The document summarizes a webinar on delivering seven day health services. It includes an agenda for presentations on the national Seven Day Services Transformational Improvement Programme and the early adopter experience in Sheffield. Marie Tarplee from the improvement program discusses the clinical standards, self-assessment tool, and case studies. The Sheffield team then presents their journey from establishing a frailty unit to implementing a "Discharge to Assess" model across specialties, with a focus on rapid assessment and support for patients in their own homes. They discuss challenges, benefits, and lessons learned in making major system changes.

1. Seven Day Services Transformational
Improvement Programme:
Community of Practice
Thursday 13th November 2014
Improving health outcomes across England by providing improvement and change expertise
Welcome, we will be starting shortly

2. Agenda
2:00 Participants join
2:10 Welcome and introductions
Rachel Chapman and Jodie Mazur
2:15 Seven Day Services Transformational Improvement Programme
Marie Tarplee
2:30 Sheffield Early Adopter Team
Dr Andrew Gibson, Ruth Brown and Paul Harriman
3:50 Summary and next steps
Marie Tarplee
4:00 Close
Improving health outcomes across England by providing improvement and change expertise

3. During the presentations pose questions and comments
using the chat facility

4. These buttons enable you to interact.
If you are asked a question respond by selecting yes or no.
During discussions raise your hand to ask a question.

5. This is the Talk button
If using a headset, your line will automatically be muted.
To unmute your line, click on the Talk button, to allow you
to speak.
A microphone will appear in the Talk button if your line is
unmuted

6. Agenda
Improving health outcomes across England by providing improvement and change expertise
2:00 Participants join
2:10 Welcome and introductions
Rachel Chapman and Jodie Mazur
2:15 Seven Day Services Transformational Improvement Programme
Marie Tarplee
2:30 Sheffield Early Adopter Team
Dr Andrew Gibson, Ruth Brown and Paul Harriman
3:50 Summary and next steps
Marie Tarplee
4:00 Close

7. Seven Day Services
Transformational
Improvement
Programme
Marie Tarplee
Senior Improvement Manager
7 Day Services

8. Seven Day Services: The Context
• Over the last ten years a growing body of evidence of poor
patient outcomes for patients admitted at weekends.
• The 5 day service model no longer meets justifiable patient
and public expectations.
• Dec 2012 NHS England Everyone Counts ( 2012/13:
Planning for patients).
• Sir Bruce Keogh Review and Forum Findings December
2013.
• Aligned with NHS England’s “Call for Action” united
approach to fundamentally changing how we deliver
health and care services: “Doing nothing is not an option”.
• Five Year Forward View ( NHSE October 2014)

9. NHS Director promises
seven-day service by
2017
‘unstoppable movement’
Sir Bruce Keogh
The Sunday Times
Seven Day Services: The Challenge

10. Taking on the challenge
“Stakeholders are finding it
difficult to ‘see outside their
own front door’ due to
operational pressures and
cost reduction”
“There are numerous plans
and strategies in place but
little positive action and
achievement”
“Competition between
Trusts and lack of trust
between us is one hurdle”.
“Everyone thinks that the CCG’s should be
driving the agenda as they have the legitimate
power but in some areas leaders are questioning
whether they have the courage to be radical”
“Patients want 7 day
services but react when
we need to close, relocate
services to offer a 7 day
service"
“We were slow to realise that
it is not about additional
funding or simply adding to
acute workforce, we were not
thinking laterally across the
whole health economy”

11. So what are we to do?
Spread what we know works
Develop models to take us further
Enroll every provider &
commissioner
Build a momentum for change
Engage the public & patients
Commission the best
See local change happen at scale
& pace.
“How can we take on
the extraordinary
challenge of
integrating services
into a seamless,
consistent, high
quality seven
day service?”
Fiona Carey,
Cancer & Patient Representative

12. National Clinical Standards:
1. Patient Experience
2. Time to first consultant review
3. Multi-disciplinary Team (MDT) review
4. Shift handovers
5. Diagnostics
6. Intervention / key services
7. Mental health
8. On-going review
9. Transfer to community, primary and social care
10. Quality improvement

