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{"page":1,"change":"Addition","str":"Where can things go wrong? page 6","line":7,"x":104.66,"y":368.95,"width":"185.87","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":1,"change":"Addition","str":"Appendice s page 42","line":10,"x":104.66,"y":108.26,"width":"103.27","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":2,"change":"Addition","str":"emerges. A timeline for its production can be found on the back page. ","line":7,"x":99.264,"y":431.38,"width":"341.75","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":2,"change":"Addition","str":" Louise Jacox, Rebecca Bartholomew and the staff of the George Eliot Hospital","line":9,"x":117.26,"y":393.67,"width":"351.62","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":2,"change":"Addition","str":" Staff at the NHS Institute for Innovation and Improvement","line":10,"x":117.26,"y":381.43,"width":"258.32","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":2,"change":"Addition","str":" Staff at the Heart of England NHS Trust","line":11,"x":117.26,"y":369.31,"width":"180.12","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":2,"change":"Addition","str":" Fellows of the Improvement Faculty","line":12,"x":117.26,"y":357.07,"width":"162.33","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":2,"change":"Addition","str":"This guide references some key documents that the Authors believe wil l help inform good practice : It is only a proportion of the good ","line":16,"x":99.264,"y":274.13,"width":"645.74","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":2,"change":"Addition","str":"literature available! The topic of handovers and transfer of care continue to be researched and were a subject theme for The Health ","line":17,"x":99.264,"y":261.53,"width":"637.71","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":2,"change":"Addition","str":"Foundation’s Clinical Systems Improvement Programme ( www.health.org ) in 2012 - 2014 . Despite research in this area, our ","line":18,"x":99.264,"y":248.81,"width":"595.92","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":2,"change":"Addition","str":"experience in pra ctice suggests that very few places have used a robust method to implement small scale or systems wide ","line":19,"x":99.264,"y":236.21,"width":"599.01","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":2,"change":"Addition","str":"approaches to improve the many aspects of transfers of care that must be addressed in order to deliver a reliable service to ","line":20,"x":99.264,"y":223.49,"width":"602.49","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":2,"change":"Addition","str":"If you have achi eved this goal the Authors would love to hear from you and help spread the learning so that others can understand ","line":22,"x":99.264,"y":185.54,"width":"636.57","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":2,"change":"Addition","str":"how they might adapt and adopt your learning to achieve reliable transfers of care in their own service. Please email ","line":23,"x":99.264,"y":172.94,"width":"566.59","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":2,"change":"Addition","str":"Lice nsed to the public under a crea tive commons attribution 4.0 license . Also please note and respect : ","line":26,"x":99.264,"y":101.42,"width":"493.96","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":3,"change":"Addition","str":"care happen s for their patients and service users . Studies have identified clinical handover as a ‘high risk scenario for patient safety","line":3,"x":99.264,"y":466.9,"width":"636.07","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":3,"change":"Addition","str":"( Clinical Handover Literature Review , 2008) . They describe the dangers and consequences of poor handovers , highlighting","line":4,"x":99.264,"y":452.38,"width":"591.71","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":3,"change":"Addition","str":"T here is also t he human cost; the distress, anxiety and loss of confidence that we know poor handovers can lead to for patients , ","line":9,"x":99.264,"y":364.99,"width":"623.86","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":3,"change":"Addition","str":"clients and their families and for staff too ( see c ase study , Appendix A ). ","line":10,"x":99.264,"y":350.47,"width":"340.01","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":3,"change":"Addition","str":"This guide is not about the justification for improving handovers ; that is covered in detail in other documents such as the OSSIE ","line":11,"x":99.264,"y":321.43,"width":"621.68","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":3,"change":"Addition","str":"detailed manual for improving every aspect of your handover process. ","line":13,"x":99.264,"y":292.25,"width":"339.94","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":3,"change":"Addition","str":"organisations and other safety critical industries across the world (e . g . SBAR, ISOBAR and IDEAL). ","line":21,"x":135.26,"y":129.98,"width":"483.55","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":3,"change":"Addition","str":"Many of the detailed tools and examples that you might want to use are included as appendices towards the end of the guide. This ","line":22,"x":99.264,"y":90.864,"width":"634.06","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":3,"change":"Addition","str":"means you can move through the guide more swiftly, but have a wealth of examples and ideas at your fingertips if you need the m.","line":23,"x":99.264,"y":76.32,"width":"631.77","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":4,"change":"Addition","str":"Welcome to this guide . It has been developed to help care teams and organisations make measurable improvements in the safety ","line":2,"x":99.264,"y":481.18,"width":"625.02","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":4,"change":"Addition","str":"and quality of patient care by ensur ing that, with every handover and transfer , the right information is given to the rig ht people at ","line":3,"x":99.264,"y":466.66,"width":"616.