Storyboard Entry Form 2014

Main author: Kim McQueen

Email:

Telephone: 01792 703938

Follow the detailed instructions in this template for writing your storyboard. Add your information in each section below and save this completed storyboard document. Please not amend this template.

Follow the instructions in the Information Guide for Authors to submit your storyboard.

The word limit is 1100 words including references. Your storyboard will not be accepted if you exceed the word limit.

1. Storyboard title:a clear concise title which describes the work
Maximising the staff resource to support patients within the operating theatre
(Co-ordinating theatre staff across 4 sites)
2. Brief outline of context:where this improvement work was done; what sort of unit/department; what staff/client groups were involved
Following the merger of the Bro Morganwg and Swansea Trusts in 2008, the theatre department in each hospital continued to work independently of each other. In 2012 the theatre department merged and now works closely together encompassing 4 sites and is comprisedof 43 theatres staffed by over 500whole time equivalent members of staff. Within each site there are satellite theatre areas which are not always adjacent to the main department;these may require a different configuration of staff with differing expertise.
Operating theatres are staffed by Nurses, Operating Department Practitioners Health Care Support workers, domestics and porters. Theatre staff care for and support patients during a stressful time in their lives, theyensure a safe environment for patients andprovide a high levelof care. They also support the medical clinicians (Anaesthetists and Surgeons) who without this support would not be able to offer surgical intervention.
ABMU Theatre department and satellite theatre areas
(distances covered on the M4 corridor from Bridgend to Swansea)

3. Brief outline of problem:statement of problem; how you set out to tackle it; how it affected patient/client care
Independent management of staff in each area led to the identification of staffing shortfalls (daily and long term)being on a site basis onlyalso:-
Rotas were done independently on all sites
Movement of staff limited to each site/area.
No process in place for staff to work flexibly throughout the areas
Manpower budget overspend due to overtime required to staff areas
Staffing shortfalls may lead to patient surgery being pushed back or cancelled, the effects of which could lead to:-
Patient surgery being delayed
Doctors not being able to support patients in other areas such as clinics or cases being delayed even further as medical staff not available
Change in bed status
4.Assessment of problem and analysis of its causes:quantified problem; staff involvement; assessment of the cause of problem; solutions/changes needed to make improvements
Pre 2012, staffing budgets, vacancy advertising and staff employment was done by differing theatre managers and HR departments (East and West of the HB). Staffing rota’s were done independently in each main theatre and satellite areas, with no or very limited links to each other and no central co-ordination.
Staff in the East were managed by paper time sheets as the electronic method (KRONOS) had not been installed, whilst staff in the West were managed by KRONOS which electronically records shift patterns and staff on duty, and allowsprogramming of rotas and therefore identification of staff availability on a daily basis.
Because there was no central management of staff, movement to cover shortfall of staff was only considered on each site and area basis.
It was recognised that the theatre staffing had to be managed centrally and that an electronic system was required across all sites. There was some resistance to this change however it was recognised that if staff were to be effectively and efficiently managed then an electronic system that worked across all sites was required. It was also recognised that implementation of these changes could only take place with the co-operation of all staff.
The benefits of an electronic system are:-
Rotas are centrally managed
Recruitment can take place that meets the need of the service and not only the site
Staff availability is instantly visible on the day
Staff leave can be more fairly managed.
5. Strategy for change: how the proposed change was implemented; clear client or staff group described; explain how you disseminated the results of the analysis and plans for change to the groups involved with/affected by the planned change; include a timetable for change
Throughout 2012-2013 changes were made to address the problem of effective management of theatre staff and included:-
Regular staff meetingsarranged with Unison and the RoyalCollege of Nursing in line with Partnership working, these meetings were arranged every 2-3 monthsand allowed discussion about future plans and resolution of any concerns as they arose.
Introduction of the KRONOS electronic system in those hospitals that were not on-line, which means that it is easier to identify staff rotas’ and those on duty as one department. Staff working issues are managed centrally, including a weekly staffing meeting by the Theatre Managers and the Theatre Operational Managers (manage the day to day staffing issues). These meetings allow management of Rotas’, leave, lieu time, overtime and other issues and have identified that there is a need for the rotas’ to be inputted and managed collaboratively and an application for IT equipment which can allow this has been made.
A draft rota for each area staff group is available 4 weeks in advance so that any shortfall in staffing levels can be identified, met and adjustments made. The rotas’ are published 3 weeks in advance thus staff has advance warning of the site they will be working in. There is a further review 1 week in advance to consider any late notice cancellations or requests for additional sessions and sickness so that amendments can be made as necessary.
6. Measurement of improvement:details of how the effects of the planned changes were measured
The main measure used to support the efficient use of staff is the manpower budget, which was previously overspent. The new processes have transformed both team working and finances, allowing the opportunity to develop different ways of working and investment into changes in the skill mix. The graph below indicates a reduction in manpower overspend.

Key performance indicators for 2012-2013 do not reflect the changes as they are influenced by problems outside of the theatre control, such as bed shortages.
Previously staff duty times were not identified as a reason for delays to the list start, now staff allocation is influenced by the liststart time, ensuring that a full theatre team is available. Theatre start times and delays are identified and can be investigated.
Overtime has fallen therefore the manpower overspend has fallen.
7. Effects of changes:statement of the effects of the change; how far these changes resolve the problem that triggered the work; how this improved patient/client care; the problems encountered with the process of changes or with the changes
There is more flexibility in staff working thus theatres run more efficiently with an effective use of staff. Theatre policies and procedures have combined resulting in universal practice. As staff work in different areas they are becoming more aware of practice and patient care on the other sites and different specialties, therefore the roles and responsibilities of the staff are not just site specific. Patient care is of the same standard in all areas and best practice is shared throughout.
There continues to be more flexibility in staff working this is identified when recruiting new staff, which means that new staff are aware from the start that they may be required to work in all four hospitals.
8. Lessons learnt:statement of lessons learnt from the work; what would be done differently next time
Following the Plan, Do, Study, Act (PDSA) model for improvement we have realised that change takes time and improvements are made in small steps. This change is a slow iterative process, with adjustments made on every cycle.
In order to take the change process forward it is imperative that lines of communication remain open and clear, and that the change is inclusive of all concerned. Involving unions and staff at the start of the process helped the transitions to take place.
9. Message for others: statement of the main message you would like to convey to others, based on the experience described
Changing culture takes a lot of emotional effort and leadership but ultimately the change speaks for itself.

The NHS Wales Awards are organised by the 1000 Lives Improvement Service in Public Health Wales.