giving staff information, skills and the time they need to regain control of their ward and the care they provide.’

MARCH 2012

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