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":4,"change":"Addition","str":"the right time and in the right way .","line":4,"x":99.264,"y":452.14,"width":"165.36","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":4,"change":"Addition","str":"We have used the word transfers of care in most, but not all, places in this guide. Transfers can include a regular handover of ","line":8,"x":99.264,"y":373.99,"width":"623.59","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":4,"change":"Addition","str":"care at the end of a shift, or the transfer of a person’ s care to another ward , team, department , or service . This includes for ","line":9,"x":99.264,"y":359.35,"width":"600.16","height":"11.04","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":4,"change":"Addition","str":"example when a patient is transferred from a care home to a hospital or from a community team to a hospice . Transfers of care ","line":10,"x":99.264,"y":344.71,"width":"617.40","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":4,"change":"Addition","str":"happen every day. They can be verbal or written; they can take place in a group or one - to - one; in person , or over the phone. But ","line":11,"x":99.264,"y":330.19,"width":"623.94","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":4,"change":"Addition","str":"different care environments (see U seful R esources , page 40 ). But, by working with frontline ","line":15,"x":99.264,"y":241.37,"width":"442.88","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":4,"change":"Addition","str":"care teams, we have identified a gap when it comes to giving staff the detailed steps they ","line":16,"x":99.264,"y":226.85,"width":"430.13","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":4,"change":"Addition","str":"transforming ideas and aspirations into sound improvement projects that link clearly ","line":20,"x":135.26,"y":147.86,"width":"408.78","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":4,"change":"Addition","str":" It introduces and explains some of the most useful transfer of care tools , including","line":22,"x":117.26,"y":114.62,"width":"396.29","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":4,"change":"Addition","str":"standardised communication tool s such as SBAR ( Situation, Background, ","line":23,"x":135.26,"y":97.824,"width":"354.61","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":4,"change":"Addition","str":"Assessment, Recommendation ) , and directs you to some resources on form ","line":24,"x":135.26,"y":81,"width":"370.51","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":4,"change":"Addition","str":"design that makes it easier to do the right thing .","line":25,"x":135.26,"y":64.2,"width":"231.09","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":4,"change":"Addition","str":"Healthcare, Passing the Baton -","line":32,"x":581.95,"y":162.26,"width":"152.39","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":4,"change":"Addition","str":"A Practical Guide to Effective ","line":33,"x":581.95,"y":147.74,"width":"142.63","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":5,"change":"Addition","str":"preventable cause of harm i .","line":3,"x":99.264,"y":466.54,"width":"134.84","height":"11.04","fontName":[null],"dir":["ltr"]}
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{"page":5,"change":"Addition","str":"The risks can be even higher when ...","line":13,"x":99.264,"y":281.69,"width":"193.30","height":"11.04","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
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{"page":5,"change":"Addition","str":"• at w eekends or holidays","line":16,"x":117.26,"y":225.89,"width":"121.96","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
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{"page":5,"change":"Addition","str":"• where there is no written documentation , or what is written is unclear (e . g . too many abb reviations).","line":18,"x":117.26,"y":196.82,"width":"480.30","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":5,"change":"Addition","str":"The trouble with handovers is a useful video for understanding ","line":20,"x":122.3,"y":140.54,"width":"303.17","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":5,"change":"Addition","str":"poor between different teams and care settings. It is a good ","line":22,"x":122.3,"y":111.5,"width":"289.10","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":5,"change":"Addition","str":"this rises to 99% when a ","line":31,"x":574.63,"y":411.31,"width":"142.09","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":5,"change":"Addition","str":"Pothier DD, An experimental ","line":35,"x":627.22,"y":333.91,"width":"129.32","height":"9.96","fontName":[null],"dir":["ltr"]}
