What is Operation FLOW?

Operation FLOW is a rapid improvement plan in response to the urgent and unscheduled care challenges across our services in Lanarkshire.

This is a fantastic opportunity that will bring the whole health and care system in Lanarkshire together in a concentrated and coordinated effort to stabilise and decompress our services, delivering benefits for both patients and staff.

It is being taken forward by NHS Lanarkshire, South Lanarkshire Health and Social Care Partnership, and Health and Social Care North Lanarkshire.

Operation FLOW, Overview

You can also watch the video via YouTube –  https://www.youtube.com/watch?v=w_ExQejv77E&feature=youtu.be

The letters of Operation FLOW encapsulate the planned approach:

• Focused – a time limited intervention with exit to a sustainable service model
• Lanarkshire – recognising the various geographies and demographics affecting our services across the County
• Optimal – focusing on patient safety and achievable service improvement during the project timescale rather than completely fixing the system, including learning from other systems
• Whole System – the project must be truly whole system covering the whole patient journey into and out of our health and social services.

Operation FLOW will include a nine-day “firebreak” when the whole health and care system in Lanarkshire will work together from Thursday 23 February to Friday 3 March 2023 on a concentrated and coordinated effort to stabilise and decompress our services.

This nine-day period is aimed at freeing staff from constantly fighting fires across our services. The firebreak’s goal is to stabilise our system – benefiting patient care and releasing the time and energy we need to make sustainable improvements for patients and staff through a new rapid improvement plan Operation FLOW.

• If the firebreak will relieve current services pressures, why not start it sooner?
• What will be different about the firebreak compared to what you are already doing?
• How do I find out more about Operation FLOW?

If the firebreak will relieve current services pressures, why not start it sooner?

The timing of the firebreak has been chosen as Thursday 23 February to Friday 3 March 2023 in order to allow enough time to involve our teams in developing the most effective set of actions. This timing will ensure the firebreak has maximum benefit. It is also important that have the time between now and the end of the firebreak to prepare for the follow phase of Operation FLOW so that we can successfully develop sustainable improvements for patients and staff.

In the meantime, we will continue to the hugely impressive work our staff have undertaken in recent weeks and months to keep our services running. We are grateful to all our staff and GPs for their continued efforts.

Back to questions

What will be different about the firebreak compared to what you are already doing?

The firebreak actions are still being developed and we will share further details when they are confirmed. Some of the actions the make up the firebreak may not be completely new. But the firebreak will involve work in a coordinated and concentrated way to bring an extra level of focus and priority to these actions for a short period of time to decompress our services.

Back to questions

How do I find out more about Operation FLOW?

We will post regular updates on this webpage as more details about the firebreak and Operation FLOW are developed and confirmed. This will include a weekly action plan update.

Back to questions

• Maintaining Good Flow Update –  Thursday 30 March 2023
• Maintaining Good Flow Update –  Friday 17 March 2023
• Maintaining Good Flow Update –  Friday 10 March 2023
• Media Release: NHS Lanarkshire celebrates staff success in reducing hospital pressures
• Firebreak – Day Nine
• Firebreak – Day Eight
• Firebreak – Day Seven
• Firebreak – Day Six
• Firebreak – Day Five
• Firebreak – Day Two
• Firebreak – Day One
• Week 0 Update
• Week -1 Update
• Week -2 Update
• Week -3 Update
• Week -4 Update

Maintaining Good Flow Update

Thursday 30 March 2023

Operation FLOW is a positive and ambitious plan to reset our system to improve flow through our system and improve the experience for our patients and staff. Operation FLOW has three stages:

• Stage 1 – Preparation & Reset – Driving the improvement bundles (Until Thursday 23 February)
• Stage 2 – Firebreak (Thursday 23 February to Friday 3 March)
• Stage 3 – Maintaining Good Flow – Implementing New Flow Model (Friday 3 March onward)

This week we are planning for the next stage of Operation FLOW.

The next stage will build on learning from the successful firebreak reflecting on our staff feedback received with an eye on more ideas to achieve sustainable improvements to our whole system.

As a result of the work delivered to date, we have a much better understanding of the challenges we face.

A short, medium and long term set of plans are being developed based on what we have learned from the firebreak with the focus remaining on sustainable improvement. It is recognised some additional work is required in order to align different parts of our system.

There is a strong need to continue to engage with clinical teams in order to embed the changes into daily practises and also create the right composition of teams to take forward sustainable improvements. This will take some time and focus.

There is also a need to invest in our workforce and our facilities as part of local delivery plans in order to make sustainable improvements.

It’s important to note that the firebreak improvements allowed our system to cope better during a challenging period across the whole of Scotland. With Boards across Scotland seeing a drop in performance, we, in Lanarkshire, were in a stronger position as a result of the improvements in performance during the firebreak.

So now let’s continue to work whole-system to continue our improvement journey and develop sustainable good flow.

And if you have ideas, comments or questions for the project team, email us at operationFLOW@lanarkshire.scot.nhs.uk

Maintaining Good Flow Update

Friday 17 March 2023

Whole-system collaboration is continuing across Lanarkshire to embed the learning from our Operation FLOW firebreak and continue our change journey.

Operation FLOW is a positive and ambitious plan to reset our system to improve flow through our system and improve the experience for our patients and staff. Operation FLOW has three stages:

• Stage 1 – Preparation & Reset – Driving the improvement bundles (Until Thursday 23 February)
• Stage 2 – Firebreak (Thursday 23 February to Friday 3 March)
• Stage 3 – Maintaining Good Flow – Implementing New Flow Model (Friday 3 March onward)

This week we have been reflecting on the firebreak and how to build on this through a series of articles on The Pulse capturing perspectives from different parts of the system:

• Sustaining the FLOW – reflections from Hairmyres
• Sustaining the FLOW – reflections from Wishaw
• Well-established collaboration crucial to fire break – South Health & Social Care
• Multi-disciplinary approach at Stonehouse Hospital
• Building on the success of Operation FLOW – View from the North

This will continue next week with an article capturing reflections from University Hospital Monklands.

