Royal Liverpool case study

The Hospital at Night concept proposes that the way to achieve effective clinical care is to have one or more multiprofessional teams who between them have the full range of skills and competences to meet patients' immediate needs.

Read about the Royal Liverpool and Broadgreen University Hospitals Trust pilot >>>

Hospital at Night aims to redefine how medical cover is provided in hospitals during the out of hours period.

The approach provides the best possible care for patients given the changes in permitted working hours for doctors in training. It offers the most efficient method of preserving, and even enhancing, doctors' training in the reduced hours available.

Calling Time spoke to Clare Pratt, WTD project manager at the Royal Liverpool and Broadgreen University Hospitals NHS Trust about how she initiated change within the organisation to expand on the Hospital at Night programme. This successful programme provides care and services in new ways.

Why was the consultation process so vital in planning and implementing change?

• "It helped us to plan, prioritise and deliver a better system for doctors, and a better service for our patients
• It helped us create better working relationships with all grades of staff and enabled them to see the problems and identify the solutions that they believed would work. This in turn increased their sign up to the project
• It symbolised the trust's commitment to being open about the proposed changes."

How did the trust ensure the outcomes were fed back to shape the direction of the work?

• "Focus groups were held for all junior doctors. Ward staff and the current out of hours team (nurse practitioners) were also consulted
• Common themes were identified and these themes were fed into working groups that had been established as sub-groups of the project group
• Each working group now has a clear implementation plan to ensure that work progresses at an appropriate rate."

What communication channels did you have in place?

• "Regular written and verbal reports were made to the Executive Team, Project Group, Local Negotiating Committee and the Patient's Council to ensure that all groups were kept informed
• Regular update sessions were held with junior doctors, ward staff and nurse practitioners
• Regular articles in the trust magazine and email newsletter
• Face to face meetings with clinical directors to discuss impact of proposed changes
• Pre-existing trust meetings such as ward managers' time out days and divisional meetings to keep staff informed."

Did the trust use clinical champions to communicate change?

"We were fortunate that because of our background of successful implementation of the Hospital at Night model there was lots of enthusiasm surrounding the project.

"We had senior level sign up from day one and our medical director, Dr White, chairs the project group. These groups are also attended by two divisional medical directors and we have three strong clinical leads

• Consultant physician in acute medical, Dr Solomon Almond is the lead for general medicine
• Consultant breast surgeon, Ms Alison Waghorn is the lead for general surgery
• SpR, Dr Simon Constable is the lead for junior doctors.

"Working groups were attended by our BMA representative and mess president who championed the cause out on the shop floor.

"I also worked closely with our team of nurse practitioners who worked tirelessly to ensure that ward staff and junior doctors were aware of developments as and when they occured. Without this team working approach, I am sure that we would not have progressed this project as quickly as we have."

Can you give Calling Time readers any top tips for consultation or initiating change?

"There is no right method of consultation that will work for all staff groups and there is no guarantee that just because it worked well with one, it will always work well. Using more than one method will increase your chances of getting some good responses from staff. Don't be disheartened if no one arrives for a focus group, you just need to plan the date and time a bit better next time or use an alternative method of consultation.

• Consult early - involve as many people as you can, as early as you can
• Make consultation an integral part of your strategy, develop a consultation strategy to keep you on track
• Ensure that you have commitment from senior staff for the need to consult
• Provide regular feedback on your plans to those you have consulted, they will feel valued knowing that their ideas have helped shape plans
• Keep going - you will have times when individual consultations go wrong, don't let this stop you."