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{"page":6,"change":"Addition","str":"I n a relay race , how the b aton is passed between the run n ers is pivotal to success or failure and i t’s a useful ","line":2,"x":99.264,"y":506.98,"width":"523.99","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":6,"change":"Addition","str":"analogy here; m issed or misunderstood information can have a direct and even dangerous impact on the care ","line":3,"x":99.264,"y":492.46,"width":"536.62","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":6,"change":"Addition","str":"of a patient .","line":4,"x":99.264,"y":477.94,"width":"57.57","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":6,"change":"Addition","str":"There are two important techniques to ensure that the ‘baton’ is always passed correctly in ","line":6,"x":99.264,"y":260.69,"width":"442.55","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":6,"change":"Addition","str":"• Standardisation : e ach participant follows the same procedure and communicates the ","line":8,"x":117.26,"y":221.69,"width":"419.03","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":6,"change":"Addition","str":"same agreed content . This will have a positive impact on both the quality of care for ","line":9,"x":135.26,"y":207.05,"width":"405.59","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":6,"change":"Addition","str":"patients and the productivit y of the organisation.","line":10,"x":135.26,"y":192.5,"width":"233.45","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":6,"change":"Addition","str":"• Streamlining : unnecessary steps in the process are identified and removed. M aking ","line":11,"x":117.26,"y":163.46,"width":"411.84","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":6,"change":"Addition","str":"transfers of care simple will reduce the risk ( improve quality) and release time to care ","line":12,"x":135.26,"y":148.82,"width":"416.02","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":6,"change":"Addition","str":"Centre for Patient Safety Solutions (2007 )","line":23,"x":583.51,"y":95.424,"width":"166.81","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 8 August 2015","line":0,"x":99.264,"y":30.84,"width":"261.24","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"P lanned, structured transfer of care : what does ","line":1,"x":99.264,"y":512.26,"width":"636.03","height":"27.96","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"All of these checklist elements need to be in place to ensure the ‘baton’ is passed successfully and that the right information is given ","line":3,"x":99.264,"y":457.78,"width":"644.15","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"to the right people at the right time, in the right way... every tim e .","line":4,"x":99.264,"y":443.38,"width":"313.57","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"Good practice checklist *","line":5,"x":99.264,"y":417.79,"width":"140.08","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"What do we need? What does it mean? Do we have it?","line":6,"x":115.58,"y":379.51,"width":"333.94","height":"14.04","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"1. Leadership There is a nominated leader for each transfer of ","line":7,"x":133.58,"y":340.27,"width":"288.01","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"2. Values Transfer s and handovers are valued as an essential ","line":9,"x":133.58,"y":286.85,"width":"278.59","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"part of care and preparation for handover is a priority.","line":10,"x":256.34,"y":274.25,"width":"235.77","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"3. R ight people The appropriate people are involved.","line":11,"x":133.58,"y":243.89,"width":"245.40","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"4. Specified time ","line":12,"x":133.58,"y":200.81,"width":"94.86","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"There is an agreed process for transfers of care. This ","line":19,"x":256.34,"y":134.78,"width":"241.14","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"includes an agreed set of information to be covered in ","line":20,"x":256.34,"y":121.46,"width":"237.69","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"a structured way, is action - focused , assigns ","line":22,"x":256.34,"y":95.064,"width":"195.93","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"* Checklist adapted from page 1 of ","line":31,"x":666.82,"y":151.46,"width":"156.01","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"the NSW [New South Wales] Health ","line":32,"x":666.82,"y":138.38,"width":"162.10","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":7,"change":"Addition","str":"Principles for Clinical Handover","line":34,"x":666.82,"y":111.98,"width":"138.79","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":8,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 9 August 2015","line":0,"x":99.264,"y":30.84,"width":"261.24","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":8,"change":"Addition","str":"The second part of this guide shows you how to identify, plan and implement changes in a way that is most likely to deliver the ","line":2,"x":99.264,"y":482.14,"width":"616.01","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":8,"change":"Addition","str":"planned, structured transfers of care you want to achieve. It is based on the six step improvement process :","line":3,"x":99.264,"y":467.74,"width":"528.11","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":8,"change":"Addition","str":"For those who are familiar with running improvement projects, a summary of t his guide for each of the six steps is included at ","line":4,"x":99.264,"y":438.58,"width":"603.83","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 10 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":"Start by finding out about any