6 Ways To Enhance Patient Safety


Assista Briefing Note 77 Preview Pic

Click on the picture above for a printable PDF

Unfortunately, it’s a fact of life that human beings don’t function as well at night as we do through the day. There’s a wealth of evidence to back this up. Obviously, there’s no getting around the night shift in the NHS, but there are some things we can do to increase productivity, improve the working environment and minimise errors.

  1. Rely on Each Other

Nowhere is team work more important than on the night shift. Try to create an environment where employees, in particular nurses, are encouraged to voice their opinion if they see something that could be a potential error. By building a system that ensures everybody is responsible for double checking things e.g. medication doses, and therefor sharing the accountability, workers will feel grateful when somebody stops and questions them, rather than feeling affronted.

  1. Break the Routine

Look into new, innovative research surrounding shift patterns. Studies show that the most valuable, replenishing sleep happens between the hours of 9pm and 3am. Shift models that emphasise this importance are being tested and implemented across the U.S right now.

Look into the benefits of reducing the typical 12 hour shift to 8 hours, ensuring workers have more time for rest during the ideal sleeping hours. Compensate night shift workers in a tangible way – pay these shifts higher, enable them to work less yet receive equal pay. Consider rotating shifts forward (morning – evening – night) to correspond with natural circadian rhythms.

  1. Take a Break.

The benefits of taking breaks are now understood and well documented. However, the notion of a ‘tea/coffee’ break is becoming outmoded by more effective methods of relaxing. For example, during shifts, napping and exercise are great ways to refresh and increase the release of endorphins. Hospitals should reflect on the paybacks of providing fitness rooms or sleeping quarters for their staff.

  1. Food for Thought

The fuel that night shift workers put into their body should be seriously considered. For ease and to combat hunger, carb rich foods seems like the best option, however these cause lethargy and sluggishness about an hour after consumption. It’s not ideal to have integral members of your staff relying on vending machines. Offer foods that are high in protein – meats, cheeses and olives. If keeping the cafeteria open all night stretches budgets constraints too much, having cold foods prepared, such as the examples above, during the day and having a cafeteria worker distribute through the night could be a solution to consider.

  1. Utilise Real-Time Pharmacists.

If your most active clinical units are A&E or the intensive care unit, try appointing a dedicated space for pharmacists where they can review dosages and be of assistance with regards to medication questions. Despite some areas of hospitals having fewer patients at night, the intensity to which patients require attention are usually increased. This could cause a rise in the need to quickly administer medication – having someone readily available for specific advice would be of great value.

  1. Gifting Goes a Long Way

Finally, recognition of the impact working unsociable hours has on an employee can go a long way to improve the general moral. Try sending regular e-mails with tips and advice on the best way to combat tiredness and cope with a night shift – especially to juniors. Consider night shift packs, including things like ear plugs, sleep masks, de-caffeinated drinks and fruit, which are inexpensive to provide but will been seen as a token of appreciation.

5 Ways To Cut Your Costs

Several years of CIP schemes have meant most trusts and FTs cutting their costs in key areas, but with little to show in terms of efficiency gain.

The five points below can go some way to improving the ‘yield’ of cost-cutting initiatives by zoning in on some less obvious savings opportunities.

1. Critically Evaluate All CIP Schemes

Most trusts and FTs have a long list of CIP schemes they are pursuing. More often than not though these schemes produce little benefit and may actually dilute operational focus.

To mitigate against this board members and senior managers should make an examination of how CIP schemes have grown over time and also their relative contribution to the organisations future plans. Then they can be ranked into core and noncore schemes, and resources can be reallocated accordingly.

2. Reallocate Your Resources

In cutting back on resources allocated to noncore and non-valued-added schemes, trusts and FTs can redeploy resources to activities that actually improve value.

For example, this could include a renewed focus on procurement across the whole organisation, rather than in just one department/specialty.

3. What Do You Define As Overhead?

Overheads can be different things to different people. The board should make a judgement on what they mean by overhead cost and then the finance department should decide on the best way of measuring those costs.

Clinical engagement is often hampered because medical staff feel they are being assessed on spend that is effectively out of their control.

Having back-office staff (e.g. finance, HR) embedded in specialties can make spend more overt, but it also muddies the water as far as overhead is concerned.

4. Focus On “Shadow Staff”

As with the example of embedded back office staff in point 3 above, there can often be staff members in specialties performing duties that are also provided on a centralised basis. Over time this can lead to overstaffing.

All trusts and FTs should have a rolling programme of rationalisation in order to make sure they are operating as efficiently as possible.

5. Reduce Excess Capacity

Excess capacity is a huge driver of cost and can display itself in a number of different ways. Most notably there can surplus physical capacity – too many operating theatres – or staff – where there are too many relative to patient volumes.

A big giveaway to me when I arrive at a trust or FT is whether I can easily get a parking space. If I can I generally also find surplus physical capacity too.

A good way to estimate the underlying costs of excess capacity is to compare the difference between operating efficiency at highest volumes against average volumes.

If you’ve got any examples from your Trust that you’d like to share email us at [email protected] and we’ll feature them in a future Briefing Note.

For a printable PDF of this briefing note please just click on the link below:

Assista Briefing Note 76 – 5 Ways To Cut Your Costs

CIP – Project Types

We think there are four types of initiative to deliver the CIP of which three can be described as projects:

Budget Clipping (BC) – Removal of excess or unrequired budgets by the Divisional Accountants with no project work to support whatsoever. This process is not a project as such but contributes to the CIP targets. Budget clipping only requires a project validation sheet completing to support evidence of delivery. The accountant however is validating that no corresponding overspends will be evidenced elsewhere.

Just Do It (JDI) – Simple projects that require little planning or management.

Typically projects that are worth less than £100k and will be completed within 45 days.

JDIs only require a project validation sheet completing.

Standard Improvement Projects (SIP) – Projects that are relatively straightforward but require planning and management. Typically SIP projects are worth up to £1.0M and take up to one full year. These require a set of paperwork completing.

Complex Projects (XIP) – Projects that require significant planning and management.

Typically projects that are worth more than £1.0M and run over 1 full year. These require a set of paperwork completing plus business case paperwork too.

Thanks to Ed Grimshaw