Patient First is a constant and exciting journey that’s always evolving. We are confident it will move the Trust forward very positively, delivering successes in many forms – maybe through a quicker and easier journey through our Emergency Department; a shorter wait for surgery; or a stabilised and improved financial position.
How has Patient First impacted experience of patients and staff at NHS Medway?
In 2022, NHS Medway implemented a programme titled ‘Patient First’ with the aim to drive improvement in a few, high-priority areas without overburdening staff. It was a way to deliver long-term change over time, by making small changes that have a big impact quickly.
It has provided tools, techniques and a standard approach to identifying and tracking improvement, giving staff clarity about what they need to do, every day. It also empowers them to make change happen and sets out clear and specific targets about what needs to be achieved in a fixed timescale.
Patient First empowers the staff with the skills, tools and confidence they need to make small sustainable changes that boost patients’ experience. All colleagues play their part in Patient First - whether they are out on the wards, in other clinical areas or providing essential support services. This means instilling a sense of purpose, motivation and energy at every level through the organisation – a ‘Board to ward’ strategy.
How has this been achieved?
- Data and insight: NHS Medway use data to help select a set of priorities where their collective improvement interventions can make the most difference (these included bringing down waiting times, freeing up beds and improving satisfaction scores).
- Clear strategy: a structured approach to ensure that all staff and stakeholders are pulled in the same direction of moving towards their ‘True North’.
- Upskilling: training staff in structured problem-solving and continuous improvement.
The approach: An integrated system running through all levels of the Trust
At the core of how Patient First is delivered, NHS Medway use data to understand the root causes of the issue – which enables them to target rather than band-aid their solutions. This perspective allows the Trust to move away from a culture of firefighting.
For this initiative, collaborative problem-solving sessions were held with multidisciplinary teams who identified the primary causes were a failure to recognise, failure to escalate, and gaps in clinical planning. This resulted in safety huddles - 15 minutes every day to identify, prioritise and action improvements linked to the set of priorities. It’s an opportunity for everyone to contribute and take accountability and on some occasion included patients who joined to raise concerns about a decline in a clinical condition and enabled frontline led improvements. This was combined with an electronic track and trigger system which helped to identify deteriorating patients early.
Alongside the daily huddles, Medway have also introduced weekly ‘driver meetings’ to track progress and discuss next steps needed to achieve the team driver's metrics. A key objective for this was to embed Patient First continuous improvement methodology in routine work and encourage engagement with frontline colleagues to deliver this.
In addition, a new medical model to reduce ambulance handover delays from 30 minutes to 15 minutes was also introduced which prioritised ambulance handovers, enabling rapid transfer of acute medical patients from the ED to wards, and promoting early consultant reviews.
Outcome: Positive experience for staff and patients
This improvement programme is a recognised and proven system for delivering significant long-term change within the NHS.
The Patient First methodology guarantees inch wide, mile deep focus so that top contributing reasons for causing negative impact on patient experience could be identified and improved. The changes introduced have included establishment of multi-disciplinary team reviews leading to an improvement in appropriate pathways for patients, relentless focus to ensure patients are receiving value added acute care and the reduction in variation in staff skills. Staff morale is also much higher. Some senior clinicians in the Trust have become great supporters and advocates of the approach.
Medway was named Southeast regional winner at the NHS Parliamentary Awards 2023 in the ‘Excellence in Urgent and Emergency Care’ category by improving the care of deteriorating patients and reducing avoidable cardiac arrest calls (2222 or crash calls) from an average of five calls per month to just one.
As a clinician who has taken part in Patient First training, I am thrilled to see how our team now uses a consistent problem-solving methodology. We have identified a few key priorities for our team, which we call our ‘team driver metrics’. These are directly aligned to the Trust’s True North – so we know we are working on the right things!
| Key achievements from Medway NHS as a result of our work | |||
|---|---|---|---|
| Financial sustainability | Referral to treatment | Friends and family test | Wellbeing checks |
| A Trust-wide efficiency programme was launched to optimise the use of medicines and realise savings through the rationalisation of medicines use. | Neurology department managed to reduce 40-week referral to treatment waits for first appointments from 374 patients in 2022 to two patients in 2023. | Pilot designed to help inpatients get a better night’s sleep during their stay which included an audit of the wards environment to create the conditions for better sleep. | Met the target for appraisals for the sixth consecutive month in July 2023 which was 90% of staff would have an annual appraisal that included a wellbeing check. |
