Royal Devon and Exeter NHS Foundation Trust
Equality rewards page 3
Inpatients give us the
Theatres ringing the changes page 4
Wonford hospital has been designated a Trauma Unit as part of a new regional NHS network providing emergency care to patients with life threatening illness or injury. Our Emergency Department, which responded to 96,437 attendances last year, is part of a new specialist trauma network in the NHS South region which became operational in April. This approach for the care of patients with life threatening illness or injury has been successfully run in London for a year and is believed to have saved over 60 lives and improved patient recovery. In the NHS South region, patients with specific specialist needs will be treated at Trauma Centres in Plymouth Derriford hospital (for head injuries) and Bristol Frenchay hospital (for burns). Devon Air Ambulance airlifted 360 patients to the RD&E for emergency treatment in 2011. Consultant Dr Alasdair Dow, who was involved in the development of this network, said: “This arrangement, setting out clear roles for each hospital emergency department in this region,
A first class emergency resource to draw on when every minute counts.
should ensure patients get the very best specialist care in the right place at the right time. “At the RD&E we will clinically assess the needs of our patients and draw on the wealth of skills and technology available to
us in our local Trauma Centres to give patients every chance of survival and recovery. For professionals working in the NHS this provides a first class emergency resource to draw on when every minute counts.”
Patients rate our hospital care highly Our adult inpatients have rated highly their experience of RD&E hospital care in the 2011 Care Quality Commission satisfaction survey. The commission sent a questionnaire to inpatients at Wonford hospital between October 2011 and January 2012 to check we met government set standards and 561 responses were returned. Patients were asked to score their experience out of 10 on a range of standards including: n Emergency Department – overall score for questions 7.9 out of 10
nW aiting lists and planned admission – 6.5 nW aiting to get a bed on a ward – 8.3 nH ospital ward and environment including meals – 8.3 nC are by doctors and nurses – 8.7 each nC are and treatment – 7.6 n S urgery and procedures – 8.3 n L eaving hospital – 7.0 nO verall patient experience – 8.2 (respect and dignity 9.2; health professionals working together 8.1) Director of Nursing & Patient Care
Em Wilkinson-Brice said: “The results of the CQC adult inpatient survey confirms that overall our patients have confidence and trust in our staff and feel respected and informed throughout their care. There are, however, always areas where we can respond positively to feedback and make improvements. The national survey results will continue to influence our improvement programme for the forthcoming year. These results are testament to the sustained dedication and commitment of our staff who strive to put patients and families first.”
Equality in action
Valuing the ability of dedicated colleagues and supporting them to work with disability has reaped positive benefits at the Royal Devon & Exeter. Matthew Good, who has Asperger’s Syndrome, has worked at the RD&E for a decade but increasingly found his job in a clinical area challenging. He had been well supported by colleagues but struggled with communication with a lot of people and having to constantly make a series of small decisions. These demands were not suitable for Matthew’s structured way of thinking but the Trust didn’t want to lose an employee with his strengths - dedication, reliability and attention to detail – so they called in Pluss. Pluss is a social enterprise which specialises in supporting people with disabilities and health conditions to secure employment, thrive, and develop careers. Matthew explains the challenge of finding a new role at the hospital: “With Pluss and the people from the Trust, I looked at different jobs I could do. I started a work trial as a driver, delivering post around the different hospital buildings. The routes were complicated. Some items that were colour coded weren’t in the right place. It confused me and made me late, which I didn’t like.” The Pluss job coach worked with the Trust to re-design Matthew’s job to help him deliver outstanding service every day. Simple adjustments addressed aspects of the job Mathew found challenging. These changes included altering the work timetable to create a streamlined and structured day-to-day routine; providing him with a bigger trolley and providing Mathew with a checklist to track his progress throughout the day. Now Matthew is on the right track every day at work because he knows exactly what route to take as he makes his deliveries
Matthew’s success illustrates how we do our best to harness a diverse range of talent in our workforce.
