Leading change

The Nurse Matrons and Senior Phlebotomist at Nottingham University Hospitals NHS Trust (NUH) have jointly led a programme of work which has a number of successful outcomes including reducing phlebotomy waiting times and improving patient experience of the service as a whole.

Where to look

The Matrons of Ambulatory Care and the Phlebotomist in Outpatient Phlebotomy completed an internal review  of waiting times (using a system called ‘Q FLOW’) as there was observable unwarranted variation with an increase in waiting times seen in the outpatient department. This was also linked to an increased number of feedback cards from patients describing the waiting times were negatively impacting on their experience of the Trust. The Matrons & the Phlebotomist undertook the review to look in more detail at current practice and identify what changes needed to be made to improve outcomes for patients.

What to change

The review highlighted the unwarranted variation in the form of patients  waiting up to two hours to have their blood taken, where local policy and Key Performance Indicators stated this should be no longer than 30 minutes. The team identified opportunities to address this variation by looking at service opening times, staggering staff break times, departmental skill mix development and other functional changes to improve the pathway as a whole.

How to change

Having identified the unwarranted variation and the possible actions, the Matrons and Senior Phlebotomist led a quality improvement programme based initiative within the department. The approach to be used was discussed and agreed at a staff meeting with management and the team of phlebotomists delivering the service. A three step approach was implemented:

• Step 1: They held ‘promoting positive practice’ sessions with the phlebotomists to share ideas and listen to any concerns they had;
• Step 2: The kiosk times were altered to match the opening times of the department;
• Step 3: Staff lunch times were staggered to meet the demands of the service.

After the 3 month pilot, they evaluated the effectiveness of the changes made by capturing feedback from patients and staff.  Results showed reduced waiting times that also resulted in reduced complaints as well as increased staff morale. The new opening times were advertised on the NUH web site and are clearly displayed outside the department. The changes are now permanent and the team continue to have positive feedback from patients in relation to waiting times.

Adding value

• Better outcomes – Further evaluation will be completed to identify other areas of improvement in this piece of work which contribute to patient outcomes. The team noted a reduced waiting time for phlebotomy which could result in more timely appointments which may expedite the identification and treatment of health concerns for patients using the service.
• Better experience – Shortened waiting times for patients were identified as leading to a greater patient satisfaction especially where patients were visiting more than one department at the Trust. Increased staff morale allowing for job satisfaction was noted by the team. Feedback cards from patients also demonstrate that they are increasingly satisfied with the service provided as the waiting times decrease.
• Better use of resources – Staff were now able not only to meet the demand in outpatients when the service users had been seen, but were also able to offer extra support to the wards if needed. The monthly data demonstrates that the waiting times have clearly reduced, highlighting significant improvements and reduced unwarranted variation in practice:
  • May 2017; 3988 patients had their bloods taken; 33% of patients seen within 30 minute goal; Average waiting time: 29 minutes and 13 seconds.
  • September 2017; 3893 patients had their bloods taken; 63% seen within the 30 minute goal; Average waiting time: 13 minutes and 38 seconds.
  • October 2017; Average waiting time: 15 minutes 27 seconds.

 Challenges and lessons learnt for implementation

The Nurse Matron and Senior Phlebotomist reflect that small scale change can be made without any financial cost. Such projects to address unwarranted variation can be resolved in a timely manner if there is engagement with all staff and patients involved.

The team reported the challenge in changing the mind-set of the staff involved, so that when they came on duty they would start venepuncture straight away rather than doing other tasks first which are now done throughout the day during quieter times.

While it was a change in process for the nurses and phlebotomy team to engage with, it was quickly supported and enhanced given such fast, observable results in waiting time reduction.

Find out more

For more information contact:

• Sharon Littlewood – Senior Phlebotomist.
• Pam Doherty – Practice Development Matron, Registered Nurse, Outpatients Phlebotomy, Nottingham University Hospital NHS Trust, pam.doherty@nuh.nhs.uk.