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Just a perfect day

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Marion Collict’s work to clarify and change ward roles meant nurses could concentrate on care and patients had a better experience

Perfection isn’t a word that is often mentioned in the NHS these days. But it was something that director of transformation at Luton and Dunstable University Hospital Foundation Trust Marion Collict was keen to achieve.

Her chief executive, Pauline Philip, a nurse by background, had set up a patient experience call centre in the hospital to obtain immediate patient feedback after discharge, and ensure improvement programmes were patient focused.

“While visiting a number of hospitals in Germany she noticed the delivery of nursing was different from here,” says Ms Collict. “She came back enthused to do things differently and set the challenge to deliver high-quality sustainable professional nursing care, and asked me to go about making that happen.”

Ms Collict’s strategy was to take a representative group - a domestic staff member, housekeeper, healthcare assistant, nurse, matron, discharge officer and ward clerk - and meet them every day for a couple of hours for two weeks.

The team started off thinking the problem was not having enough people but, after “digging and digging”, they believed the root cause was how far the nurse had moved from the bedside.

“The feedback from patients was that nurses didn’t know them and communication and discharge was poor,” she says.

The feedback from nurses concurred. “They said they couldn’t get to the bedside because they were distracted by so many non-nursing duties.”

Her team compiled a list of everything nurses and other ward staff groups undertake.

They found that nurses carried out 66 activities in which they could become involved - including, for example, the job of the ward clerk after the clerk had gone home.

“If we felt there was no added value in the nurse doing it - we put it to one side. We weren’t asking if the nurse needed to do it. For example, a lot of people would say nurses don’t have to wash patients, but I say they do.

“That whole exercise is about communication and observation - you can get a lot of information from that patient during that activity. The same with helping with meals. I was determined that the nurse would retain those elements of the role.”

She adds: “Registered nurses have handed over far too much to people who are not as skilled, and that is where it has gone wrong.”

So in the Perfect Ward Project - as the trust names it - there is one nurse and one healthcare assistant for every 10 patients, the ward clerk role and housekeeper roles are covered for longer, phones are diverted to the clerk instead of the nurses’ station, cleaners make the beds and a progress chaser follows up diagnostics.

“The Perfect Ward is so quiet - no phones ringing, no buzzers. People don’t even talk loudly - the noise level is one of calm and peacefulness,” says Ms Collict. “All the nurse and HCA do is focus on the 10 patients, their medication and care, and the ward sister is in supervisory role 7/7.

“After lunch, we are able to lower the lights and give patients a rest. It has to be seen to be believed, it’s a palpable difference.”

Changing the roles of people has made a dynamic difference, according to Ms Collict.

“The cleaners have been phenomenal and feel so much part of the ward team now,” she says. “One of our cleaners had never made a bed, and it took him half an hour to do his first one. But, by the end, he was making them in three minutes - and he’d noticed

that when patients moved in the bed, the sheets slipped, so he did something to the corners to make a fitted sheet so it didn’t move for love nor money.”

Patient experience satisfaction scores have gone from 72% and 65% the two months before the pilot to 91% after and the number of falls halved in the first month. Outcome measures continue to be monitored.

Ms Collict is now keen to roll it out to the whole trust, without making it a one size fits all approach.

Jenni Middleton

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