to each of the hospital site buildings and simple changes helped him settle quickly into his new role. Matthew successfully completed his work trial and was offered the job. Transport service lead Dave Searle, who is Matthew’s line manager, said: “These adjustments harnessed Matthew’s disciplined attention to detail. He is now able to make on-thespot decisions and can suggest alternative ways of doing things to improve efficiency. Matthew does a good job every day. He cares about the job and is very conscientious.” Matthew said his job coach gave him the confidence to continue by helping him realise that he could do a good job. “I am happier and less stressed. I enjoy my job so much and feel valued and appreciated. I would like to thank Paul Stone, Sarah King, Dave Searle and Martin Hawkins
for their support.” Lynn Lane, Director of Human Resources, said: “Matthew’s success illustrates how we do our best to harness a diverse range of talent in our workforce. It makes the RD&E a great place to work and ultimately results in a better service for patients.”
n For information about what the RD&E can do to support someone with disability in the workplace contact Tony Williams, our Equality and Diversity Manager, on extension 6942, or e-mail him at Anthony.williams1@ nhs.net.
Fit For The Future
Theatres service re-design Our colleagues in theatres have been making small step changes which collectively should improve patient care and experience & make better use of our resources. The Theatres Redesign Project is part of our ‘Fit For The Future’ programme to improve our ways of working to ensure the service is safe, smooth, efficient and able to respond to the changing demands on our Trust and the wider NHS community. Theatres facilitator Alfi Blackwell explains the re-design approach which involved and empowered colleagues to identify areas for improvement and deliver an agreed action plan: “We developed the ‘Formula One’ team approach, with a launch event where all staff could share ideas and discuss what could be changed to achieve improvements. This was followed up by a session to agree actions and my role has been to support and facilitate them to make the changes, which often involves working with other Trust departments or services. This work continues.” Positive outcomes coming from this work include: n Improved patient experience – we now stagger the theatre list start times instead of all our patients being expected to arrive at Wonford hospital at 8am. Now there is a 7.30am and an 11.30am start time depending on where the patient is
on the list which means they wait less in hospital before their procedure; they have a reduced starvation period and consequently patient recovery is better if they are less hydrated n Improved patient flow – we are developing the use of a bell system linking Plato with the ward whiteboard in surgical & orthopaedic admissions and day case. Knapp Ward matron Wendy Strode explains the benefit of the bell signal: “Often when we informed a patient it was time we took them down to theatres they would spend several minutes saying their goodbyes to relatives, packing away their belongings or visiting the toilet. These minutes across days and weeks created significant overall delay in patients arriving at theatres. The bell signal gives us notice that the patient needs to be in theatres in five minutes time – we can then prompt the patient to do what they need to before we escort them down on time to the theatres team waiting for them.” n Increased theatres capacity – we have transferred some day case lists across to other theatres for example Ear Nose Throat Day Case has moved from Wonford to Heavitree: and Vascular Day Case from Heavitree to Tiverton community hospital so that local anaesthetic renal work can be
done at Heavitree. This is making more efficient use of the theatres service and resources and increases capacity at Wonford for more complex or emergency cases. n Improved planning & preparation – the introduction of a standardised use of Outlook to schedule operating lists has realised several benefits. Further work will be done to take this forward. ENT Waiting List Coordinator Val Cooke explains why this works better: “Theatres staff can look easily at lists booked up in advance and prepare and book equipment. Patients are not moved around as much on the list and consultants can access the information from anywhere and track progress of the patient, such as when they have been sent for by theatres. Managers can also see where theatres have capacity for more cases, which makes more efficient use of our theatres resources.” n Reduced preparation time & financial costs – Plastics theatre matron Jane Benson questioned the historic use of two separate sets of surgical instruments prepared by our HSDU service for procedures on hands. By designing a single set she has reduced the time needed to unpack two sets. HSDU last year processed 826 hand sets (costing £13 each) and the measure Jane has developed will achieve a recurrent budget saving.
