Operation FLOW 2​ – FIREBREAK: Insights and Next Steps

Thursday, 7 December 2023

The recent targeted firebreak across our whole-system made a positive difference to our drive to reduce bed occupancy and enable improved flow across the acute sites in preparation for winter.

The key points from the firebreak remain crucial as we enter the winter period:

• Reducing our occupancy – even by a relatively small amount – can make a huge difference to our patients and staff.
• Every member of Team Lanarkshire has a part to play. Teams are working hard to further embed the Flow Foundation Bundle to improve patient flow and prevent unnecessary waiting for patients.
• Reducing the length of stay of patients is crucial to help us address our occupancy levels.  A particular focus continues on patients whose length of stay is 14+ days with clear plans in place to support their journey.

One of the key benefits of the firebreak was as a learning tool to help us better understand and refine the actions that make the biggest difference, so we can effectively target further Operation FLOW developments and firebreaks.

An exercise to capture the lessons learned from the firebreak has been competed to provide an overview of the system wide learning with, along with the learning from the acute sites, and North and South health and social care partnerships.

The firebreak approach involved two primary strategies: a system-wide review of inpatients with a stay exceeding 14 days and site-based improvement actions aimed at increasing discharges and reducing occupancy levels.

Our review process looked across both acute and community sites, focusing on patients with extended lengths of stay. We identified actions to enhance discharge planning and encountered various challenges, including the need for more explicit documentation and training on palliative care referral processes.

Each site provided valuable feedback, revealing the effectiveness of initiatives like Criteria Led Discharge (CLD) and frailty pathways. This feedback also highlighted the necessity for more robust discharge planning and reducing duplication of processes.

There was a promising shift in crucial performance metrics:

• A slight improvement in NHS Lanarkshire’s 4-hour compliance
• A significant reduction in patients waiting over 12 hours
• Stable occupancy levels with notable improvements at some sites.

Further work is now taking place on how to best embed the learning from the November firebreak and to agree the timing and details of the next firebreak. We will keep you updated on this work.

Thank you for your continued support. #TeamLanarkshire

We are current redeveloping our Operation FLOW webpages and will relaunch soon to give easier access information and resources for staff: www.nhslanarkshire.scot.nhs.uk/OperationFLOW .

Questions, comments or ideas can be sent to the project team by emailing: operationFLOW@lanarkshire.scot.nhs.uk

Operation FLOW 2​ – FIREBREAK: Reducing occupancy ahead of winter

Friday 24 November 2023

Thank you for everyone’s hard work this week on the short, targeted firebreak across our whole-system – community and acute sites. This has made a positive difference to our whole-system drive to reduce bed occupancy to enable improved flow across the acute sites in preparedness for winter. Well done #TeamLanarkshire!

We will share more details about the outcomes of the firebreak and the next steps next week.

The key points from the firebreak remain crucial as we enter the winter period:

• Reducing our occupancy – even by a relatively small amount – can make a huge difference to our patients and staff.
• Every member of Team Lanarkshire has a part to play. Teams are working hard to further embed the Flow Foundation Bundle to improve patient flow and prevent unnecessary waiting for patients.
• Reducing the length of stay of patients is crucial to help us address our occupancy levels.  A particular focus continues on patients whose length of stay is 14+ days with clear plans in place to support their journey.

Thank you for your support. #TeamLanarkshire

Questions, comments or ideas can also be sent to the project team by emailing: operationFLOW@lanarkshire.scot.nhs.uk

Operation FLOW 2​ – FIREBREAK: Reducing occupancy ahead of winter

Monday, 20 November 2023

This week will see the start of a short, targeted firebreak across the whole-system – community and acute sites. This will involve a whole-system drive to reduce bed occupancy to enable improved flow across the acute sites in preparedness for winter.