The firebreak dramatically reduced pressure across the three acute hospitals reducing occupancy, increasing four-hour emergency standard performance, and leading to improved relationships and increased understanding among different teams.

As we continue our change journey it is crucial that continue to focus on embedding the FLOW Foundations bundle to maintain good flow. The bundle is a combined set of simple rules for all receiving and inpatient wards to improve patient flow and prevent unnecessary waiting for patients. It consists of:

• Discharge Beat for each ward
• Multi Disciplinary Team (MDT) Board Rounds (three times a day)
• Planned Date of Discharge (PDD)
• Criteria-led Discharge
• Pre-noon Discharge and Use of Discharge Lounge
• Real updating of patient movements on Trakcare

And if you have ideas, comments or questions for the project team, email us at operationFLOW@lanarkshire.scot.nhs.uk

Maintaining Good Flow Update

Friday 10 March 2023

Our Operation FLOW change journey is continuing to progress one week on from the successful firebreak.

Operation FLOW is a positive and ambitious plan to reset our system to improve flow through our system and improve the experience for our patients and staff. Operation FLOW has three stages:

• Stage 1 – Preparation & Reset – Driving the improvement bundles (Until Thursday 23 February)
• Stage 2 – Firebreak (Thursday 23 February to Friday 3 March)
• Stage 3 – Maintaining Good Flow – Implementing New Flow Model (Friday 3 March onward)

The firebreak dramatically reduced pressure across the three acute hospitals reducing occupancy, increasing four-hour emergency standard performance, and leading to improved relationships and increased understanding among different teams.

This week the focus has been on collecting learning as a result of the firebreak from across the system to inform the next stage of improvement journey to maintain good flow.

Our teams are continuing to use the FLOW Foundations Bundle which remains a priority and is key to maintaining improvement in flow.

Work on the firebreak took place right across our whole system, within and beyond he walls of our three acute hospitals. In the coming weeks we will shine a spotlight on the varied successes and ongoing improvement work.

Today’s update includes a video filmed at Stonehouse Hospital. Staff talk about their multi-disciplinary approach to patient rehabilitation and how the firebreak helped with their ongoing work to make the journey home as smooth as possible for those who are transferred from the acute sites.

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

• Vimeo – https://vimeo.com/806718480
• YouTube – https://www.youtube.com/watch?v=HI7fBo9fYWg

Thank you again to everyone who contributed to the firebreak – and for your continued enthusiasm and commitment to the next stage of our improvement journey.

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

NHS Lanarkshire celebrates staff success in reducing hospital pressures

Monday 6 March 2023

NHS Lanarkshire has dramatically reduced pressure across its three acute hospitals improving patient care and experience following a successful nine-day “firebreak”.

The firebreak, part of Lanarkshire’s positive and ambitious Operation FLOW plan, has resulted in a significant improvement in the percentage of patients meeting the four-hour emergency standard.

It also led to a big reduction in hospital occupancy levels over the nine-day period from Thursday 23 February until Friday 3 March, creating a safer and more effective environment for patients and staff.

Professor Jann Gardner, Chief Executive of NHS Lanarkshire, said: “After weeks of hard work to prepare, and a tremendous effort and focus across our whole system over the nine days, we have successfully achieved the first phase of changes to our system that have been so needed.

“Well done to all our wonderful colleagues in Lanarkshire right across our acute sites, community health and social care, and primary care. They have shown amazing focus, commitment, enthusiasm and energy to make the firebreak such a big success – and bring about immediate benefits to our patients and staff. Thank you too to the Lanarkshire public for their incredible support and understanding during the firebreak.

“We have achieved our initial aim of rapidly relieving pressure in Lanarkshire’s three university hospitals – Hairmyres, Monklands and Wishaw. While the firebreak may have ended, the service transformation is just beginning as we move to the next stage of Operation FLOW – Maintaining Good Flow.

“Significantly, our improved position has meant that we have been able to take the decision to step down from black status, the highest risk level, to red. This is the first time since July 2022 we have been in red, having previously been in black from October 2021 to May 2022.

“Getting out of black status and seeing our occupancy levels reduce below 100 per cent are huge milestones on our change journey and the result of the hard work and commitment our staff have shown before and during the firebreak.

“But they are only first steps and we know we must remain focused if we are to successfully reduce risk in a sustainable way and continue to make further improvements.

“There is much work still ahead to continue our progress and ensure we have robust and effective services to provide the best care we can.”

Operation FLOW has been developed over the last two months by the whole health and care system in Lanarkshire, working closely with key partners in North and South Lanarkshire Councils and the Scottish Ambulance Service.

Flow refers to the way patients move through a hospital, from admission to discharge. Improving hospital flow can lead to better patient outcomes, increased capacity, improved staff satisfaction, and improved patient safety. It helps reduce wait times and improve overall patient satisfaction.

Operation FLOW (Focused, Lanarkshire, Optimal, Whole System) is divided into three stages: Stage 1, Preparation & Reset; Stage 2, Firebreak; and Stage 3, Maintaining Good Flow, which will involve resetting our system to improve flow through our acute hospitals.

NHS Lanarkshire has now moved to stage 3 of Operation FLOW to build on the firebreak progress and introduce a new flow model to ensure sustainable improvements to our services.