Fit For The Future
Staff health & wellbeing
Changes to Stagecoach staff discount scheme Recent HMRC Guidance for employers who subsidise discount benefits for their staff prompted a review of our current scheme providing cheaper Stagecoach bus service travel when staff show their Trust ID badge to the drivers. Unfortunately the review found that the Trust cannot continue with this travel discount scheme in its current form. This situation is not unique to the RD&E and affects similar initiatives run by other major employers across the country. It is with great regret that we have therefore decided to cease this current arrangement we have with Stagecoach. It will end on Saturday 30 June 2012. We have however been able to negotiate and secure a 10% discounted price for RD&E staff for Stagecoach 4, 13 and 52 week season tickets. This new arrangement has been generously agreed by Stagecoach and meets the HMRC guidance requirements. Our parking service will be able to issue the discounted season tickets. This change does not affect the Megarider season ticket which staff can pay for direct from their salary. We are playing a key part in a world first charity bid to find a cure for Parkinson’s. The charity Parkinson’s UK is investing over £1.6 million into the biggest ever in-depth research study tracking people with the neurological condition. The study aims to unlock secrets about the condition and boost the chances of finding a cure. Our Movement Disorder Team is a key centre taking part in this research led by Consultant Physician Dr Ray Sheridan. To qualify as a volunteer for ‘Tracking Parkinson’s’ at one of the UK centres, people need to have been diagnosed under the age of 50 or have been diagnosed with Parkinson’s within the last three years (from the date they register for the study). Brothers or sisters of either set of participants are also invited to take part. To find out more about how to take part in Tracking Parkinson’s call the freephone helpline 0808 800 0303, or visit www.parkinsons.org.uk/ tracking for full details and links to other Parkinson’s UK funded research.
Safe & secure A uniform change for our security team reflects the emphasis they place on professional, preventative and specialist support for colleagues and patients. Deputy security service manager Simon Dallas explains the thinking behind this: The uniform change is more flexible for the distinctly different roles of our security officers – with the formal tie and high visible jackets for when we need them to respond to scenarios involving aggression, anti-social behaviour and criminal activity on our hospital sites and then, without the tie and jacket, for a less formal appearance when assisting staff looking after confused or vulnerable patients. The rota pattern for our security team has changed to free up more of their time to provide physical intervention Doctor Philippa Jefferson knows first hand the benefits of the RD&E having security camera coverage on hospital sites. Her stolen bicycle was recovered and camera footage provided film evidence of the thief at Wonford. She said “it is reassuring to know that even if the security officers are not there in person they are keeping an eye out for us and our property.”
and escalation training for frontline staff. It also enables officers to spend time with colleagues on their designated ward and clinical areas to identify issues and develop solutions and training to address them. I have already seen first hand the positive benefits of the preventative training and support we have given to frontline staff. I responded to a call for assistance on the Acute Medical Unit and on arrival I saw colleagues applying text book perfect techniques to safely and calmly manage a challenging patient. They were practising the de-escalation training they had received and contained the situation in a professional safe manner. We also know that more staff awareness through training has resulted in more pro-active accurate reporting of incidents. when someone was escorted off the premises. The cameras have also proven to be useful to find missing people and property, for example pharmacy boxes couldn’t be accounted for and our footage showed they had been innocently moved to another location by a colleague.”
Our security team has a state of the art CCTV operations room with an extra 230 camera ‘eyes’ all over the Trust property to monitor activity. Security Service Manager Paul Honey said: “We are very mindful of striking a balance with the presence and use of cameras. We hope that our patients, visitors and staff can have peace of mind that we do have the resource intended to help us prevent situations escalating and as a deterrent for people who want to steal or cause damage. Recent examples where the cameras proved invaluable include the discrete surveillance of a protest group at our Barrack Road entrance and film evidence of an incident
The Improving Working Lives Staff Lottery wants project ideas to fund – contact us v
Improving patient care
image courtesy of Matt Austin
The contribution our staff made to an innovative approach to patient care to speed up the successful recovery after surgery was recognised at a national launch summit.
n RD&E consultants Nigel Acheson and John McGrath were national advisors on Enhanced Recovery for gynaecology and urology patient care. The RD&E was instrumental in the development and adoption of The Enhanced Recovery programme which is being rolled out across the NHS nationally. In April a London summit event was held to launch the publication ‘Fulfilling the potential: a better journey for patients, a better deal for the NHS’ which sets out how patients can benefit from the good practice learned and shared through Hundreds of you signed up to a hand hygiene pledge in support of the World Health Organisation ‘Save Lives: Clean your hands’ 2012 campaign. Our infection prevention and control team (pictured) hosted an awareness raising display and visited wards on a dedicated day in May but with the universal message that effective hand hygiene is a 365 day commitment. Colleagues pledged their commitment to comply with good practice, challenge non-compliant staff and be ‘bare from the elbows down.’ Director of Nursing & Patient Care Em Wilkinson-Brice and Joint Medical
this initiative. Summit speakers included Minister of State for Care Services Paul Burstow MP, NHS Medical Director Sir Bruce Keogh and Professor Sir Mike Richards CBE, Chair of the Enhanced Recovery Partnership. The event was an opportunity for clinicians to share their experiences and learning from the Enhanced Recovery work for planned and emergency surgical and medical care. RD&E consultants Mr Nigel Acheson and Mr John McGrath were national advisors to the NHS Enhanced Recovery Partnership on the care of gynaecology and urology patients. They fielded questions as members of the Expert Panel discussion at the event, and colleague, consultant anaesthetist Dr Colin Berry presented a talk about the added value of incentivising commissioning of Enhanced Recovery in terms of encouraging a greater pace of change. The Royal Devon & Exeter trialled and developed The Enhanced Recovery programme with patients who had hip and knees replacements, and major bowel, urology and gynaecology operations at Wonford hospital.