Some key points to note:

• Reducing our occupancy – even by a relatively small amount – can make a huge difference to our patients and staff.
• Every member of Team Lanarkshire has a part to play. Teams will be working hard to further embed the Flow Foundation Bundle to improve patient flow and prevent unnecessary waiting for patients.
• Reducing the length of stay of patients is crucial to help us address our occupancy levels.  A particular focus will be on patients whose length of stay is 14+ days with clear plans in place to support their journey.

Thank you for your support. #TeamLanarkshire

Questions, comments or ideas can also be sent to the project team by emailing: operationFLOW@lanarkshire.scot.nhs.uk

Operation FLOW 2 progress update from Monklands

Thursday 3 August 2023

The senior team at University Hospital Monklands have provided an update on the progress of Operation FLOW 2 in a video message for staff.

Hospital site director Stephen Peebles and chief of nursing services Karen Goudie talk about the progress being made and good work being done on the site as well as the next steps in the journey of Operation FLOW alongside director of acute services Judith Park, executive medical director Chris Deighan and chief executive Jann Gardner.

Operation FLOW 2 progress update from Hairmyres

27 July 2023

The senior team at University Hospital Hairmyres have provided an update on the progress of Operation FLOW 2 in a video message for staff.

Hospital deputy site director CJ Graham, chief of medical services Dr Claire McDougall and chief of nursing services Lise Axford talk about the progress being made and good work being done on the site as well as the next steps in the journey of Operation FLOW.

The video can be accessed on Vimeo and YouTube using the links below:

• Vimeo – https://vimeo.com/849034654
• YouTube – https://youtu.be/50tg7eWedVg

Operation FLOW 2: Progress update from Wishaw

Friday 21 July 2023

The senior team at University Hospital Wishaw have provided an update on the progress of Operation FLOW 2 in a video message for staff.

Hospital site director Claire Ritchie, chief of medical services Dr Ken Dagg, chief of nursing services David Watson and chief midwide Cheryl Clark talk about the progress being made and good work being done on the site as well as the next steps in the journey of Operation FLOW.

Chief executive Jann Gardner also gives her reflections on the learnings from Operation FLOW 1 and the importance of Operation FLOW 2 in preparing for winter.

Operation FLOW 2 University Hospital Wishaw_July 23 from NHS Lanarkshire on Vimeo.

Operation FLOW 2: A New Model of Care

Monday 5 June 2023

The last year, and the winter in particular, was a very challenging time for our services, our patients and our staff.  The impact of the COVID-19 pandemic continued to create service pressures with ongoing service disruption.  In response we developed a clear plan to help us redesign and rebuild our service to be more resilient and for Lanarkshire to be a good place to be cared for and to work – there is nothing more important than our people.

Earlier this year we launched our whole system improvement programme –  Operation FLOW 1 which included the very successful short term Firebreak in late February – early March.

During this time, we saw significant improvement across our system including improved opportunities to support people to remain well at home, reduction in hospital occupancy and length of stay and a very significant improvement in our 4 Hour A&E access and an important reduction in ambulance waits and 8 and 12 hour delays.

While it was disappointing that we could not sustain the improvements at that time, we took fantastic learning from this initial phase of the programme including the staff and patient positive reflections on the impact of improving flow across the whole system.

Since then a huge amount of work has been underway to build the second phase of this work which we are excited to launch this week: Operation FLOW 2 – a plan for a sustainable and resilient way forward with a clear focus on improving patient and staff experience as well as key performance improvements.

The new program is focused at improving the system across the full patient pathway from avoiding hospital admission through to discharge and beyond.  To ensure that we can sustain the improvement plans in we have established the Operation FLOW 2 Programme structure.