Firebreak – Day Nine

Friday 3 March 2023

Well done #TeamLanarkshire! We did it! Our change journey has begun…

After weeks of hard work to prepare, and a tremendous effort and focus across our whole system over the last nine days, we have achieved the first phase of changes that have been so needed.

The Operation FLOW firebreak ends later today having already made a huge impact:

• A big reduction in occupancy levels – sitting at 94 % yesterday (down from 105% before firebreak)
• A significant improvement in the percentage of patients meeting the four-hour emergency standard – sitting at 71.7% yesterday (up from 49.7% before firebreak)
• The FLOW Foundations Bundle successfully embedded in the three university  acute hospitals
• Staff reporting a greater sense of control, coordination and calm, which is starting to have a positive impact on their wellbeing.

We will feedback more next week on the learning and successes from the firebreak. This will include a special feature on The Pulse website that zooms in on the work in each of the three hospitals and in the health and social care partnerships.

For now, please take a bow #TeamLanarkshire. You have shown amazing focus, commitment, enthusiasm and energy to make the firebreak such a big success – and bring about immediate benefits to our patients and staff.

Our Chief Executive Professor Jann Gardner has been visiting all of our acute sites during the firebreak. She recorded the following video during a visit to University Hospital Monklands yesterday thanking staff and reflecting on the success of the firebreak. The video can be accessed on Vimeo and YouTube using the links below:

• Vimeo –  https://vimeo.com/804311713
• YouTube –  https://youtu.be/WmizGsEfcXs

What happens next?

The firebreak may be ending, but the service transformation is just beginning. The improvements we have made during the firebreak are a springboard to the next stage of Operation FLOW.

Some of the additional resources and elements to support the firebreak, such as daily site multi-disciplinary team (MDT) meetings, will stand down from today. But it is vital that lots of other good work continues as we transition over the weekend into the next stage of Operation FLOW, especially Planned Date of Discharge and ward board-rounds using the SHOP script.

Crucially, the FLOW Foundations Bundle continues to be a priority and is key to maintaining improvement in flow.

From next week, we will start extending the FLOW Foundations Bundle with the phased and supported introduction of a new Optimal Flow Model. This will begin by being rolled out at University Hospital Hairmyres from Tuesday then across our acute and community hospitals in full discussion with site teams and staff.

We will continue to build on the successful joint work with the Scottish Ambulance Service on patient pathways.

We will keep growing the excellent relationship building and increased understanding that has developed between different teams during the firebreak.

We are also reviewing and agreeing what is needed in the short term to continue to support optimal flow across our system. One early example is the decision to continuing opening the discharge lounge at University Hospital Wishaw seven days a week.

Operation FLOW is a positive and ambitious plan to reset our system to improve flow through our system and improve the experience for our patients and staff. Operation FLOW has three stages:

• Stage 1 – Preparation & Reset – Driving the improvement bundles (Until Thursday 23 February)
• Stage 2 – Firebreak (Thursday 23 February to Friday 3 March)
• Stage 3 – Maintaining Good Flow – Implementing New Flow Model (Friday 3 March onward)

We said at the outset that your input was crucial to Operation FLOW. Thank you for answering the call in such an amazing and resounding way. #TeamLanarkshire We look forward to taking next step of the journey together as we get ready to enter stage 3.

And if you have ideas, comments or questions for the project team, email us at operationFLOW@lanarkshire.scot.nhs.uk

#TeamLanarkshire

Firebreak – Day Eight

Thursday 2 March 2023

Thank you for everyone’s continued commitment to making the firebreak a success. Discussions have taken place today with the acute site teams on how to build the positive progress made to ensure we continue to support optimal flow in our hospitals. We will share more details on the key actions being taken forward as they are finalised.

As we enter the ninth day tomorrow, we will gather all the key themes and feedback from the firebreak.  These will be collated into a report and key learning points shared with staff next week.

What is already clear is the huge amount of energy and the spirit of cooperation from staff across the whole system that has driven positive change over the last week – and the desire of everyone involved to see this progress continue. #TeamLanarkshire

Firebreak – Day Seven

Wednesday 1 March 2023

We are now on day seven of the Operation FLOW firebreak. Staff are continuing to show tremendous enthusiasm and effort to maintain the excellent progress made so far. #TeamLanarkshire

Today we are reminding staff that Planned Date of Discharge (PDD) is a crucial element of the FLOW Foundations bundle that supports the firebreak. PDD is an important part of daily discharge planning that should happen as part of the Multi-Disciplinary Team (MDT). A multi-media guide to PDD is available at: https://www.nhslanarkshire.scot.nhs.uk/hospitals/dwd-pdd/

A PDD – a specific date of discharge from hospital – should be identified at the earliest opportunity with plans made to agree a safe and appropriate transition back home.

Creating a clear destination and end point can alleviate stress and anxiety for the patient and carer. Crucially, the PDD programme takes into account a person’s medical and social care needs in terms of their ability to safely return home (or to a community setting.)

Planning a patient’s discharge journey as soon as they are admitted to hospital allows for any care needs to be set out in advance – which reduces any delay when it’s time to leave hospital.

The firebreak is already making a difference to our patients and staff by decompressing our system over a nine-day period from Thursday 23 February to Friday 3 March. Importantly, it sets up further reform to improve flow in a sustainable way in the longer term. We will be sharing further details later this week on the next stage that follows the firebreak.

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

#TeamLanarkshire

Firebreak – Day Six

Tuesday 28 February 2023

The excellent work across our whole system to support the Operation FLOW firebreak is continuing on day six. Thank you to all our staff as we look to keep the progress going for the remainder of the firebreak and beyond. #TeamLanarkshire Just one of many examples of the amazing work taking place is Hospital@Home which has being providing increased support and is receiving really positive feedback from patients and families.

