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Tairawhiti DHB Case Study

Change for the better from the ground up

Nine months ago Tairawhiti District Health Board embarked on a new journey implementing Care Capacity Demand Management (CCDM) and Releasing Time to Care in a combined programme called the Tairawhiti “FIT Approach”. Along with looking for a scientific, evidence-based way to manage supply and demand, Tairawhiti was looking to improve patient outcomes and experiences of care. And the DHB got more than it bargained for; the new thinking is giving staff professional development opportunities and the whole team are involved. Patients are in a safer environment because of the programme, are less likely to fall while admitted, and are receiving more timely care.

Tairawhiti chose CCDM because its a NZ based system. More importantly the DHB saw that the programme complements Releasing Time to Care and improves the usage of other systems like TrendCare. Sonia Gamblen, Director of Nursing says Tairawhiti already had TrendCare and CCDM uses much of the data of the TrendCare acuity system. “Why would we go with anything different?” Sonia also saw that CCDM had worked particularly well at other DHBs which had implemented Releasing Time to Care so Tairawhiti decided to launch that too, in order to get the most out of both.

Having NZNO’s support has been crucial to the programme success. Sonia says Tairawhiti has worked closely with them every step along the way.

NZNO has worked hard to help its members understand the programme and its benefits. Tairawhiti also appointed a project co-ordinator last year, and undertook an intensive campaign to ensure all staff were on the same page.

Enhancing staff competencies

“The change in staff culture has been dramatic and positive.”

As the FIT Approach has rolled out some staff have stepped up, and found themselves in leadership positions across the programme. Managing meetings, for example, requires specialised skills that often staff nurses have not been exposed to previously – skills such as these develop over time with encouragement and support from the programme facilitator.

By streamlining processes and ensuring staff and equipment are in the right place at the right time, less time is soaked up in administration. This translates into more time for nurses to spend with patients.

The development of various new skills has empowered staff, many of whom are showing new confidence. Sonia says they realise: “If they want something to happen they can make it happen.”

More efficient wards

Driven by confidence in their abilities, staff have taken the initiative to review systems for a safer environment.“For example,” says Sonia, “their early warning systems weren’t working properly and rather than an audit being directed by management, it came from the ground up.”

Staff drove the audit and review and the improvements are measurable. Sonia says because of staff initiative, “patient care is getting better”.

Staff also looked at their broader environment and started doing their own patient satisfaction surveys. They cleared out-of-date stock from the shelves and made sure everything they needed was on the ward. They removed stock lines that were no longer being ordered. The staff drove greater efficiency, saved time and improved patient safety.

Reducing falls and preventing readmission

A very clear result of the programme is a measurable reduction is patient falls, says Sonia. “The pilot ward hasn’t had any falls in four months, and they’re very proud of that.” They should be, she adds:“The programme has directly improved patient safety because staff are more engaged in the patient outcomes of the care they provide.”

Because of the new thinking that has emerged from their journey, the ward teams have begun looking at how best to keep patients who have been discharged home – staying at home.

This critical thinking has led to the question: ‘What can we do better so that patients don’t have to be readmitted?’

”Ultimately,” says Sonia, “a return to hospital is not what we want for them.”

The team used CCDM to dig down and assess their procedures. Issues like effective pain relief, availability of dressings on discharge, on-going support in the community or whether the patient had fallen while in hospital may increase the likelihood of a patient returning. The team identified these areas for monitoring and Sonia says what’s great is that the staff own this because they’re the ones doing it. “They are owning this work.”.

Working better with staff

By implementing CCDM, staff were given a platform to openly discuss their concerns. The first part of the implementation process required Tairawhiti to look closely at how work is organised and how rosters are planned – everything is transparent and is discussed with staff.

Sonia said this created a positive response because, team members felt good that they could air some of their frustrations. ”They were things like: ‘Nobody knows how busy we are, nobody knows what’s going on.”

“Results go further than improved staff morale, however. The FIT Approach has engendered a desire from staff to see real change. “If they know that’s happening in the future [staff consultation], they’ll be pleased and they will make the mechanisms that trigger a response from management.”

Through the process of implementation, it became clear what understanding staff had of hospital operations. After a ‘table top exercise’ it became apparent many staff didn’t know what was going on because they were isolated. “They were in their own silos.”

Sonia says the hospital needs to be managed holistically for a smoother, inclusive operation.

“We hope to change from a silo approach to how wards are run to a more hospital wide approach.”

Future of CCDM

Sonia believes New Zealand needs a scientific basis for managing hospitals and that CCDM is the best thing for that. “I would absolutely recommend it.” Within five years she would like to see it rolled out nationally and believes its role in our public health system is critical because it’s safe, meaningful and evidence-based.

“Ultimately CCDM gives you the opportunity to change the model of care we currently have…if we can make savings somewhere, then we can develop another service.”

In a world where funding is tighter and needs are higher, CCDM has a proven place to help District Health Boards provide better services and improve patient care.

Key Facts

Zero patient falls in four months (Pilot ward)

Greater staff input

Greater hospital efficiency