Page last updated at 23:16 GMT, Friday, 11 July 2008 00:16 UK

Small changes for big patient gains

By Jane Elliott
Health reporter, BBC News

Feeding the elderly. Photo caption:John Cole/SPL
Time saved has been reinvested in helping feed the elderly

When ward manger Liz Ward and her staff looked around Barnsley Hospital it was clear that changes were needed.

Despite medical advances, changes in nursing methods and brand-new equipment, the basic layout of the hospital had changed little over the 36 years since it was first built.

They were doing the same routines day in and day out, because that was the way they had always done it.

Top shelves in store cupboards were lying idle and gathering dust because they were too high for the nurses to use, and working areas were not being used as efficiently as possible.

Making the hospital user friendly

But when a government initiative gave them funding to free up staff to allow them to take a fresh look at how things were done, they found they could save time and money.

Now Health Secretary Alan Johnson has invested 50 million to help fund the national rollout of 'Productive Ward', for which Barnsley was one of four pilots.

We have so much more time for patients because everything is slicker
Liz Ward

Liz explained that on her wards staff had identified the meals trolley as one area where they were wasting time.

The nurses videoed the meal run and found they spent an average of 45 minutes serving dinners, during which time the food was getting cold and some had to be replaced.

"Nurses were wrapping knives and forks in serviettes and putting them on the tray. and folding down meal cards.," she said.

"'Productive Ward' gives us the time to sit back and look at it with a fresh eye and the time to say 'Why are we doing that?'

"Patients need a nice hot meal they are more likely to eat the meal if it is hot and well presented.

"We worked with the catering department and they agreed to send out the knives and forks wrapped and the meals in room order from catering, which saved time.

"All in all we made 14 little changes like this.

"We reinvested the time in the patients and as we trialled it on an elderly ward it meant we had more time to feed the patients," she said.

Logical changes

Nurses were also encouraged to think logically about their work stations and how they could be reorganised.

Liz said that on one ward the sluice area, where the bed pans are situated was identified as a problem area.

Nurses were back and forth from this area about 30 times a day, but it was poorly designed.

By moving shelves and equipment the staff were able to save minutes each day - adding up to 37.5 nurse hours a year.

Shelves were lowered so they were accessible to all and unnecessary and duplicate paperwork cut back to save on administration.

Liz Ward at Barnsley Hospital
Nurses have extra time for patient care

Liz said the small changes had transformed her wards.

"It is over two years since we started on 'Productive Ward' as we were a test site.

"I was a ward manager and a case manager and used to go round all the wards in acute and medical and I just remember a real sense of chaos, nurses running around and trying to and delivering in a really chaotic environment.

"Now when we walk on one of the showcase wards there is a real sense of calmness. Pride in the environment. It is a whole team approach.

"We have so much more time for patients because everything is slicker, the processes are so more tight and everything seems to go much smoother, " she said.

Empowering nurses

Professor Bernard Crump, chief executive of the NHS Institute for Innovation and Improvement, said the pilots for 'Productive Ward' had proved a big success and that rolling it out nationwide would empower more nurses.

"The great factor in this work is that it is developed by the people delivering the service. They are the ones to make the improvements - they don't need others to tell them how but are empowered to do it themselves in their team for the benefit of their patients."

Dr Peter Carter, general secretary and chief executive of the Royal College of Nursing, agreed: "Nurses want to provide high quality care and improve safety standards for the benefit of patients.

"The 'Productive Wards Programme' provides nurses with the power to devise and implement changes in their environment, allowing them to spend more time at the bedside caring for patients.

"Not only does the programme allow nurses to work more effectively and efficiently but also saves money, which can be re-invested to deliver quality patient care."

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