13. Delivering the Standards - Three Year plan
• Local contracts should include an Action Plan to deliver the
clinical standards within the Service Development and
Improvement Plan Section.
Year 1
2014/15
• Those clinical standards which will have the greatest impact
should move into the national quality requirements section of
the NHS standard contract.
Year 2
2015/16
• All clinical standards should be incorporated into the national
quality requirements section of the NHS standard contract with
appropriate contractual sanctions in place for non-compliance,
as is the case with other high priority service requirements.
Year 3
2016/17

14. NHS Improving Quality
7 Day Services Improvement Programme
• The next 3 to 5 years, dedicated support, dedicated investment
• Signpost evidence from the diagnostic service reviews for 24/7 provisions across
England including Interventional Radiology, Endoscopy and Scientific services to
ensure providers and networks have plans in place to implement evidence
based seven day diagnostics services and models.
• Start the drive for spread: engaging every commissioner and provider in moving
towards the provision of services that are delivered in a way that meets NHS
England’s Seven Day Services clinical standards.

15. NHS Improving Quality
7 Day Services Improvement Programme
• Support organisations to understand their baseline position – self assessment
tool, build on the evidence, measure outcomes.
• Start to identify the top interventions which will make the biggest difference to
supporting delivery of local seven day services across the whole system.
• Supporting learning networks, communities of interest, building capability and
capacity, communication & engagement.
– CCG Development, Service Improvement & large scale change programmes
• Share the learning widely across the health and care communities

16. 7 Day Self Assessment tool
• The national self-assessment
toolkit has been developed to
enable organisations to
baseline provision of seven
day services.
• The toolkit will enable you to
assess your current level of
service provision, using
nationally agreed definitions,
and help you to understand
your local needs and
requirements to deliver
extended services
• Accessed at:
http://www.7daysat.nhs.uk/

17. 1. Patient Experience – Lack of access to social care across 7 days.
2. Consultant review – NEWS score widely used upon admission, but reduced review of
NEWS after admission.
3. MDT – Significant variation, in terms of access to timely complex needs assessment and
medicines reconciliation. No area reports having access to patients’ primary and community
care records.
4. Shift Handovers – Little electronic recording of clinical data.
5. Diagnostics – Lack of weekend access to Bronchoscopy, Histopathology and MRI.
6. Intervention / key services – The majority of inventions / key services are available across
7 days across the country, variation in urgent radiology.
7. Mental Health – Variation in access across the country, particularly 1 hour standard.
8. On-going review – Lack of an electronic record is hindering achievement
9. Transfer to care – Lack of weekend access to equipment provision, occupational therapy,
social services, senior clinical expertise & access to an integrated care record
10. Quality improvement – Good involvement of those who deliver care in the review of
patient outcomes, majority of sites give training that is consistent with General Medical
Council and Health Education England curriculum recommendations.
7DSAT: Early learning

18. Seven Top Tips
2. Understand your baseline position
– “Don’t jump to solutions before you
understand the real problem “
3. Engage, communicate, partner, network ,
align with the whole system - “You cannot
achieve this alone”
4. Keep the focus on patients , safety, quality
of care & outcomes
5. Don’t ignore the big challenges
6. If your not measuring– you’re not improving
- If you are only measuring you’re not
improving, but measure & improve the right
thing that adds value
7. Get the messages right - services not
working. Share the learning. Think scale & pace
1. Use a
systematic
Approach

19. Case studies
www.nhsiq.nhs.uk
7DayServices@NHSIQ.nhs.uk

20. Thank you
marie.tarplee@nhsiq.nhs.uk
07917 233248
www.nhsiq.nhs.uk

21. Agenda
Improving health outcomes across England by providing improvement and change expertise
2:00 Participants join
2:10 Welcome and introductions
Rachel Chapman and Jodie Mazur
2:15 Seven Day Services Transformational Improvement Programme
Marie Tarplee
2:30 Sheffield Early Adopter Team
Dr Andrew Gibson, Ruth Brown and Paul Harriman
3:50 Summary and next steps
Marie Tarplee
4:00 Close

