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Energise for exellence: our Portsmouth story


Portsmouth hospital was inspired to relaunch its quality improvement program with fantastic results

Portsmouth Hospitals NHS Trust (PHT) is a large general hospital with specialist renal transplant services, wards on three sites and is a military defence hospital unit too.

In September last year our hospital staff felt overwhelmed by huge numbers of quality and productivity improvement initiatives. So we decided to act and relaunch the roll out of our “productive ward program”, a tool that underpinned the trust quality improvement productivity and prevention (QIPP) objectives.

Our mission

It was about the same time that the Energise for Excellence (E4E) framework was being developed and since it combined all the quality improvements we wanted, we decided to seize the opportunity and use it as an overarching umbrella.

And so Portsmouth Hospitals NHS Trust launched its RTTC Bundle using “social movement theory”.

The aim was to empower clinical teams to lead and contribute to QIPP, with 5 key benefits:

  1. Quality: increase direct nursing time for patient care, improving the patient experience.
  2. Care Delivery: deliver a smooth patient healthcare journey
  3. Safety: increase nursing time to initiate preventative interactions to contribute towards a reduction in hospital acquired pressures ulcers, falls and medication errors.
  4. Cost: improve the timeliness of care interventions reducing the patients’ length of stay
  5. People: improve staff morale and job satisfaction

A clear plan was developed for the RTTC Bundle program that started with the productive ward foundation modules then adapted to include high impact actions and essence of care, such as “no delays” and “care environment”.

The results

Initially there were some reservations from staff about the bundling approach, with a ward manager saying “this isn’t going to work”. However now they not only feel that it works but there is a real “momentum and buzz from wards”. 

The bundle contributes towards the reduction in the patients’ length of stay, monitored as part of the cost improvement program in the trust. Some specific improvements include:

  • Increases in direct care time
  • Decreases in motion
  • Decreases in interruptions of staff
  • Increase in incident reporting with a reduction in serious incidents
  • Increase in RTTC Bundle healthcare scores

We monitor our progress to ensure sustainable improvements via thirty day reviews with the clinical teams. We even use our own sustainability healthcare scoring tool.

Early indicators demonstrate improvements in direct care time, increased by 14%, motion has reduced by a total of 13% and interruptions reduced by 73%. In addition the trust has seen a reduction in hospital acquired grade 3 and 4 pressure ulcers, a reduction in complaints and reductions in length of stay.

Time to celebrate

To celebrate the achievements so far we have:

  • Shared our story as a case study with the NHS Institute for Innovation and Improvement
  • Presented at local and national events (such as the recent NHS Innovation Expo in London)
  • Held external visits to PHT
  • Held a local competition for exemplar awards (winner due to be announced June to 2011).

We’re proud of our achievements, does it inspire you to energise for excellence?

Nicky Lucey is the deputy director of nursing at Portsmouth Hospitals NHS Trust and Caroline Churcher is the practice transformation sister.


Readers' comments (4)

  • I still don't know much about e4e, and would like to learn more, how is it applied in practice? Can it be applied to any care environment or just wards?

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  • nadine woogara

    Hi mike

    Thanks for your comment. We're going to be doing a series of these e4e stories, and we'll try to also publish a more general article describing the ins and outs in practice.


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  • Nadine, that's great, thankyou. But it is still confusing as to exactly what it is. Can we have a series of how this can be practically applied in different settings, say a ward, a walk in centre, community, Nursing home, etc etc?

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  • Hi Mike

    Each SHA has an E4E Regional Lead who will be able to tell you more and share what is happening in your area.

    Please contact me at and I can link you in with the relevant person.

    E4E National Implementation Director

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