A team of clinical and non-clinical health and government leaders from Nova Scotia, Canada visited East Surrey Hospital, part of Surrey and Sussex NHS Healthcare Trust (SASH), to learn about how the Trust is improving outcomes by reducing length of stay for patients.
The team were joined by Nick Holding, Head of Improvement for Emergency Care Improvement Support Team (ECIST), NHS England, and Pete Gordon, previous Head of Improvement for ECIST. ECIST is a clinically led national NHS team that has been designed by clinicians to help health and care systems deliver high quality emergency care and have been supporting health and care colleagues in Nova Scotia.
The team visited the Trust to understand what is being done at SASH to tackle improving outcomes though reducing length of stay for patients and preventing delayed discharge. This included learning more about the Let’s Get You Home programme, enhanced acute pathways to ensure people receive the right care first time, and the culture of continuous improvement (Kaizen).
Karen Breen, Chief Operating Officer, Surrey and Sussex Healthcare NHS Trust, said: “Recognising the ongoing challenges we continue to face daily and the impact this has on our patients and staff, this visit marked an important opportunity to reflect on our journey so far and all our teams have done to improve care for our patients. I am proud to be part of this journey and once again inspired by all our teams and their relentless focus on doing the right thing for our patients.”
Lynn Edwards, Senior Director, Clinical Networks, Integrated Access and Flow and Frailty and Elder Care, Nova Scotia Health said: “I was impressed with the way clinical staff worked across the social and medical system to support the ongoing independence of all patients to get home – in particular, their frail patients. There was a sense that all leaders and providers knew the importance of flow to home for patients and were aware of the metrics that they reported daily. National guidelines and policies were critical enablers for change; this was balanced with the importance of building relationships.”
The Nova Scotia team visited several key areas of the hospital, observed board rounds and received insight into how the hospital is managed operationally on a day-to-day basis.
Improving outcomes for people with more complex needs was a key theme of the day. A multi-organisational discussion with healthcare partners from across Surrey and Sussex was held looking at ways the Trust have tackled this and the journey ahead in supporting the needs of the most vulnerable residents.
The team fed back that seeing the Trust’s improvement journey to date, and the commitment to continuous improvement for both patients and staff, had left them with a real sense of hope.
They also noted that through leadership and staff empowerment in all the areas they visited, they saw a genuine sense of partnership and shared ambition to support people to live healthier, longer lives at home – with the close working relationships between the Trust and its system partners a particular highlight.
Nick Holding, Head of Improvement, ECSIT, said: “It was a pleasure to join the visit to Surrey and Sussex, to hear from those who do the work daily about their real-life experience of an organisational-wide approach to continuous quality improvement. It is clear from the conversations we had that teams are engaged in ongoing efforts to improve their work on behalf of their patients and colleagues and feel empowered to try new ideas when they feel it’s necessary. On leaving the building, my over-riding sense was of an organisation that stays true to its strategy triangle, providing clear direction and then allow their people to get on and deliver the changes needed, yet embracing the mantra that better never stops.”
The visit was part of a five-day visit to several other Trusts to collaborate internationally on key issues affecting patient outcomes, such as partnership working and embedding a ‘home first’ mindset.
Dr. Tanya Munroe, Senior Medical Director, Access & Flow Network/C3, Medical Site Lead, Colchester East Hants Health Centre, Assistant Professor, Emergency Medicine, Dalhousie University, Nova Scotia Health, said: “I was in awe by the degree of integration across the site. It truly seemed to function as an entity, and not just as a collection of individual parts. The leadership team was highly engaged, and the approach was one of continued improvement. They were also candid about their challenges and struggles. The ability to access appropriate services from the community without relying on the emergency department as the only “front door” to healthcare was evident across all sites we visited. I left with so many ideas that my head was spinning.”
The Nova Scotia Team spoke with passion about their shared desire to support more people be discharged home from hospital sooner, and for partnerships to work together to prevent avoidable admissions in the first place.
We look forward to staying in touch with our new international colleagues to continue learning together and doing the best we can for our residents.