22. Sheffield Led 7 Day Services
Community of Practice
Webinar
13 November 2014
Version 3
13 August 2014

23. Ruth Brown
Operations Director
Combined Community & Acute Group
Ruth.brown10@nhs.net
Presenting Today
Dr Andrew Gibson
Deputy Medical Director
Andrew.gibson@sth.nhs.uk
Paul Harriman
Assistant Director, Service Improvement
Paul.harriman@sth.nhs.uk

24. The Sheffield Team at
the Delivering Services,
Seven Days a Week
Conference held on
22 July 2014

25. Dr Andrew Gibson,
Deputy Medical Director
speaking at the Delivering
Services, Seven Days a
Week Conference held on
22 July 2014

26. This afternoon we will talk through …
• Our journey so far
• An overview of our approach, model and results
• Our next steps
• Our approach to measurement and tests of change

27. The Starting Point……
• In 2010, a Geriatric Medicine Consultant analysed 23 sets of
notes
• All 23 patients had avoidable delays in discharge
• 2259 bed days used, could have been 515
• Highlighted the discharge opportunities missed

28. The Big Room (Oobeya)

29. PDSA Cycle

30. The Big Room in action
Physiotherapist gives an
account of the test of change
to get a patient home on the day
they
were discharged by the GSM
consultant
Senior
registrar
General
Manager
For
Medicine
GSM
Matron
Service
Improvement
Social
Services
Manager
Community
Services
managerPhysiotherap
ist
Secretary
Discharge
Liaison

31. Development of the Frailty Unit
• Medical Assessment Unit (MAU) to Frailty Unit
• In April 2012 all Geriatric & Stroke Medicine Consultants
changed their job plans enabling earlier senior review
• In May 2012, the Frailty Unit become a physical entity
supported by a Front Door Response Team

32. Development of the Frailty Unit
• During this time, adult Community Services had merged with
STHFT as part of ‘Transforming Community Services’
• Hospital and community teams at the interface were brought
together and we began to understand each others worlds
• Single Front Door Response Team including therapy, managed
within Community Services

33. Development of the Frailty Unit
• Assessment delays within hospital became more obvious
• The Big Room considered data and impact of standard
method of discharge
• PDSA Testing – started with 1 patient, repeated with 3, then
whole week

34. Frailty Unit Results in 2012
• 34% increase of patients discharged on the day of admission
or following day
• No increase in the population of patients being readmitted
• Length of stay reduced by 4 days
• This model is now embedded

35. “Discharge to Assess”
“Discharge to assess as soon as the acute
episode is complete in order to plan post-acute
care in the person’s own home”
Imison. C. et al. (2012)
Older People and Emergency bed use: exploring variation The Kings Fund

36. “Discharge to Assess” Concept on a Base
Ward
• In 2013, we chose RH6 to test “Discharge to Assess” based on
local learning from Frailty Unit
• RH6 has 28 beds and is an elderly medical ward, part of the
Geriatric Medicine and Stroke Directorate
• Patients have a wide range of medical conditions most with
complex social problems and care needs

37. The Hospital Perspective
• Patients were waiting an average of 10 days to go home after
their acute episode
• Medical patients were being treated on other wards eg
surgery
• Impact on flow, cancelled elective care
• Assessments were undertaken in hospital environment

38. The Hospital Perspective
• Equipment delivery would take between 48 hours – 5 days
• Referrals for on going services had to be booked several days
in advance
• Discharge for complex patients did not regularly take place at
a weekend
• Hospital staff did not know or have trust in the Community
staff or services

39. The Community Perspective
• Provide rapid support for patients in their own home
(admission avoidance or hospital discharge)
• All patients in their own bed had to be seen within 2 hours if
urgent or 24 hours if routine
• The service was available 7 days a week 8am – 10pm
• Generic assessment in place, supported by core skills training
with Sheffield Hallam University

