Professor Fiona McQueen Chief Nursing Officer Scottish Government - - PowerPoint PPT Presentation

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Professor Fiona McQueen Chief Nursing Officer Scottish Government - - PowerPoint PPT Presentation

Nov 16, 2022 151 likes •704 views

Professor Fiona McQueen Chief Nursing Officer Scottish Government Supporting the best start.the best journey If not us.. Vision Programme for Government Increasing income in lowest three deciles Reducing depopulation of rural

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Professor Fiona McQueen Chief Nursing Officer Scottish Government

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Supporting the best start….the best journey

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If not us…..

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Vision

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Programme for Government

  • Increasing income in

lowest three deciles

  • Reducing

depopulation of rural areas

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Our Context

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Some reminders

  • Scotland has one of the world’s best performing health

services

  • But we also suffer from some of the poorest health in the

western world

  • While our health has improved over time, it has not

improved on an equal basis for all

  • Improving the public’s health is a shared effort

across a broad range of partners

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Reality

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More people have 2 or more conditions than only have 1

Multimorbidity is common in Scotland

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Strategic Direction of Change

Improving Population Health

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Strategic Context

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Setting the Context for Change

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If not us………

  • Prevention
  • Service Delivery
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Policy aspirations

 People at the centre  Right care, right person, right place, right time  Maximising all contributions  Integrated teams working with people  Harnessing assets & managing self

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TRANSFORMING ROLES Maximising everyone’s contribution

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Transformed roles Education  Public confidence

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What is needed of us now?

Transformed NMaHP roles  Thinking differently  Explicit NMaHP contribution  Current, new & advanced roles  Attractive career pathways in & out hospital Transformed NMaHP education  Fit for the future  Flexible  Lifelong learning & development  Registration to advanced practice  Sustainable provision

Transformed services

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Prof Fiona McQueen Chief Nursing Officer Scottish Government

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Patient/client

TEAM TEAM TEAM TEAM TEAM

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Dream Team Scream Team

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INDIVIDUAL Growth AIM Achieved CAPACITY Built

3 Criteria for Effective Leadership Teams

1- Achieves real outcomes for the many constituencies they serve 2- Builds capacity for sustainability & future efforts; gets better, smarter and more capable over time 3- Develops individual leaders as stewards of the whole as a consequence of working together

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Skills & Resources

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Three Conditions That Enable A Team’s Effectiveness

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A Real Team

 Leaders know who is

  • n the team and who

is not  Team meets regularly and membership is constant  Every team member is critical to success

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Three Conditions That Enable A Team’s Effectiveness

Bounded, stable & interdependent The right people with capabilities to lead inter- dependently

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  • Clear: We know what the outcomes would

look like if we were to achieve it

  • Challenging: Has to engage the best of what

people are capable of, a real stretch

Condition 2: A Compelling Purpose

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Three Conditions That Enable A Team’s Effectiveness

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  • Interdependent roles
  • Real teamwork
  • Norms of conduct

Condition 3: Enabling Structures

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28 33 36 41 45 45 49 49 51 52 55 62 62 73 75 80 98 20 40 60 80 100 CCU REHAB OR EMERG 5 WEST 6 WEST PEDS GERI DIALYSIS PERIOP PHARM 3WEST ICU NICU SICU PEDS OB Teamwork Climate Scores Across Facility

HCAHPS 92 50 Medication Errors per Month 2.0 6.1 Days between C Diff Infections 121 40 Days between Stage 3 Pressure Ulcers 52 18 Illustrative Data: Extracted from Blinded Client Data

CULTURE IS RELATED TO…

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28 33 36 41 45 45 49 49 51 52 55 62 62 73 75 80 98 20 40 60 80 100 CCU REHAB OR EMERG 5 WEST 6 WEST PEDS GERI DIALYSIS PERIOP PHARM 3WEST ICU NICU SICU PEDS OB Teamwork Climate Scores Across Facility

Employee Satisfaction 91 55 Employee Injury per 1000 days 0.1 16 Employee Absenteeism per 1000 days 10 15 RN Vacancy Rate 1 9

<60% Score = Danger Zone

Illustrative Data: Extracted from Blinded Client Data

… AND UNFAVORABLE EMPLOYEE OUTCOMES

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Staff health and wellbeing is a public health issue

  • 42% UK nurses experience stress & burnout
  • 36% are over 50
  • Older nurses struggle with physical and psychological

demands, exasperated by 12 hr. Shifts

  • 3 in 10 Scottish nurses are obese
  • 42% nurses have a physical or mental health condition
  • Musculoskeletal disorders are problems for both younger

and older nurses

  • 4.5% sickness absence
  • 3x more likely experience domestic violence
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Healthcare Scientists Pushing the Professional Boundaries in Audiology

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Patient History

  • Attended Audiology direct access clinic following GP

referral

  • 6 weeks ago – acute vertigo and vomiting
  • Out of Hours – antiemetic injection
  • Unilateral hearing loss/tinnitus (right)
  • Vertigo on quick head movement
  • “walking on marshmallows”
  • Visual preference
  • Taking Cinnarizine
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Historically

  • Patient would have been referred to ENT

– Attends ENT clinic

  • Hearing test by Audiology
  • History by ENT
  • Bedside assessment by ENT
  • Further tests requested

– Audiology clinic for assessment

  • Report back to ENT

– Attends ENT clinic for diagnosis

  • Referred for vestibular rehabilitation

– Attends Audiology clinic for rehabilitation

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Present

  • Condensed into one appointment at Audiology

– History, hearing test, vestibular assessment, vestibular rehabilitation

  • Reduces

– Multiple referrals – The risk of referrals being missed – Multiple appointments – Long waits

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Assessment Results

Otoscopy Pure Tone Audiometry vHIT (Head Impulse) Computerised Dynamic Posturography

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Management

  • MRI scan
  • Hearing aid
  • Vestibular Rehabilitation
  • Patient managed entirely by Audiology, no

requirement for ENT input at the present time.

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Clinical Snapshot

  • 30 clinics in 2016 during

– 107 patients

4 Did Not Attend 3.74% 107 Patients attended 5 Referred to ENT 4.85% Longest Wait 110 days Shortest Wait 11 days Average Wait 37 days

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Outcomes

  • Reducing steps in the initial pathway and utilising the skills

mix available has helped reduce waiting times – Over 100 days initially to approximately 20 days as the clinic progressed

  • Low DNA Rates
  • High discharge Rate
  • Low onward referral rate
  • No new equipment or resources required
  • More economical to use an Audiologist and free up consultant

clinics for more complex patients

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Stepping into the Future

  • Increase in clinics as GPs become more

aware of the services offered

  • Information to GPs and referrers to

make sure appropriate patients are booked

  • Implemented in other areas
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The House of Tomorrow

For their souls swell in the house of tomorrow, which you cannot visit, even in your dreams