Niche In-Brief Spring 2018 - Flipbook - Page 2
Unless we understand the relationship between inpatient
and community services, we will not understand the
overall level of resources being used across a given
pathway, nor their impact. Initiatives which successfully
divert people from admission also often drive up inpatient
lengths of stay, as those who are still admitted are those
with the greatest needs.
4. The organisation of services into bed pools can
create misleading results
This is a particular problem when length of stay is
reported by ward, rather than by whole episode. Frequent
moves between wards can artificially deflate reported
lengths of stay. Creating a new assessment ward for all
short-stay work can lead to increased lengths of stay on
other wards. Useful analysis will track episodes across
wards, not simply link them to the ward of admission or of
discharge.
5. We need to understand specific patient needs and
impacts
What is the length of stay by age? By diagnostic group?
By ethnicity? By sex? By locality? All of these questions
might illuminate practice in a way which is masked by a
single average length of stay figure.
If you’re looking at the performance of services you
provide or commission, and the average length of stay is
presented as a key metric, it may well be worth bearing
these concerns in mind. Many new metrics can be
developed and used in a much more intelligent way,
helping you to answer the questions you have about your
services and, ultimately, helping you to make better
decisions about resources.
James Fitton, Partner, Niche
James.Fitton@mentalhealthstrategies.co.uk
2
Snap-shot on the well-led ward
The Well-led Framework is predominantly
focussed upon the work of the board and senior
managers, specifically, their effectiveness, impact,
capability and capacity to lead. However, I still
often find myself saying, that the ward manager is
arguably the most important person in a hospital;
a good one is worth their very weight in gold.
When you are fortunate enough to have a
collection of good ones, you tend to have good
services and a good hospital.
Yes, it sounds like far too simple an equation for
success but how many of you know which are the
stand-out wards in your hospital and how many
can (in turn) link this to good ward management?
Walk onto a well-led ward and you can tell straight
away. Conversely, you can tell when a ward is
struggling with its leadership; high rates of staff
attrition, poor staff satisfaction and lack of pride in
the care being delivered can often be down to how
the ward manager transacts that role. Over the
years, I have seen many outstanding ward
managers come and go. In many cases the best
have gone onto become nursing leaders, but the
very best have trained the next generation of ward
manager to be outstanding in their turn.
A good ward manager will:
• ensure that the team works well together;
• tackle disruptive or corrosive behaviours;
• hold the clinical red lines and will be the
best advocate for his/her patients;
• provide consistent and useable information
for staff;
• not set up a ‘them and us’ culture between
senior-leaders and ward staff;
• set standards above and beyond those
required by the trust/service;
• seek out opportunities to train and develop
his/her teams; and
• include all members of his/her team in
generating ideas for improvements.
The ward manager is often the main conduit
between the ‘organisation’ and the ward. This is a
complex role which carries a heavy burden of
responsibility. Ensuring adequate staffing
numbers, balancing risks, balancing budgets,
training staff, informing staff, appraising staff, are
just some of the daily duties required.
Without this collection of staff the finely tipped
balance between operations, finance and quality
would simply fall over. So I, for one, stand-up in
absolute praise of the good ward manager.
www.linkedin.com/in/kate-jury- 241a4135