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Hospitals

'Making a Difference: Reducing Burdens in Hospitals' [PDF 401KB, 68 pages], published 31 July 2002, was the first joint project between the unit and the Department of Health (DH) in the acute healthcare sector.

Scope

• To find practical solutions to reduce or remove bureaucratic burdens on front line staff.
• To promote clear, concise and user-friendly good practice guidance in hospitals to replace outmoded methods.
• To avoid initiative overload by finding solutions that dovetailed into policy areas.
• To make a difference now and in some cases also pave the way for longer term policy initiatives such as work on standardising patient records as a precursor to the implementation of electronic records.
• To avoid simply transferring a burden from one hospital professional to another.
• To differentiate between NHS-wide and hospital-specific issues and solutions.

Approach

In the scoping phase of the project, key stakeholders in the acute healthcare sector were identified and interviewed. Preliminary interviews and observational visits were also undertaken in six hospitals. Research was undertaken to reinforce and inform the emerging issues. Combined, this provided a snapshot of the emerging issues which informed a semi-structured questionnaire for use in hospital interviews with front line staff.

Approximately 250 semi-structured interviews with front line staff from 37 hospitals were conducted during November 2001. During these interviews the staff were encouraged to be frank with their views and were challenged to suggest alternative solutions to the problems they were experiencing.

An Advisory Panel was established to provide specialist advice throughout the project. It comprised a cross section of the Health Service and included both front-line staff and representatives from relevant stakeholder groups, professional bodies, government departments and patients' organisations. Potential solutions were brokered through negotiations with the Advisory Panel and relevant stakeholders, both within and outside the DoH.

Commitment was gained from stakeholders to a time-scale for delivery of the outcomes. A number of the problem areas were quite complex and had many possible solutions. Often, more than one stakeholder was approached. It was, therefore, imperative that an holistic approach to the problem was adopted to ensure co-ordinated delivery of the outcome.

Key Achievements

In March 2004 a Single 'crash call' telephone number was launched across all hospitals in England and Wales by Lord Hunt, Chair of the National Patient Safety Agency, in his first major speech on patient safety. With an increasingly mobile workforce, this reduces confusion in emergencies and was described by Lord Hunt as 'part of a wider drive to reduce unnecessary bureaucracy on the front-line so that staff can get on with the job of caring for patients'.

Standard consent to treatment forms for use by all NHS Trusts were introduced in April 2002.

The Gateway 'Information Reader Box' (IRB) was launched on 9th January 2003. The IRB contains a unique reference number for each non-routine communication with the NHS. This acts as a kitemark to show that the document has been scrutinised by the DH Gateway team.

Next Steps

Responsibility for delivery rests with the stakeholders, policy leads or process owners. Key to the success of the project will be the commitment of staff locally to implement the changes. An extraordinary amount of good practice was observed during visits to hospitals. It is hoped that, with less burdens and more time, the staff will be able to share their innovations with their colleagues for the benefit of the wider NHS, and, ultimately, the patient.

The unit continues to work with stakeholders and front-line staff to monitor how the outcomes are being implemented, evaluate their impact and to report back on the progress. In January 2003, an Implementation and Monitoring Task Force to oversee the effective implementation of the Hospitals report outcomes was convened. The unit has also begun a programme of periodical evaluations to assess how effectively the outcomes have been communicated to the service, how they have been implemented locally and to appraise the cumulative benefits to front-line staff.

For further enquires or information please contact the unit at psinfo@cabinet-office.x.gsi.gov.uk