The firebreak is already making a difference to our patients and staff by decompressing our system over a nine-day period from Thursday 23 February to Friday 3 March. Importantly, it sets up further reform to improve flow in a sustainable way in the longer term.

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

#TeamLanarkshire

Firebreak – Day Five

Monday 27 February 2023

We are continuing to see improvements across our acute sites on day five of the firebreak. Staff showed incredible commitment over the weekend working as a team to implement the firebreak. #TeamLanarkshire Community colleagues provided excellent support, and we are seeing real benefits in understanding and connection between community and acute staff through the multi-disciplinary teams.

Wards are working to deliver their Daily Discharge Beat – the number of discharges a day that need to take place in each ward to maintain a healthy flow through the hospital and keep overall occupancy at a safe level. Daily reports are providing wards with the information they need to achieve and track their discharge beat. At times some wards have achieved more than 200 per cent of their daily beat which is a fantastic achievement.

The Daily Discharge Beat is part of the FLOW Foundations bundle which has been introduced to support staff with Operation FLOW. It is a package of simple rules that underpins not just the firebreak, but also the maintenance of good flow on an ongoing basis.

The firebreak is already making a difference to our patients and staff by decompressing our system over a nine-day period from Thursday 23 February to Friday 3 March. Importantly, it sets up further reform to improve flow in a sustainable way in the longer term.

Firebreak – Day Two 

Friday 24 February 2023

A massive thank you to staff for pulling together to ensure that the hugely positive start to the Operation FLOW firebreak has continue into day two. #TeamLanarkshire

The firebreak methodology and actions are being successful embedded across the whole-system – and this is being reflected in positive progress to decompress the three acute hospitals. Senior staff are looking forward to seeing staff and listening to their feedback when they visit our sites at the weekend.

This is the start of our journey to stabilise our system to set up reform that improves flow and experience for our patients and staff in a sustainable and robust way.

Professor Jann Gardner, NHS Lanarkshire chief executive, included an update on the firebreak at the end of her weekly video which was filmed during a visit to the primary care out of hours service Dr Chris Deighan, NHS Lanarkshire executive medical director, on Thursday 23 February.

The video, which was also shared earlier today in the weekly email staff briefing, can be accessed on Vimeo and YouTube using the links below:

• Vimeo –  https://vimeo.com/801991125
• YouTube –  https://youtu.be/G1mKXt0vpAA

Firebreak – Day One 

Thursday 23 February 2023

The Operation FLOW firebreak is off to a really positive start on day one, with excellent work underway across our acute hospitals. Teams are already making good progress across the range of measures in the FLOW Foundations Bundle, such as pre-noon discharges and use of discharge lounges, and we are seeing a positive impact on site occupancy.

Enormous thanks to everyone for the commitment and effort to get us to this point and make the firebreak happen. #TeamLanarkshire

The firebreak is our chance to make a massive difference to our patients and staff by decompressing our system over a nine-day period from Thursday 23 February to Friday 3 March. Importantly, it sets up further reform to improve flow on an ongoing basis.

Each day, we will give a reminder of the key elements of Operation FLOW. Today we are focusing on Planned Date of Discharge (PDD). This is an important part of daily discharge planning that should happen as part of the Multi-Disciplinary Team (MDT). A multi-media guide to PDD, along with further guides to Discharge Without Delay and Discharge To Assess, is available at: https://www.nhslanarkshire.scot.nhs.uk/hospitals/dwd-pdd/

PDD is person centred, as the discharge is planned around the patient and not on the availability of care, equipment or long term care placement.

The key feature of PDD is MDTs of health and care professionals working together with hospital staff and looking at discharge planning with the patient and family as soon as possible. A PDD – a specific date of discharge from hospital – is identified at the earliest opportunity with plans made to agree a safe and appropriate transition back home.

Creating a clear destination and end point can alleviate stress and anxiety for the patient and carer. Initial and overwhelming positive feedback from patients and carers strongly indicates PDD makes the reduction of worry a reality. Crucially, the PDD programme takes into account a person’s medical and social care needs in terms of their ability to safely return home (or to a community setting.)

Planning a patient’s discharge journey as soon as they are admitted to hospital allows for any care needs to be set out in advance – which reduces any delay when it’s time to leave hospital.

Operation FLOW is a positive and ambitious plan to reset our system to improve flow through our system and improve the experience for our patients and staff. Operation FLOW has three stages:

• Stage 1 – Preparation & Reset – Driving the improvement bundles (Until Thursday 23 February)
• Stage 2 – Firebreak (Thursday 23 February to Friday 3 March)
• Stage 3 – Maintaining Good Flow – Implementing New Flow Model (Friday 3 March onward)

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

#TeamLanarkshire

Week 0 Update

Wednesday 22 February 2023

There is just one day left until the Operation FLOW firebreak begins. Thank you to everyone involved for the huge amount of work to bring us to this stage. #TeamLanarkshire

The firebreak is our chance to make a massive difference to our patients and staff by decompressing our system over a nine-day period from Thursday 23 February to Friday 3 March. Importantly, it sets up further reform to improve flow on an ongoing basis.

Throughout the firebreak we will use a range of measures to monitor its impact on daily basis. This will ensure we learn from and respond to what is happening with the firebreak. We will share key updates from this process with staff.

Today we have issued a media release asking for the public’s support to make our firebreak a success. This will be supported by social media messaging during the firebreak.

In the coming days we will highlight key parts of Operation FLOW. Today we are focusing on Board rounds which are a structured way to support the day-to-day running of the ward and help the ward team manage patients safely and effectively. They bring the multi-disciplinary team together daily to ensure everyone is working jointly to ensure patients get the best care and are discharged home when they are ready.