40. The Community Perspective
Following the merger of Community Services with the hospital
(and a period of settling in!) it became apparent that:
• the waiting time for patients into the intermediate care
service was often over 10 days
• there was a need to build confidence and relationships with
hospital based colleagues
• the discharge pathways were complex

41. The Big Room (Oobeya)

42. Testing Discharge to Assess on a Base Ward
• To support the testing, real time working was crucial for
Community services
• Big Room principles allowed rapid, small ‘tests of change’
• Most patients assessed as needing lower levels of care than
predicted by ward staff. Staff confidence increased.
• New processes were quickly adopted as routine for RH6 ward

43. The Big Room – Benefits
• Patient Focus
• Development of a no blame culture
• Able to challenge historic practice and mind sets
• Reviewing expectations
• Understand each others language
• PDSA - Staff empowered to test

44. Sheffield’s Right First Time Programme
• Sheffield health and social care partnership
• Working together since 2011 to provide high quality, safe and
effective care in the most appropriate setting
• Transitional care project
• Senior weekly meeting to understand and escalate any flow
issues; CEO level sponsorship

45. October 2013
• Discharge to Assess was implemented on RH6 in October
2013
• It was already well embedded on the Frailty Unit
• The Community Intermediate Care Service aligned with the LA
Short Term Intervention Team to create Active Recovery
• The results……..

47. RH6: Discharge count increased by 34%

48. RH6: Mean LoS reduced by 30%

49. RH6: Falls count reduced by 30%

50. Intermediate Care Results
• We combined health and social care to form a new rapid
response service called Active Recovery
• Reduced the length of stay from 12 weeks to 6 weeks
• In September 2014, 100% of patients were seen at home
within 24 hours
• 99% of patients were seen within 24 hours on the hospital
discharge pathway (reduced from an average of 10 days)

51. The Discharge to Assess model
• Proportionate assessment process in hospital
• Patients leave hospital as soon as they no longer need acute
care
• All patients receive the same responsive service
• Transfer of care from the hospital to Active Recovery is within
24 hours, so discharge can be planned on same day or
planned for next morning

52. The Discharge to Assess model
• Broader range of Community Services considered to meet the
patients needs
• Single point of access – health and social care
• Discharged patients can be met at home
• Increase in community capacity via Active Recovery

53. Challenges
• Major culture change - challenging historic practice
• Building confidence and trust
• Transport and admin systems
• Capacity to work real time
• 7 day working
• Expectations – Patient and Carers, Commissioners and
Management

54. Benefits
• Improved patient experience
• Reduced length of stay, falls and geriatric medical outliers
• Increased discharge rate
• Increased trust between hospital and community staff
• Removal of processes that don’t add value
• Joint core skills training rolled out to hospital therapists in
provided by Sheffield Hallam University

55. Lessons Learnt
• This takes time, but the results are worth it
• The culture change required must not be underestimated
• Use shared values as a starting point – Patients First
• Ensure senior leadership manages Executive and
commissioner expectations

56. Take time to make sure you understand each other
#NOF
Lessons Learnt

57. Our Next Steps
• Roll out of Discharge to Access across the Trust, increasing
Community capacity ready for winter
• Focus of the Big Room is now ‘7 day working’
• Better Care Fund
• Merger of Community Services, Geriatric Stroke Medicine and
all hospital AHP services on 1 October

59. 7-day services - Our Approach to
Measurement and Tests of Change

60. Topics
• Measurements
• Types
• Data sources
• Example
• 7-day tests of change
• Understanding the current problem
• The tests
• What we have learned and results
• What about costs

61. Measurements
• Various types
• Measurements for Diagnosis
• Measurements for Improvement
• Measurements for Performance
• System level measures
• Demand
• Supply
• Time
• WIP

62. Data sources
• Patient events are recorded within our PAS
system.
• All data is extracted daily into SQL tables
• Relevant one for this is our Inpatient transaction
table
• One line per episode with 180 fields per episode
• Data extracted into Access and then Excel to
create admission and discharge pivot tables
• Also need midnight bed occupancy table

