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Building a team: improving acute elderly care services at Mid Yorkshire NHS Trust by supporting staff engagement

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Describing the progress the team at Mid Yorkshire NHS Trust have made since their involvement with the Future Hospital Programme as a development site in 2014, Dr Zuzanna Sawicka highlights the importance of staff engagement and wellbeing when implementing a new service.

Mid Yorkshire NHS Trust has three hospital sites and is in the process of reconfiguring most of its acute services onto one site at Pinderfields Hospital, Wakefield. This, alongside a rapid increase in the number of frail and older patients within the local community, has led to a redesign of services to ensure older patients have access to early comprehensive geriatric assessment seven days a week. We will be extending this service to those who are frail by the creation of a dedicated older person’s assessment or frailty unit through the support of the Rapid Elderly Assessment Care Team (REACT).

Establising a 7-day service

REACT is a multidisciplinary and multiagency team which works extended hours seven days a week with third sector support to provide a rapid holistic assessment of older patients on the acute assessment unit at Pinderfields Hospital. The team is dedicated to completing an individual’s comprehensive assessment and identifying their needs in a timely manner and, where possible, facilitating their discharge and providing alternatives to acute hospital care.

When building the team and designing the services, steps were undertaken to make staff feel they were a vital component of the project group. This was especially important because the Trust is below average nationally in terms of staff engagement. By helping staff to feel part of the team, they have taken ownership of quality improvement ideas such as the development of a shared competency framework for the therapists.

The team openly discusses issues and shares ideas

Dr Zuzanna Sawicka

Staff wellbeing and resilience

Through staff engagement we have also developed greater resilience within the team. The team openly discusses issues and shares ideas, and as a consequence, this fosters a quality improvement culture. The project team initially met weekly but now meet monthly. Breakout sessions for all staff are also planned to ensure ongoing engagement. Our partner agencies, Wakefield Council and Age UK Wakefield work closely with us, thus ensuring ongoing integration across the primary, secondary and third sector and team members are actively encouraged to be proud of the team, thus help sharing our vision.

The team is not complete however without the involvement of both a local and a RCP Patient Carer Network (PCN) representative, who critically appraise data and plans. They have been instrumental in helping create resources for the team to benefit patients and carers and in guiding patient feedback mechanisms. Crucially, they act as critical friends as part of the process of ongoing innovation.

Engaging with change

Since moving to a 7-day service in September 2015, the team see 34% more patients and the number of people discharged directly from the acute assessment unit has increased by 38% from April 2015 to January 2016. The team continually strive to improve services for the benefit of patients by working closely together.

In July, the team completed a culture questionnaire as part of the evaluation of the Future Hospital Programme and these results were compared with the Trust Staff Survey Results. This revealed that 63% of respondents felt engaged in the changes being made (which is higher than the trust average of 45%) and 87% felt able to use their skills at work (which is higher than the trust average of 70%). The outcomes of this are different individuals being part of innovative projects such as an information hub and a dedicated consultant phone for direct liaison with the emergency department and general practitioners.