Leading change

The Matron for Geriatric and Stroke Medicine at Sheffield Teaching Hospitals NHS Foundation Trust (STHFT), along with the nursing team, developed an Integrated Ward model to address unwarranted variation in practice. Implementing this model on one of the Geriatric and Stroke Medicine wards has resulted in improved patient outcomes and experience and a better use of resources.

Where to look

Within the STHFT acute wards, the Matron for Geriatric and Stroke Medicine identified unwarranted variation in how care was coordinated and supported across the disciplines which was influencing patient outcomes and experiences as well as the effective use of resources.

The Matron and the nursing team recognised this as an opportunity to develop an Integrated Ward programme, focused on effective multidisciplinary team (MDT) working. The evidence suggested that the improvement programme could minimise duplication, improve coordination across professional disciplines and enhance support for patients.

What to change

The Matron for Geriatric and Stroke Medicine at STHFT identified the need for a new way of working to be trialled on the ward, to address the unwarranted variation. The Matron took on the opportunity to work in a different way, with more integrated working across the professional disciplines, to ensure patient and staff needs were met.

The Calderdale Framework was introduced to the wards to enhance the skillset, empower and develop the non-registered workforce, with a focus on competency, training staff in delegated tasks to support a more flexible and adaptable approach to patient care and needs. The Calderdale Framework was designed to engage team members in a seven-step process involving: awareness raising, service analysis, task analysis, competency identification, establishing support systems, training and sustaining (Calderdale Framework, 2010). The Calderdale Framework provides a structure specifically for the planning and implementation of assistant roles and cross-discipline skill-sharing in health and social care settings (Nancarrow et al., 2012).

How to change

The project initially focused on 1 acute hospital ward. The Matron, in collaboration with the wider nursing leadership team and ward clinicians, led on the implementation of the new way of working. The change included training provision as well as continued support and guidance for staff throughout the programme.

Elements of the new ways of working include:

• Introduction of Multidisciplinary Falls Huddles – to raise awareness and coordinate approaches to reducing incidents. These huddles support staff to monitor the impact of implemented safety measures. Mobility Boards have also been introduced to aid communication and contribute to the shared aim of reducing patient falls.
• Introduction of a Social Dining Initiative – this includes all patients being supported to attend the day room for meals, even those who are not readily mobile. Ward staff support and facilitate conversations with and between patients, as well as monitoring dietary intake.
• Introduction of a ward activity group – this element of the Integrated Ward model strives to improve patient experience through mental and physical activities. Supported by physiotherapists, nurses and occupational therapy staff, this has been especially helpful in supporting integrated pathways of working.

Adding value

Better outcomes – The Multidisciplinary Falls Huddles have resulted in a 50% reduction in falls. The Social Dining Initiative has supported the ward to offer enhanced dignity in care and has anecdotally had a positive impact on promoting patient independence as well as increasing dietary intake of patients on the ward.

Better experience – Patients and their families have responded positively to the new

integrated way of working, with one patient commenting “I really enjoy it, it is great”.

Staff have also responded positively to the programme with therapists and nursing staff reflecting that they are now sharing skills to support each other’s roles. By working closer together, staff working across several disciplines are also reporting that they are developing a greater understanding of each other’s roles in delivering and optimising patient care.

Better use of resources –  A measurement of how the Integrated Ward model has impacted on use of resources has not yet been completed. However, the model is seen to be more efficacious – particularly minimising duplication, suggesting a better use of time. Patients are receiving high standards of care, reinforced by all professions working closely together. Nursing staff have also reported that they are able to focus on more acutely unwell patients as a result of the Integrated Ward model.

Challenges and lessons learnt for implementation

Exploring new ways of working together across the MDT has supported the Matron and the ward team to meet the needs of the patients within the resources available.

Therapists have shared skills across Occupational Therapy, Physiotherapy and Nursing, and the Calderdale Framework is now being used to identify required competencies for therapy and nursing staff, establishing an integrated approach.

The team are now looking to test further Integrated Wards at the Trust, by introducing it as a formal therapy rotation as a part of Band 5 training.

For more information contact

Nigel Coulson, Matron – Geriatric and Stroke Medicine,
Sheffield Teaching Hospitals NHS Foundation Trust
Nigel.Coulson@sth.nhs.uk