Releasing Time to Care delivers positive outcomes to more teams

Releasing Time to Care delivers positive outcomes to more teams

Earlier this year, Cardiff and Vale University Health Board’s improvement and implementation team, Shaping Change, developed and implemented a new team-based improvement programme called Releasing Time to Care (RT2C). 

RT2C was developed following an exceptionally challenging winter during which the Shaping Change team were embedded in operational activities to support colleagues with the pressures facing the health system. This gave the team an in-depth understanding of the ways of working, use of current tools, operational challenges and teams daily activities.  

Shaping Change observed that clinical teams spend a lot of time troubleshooting daily issues, gathering performance data on paper-based systems, ensuring communications are met within multidisciplinary teams, resulting in reduced time completing patient facing activities. This in turn, impacts on patient’s experience, breaking down continuity of care and causing potential harm to patients. 

While there have been several initiatives in the past designed to “give time back” to clinicians to care for their patients, RT2C is unique in its modular structure which allows teams to focus on difference areas for improvement throughout its duration. Over the course of 6 weeks, teams across the Health Board are taken through the programme which encourages them to improve their practice by focusing on: 

• Setting a shared vision and making progress visible    
• Adopting a structured routine of weekly planning and daily measures    
• Embedding a culture of continuous improvement    
• Developing capability and recognising improvement    
• Ensuring new ways of working are embedded into daily working patterns   

The framework itself is a blend of NHS Improvement’s Releasing Time to Care Programme and various other improvement frameworks that focus on the people element of change. Working alongside each other within the dedicated weeks provided, the improvement and ward teams collaborate to create alignment, problem solve, utilise knowledge and have a better understand of their capacity to assist in sharing workload.  

The framework is rolled out in a flexible way, allowing teams to focus their efforts on their immediate problems, while speaking a common improvement language that is understandable across the organisation. The main aim of this is to share learning and help to build a system in our organisation based on real life improvement work. 

Following a successful initial pilot on a respiratory ward, Service Improvement Manager Dolores (Loli) Macchiavello has been working with the Health Board’s Stroke Rehabilitation Centre (SRC) to implement the programme with the aim of giving back 20% of time to the centre’s multidisciplinary team by the end of April 2023. 

During the assessment phase of RT2C, Loli discovered that the SRC team were spending a lot of time capturing data that they needed to report to the Sentinel Stroke National Audit Programme (SSNAP), the database that they were filling in was not fit for purpose and clinicians spent time ensuring communication was met through redundancies. To address this, Loli and the SRC team developed their own aim and driver diagram to develop their own ideas for change. 

These included: 

• Huddles 

• Board Rounds 
• MDT meetings 

• Digital Tools 

• Use of single source of truth (excel, teams) 

• Use of Kanban on Teams for MDT 
• Use of the CAV UHB Patient Management System 

• Communication 

• Standardisation of the MDT weekly report 
• Standardisation of the MDT discharge report 

As a result of the work carried out so far, a single team re-gained 7.5 hours a month when improving their data gathering, this saw an increase in hours spent with direct patient care (allowing approximately 12 extra patients to be seen every month). Similar solutions were developed internally for five other teams within SRC.  

To date, Shaping Change has involved 3 different CAVUHB wards in the RT2C programme (one respiratory medicine, one stroke rehabilitation ward, and one mental health ward have completed their initial assessment phase). They have also developed 10 RT2C trainers and prepared a wider implementation plan for roll-out across the Health Board. Feedback received from all parties so far has been excellent and supports that the hands-on nature of doing improvement in this way is welcomed by the different teams.  

Further to this, we have linked RT2C to the Ward Accreditation Improvement programme to ensure that teams are recognised for their efforts and supported to achieve accreditation in line with the wider corporate nursing strategy for Cardiff and Vale University Health Board. 

In the long term, we are excited to implement the RT2C way of working as business as usual in the organisation with a view to one day spreading and scaling it across the whole of NHS Wales. The aim is to empower more teams to make changes for themselves and their patients. We are proud to be improving healthcare for the patients we serve one team at a time.