existing policies or protocols for transfer of care in your organisation. You may not know exactly ","line":2,"x":99.264,"y":444.22,"width":"617.07","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":"what part of the transfer process you want to improve yet, or even how wide your focus will be (e . g . team, department or ","line":3,"x":99.264,"y":429.58,"width":"583.18","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":"organisation). This is fine. The purpose of this first step is to get a clear idea of what is happening in yo ur current transfer processes ","line":4,"x":99.264,"y":415.15,"width":"642.96","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":"and start to understand where the problems and solutions might be found . ","line":5,"x":99.264,"y":400.51,"width":"359.70","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":"Observe a transfer of care a nd r ecord the findings, but ensure that staff know they are not being tested . Transfers of care can be ","line":6,"x":99.264,"y":379.99,"width":"623.79","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":"varied, depending on the time of day and who is doing it , so it’s a good idea to observe several transfers.","line":7,"x":99.264,"y":365.35,"width":"505.84","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":9,"change":"Addition","str":" observation techniques (consider using photos and/ or videos)","line":9,"x":117.26,"y":323.59,"width":"295.53","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":" group discussion and/or interviews .","line":11,"x":117.26,"y":292.97,"width":"176.71","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":"Think about what happens before and after the transfer of care.","line":12,"x":99.264,"y":272.45,"width":"305.05","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":" How is information prepared for the transfer of care?","line":13,"x":117.26,"y":251.09,"width":"259.96","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":" Is information easy to find?","line":14,"x":117.26,"y":235.85,"width":"136.55","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":" What happens to documentation after the transfer of care?","line":15,"x":117.26,"y":220.61,"width":"290.10","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":"your transfe r of care processes might ","line":19,"x":283.97,"y":143.18,"width":"184.54","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":9,"change":"Addition","str":"ideas for improvement. Royal College of Physicians, Acut e ","line":23,"x":283.97,"y":84.984,"width":"269.43","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 11 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":"Measure the processes you are observing. You will need to do more detailed ","line":1,"x":99.264,"y":507.7,"width":"375.27","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":"measurement later in your improvement project , but gathering some initial data ","line":2,"x":99.264,"y":493.06,"width":"383.02","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":" T ime the transfer of information .","line":5,"x":117.26,"y":436.66,"width":"160.91","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":" C ount the number of interruptions during the transfer of ","line":6,"x":117.26,"y":421.39,"width":"276.41","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":" C ount the number of times transfer of care documentation is ","line":8,"x":117.26,"y":391.51,"width":"300.97","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":"complete d .","line":9,"x":135.26,"y":376.99,"width":"53.95","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":" L ist the type information included in transfers of care and record ","line":10,"x":117.26,"y":361.75,"width":"318.68","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":"how often this information is included in each communication .","line":11,"x":135.26,"y":347.11,"width":"298.94","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":" M easure h ow often the information is repeated.","line":12,"x":117.26,"y":331.87,"width":"235.06","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":"A flipchart is a simple but good way to record your ","line":13,"x":136.82,"y":154.22,"width":"223.60","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":"F or f urther ideas of how to map and measure current practice see ","line":16,"x":118.58,"y":274.97,"width":"317.44","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":" The Quality and Value Toolkit (process mapping, patient ","line":18,"x":136.58,"y":235.13,"width":"288.14","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":" The Productive Ward (acute), Productive Mental Health ","line":20,"x":136.58,"y":205.37,"width":"286.92","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":"Ward , Productive Community Hospital and Productive ","line":21,"x":154.58,"y":190.7,"width":"278.61","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":" The Productive General Practice for general practice","line":23,"x":136.58,"y":160.94,"width":"268.69","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":" The Care Homes Wellbeing Programme for the care home ","line":24,"x":136.58,"y":145.58,"width":"300.35","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":10,"change":"Addition","str":"Some of these resources are still available on the NHS Instit ute’s ","line":26,"x":154.58,"y":106.34,"width":"319.09","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":10,"change":"Addition","str":"For alternatives contact us at