63. Example: Discharge Table
ShortDayName (All)
Registered Practice Code (All)
AdmissionGroupWLAP (All)
Intended Management Description (All)
Hospital (All)
Admission Method Description (All)
EpisodeTypeDescription (All)
Consultant Surname (All)
Disch Day (All)
SpellLOS (All)
AgeOnAdmission2 (All)
AgeOnAdmission (All)
Specialty Description2 (All)
Specialty Description CARE OF THE ELDERLY
Discharge Destination Description (All)
Ward on Discharge (All)
Discharge Destination Description2 (All)
Count of Casenote Number Disch Day2
Discharge Date Weekday Weekend Grand Total
28/03/2011 22 22
29/03/2011 18 18
30/03/2011 18 18
31/03/2011 21 21
01/04/2011 16 16
02/04/2011 11 11
03/04/2011 6 6
04/04/2011 20 20
05/04/2011 27 27
06/04/2011 19 19
07/04/2011 25 25
08/04/2011 18 18
09/04/2011 12 12
10/04/2011 5 5
11/04/2011 31 31
12/04/2011 20 20
13/04/2011 16 16
14/04/2011 19 19
15/04/2011 17 17
16/04/2011 11 11
17/04/2011 7 7
18/04/2011 21 21
19/04/2011 18 18

64. Data plotted onto Control chart

65. What should we measure?
• DO NOT use the average for weekdays and the
average for weekends and ratio them.
• If a patient should be discharge with equal
probability on any day of the week
Then
Probability of discharge = 1/7= 0.143
So
Probability of discharge on a weekday = 5 x 0.143 =
0.71

66. Calculate the ratio for a specialty
Count of Casenote Number Disch Day2
Discharge Date Weekday Weekend Grand Total Ratio
<28/03/2011
28/03/2011 - 03/04/2011 95 17 112 0.848
04/04/2011 - 10/04/2011 109 17 126 0.865
11/04/2011 - 17/04/2011 103 18 121 0.851
18/04/2011 - 24/04/2011 108 21 129 0.837
25/04/2011 - 01/05/2011 81 7 88 0.920
02/05/2011 - 08/05/2011 86 17 103 0.835
09/05/2011 - 15/05/2011 110 20 130 0.846
16/05/2011 - 22/05/2011 110 14 124 0.887
23/05/2011 - 29/05/2011 96 11 107 0.897
30/05/2011 - 05/06/2011 81 17 98 0.827
06/06/2011 - 12/06/2011 106 18 124 0.855
13/06/2011 - 19/06/2011 109 10 119 0.916
20/06/2011 - 26/06/2011 100 14 114 0.877
27/06/2011 - 03/07/2011 99 14 113 0.876
04/07/2011 - 10/07/2011 110 10 120 0.917
11/07/2011 - 17/07/2011 111 19 130 0.854
18/07/2011 - 24/07/2011 85 14 99 0.859
25/07/2011 - 31/07/2011 83 12 95 0.874
01/08/2011 - 07/08/2011 95 11 106 0.896
08/08/2011 - 14/08/2011 82 6 88 0.932

67. Plot that ratio on a chart

69. 7-day tests of change
• Big Room
• What is the problem
• Equality of discharge opportunity
• What is the cause of the problem
• Weekends are different to weekdays
• What is different about the weekend?

70. Identified issues
• No ward nurse coordinator on duty
• Reduced OT/Physio presence at weekend
• Weekend therapy cover often from different specialty staff with no knowledge of
ward or patient
• Lack of up-to-date knowledge of discharge system means it takes longer for a ward
nurse to process the work (as well as taking them away from patient care)
• Lack of ward pharmacist
• Difficulty in making Anticoagulation appointments
• No junior docs on ward (1 on for acute medicine)
• More difficult to arrange direct transport
• Difficult to access Satellite SPA
• Access to offsite beds
• Lack of ward admin cover
• Lower District Nurse numbers at weekend
• More difficult to access GP
• Access to imaging
• Access to laboratory service
• No consultant

71. Tests of change
• Start small
• One ward voted to be test-bed with others
watching
• What could we change
• Nurse coordinator
• OT and PT
• Ward clerk
• ? Pharmacy
• ? junior doc
• Set up 1 weekends test
• BUT……