There are five Operation FLOW 2 Task & Finish Groups who are responsible for developing and implementing the key changes. These groups are:

• Group 1 – Overarching – escalation, system management, resource, performance
• Group 2 – Keeping People Well at Home
• Group 3 – Pan Lanarkshire Front Door Redesign
• Group 4 – Ward and System Flows
• Group 5 – Frailty and Off-site Beds

For more information about these groups, the leadership teams involved and the scope of their work please view our Operation FLOW 2 launch video which includes:

• Introduction and presentation Chief Executive Professor Jann Gardner
• Task and Finish Group 1 Chair Russell Coulthard, Deputy Director Acute Services (starts at 7m 23s)
• Task and Finish Group 2 Chair Claire Ritchie (starts at 10m 13s)
• Task and Finish Group 3 Chair Stephen Peebles (starts at 13m 09s)
• Task and Finish Group 4 Chair Margaret Meek (starts at 15m 38s)
• Task and Finish Group 5 Chair Trudi Marshall (starts at 18m 05s)

Operation FLOW 2 from NHS Lanarkshire on Vimeo.

The Operation FLOW 2 Programme includes three key steps:

Step 1 – A new Operation FLOW 2 Model of Care has been designed

The new model is based on the learning from the work earlier this year and key changes are planned to improve and implement a single pan Lanarkshire approach including:

• • Ward bundles – daily ward discharge beat, board rounds, am discharge focus etc.
  • Discharge lounge open 7 days a week to support discharge as early as possible
  • consistent pan Lanarkshire hospital and system huddles to look for early signs of system challenge and implement early actions to reduce pressures
  • refreshed FLOW Management teams with new resources focused on out of hours and weekends to help sustain our system across 7 days
  • Escalation Policy – step by step approach with clear roles and responsibilities to de-escalate as early as possible to reduce risk and improve patient care and staff experience

Step 2 – A review of the current use of temporary staff at front door with potential to create new permanent roles

Since 2019/20 we have increased the staff resource at our acute hospital front doors (Emergency Departments) by almost 17% however as many staff are not permanent this leads to challenges for teams in terms of local knowledge, skills and experience.  We are therefore committed to designing our new staffing model and to review the current temporary front door posts with a view to creating the right permanent roles instead.  This will be done on a post-by-post basis.

Step 3 – Despite the very significant financial challenges that we face this year we have agreed with our Board to invest over £5million in new posts

Investing in these new posts across the system will support the changes required. Following the firebreak, we listened to feedback from staff who told us investment in our workforce was important to making sustainable changes through Operation FLOW. Given the financial challenges facing NHS Lanarkshire and other Boards, it is important that we get the maximum benefit from this investment. The funding will help unlock the huge potential to make real changes through Operation FLOW, but by far the most important thing is how we make best use of our existing resources and workforce to transform our system.

Professor Jann Gardner, Chief Executive of NHS Lanarkshire, said: “I asked you for your support with Operation FLOW in February. I am really grateful for your amazing response in making the Firebreak a such a success. I am now asking you once again rise up and work with us to make the changes we desperately need in Lanarkshire.

“Every person, every penny, every week, every action makes a difference.  Together we can make Lanarkshire a brilliant place for our patients and staff. #TeamLanarkshire

“The huge prize ahead for all of us in getting it right is that we go into winter period confident that our system is robust and resilient to deliver high quality and safe patient care while ensuring staff wellbeing, even when our system is at its busiest.”

Operation FLOW 1 involved considerable whole-system development work undertaken jointly by NHS Lanarkshire, Health and Social Care North Lanarkshire, South Lanarkshire Health and Social Care Partnership and Scottish Ambulance Service and this will continue through the duration of Operation Flow 2.

Key learning and practice from the first phase of Operation FLOW are already being embedded by many staff. We need to replicate this right across our system over summer – even before the impacts of the additional investment are being felt.

We will share more details of the work of the five Task and Finish Groups as this progresses – along with details of how you can get involved and contribute to Operation FLOW 2.

To support staff with the changes and the introduction of the new model of care, we are developing an Operation FLOW Playbook. It will set out details of all the systems and procedures associated with Operation FLOW and staff’s individual roles and responsibilities for these. We look forward to your feedback on the playbook as it becomes an essential guide to how we deliver the best possible care.

If you have ideas, comments or questions, email us at operationFLOW@lanarkshire.scot.nhs.uk

#TeamLanarkshire