www.qualityimprovementclinic.com","line":28,"x":154.58,"y":67.32,"width":"314.65","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":11,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 12 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":11,"change":"Addition","str":"What does ‘good’ look like?","line":1,"x":99.264,"y":523.66,"width":"207.10","height":"15.96","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":11,"change":"Addition","str":"At this stage , it is useful to consider what ‘good’ would look like for the people in your care. One way of thinking about this is to ","line":2,"x":99.264,"y":500.98,"width":"610.14","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":11,"change":"Addition","str":"consider what processes and behaviours you would want to see happen for yourself or a member of your family whose care is bei ng ","line":3,"x":99.264,"y":486.46,"width":"645.62","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":11,"change":"Addition","str":"transferred to another person or team. If yo u don’t usually include patient s in your improvement work, we’d encourage you to ask ","line":4,"x":99.264,"y":471.94,"width":"625.33","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":11,"change":"Addition","str":"their opinion, and if you want to do more see the link below on experienced - based design.","line":5,"x":99.264,"y":457.42,"width":"436.48","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":11,"change":"Addition","str":"Use what you have l earnt from your observations, measurements and proc ess mapping and compare your current processes with ","line":6,"x":99.264,"y":436.78,"width":"627.93","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":11,"change":"Addition","str":"the elements in the good practice checklist. ( s ee Appendix B for examples of questions you can use to prompt discussion and ","line":7,"x":99.264,"y":422.23,"width":"609.95","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":11,"change":"Addition","str":"generate ideas with staff, patients or clients. )","line":8,"x":99.264,"y":407.71,"width":"217.53","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":11,"change":"Addition","str":" Experienced based design","line":11,"x":121.58,"y":138.86,"width":"134.91","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":11,"change":"Addition","str":" Process mapping","line":12,"x":121.58,"y":123.62,"width":"90.04","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":11,"change":"Addition","str":" Root cause analysis (including the ‘Five whys’) ","line":13,"x":121.58,"y":108.26,"width":"232.34","height":"11.04","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":11,"change":"Addition","str":"You could u se process mapping ","line":14,"x":260.3,"y":346.75,"width":"159.70","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 13 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"Once you have identified and captured what ‘good ’ looks like in your transfer of care ","line":2,"x":99.264,"y":441.22,"width":"408.45","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"processes, and started to id entify what you need to improve in your own systems , the next key ","line":3,"x":99.264,"y":426.7,"width":"461.58","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"step is to define a clear aim for your project.","line":4,"x":99.264,"y":412.27,"width":"211.50","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"This is where the Model for Improveme nt published in The Improvement Guide (Langley et ","line":5,"x":99.264,"y":383.11,"width":"442.47","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"al. 1996) can help you . Whatever your project and however big or small, the Model for ","line":6,"x":99.264,"y":368.47,"width":"420.56","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"Improvement will give y ou a simple, adaptable and thorough framework for developing, testing ","line":7,"x":99.264,"y":353.95,"width":"457.99","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"and implementing changes . Using the Model for Improvement means your changes are more ","line":8,"x":99.264,"y":339.43,"width":"452.43","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"likely to lead to the improvement you set out to make . ( For more information on the Model for ","line":9,"x":99.264,"y":324.79,"width":"454.29","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"Improvement, see Appendix C . )","line":10,"x":99.264,"y":310.25,"width":"154.53","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"Thi s is the first question in the Model for I mprovement. Being clear about the aim of the work ","line":12,"x":99.264,"y":250.85,"width":"447.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"will improve your chances of success. Using a SMART aim is one way to focus your project. ","line":13,"x":99.264,"y":236.21,"width":"452.82","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"( For more on SMART aims see Appendix D .)","line":14,"x":99.264,"y":221.69,"width":"218.89","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"Example – project aim: ‘By December 2015, reduce the time the team spends on ","line":15,"x":311.45,"y":144.86,"width":"437.24","height":"12.00","fontName":[null,"Arial,Bold","Arial,Italic"],"dir":["ltr"]}