72. Initial test
• Timing meant we couldn’t start
• So alternate proposed Project: Older Peoples Care Service
Improvement
Cycle: SD1 Date: weekends of 23/24
Aug and 31/1 Sept
Objective; We have noted over the past few years that weekend discharge counts are obviously
lower than during the week. As part of the thinking around 7-day services and potential for
reducing variation within and between wards we propose to learn how to move towards an equal
chance of discharge on any day of the week. The ward teams have already identified resource
differences at weekends.
This test looks to see if identification of patients who could go home at the weekend enables the
wards to prime the weekend discharge teams to affect that discharge.
PLAN
Questions Predictions
1. Will we be able to remind the wards to
identify pts for discharge by Friday 1700
1. Yes, in the test Chris Hayden and 1 other
will remind the wards on Friday afternoon.
2. Will the wards be able to identify patients
who will be ready for discharge weekend
2. Yes
3. Will the weekend discharge team be able
to effect those discharges
3. Yes
4. Will focusing on GSM discharges have an
impact on other specialties
4. Yes
5. Will Active Recovery be able to take
discharges at the weekend
5. Yes previous test have confirmed this
What data will be collected during this time? (Forms to be used)
To be measured:
Number and time patient identified on Friday
Time w/e discharge team start and end the process
Time patient leaves NGH
Arrival time at home
If patient stays at home with appropriate package
Patient experience (narrative)
Readmission
Plot of weekday discharge ratio
Who, what , when and where:
All NGH GSM base wards, w/e discharge team, Active Recovery, SPA, transport, Chris Hayden
Any patient who is capable of being discharged on the weekend who otherwise would have
waited until the next normal working day.
DO the Action Plan
What went wrong? What happened that was not part of the plan?
STUDY
Complete analysis of data. Summarize what was learned include results of predictions.
ACT
What decisions were made from what was learned?
What will be the next cycle?

73. Cycle 2 PlanProject: Older Peoples Care Service
Improvement
Cycle: SD2 Date: weekends of 4th
/5th
Oct
Objective; As part of the thinking around 7-day services and potential for reducing variation
within and between wards we propose to learn how to ensure that ward staffing is consistent
across the whole week and we move towards an equal chance of discharge on any day of the
week. The ward teams have already identified resource differences at weekends. During test
cycle SD1 we identified patients on Friday who could leave over the weekend. This led to a
partial increase in discharges but it has highlighted that patients admitted at the weekend wait
until Monday for a range of assessment/treatments.
This test will attempt to staff across the weekend to the same level as during the week so that
care appears more equal. Learning from this test will be carried forward to potential repeat tests
over the next 8 weeks.
PLAN
Questions Predictions
1. Will we be able to provide additional
nurse, therapist, admin, pharmacy and
medical staff cover
1. No. We will struggle to be able to provide all
staff groups. Pharmacy and junior doctors are
main risk
2. Will the wards be able to discharge
patients over the weekend
2. Yes
3. Will we be able to reduce the number of
patients who remain unassessed on Monday
morning
3. Yes
4. Will we be able to prevent the additional
staff being removed from the ward to cover
shortfalls elsewhere
4. No. Staff (nursing) shortfall elsewhere will
see the additional staff input removed
5. Will patients require consultant input over
the weekend
5. No, lack of direct consultant input is not likely
to be an issue at this stage
6. Will transport be an issue 6. No, we predict that Arriva, Event or City taxi
options will allow us to discharge
What data will be collected during this time? (Forms to be used)
To be measured:
Number of admissions and discharges over the weekend (existing data sets)
List of identified defects and successes (Helen et all to create and keep a list)
Unassessed therapy workload on Monday morning (OT/Physio to count on Monday morning)
Any patient carer/comment
Any AR issues
Who, what , when and where:
RH6 staff on daytime period over the weekend 4/5 Oct
DO the Action Plan
STUDY
ACT

