LAUSR

Aims To evaluate current service demands, the effect these are having on staff experience and devise options for improvement. Methods Information input came from multiple sources. Firstly we generated an output of the increasing demand on our service by assessing admission rates bi-annually over the last 10 years. This allowed us to judge the current situation goal gap and create goal attainment options. We produced staff questionnaires for doctors and nurses to gain their views on our service. We collated data on ward rounds from team members on patients seen, timings and confidence regarding decisions made achieving intended goals. We hosted workshop and table-top simulation sessions to determine agreed solutions for further system modelling. Results In 10 years, our admission rate has more than doubled. Data capture from ward rounds over 3 consecutive weeks revealed an average cycle time of 18 min per patient. On average, less than 1 in 40 inpatients saw the same decision maker on consecutive days; of these the average run of consecutive care was 2 days. Influencing factors included middle grade rostering, policy that ‘every new patient is seen by consultant within 24 hours’, reactive system design and geographic deployment strategy. Our workshop highlighted the requisite for ward round re-design. A table-top simulation comparing different ward round designs provided participants an opportunity to experience contrasting ward round designs in a ‘safe’ environment. The shared experiential learning method was used to gain team permission to consider ward round re-design. Conclusions With an ever-increasing demand for our service, we are getting concerned that if we don’t work differently, we will be unable to cope. There is a consistent lack of continuity of decision makers on ward rounds and we believe that increasing continuity has the potential to reduce time used for ward rounds, improve patient experience, enhance staff learning and reduce patient length of stay. We therefore propose health system strengthening measures through ward round re-design to improve our service to both patients and staff.