During a board round staff will review each patient, sharing information on what has happened with the patient since they last met. They will ensure there is a plan in place for the patient for that day. We have produced a video about board rounds which was filmed at University Hospital Monklands. It can be viewed at the following links:

• Vimeo – https://vimeo.com/799451448
• YouTube – https://youtu.be/nSXDk_SXU28

Tuesday 21 February 2023

There are two days left until the Operation FLOW firebreak begins.

The firebreak is our chance to make a massive difference to our patients and staff by decompressing our system over a nine-day period from Thursday 23 February to Friday 3 March. Importantly, it sets up further reform to improve flow on an ongoing basis.

What does Operation FLOW mean for my ward?

In each ward, every day:

• Protect time to plan/prepare (3 x daily structured board rounds)
• From admission, set a Planned Date of Discharge (PDD) as a team with patient/significant others
• Adopt a ‘day before’ approach to discharge letter, drugs, transport booking, etc.
• Implement ordered ward rounds (see sick patients first; then planned discharges; then others)
• Use criteria-led discharge
• Use your ward discharge beat to support hospital flow
• Discharge lounge as default to support pre-noon discharges
• Communicate and escalate where flow barriers exist to the site huddles

When discharge planning is more complex also ensure:

• Early discussion with patient and family re existing care/home situation
• Understanding of when existing care might stop (care packages will be held open for 72 hours)
• Consider Discharge to Assess
• Therapy assessments if required
• Equipment ordering in advance of PDD

Seek support from your social work and discharge team to support complicated and complex discharges.

The attached FLOW Foundations Bundle and Pathway provides more information to support staff with Operation FLOW within their area.

Operation FLOW is a positive and ambitious plan to reset our system to improve flow through our system and improve the experience for our patients and staff. Operation FLOW has three stages:

• Stage 1 – Preparation & Reset – Driving the improvement bundles (Now to Thursday 23 February)
• Stage 2 – Firebreak (Thursday 23 February to Friday 3 March)
• Stage 3 – Maintaining Good Flow – Implementing New Flow Model (Friday 3 March onward)

And if you have ideas, comments or questions for the project team, email us at operationFLOW@lanarkshire.scot.nhs.uk

#TeamLanarkshire

Monday 20 February 2023

There are three days left until the Operation FLOW firebreak begins.

The firebreak is our chance to make a massive difference to our patients and staff by decompressing our system over a nine-day period from Thursday 23 February to Friday 3 March. Importantly, it sets up further reform to improve flow on an ongoing basis.

As part of the final preparations, Q&A sessions with our Chief Executive Professor Jann Gardner on Operation FLOW are being held at each of the acute hospitals tomorrow (Tuesday 21 February 2023).

Professor Gardner will be joined by Chris Deighan, Executive Medical Director, Eddie Docherty, Executive Nurse Director, Judith Park, Director of Acute Services and Colin Lauder, Director of Planning, Property and Performance.

The sessions are an opportunity for staff to hear the details of Operation FLOW and ask any questions they have.

Details of the briefing sessions have been issued on each site. Please be aware that numbers at each briefing are limited. Here is a reminder of the times and venues:

• The University Hospital Hairmyres session will take place on Tuesday 21 February 2023 in the Lecture Theatre, Hairmyres Hospital between 0900 and 1030 hrs.
• The University Hospital Wishaw session will take place on Tuesday 21 February 2023 in Conference Room 1, University Hospital Wishaw between 1200 and 1300 hrs.
• The University Hospital Monklands session will take place on Tuesday 21 February 2023 in the Lecture Theatre, University Hospital Monklands between 1400 and 1600 hrs.

Operation FLOW is a positive and ambitious plan to reset our system to improve flow through our system and improve the experience for our patients and staff. Operation FLOW has three stages:

• Stage 1 – Preparation & Reset – Driving the improvement bundles (Now to Thursday 23 February)
• Stage 2 – Firebreak (Thursday 23 February to Friday 3 March)
• Stage 3 – Maintaining Good Flow – Implementing New Flow Model (Friday 3 March onward)

And if you have ideas, comments or questions for the project team, email us at operationFLOW@lanarkshire.scot.nhs.uk

#TeamLanarkshire

Week -1 Update

Friday 16 February 2023

We now have less than one week to go until the start of our Operation FLOW firebreak and preparations are in their final stages.

Operation FLOW is a positive and ambitious plan to reset our system to improve flow through our system and improve the experience for our patients and staff. Operation FLOW has three stages:

• Stage 1 – Preparation & Reset – Driving the improvement bundles (Now to Thursday 23 February)
• Stage 2 – Firebreak (Thursday 23 February to Friday 3 March)
• Stage 3 – Maintaining Good Flow – Implementing New Flow Model (Friday 3 March onward)

The firebreak is our chance to make a massive difference to our patients and staff by decompressing our system over a nine-day period from Thursday 23 February to Friday 3 March.  Importantly, it sets up further reform to improve flow on an ongoing basis.

Play your part by making sure you know what is happening within your ward or service. We will be emailing staff daily in the final run up to the firebreak and during it. Please look out for these important communications to ensure you are full informed and can help support this crucial work.

Our Chief Executive Professor Jann Gardner was out at University Hospital Hairmyres this week meeting staff members ahead of the firebreak. She talks about Operation FLOW at the start of her weekly video (also circulated in today’s NHS Lanarkshire email staff briefing):

• Vimeo – https://vimeo.com/799831289
• YouTube – https://youtu.be/XpB6keaoBs0

To support the firebreak a Flow Foundation Bundle is being developed and will be issued next week before the firebreak begins. The bundle is a combined set of simple rules for all receiving and inpatient wards to improve patient flow and prevent unnecessary waiting for patients. It consists of:

• Discharge Beat for each ward
• Multi Disciplinary Team (MDT) Board Rounds (three times a day)
• Planned Date of Discharge (PDD)
• Criteria-led Discharge
• Pre-noon Discharge and Use of Discharge Lounge

The Discharge Beat is the number of discharges a day that need to take place in each ward to maintain a healthy flow through the hospital and keep overall occupancy at a safe level. Daily reports will provide wards with the information they need to achieve and track their discharge beat. The daily reports will start next week.