74. Now upto 7 cycles
• What have we learned?
• Not having one of the key staff causes a problem
• Ideally need staff from existing ward team
• Lack of ward-based Junior doctor is an issue
• Lack of ward-based pharmacy is an issue
• No identified need for a consultant
• Removal of staff on Friday compromises weekend
discharges
• Reduced Monday morning batches
• Admit and discharge within the weekend

75. • Cycle 2 - 7 discharged, 1 admit & discharge
• Cycle 3 - 3 discharged, OT not from base ward
only 1 PT pt for Mon am
• Cycle 4 - 3 discharged but could have been 8
(no staff for Sat)
• Cycle 5 - 4 discharged (but 16 others in week)
• Cycle 6 - 3 discharged, the only ones who
could
• Cycle 7 – 4 discharged, no OT on Sunday

77. What about the cost?
• Cost is a balance measure
• So far about £900 per weekend (equivalent of
3 nights stay)
• No additional patients, just earlier
• Will reduce total ward capacity allowing
reallocation of resources

78. 5-day system example
Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun LoS
1 1 1 1 4
1 1 1 1 4
1 1 1 1 1 1 6
1 1 1 1 1 1 6
1 1 1 1 1 1 6
1 1 1 1 1 1 6
1 1 1 1 1 5
1 1 1 1 4
1 1 1 1 4
1 1 1 1 1 1 6
1 1 1 1 1 1 6
1 1 1 1 1 1 6
1 1 1 1 1 1 6
1 1 1 1 1 5
1 1 1 1 4
1 1 1 1 4
1 1 1 1 1 1 6
1 1 1 1 1 1 6
1 1 1 1 1 1 6
1 1 1 1 1 1 6
1 1 1 1 1 5
1 1 1 1 5.29 mean
1 1 1 1
1 1 1 1 1 1
1 1 1 1 1 1
1 1 1 1 1
1 1 1 1
1 1 1
WIP per night 6 6 6 6 4 4 5 6 6 6 6 4 4 5 6 6 6 6 4 4 5
WIP per night x 60 360 360 360 360 240 240 300 360 360 360 360 240 240 300 360 360 360 360 240 240 300
max WIP 360
mean WIP 317
Util with 360 beds 100% 100% 100% 100% 67% 67% 83% 100% 100% 100% 100% 67% 67% 83% 100% 100% 100% 100% 67% 67% 83%
mean util 88%
0
1
2
3
4
5
6
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
LoS

79. 7-day system example
Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun LoS
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4 mean
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240 240
mean WIP 240
Util 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

80. • Initial ’5-day’ system required 360 beds
• Redesigned ‘7-day’ system requires 240 beds
• Same number of patients being admitted
• Which was better for the patient?

82. Thank you!
Andrew Gibson
andrew.gibson@sth.nhs.uk
Ruth Brown
ruth.brown10@nhs.net
Paul Harriman
paul.harriman@sth.nhs.uk

83. Agenda
Improving health outcomes across England by providing improvement and change expertise
2:00 Participants join
2:10 Welcome and introductions
Rachel Chapman and Jodie Mazur
2:15 Seven Day Services Transformational Improvement Programme
Marie Tarplee
2:30 Sheffield Early Adopter Team
Dr Andrew Gibson, Ruth Brown and Paul Harriman
3:50 Summary and next steps
Marie Tarplee
4:00 Close

84. Next Community of Practice:
Led by County Durham and Darlington Early Adopter
• “Preparing for the implementation of 7 day services”
• Wednesday 14th January 2015 11:30-13:00
www.nhsiq.nhs.uk
7DayServices@NHSIQ.nhs.uk
#nhs7dayservices
Seven Day Services
Transformational Improvement Programme

85. Agenda
Improving health outcomes across England by providing improvement and change expertise
2:00 Participants join
2:10 Welcome and introductions
Rachel Chapman and Jodie Mazur
2:15 Seven Day Services Transformational Improvement Programme
Marie Tarplee
2:30 Sheffield Early Adopter Team
Dr Andrew Gibson, Ruth Brown and Paul Harriman
3:50 Summary and next steps
Marie Tarplee
4:00 Close