{"page":12,"change":"Addition","str":"transfer of care (productivity) AND make the information handed over or transferred ","line":16,"x":311.45,"y":129.02,"width":"445.20","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 14 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"Link your improvement project to your organisation ’s strategic aims ","line":1,"x":99.264,"y":523.66,"width":"523.31","height":"15.96","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"A project that meets the practica l , day - to - day needs of your team and your patients or clients, as well as the priorities of the ","line":2,"x":99.264,"y":500.98,"width":"594.95","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"organisation you work for , will be much more likely to succeed. ","line":3,"x":99.264,"y":486.46,"width":"301.37","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"Your organisation, health community or commissioning group will have a number of key issues identified as priorities. We know that ","line":4,"x":99.264,"y":465.94,"width":"632.60","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":" in the organisation’s business plan or annual report","line":7,"x":117.26,"y":401.47,"width":"253.96","height":"11.04","fontName":["Symbol","Arial"],"dir":["ltr"]}
{"page":13,"change":"Addition","str":" on the trust or commissioning group website or intranet","line":8,"x":117.26,"y":386.23,"width":"272.71","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":" b y asking your project sponsor","line":9,"x":117.26,"y":370.99,"width":"154.20","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":" delays in discharge","line":11,"x":117.26,"y":321.07,"width":"99.38","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"Capturing and tracking the link","line":16,"x":99.264,"y":234.41,"width":"173.30","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"You can track the links and test your ideas using simple ‘ driver diagram s ’.","line":17,"x":99.264,"y":213.53,"width":"357.72","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"This type of diagram can be useful to generate in t erest and commitment from your ","line":18,"x":99.264,"y":192.98,"width":"399.82","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"understand the impact of improvement work undertaken at the front line and its ","line":20,"x":99.264,"y":163.82,"width":"386.29","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"contribution to the organisation ’ s high - level performance targets. ","line":21,"x":99.264,"y":149.3,"width":"316.26","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"It is important that your project is supported ","line":23,"x":518.23,"y":392.23,"width":"213.98","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"by an enthusiasti c and empowered sponsor. ","line":24,"x":518.23,"y":377.71,"width":"218.40","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":"The right sponsor will :","line":25,"x":518.23,"y":348.67,"width":"106.87","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":" p rovide high - level support for your ","line":26,"x":536.23,"y":333.31,"width":"174.49","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":" o ffer advice","line":28,"x":536.23,"y":303.53,"width":"62.07","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":" h elp to engage other team members","line":29,"x":536.23,"y":288.17,"width":"182.49","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":" link your improvement project aim to ","line":30,"x":536.23,"y":272.93,"width":"184.79","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":" h elp remove obstacles to progress.","line":33,"x":536.23,"y":228.53,"width":"176.33","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":" Director of Nursing or Matron","line":35,"x":536.23,"y":182.66,"width":"146.96","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":" Medical or Clinical Director","line":36,"x":536.23,"y":167.42,"width":"135.88","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":13,"change":"Addition","str":" Practice or Care Home Manager","line":37,"x":536.23,"y":151.94,"width":"163.38","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":14,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 15 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":14,"change":"Addition","str":"Example driver diagram linking a transfer of care improvement aim to the organisational aim of reducing mortality .","line":1,"x":99.264,"y":528.34,"width":"589.12","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":14,"change":"Addition","str":"basic diagr am, adding on your ","line":4,"x":611.23,"y":394.39,"width":"150.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":14,"change":"Addition","str":"measures and your change ","line":6,"x":611.23,"y":365.47,"width":"136.37","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":14,"change":"Addition","str":"interventions as you develop ","line":7,"x":611.23,"y":350.95,"width":"146.09","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":14,"change":"Addition","str":"Click here f or more information about ","line":10,"x":591.07,"y":98.784,"width":"183.94","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":14,"change":"Addition","str":"using driver diagrams in your ","line":11,"x":591.07,"y":84.24,"width":"141.08","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 16 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"What is the scale of your improvement project?","line":1,"x":99.264,"y":523.66,"width":"356.43","height":"15.96","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"You may be using this guide to make a small change in the way you manage transfers of care , or you might be trying to make a ","line":2,"x":99.264,"y":500.98,"width":"619.12","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"change across your whole organisation, or even across the local care community. Whatever level you are working at, you