Three-times-a-day Board rounds are a structured way to support the day-to-day running of the ward and help the ward team manage patients safely and effectively. They bring the multi-disciplinary team together daily to ensure everyone is working jointly to ensure patients get the best care and are discharged home when they are ready. During a board round staff will review each patient, sharing information on what has happened with the patient since they last met. They will ensure there is a plan in place for the patient for that day. We have produced a video about board rounds which was filmed at University Hospital Monklands. It can be viewed at the following links:

• Vimeo – https://vimeo.com/799451448
• YouTube – https://youtu.be/nSXDk_SXU28

Planned Date of Discharge (PDD) is an element of daily discharge planning that should happen as part of the MDT. A multi-media guide to PDD is available at: https://www.nhslanarkshire.scot.nhs.uk/hospitals/dwd-pdd/

Criteria-led Discharge helps wards that routinely have patients transferred from the Emergency Department and Assessment Units on a daily basis to create capacity pre-noon for the new and incoming patients. Wards should use nurse-led criteria led/facilitated discharge for patients with clear clinical criteria for discharge.

Patients should go to the discharge lounge on the morning of their day (pre-noon) of discharge from hospital. Making use of the discharge lounge provides an appropriate environment for patients while helping hospital flow by freeing up acute beds for patients awaiting admission.

In addition to the Flow Foundation Bundle, a Communication and Escalation Pyramid Standard Operation Procedure (SOP) for Firebreak is also being finalised and will be issued next week. The purpose of this SOP is to describe the communication and escalation pyramid that will be in place during the nine-day firebreak period. It also describes the roles and responsibilities of all team members to support flow to achieve the objective of firebreak to reduce hospital occupancy and decompress the system.  Safe and effective patient flow is critical to ensuring patients receive high quality care. 

Staff and teams across our health and care system have worked together to make huge progress in developing Operation FLOW in recent weeks. #TeamLanarkshire Thank you for the commitment and enthusiasm you have shown to developing and preparing for the firebreak which includes the following key actions:

1. A mobile multi-agency team will undertake a daily review of all acute inpatients across the nine days. The objective of this team is to identify actions that can be taken to facilitate discharge or transfer to a more appropriate location to reduce the number of additional patients across our acute hospitals.
2. A mobile multi-agency team will undertake a daily review of all patients in an offsite bed across the nine days. The objective of this team is facilitate discharge and create flow from our acute sites.
3. The mobile multi-agency teams will capture the number of clinical stable patients who are waiting for a diagnostic test by modality. They will endeavour to expedite these tests/procedures to facilitate discharge.
4. Provision of professional-to-professional clinical making support for care home residents prior to conveying to hospital.  Scottish Ambulance Service (SAS) crews will use consultant connect to access support and advice from emergency medicine colleagues for patients prior to making a decision to convey to hospital (excluding 999 category patients).
5. Reduce the number of access routes to hospital based urgent and emergency care. All potential referrals to Emergency Department, Care of the Elderly and Hospital @ Home from SAS crews will go via Consultant Connect to determine if there are other alternative care options rather than hospital (excluding 999 category patients).
6. Expand access to ambulatory care during the firebreak period by increasing hours of operation over the weekend period and redirection of patients referred by NHS 24 on 111 to treatment rooms for wound care, minor burns, etc.
7. Increase senior clinical decision maker resource in Hospital @ Home to support more people in the community for the duration of the firebreak period.
8. Increase capacity within care home teams within Wishaw and Cumbernauld areas to support discharge.

And if you have ideas, comments or questions for the project team, email us at operationFLOW@lanarkshire.scot.nhs.uk

Week -2 Update

With less than two weeks to go to the firebreak, this briefing sets out some key information that staff need to know to prepare for this important part of Operation FLOW.

Operation FLOW is a positive and ambitious plan to reset our system to improve flow through our system and improve the experience for our patients and staff. Operation FLOW has three stages:

• Stage 1 – Preparation & Reset – Driving the improvement bundles (Now to Thursday 23 February)
• Stage 2 – Firebreak (Thursday 23 February to Friday 3 March)
• Stage 3 – Maintaining Good Flow – Implementing New Flow Model (Friday 3 March onward)

The firebreak will involve concerted efforts to decompress our system to give us head space for a next phase of reform. This next phase of Operation FLOW will focus on evolving our services, reviewing our resources and refresh our flow model.

To hear more about why Operation FLOW is happening watch our overview video:

Or watch on Vimeo.

To ensure we are ready, it is essential that staff take the time to discuss and agree what is happening within their ward or area of the hospital so they know their role in preparation for and during the firebreak. #TeamLanarkshire

In particular staff should be familiar with the following:

• Discharge beat
• Board rounds
• Discharge lounges
• Discharge without Delay (DwD), Planned Date of Discharge (PDD) and Discharge to Assess (D2A) Programmes

One of the key concepts at the heart of the Operation FLOW and the firebreak is the ward discharge beat. Each ward will be given its own discharge beat. This is number of discharges a day that need to take place to maintain a healthy flow through the hospital and keep overall occupancy at a safe level.

Just like a patient’s heartbeat, an acute hospital needs to keep a regular discharge beat if it is to function normally. When too many beats are missed flow is interrupted and the hospital, patients and staff will start to experience difficulties.