Director Dr Vaughan Lewis, joined in with the hand paint and printing activity on the day. Many thanks to Exeter Healthcare Arts for providing the paint materials.
via IaN (look up L for Lottery) or speak to Bernadette on ext 3977
A local woman shared her experience of the End of Life Care of her late husband in a film watched at the launch of our Palliative Discharge Team pilot. Andrea Pearson of Tiverton generously gave a personal insight into her experience when her husband Chris was treated for cancer until his death earlier this year. The film was produced by our Communications Service. Lead Nurse for Cancer Tina Grose welcomed to the pilot launch Mr Les Storey, National Lead for Preferred Priorities of Care (pictured). Our Palliative Discharge team has started a six month pilot across six wards – Culm East, Culm West, AMU East, AMU West, Kenn and Bovey – to focus on co-ordinating an integrated discharge service for patients in the last three months of their life. Key objectives of the pilot are: n To identify and enable patients to be able to die in their preferred place of care (wherever possible) n To identify patients who may be considered to be in the last year of life that may be appropriate to place on the End of Life Palliative Care Register in collaboration with NHS Devon. n To facilitate complex palliative discharges in the last three months of life. There will also be raised awareness among colleagues about end of life issues and the team will work closely with the pilot wards to develop education and understanding.
News in brief
Fond farewell MS Specialist Nurse Gail Hayes retires in June after clocking up 12 years service with us. Gail has been a leading light in developing services for our Multiple Sclerosis patients and worked tirelessly with colleagues in setting up Tysabari treatments on a regular outpatient basis. She also expanded her knowledge with Masters degree level study. The remarkable contribution Gail has made over the years to patient care was recognised by The UK Multiple Sclerosis Specialist Nurse Association
when she received an award for making a difference and in 2011 Gail was given a Lifetime Achievement Award from the MS Trust.
We have trialled a zero-emissions van with the aim of reducing the carbon footprint of our hospital courier and car park patrol service. In the week leading up to NHS Sustainability Day our transport service manager Dave Searle test drove an electric powered van for regular courier and patrol activity between the Wonford and Heavitree hospital sites in Exeter. Dave said: “There is potential for a zero emission vehicle for this regular courier and patrol work instead of the 1.6 diesel vehicle we currently use. We have used an electric-powered van kindly loaned to us by Bristol Street Renault garage to see how it would best serve the operational needs of the RD&E. If we invested in this technology it would certainly be a cleaner, greener way of doing our business. Re-charging the power is simple enough, it just takes getting used to driving without hearing any engine noise.”
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Another 30 members of male and female staff have benefited from the ‘New Year New You’ staff weight management programme run by the Trust’s Nutrition & Dietetics service. The 12 week programme, which ended in April, included a series of simple lifestyle and diet changes together with moderate exercise was delivered by dietitians, a physiotherapist and Consultant Dr Mark Daly. There was also a presentation on the Virtual Gym which is a fitness programme available to all NHS staff through IaN (any questions please email: email@example.com)
Winner Hosea Litiku said: “I found the sessions extremely informative and provided a greater understanding of how to get my weight down. The weekly weighing sessions provided the greatest incentive for me as I would know whether or not my actions during the week had been effective. The Dietetic team gave us encouragement and support through the whole process.” Overall the weight loss for the group was 73kg (11 stone 6 lbs) n If you are interested in attending the next programme please email: Lesley.firstname.lastname@example.org
The Royal Devon and Exeter NHS Foundation Trust has not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor does Royal Devon and Exeter NHS Foundation Trust endorse any of the products or services.
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RD&E News June 2012