ne ed to","line":3,"x":99.264,"y":486.46,"width":"622.95","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"s et the scope of your project at the start to ensure it is manageable and achievable. Go where you think there is most need or where ","line":4,"x":99.264,"y":471.94,"width":"639.30","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"there is most enthusiasm. A success early in the project is vital to help stimulate enthusiasm and spread the good wo rk.","line":5,"x":99.264,"y":457.42,"width":"580.77","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"E ngage staff, patients and users and s et up your project team ","line":6,"x":99.264,"y":432.22,"width":"469.06","height":"15.96","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"stakeholders (staff, patients and service ","line":9,"x":109.58,"y":323.35,"width":"196.85","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"users) and convince them of the ","line":10,"x":109.58,"y":308.81,"width":"159.57","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"transfer of care ‘Useful resources ’ at the ","line":14,"x":109.58,"y":240.53,"width":"195.04","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"back of this guide. The ‘ Clinical ","line":15,"x":109.58,"y":226.01,"width":"157.64","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"engagement ’ page of the NHS Institute’s ","line":16,"x":109.58,"y":211.49,"width":"200.42","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"Ever yone wants to deliver good care; using ","line":19,"x":529.87,"y":306.17,"width":"210.20","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"patient stories (like the one at Appendix A)","line":20,"x":529.87,"y":291.65,"width":"203.64","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"or staff experiences can help teams commit ","line":21,"x":529.87,"y":277.13,"width":"215.20","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"to change and improvement. The film: The ","line":22,"x":529.87,"y":262.61,"width":"209.63","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"trouble with handovers is a pow erful ","line":23,"x":529.87,"y":247.97,"width":"175.61","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"reminder about why it is so important to ","line":24,"x":529.87,"y":233.45,"width":"192.05","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"transfer the right information to the right ","line":25,"x":529.87,"y":218.93,"width":"192.61","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":15,"change":"Addition","str":"person at the right time .","line":26,"x":529.87,"y":204.41,"width":"115.70","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 17 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"Finding the right people to champion the project and drive it forward with insight and enthusiasm is crucial. Consider what each ","line":2,"x":99.264,"y":500.98,"width":"622.24","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"team member can offer ; do they have expert kn owledge and/or are they empowered to make decisions? This simple grid tool can ","line":3,"x":99.264,"y":486.46,"width":"628.53","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"help you identify what each team member will be able to bring to the project. Examples of the team selection grid for different ","line":4,"x":99.264,"y":471.94,"width":"606.33","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"Project team ‘knowledge and empowerment’ grid","line":6,"x":99.264,"y":431.86,"width":"279.32","height":"12.00","fontName":["Arial,Bold"],"dir":["ltr"]}
{"page":16,"change":"Addition","str":" Senior leadership is essential . I dentify a clinical or ","line":8,"x":488.59,"y":400.99,"width":"250.84","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"supporter of your improvement project.","line":10,"x":506.59,"y":371.95,"width":"185.89","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":" I nclude staff who are actually involved in the transfers ","line":11,"x":488.59,"y":356.59,"width":"269.20","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"of care on a day - to - day basis - both those who deliver ","line":12,"x":506.59,"y":342.07,"width":"258.53","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"and receive the co mmunication.","line":13,"x":506.59,"y":327.55,"width":"155.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":" Consider who else might use the transfer of care ","line":14,"x":488.59,"y":312.19,"width":"244.72","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"information. For example, might the physiotherapists ","line":15,"x":506.59,"y":297.65,"width":"258.61","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"use or update information about falls risk on the ","line":16,"x":506.59,"y":283.13,"width":"228.72","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":" H ave you included someone from the IT team?","line":18,"x":488.59,"y":253.25,"width":"233.93","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":" I nclude peopl e who can relate their experience of the ","line":19,"x":488.59,"y":238.01,"width":"266.22","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"transfer of care, e . g . the patient, resident or client . As a ","line":20,"x":506.59,"y":223.49,"width":"265.00","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"their experiences can be a particularly powe rful tool ","line":23,"x":506.59,"y":179.78,"width":"253.68","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"and is not difficult to set up . The experience based ","line":24,"x":506.59,"y":165.26,"width":"251.28","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":16,"change":"Addition","str":"design toolkit provides further guidance on inter viewing ","line":25,"x":506.59,"y":150.74,"width":"267.68","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":17,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 18 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":17,"change":"Addition","str":"P utting it all together","line":1,"x":99.264,"y":495.1,"width":"159.71","height":"15.96","fontName":[null],"dir":["ltr"]}