Daily update reports will provide wards with the information they need to track if their discharge beat is at, above or below the required level. This will allow staff to take early action before things begin to deteriorate.

Good flow across the hospital is a result of all areas of the hospital playing their part.  By knowing and monitoring your ward’s discharge beat you can keep the hospital functioning well and our patients and staff safe.

Work is taking place through Operation FLOW to identify the daily discharge beats for each ward area. Daily reports are expected to begin by Monday 20 February 2023.

Board rounds bring the multi-disciplinary team together daily to ensure everyone is working jointly to ensure patients get the best care and are discharged home when they are ready.

During a board round staff will review each patient, sharing information on what has happened with the patient since they last met. They will ensure there is a plan in place for the patient for that day

Staff should identify any barriers to discharge and ensure actions are agreed and allocated to make any delays are resolved. This enhances patient experience and reduces the risk factors associated with a prolonged hospital stay

Those attending the board round as part of the multi-disciplinary team can include: consultants, senior charge nurses, social work, occupational therapists, pharmacists, physiotherapists and junior doctors.

We are developing a video on the Lanarkshire approach to board rounds which will be shared in advance of the firebreak.

Discharge lounges are relaxing and comfortable areas within the hospital for patients awaiting discharge. Patients should go to the discharge lounge on the morning of their day of discharge from hospital.

Making use of the discharge lounge provides an appropriate environment for patients while helping hospital flow by freeing up acute beds for patients awaiting admission.

Discharge lounge staff will work closely with the ward staff, transport, social services and pharmacy to ensure your safe discharge from the hospital.

We have developed a one-stop essential staff and partner guide to our Discharge without Delay (DwD), Planned Date of Discharge (PDD) and Discharge to Assess (D2A) Programmes.

The guide includes a multi-media guide to watch, read, listen and learn about the key components of PDD, DwD and D2A – and, crucially, why we’re implementing them. It is available at: https://www.nhslanarkshire.scot.nhs.uk/hospitals/dwd-pdd/

Understanding your role in relation to Operation FLOW and these key areas is crucial to its success. #TeamLanarkshire

We are now in week -1 in the countdown toward the start of the Operation FLOW firebreak with massive progress being made across all our services in preparation for the firebreak.

Updates and progress from week -2 include the following:

• NHS Lanarkshire’s Capital Investment Group approved funding to start a programme of work to expand clinical space in the University Hospital Wishaw Emergency Department. The first phase will create an additional seven treatment bays and provide improvements to current space, with additional phases planned to further increase capacity. Work is expected to start next week and be completed in 2023.  The upgrade work will be taken forward in a number of distinct phases due to the constraints of space and the need to maintain a working in the Emergency Department throughout the building works. The work is being carried out in a way to avoid any disruption to the functioning of the department.
• Well done to staff for the reduction in the 12-hour waits in our Emergency Departments as Operation FLOW actions start to be implemented
• Creation of a new senior manager data dashboard to provide comprehensive metrics from our across our sites in real time. Regular monitoring of this information will be an important part of the firebreak and our new flow model
• Review and learning from the mini firebreak at University Hospital Wishaw during the previous week. To find out more about this, watch our videos with our Chief Executive Professor Jann Gardner and Medical Director Dr Chris Deighan and the UHW triumvirate:
  • https://vimeo.com/797427809
  • https://youtu.be/jbG6U6A3M6g
  • https://vimeo.com/797418656
  • https://youtu.be/zO-cYEoWZ4E

And if you have ideas, comments or questions for the project team, email us at operationFLOW@lanarkshire.scot.nhs.uk

Week -3 Update

It has been another busy week for Operation FLOW as preparations for the firebreak continue and plans really take shape. Operation FLOW is a positive and ambitious plan to reset our system to improve flow through our system and improve the experience for our patients and staff. Operation FLOW has three stages:

• Stage 1 – Preparation & Reset – Driving the improvement bundles (Now to Thursday 23 February)
• Stage 2 – Firebreak (Thursday 23 February to Friday 3 March)
• Stage 3 – Maintaining Good Flow – Implementing New Flow Model (Friday 3 March onward)

Why is Operation FLOW happening? We have seen the challenges facing our services and listened to the feedback from our staff. Our whole health and care system continues to be under pressure and is not yet stabilising. We have heard your concerns and recognise the challenges with staff fatigue, long waits for patients, and difficulties in providing the best possible care in the right places. We all want a safer environment for our patients and staff. Operation FLOW is our plan to address this so we call all pull together to and make important changes to our system that will make improvements for our patients and staff.

In the first phase we are making concerted efforts to decompress our system through a short firebreak to give us head space for a next phase of reform. This next phase of Operation FLOW will focus on evolving our services, reviewing our resources and refresh our flow model.

To hear more about why Operation FLOW is important view our new video with NHS Lanarkshire Chief Executive Professor Jann Gardner:

Professor Jann Gardner, Chief Executive

Staff message 3 February 2023

You can also watch the video via YouTube –  https://youtu.be/WghBimcvfmI

A huge amount of work is already taking place across the whole health and care system to make Operation FLOW a success. Thank you to everyone involved. If you aren’t already part of Operation FLOW we are asking you to consider ‘How can I help make a difference?’ – working together we can make this project a real success. #TeamLanarkshire

We are now in week -2 in the countdown toward the start of the Operation FLOW firebreak in 19 days’ time.

