Conflicts of Interest

1. Conflicts of Interest • None to declare

2. Samantha Jones, Chief Executive Dr Mike van der Watt, Medical Director

3. Onion “ A way of enabling staff to solve issues”

4. How it all started.. • Overheated hospital: • Daily “silver command” • Inability to maintain a safe A+E • Staff left accepting “this is how it is around here” • No direct daily interaction between management and staff

5. Stop the clock….. • Cancel all non-urgent meeting (clinicians and managers) for a week • Executive and senior clinicians met daily with one question “What needs to be done to improve patient safety”

6. Onion grew bigger and bigger! 08.15 AM Every day Board to Ward Visibility of exec Quality & Safety No blame Assurance Listening, Support “collectively, as a team, we all know everything we need to know” Elderly Care Physician

7. Daily Nursing “Sit-rep” at Onion

8. Root Cause Analysis Any issues of patient safety or experience today? Gathering information …. evidence vs layers Rapid response time (bring it back tomorrow?) Multidisciplinary forum Solutions, not problems Spreading success and learning “Impressed at so many people, a sight to behold, fired up to make the hospital work better” Junior Doctor

9. Improvements & Outcomes • Making services flow for our patients: • Review of nursing roles + establishment • Supervisory band 7 • Prescribing in Discharge Lounge • 77% increase in use of discharge lounge since May • Integrated discharge team • Enhanced Therapy services • Rapid review & change based on evidence and fact “Onion has sorted something in 3 days that I haven’t been able to sort in 3 years”

10. Improvements & Outcomes Onion’s measure of success is patient experience and safety • Sustaining 95% performance on A&E • Increase in EDD in a single day • Board & ward rounds re-scheduled • Reduction in cancelled operations • Reduction in use of escalation areas • Up to 40% of ‘take’ patients to Ambulatory Care • Reduction in delayed discharges • Removed delays in death certificates “Consultant ward rounds at weekends a massive help; saves lives” Junior Doctor

11. Culture Change Improving Care through Culture Change… No issue too big or too small or off-limits “Hello. My name is Dr Kate Granger. How are you feeling today?” Locally: “I am a person not a number”

12. Improvements & Outcomes • Looking after our patients’ experience: • “the standard you walk past • …….is the standard you accept” • Learning from patient stories • Visiting times • Portering practice • Availability of hot meals in A+E • New wheelchairs & more repairs • Lines of responsibility made clear

13. Improvements &Outcomes • Team working • Multidisciplinary clinical team • Board to ward • External partners • Feeling part of the hospital team • Similar to “Schwartz Rounds” where staff connect and support • Renewed energy/optimism/belief • New language – ‘onion-ising’

14. Does it really have an effect? • Crude mortality down 20% • HSMR 101 (110) • SHMI 105 (107)

15. ONION

16. So, what is Onion? Onion is compelling and highly replicable Powerful ingredients: • People • Passionate commitment to putting the patient first and • Doing tomorrows work today CEO: “I want to lead an organisation that knows what it does well, knows what it doesn’t do well & above all, isn’t afraid of saying things aren’t right and wants to deal with those areas and improve.”