Progress in week -3 includes:

• Further developing our firebreak plans (see below for more details)
• A mini firebreak taking place throughout the week at University Hospital Wishaw to introduce improvements early and test them ahead of the whole system firebreak
• Visits to Ninewells Hospital in Dundee NHS Tayside and Queen Elizabeth Hospital in Glasgow NHS Greater Glasgow and Clyde to see NHS Tayside and NHS Greater Glasgow and Clyde’s flow models in action and apply learning to Lanarkshire’s plans
• Reintroduction of the Scottish Ambulance Services’ Hospital Ambulance Liaison Officers (HALOs) back into our acute hospital sites
• Listening to staff feedback as to inform plans including: staff input to shape local firebreak preparations; developing an Operation FLOW evaluation survey to capture staff viewpoints; a feedback inbox for questions and comments (email us at OperationFLOW@lanarkshire.scot.nhs.uk)
• Issuing a media release issued to announce Operation FLOW publicly: https://www.nhslanarkshire.scot.nhs.uk/pulse-news-ambitious-plan-to-improve-patient-flow-and-care/

The firebreak key actions in detail are:

1. Commission mobile multi-disciplinary teams (MDTs) to undertake a daily review of all patients for the nine-day firebreak to ensure that all patients meet the criteria to reside in an acute bed
   AND
2. Commission a mobile multi-disciplinary team to undertake a daily review for the nine-day firebreak to ensure that each patient meets the criteria to reside in an off-site bed

• • The multi-disciplinary teams will include health and social care staff. This will be a supportive approach to assisting staff already working in these areas.
  • All inpatient areas will have flow foundations in place which include whiteboards, board rounds and ward based safety huddle in place ahead of Firebreak. Wards will be fully supported in this – led by the acute site directors and further supported by NHS Lanarkshire’s Quality Directorate, service improvement managers and Scottish Government’s national improvement advisors.
  • Confirming criteria to reside checklists for the review of all inpatients
  • Provision of additional portering / transport (via taxis) / domestic staff to support pharmacy and discharge processes as identified via multiagency process
  • Confirming daily escalation and action process to support

3. Expediting clinically stable inpatients waiting for diagnostics to discharge

• • This is linked this action to the inpatient MDT and criteria to reside process
  • Confirming daily escalation and action process to support MDT teams in identifying patients who are clinically stable but awaiting diagnostics ahead of discharge
  • Exploring use of Medica (remote radiology) for scans, in particular during the out-of-hours period to speed up discharge
  • Looking at the number of patients in this category using Demand, Capacity, Activity and Queue (DCAQ) methodology in order to scope the creation of a diagnostic virtual ward for post-firebreak Operation FLOW improvement sprint.

4. Provide professional-to-professional clinical decision making support for care home residents prior to conveying residents to hospital

• • Developing a process where all potential referrals from care homes are reviewed via a professional-to-professional clinical decision making support function prior to making the decision to transfer to hospital
  • Developing a standard operating procedure for Scottish Ambulance Service (SAS) crews to seek further guidance via Consultant Connect / Flow Navigation Centre (FNC) for patients who are unseen by a GP and not requiring a 999 response
  • Determining and scope what role there is for the FNC in coordinating these calls during the firebreak period
  • Determining and scoping the workforce implications for the clinical teams to implement this process
  • Scoping the opportunities for community nursing to teams to provide support specific care homes with assessment prior to a plan to convey to hospital.

5. Reduce the number of access routes to hospital based urgent and emergency care during the period of the firebreak

• • All potential referrals to the emergency departments, care of the elderly and Hospital @ Home from the Scottish Ambulance Service (SAS) will go through Consultant Connect for the duration of the firebreak this is to manage demand by determining if redirection is possible.

6. Expand access to Ambulatory Care for the duration of the Firebreak

• • Re-directing patients referred from NHS 24 via 111 from FNC to treatment rooms for wound care, minor burns etc.  Demand scoping ongoing with resource and pathways being developed.

7. Increase senior clinical decision maker resource in Hospital@Home (H@H) to support more people in the community for the duration of the firebreak period

• • Scoping the potential to reduce care of the elderly clinics during the firebreak to increase senior clinical decision maker resource for H@H
  • Scoping the feasibility of extending the time of the last referrals accepted by H@H and increasing resources over the weekend of the firebreak period
  • Determining the workforce model to support the expansion in service i.e. advanced nurse practitioners and nursing staff
  • FNC to offer all SAS H@H review prior to conveying to hospital for the period of the firebreak

8. Increase capacity within Home Care Teams within Wishaw and Cumbernauld Localities

• • Expanding capacity in Home Care teams for Wishaw and Cumbernauld localities to support Discharge.

Week -4 Update

Wednesday 25 January 2023

The Operation FLOW plans were presented to the NHS Lanarkshire Board on Wednesday 25 January 2023 where members positively welcomed and supported them. To access the full agenda and papers for the Board meeting visit: https://www.nhslanarkshire.scot.nhs.uk/about-us/board/

A recording of the meeting is also available to view on YouTube until 5pm on Friday 13 February. The Operation FLOW is in part 1 and starts at 1:39:41:

• Part 1: https://www.youtube.com/watch?v=Iz5T7ikd-9o
• Part 2: https://youtu.be/k75CpUjkBjI

Now to Thursday 23 February – Driving the improvement bundles

The focus of our work is to reset our system improving patient flow using all tools available. This includes:

• active flow out of the emergency departments;
• clear management plans;
• setting early planned date of discharge (PDD);
• and every ward ensuring discharges are actioned as early as possible.

We are working on all of this ahead of our full firebreak.

• Firebreak Key Actions

Other progress includes:

• Confirmation of quality improvement support for Operation FLOW by the Quality Directorate
• Operation FLOW project board agreement to set up a data group to ensure we effectively measure the impact of Operation FLOW our performance
• Launch of a reset of our internal communications approach to ensure we best support Operation FLOW and communicate effectively with you
• Launch of an Operation FLOW inbox for staff to let us know their questions and comments. Email us at operationFLOW@lanarkshire.scot.nhs.uk