{"page":17,"change":"Addition","str":"By this stage, you and your team will have agree d the aim and scope of the improvement and how it fits with ","line":2,"x":99.264,"y":481.3,"width":"522.60","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":17,"change":"Addition","str":"your organisation’s wider strategi c aims and targets. It is a good idea to capture this in one place, using a ","line":3,"x":99.264,"y":466.66,"width":"510.58","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":17,"change":"Addition","str":"simple template such a s the one shown in Appendix F . It will be a useful f ocus for further discu ssions with ","line":4,"x":99.264,"y":452.14,"width":"512.94","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":17,"change":"Addition","str":"Sustaining your improvements should never be an afterthought. Sustainability is a crucial ","line":7,"x":99.264,"y":395.11,"width":"435.11","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":17,"change":"Addition","str":"how you engage leaders, staff, patients and cli ents in developing, testing and implementing ","line":10,"x":99.264,"y":351.55,"width":"446.34","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":17,"change":"Addition","str":"See Step 6: Sustain and share ( p age 38 ) for more information about sustainability.","line":12,"x":99.264,"y":316.51,"width":"399.08","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":17,"change":"Addition","str":"The OSSIE Guide to Clinical Handover Improvement and the ","line":14,"x":106.46,"y":253.61,"width":"296.38","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":17,"change":"Addition","str":"anyone involved in improving handover or transfer of car e in ","line":16,"x":106.46,"y":224.57,"width":"295.23","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":18,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 19 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":18,"change":"Addition","str":"Measurement for improvement does not have to be onerous ; it is about using a few specific ","line":2,"x":99.264,"y":440.02,"width":"447.00","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":18,"change":"Addition","str":"measures, linked to your projec t aim to answer the question: ‘H ow will I know that my ch anges ","line":3,"x":99.264,"y":425.5,"width":"458.09","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":18,"change":"Addition","str":"For your overarching improvement aim you might want to choose a process measure and an ","line":7,"x":99.264,"y":347.35,"width":"456.61","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":18,"change":"Addition","str":"outcome measure from the list below :","line":8,"x":99.264,"y":332.71,"width":"182.97","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":18,"change":"Addition","str":" No. of transfers right each time – based on your definition of ‘right’ ( Process measure )","line":9,"x":135.26,"y":311.45,"width":"416.06","height":"11.04","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":18,"change":"Addition","str":" No. of staff who know which patients are at risk of fall (Outcome measure)","line":10,"x":135.26,"y":296.21,"width":"364.44","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":18,"change":"Addition","str":" No of patients who get diagnostic tests when requested (Outcome measure)","line":11,"x":135.26,"y":280.85,"width":"372.26","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":18,"change":"Addition","str":" No. of staff who know who is in charge of handover and get the information they require","line":12,"x":135.26,"y":265.61,"width":"427.61","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":18,"change":"Addition","str":"for their job (Outcome measure)","line":13,"x":153.26,"y":250.97,"width":"155.84","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":18,"change":"Addition","str":" No. of times when number of staff involved in handover and time taken is within agreed limit (Outcome measure)","line":14,"x":135.26,"y":235.73,"width":"548.26","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":18,"change":"Addition","str":"You will find some more on measures for the smaller pieces – after we have described the 7 steps to measurement. ","line":15,"x":99.264,"y":215.21,"width":"562.31","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":19,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 20 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":19,"change":"Addition","str":"Whatever you choose to measure, there are seven basic steps to follow:","line":1,"x":99.264,"y":528.22,"width":"351.47","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":19,"change":"Addition","str":"The 7 steps to measu rement","line":2,"x":99.264,"y":506.62,"width":"162.20","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":19,"change":"Addition","str":"4: Collect data Think about what , who , how and when to measure and establish a ","line":13,"x":105.38,"y":369.43,"width":"364.67","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":19,"change":"Addition","str":" run charts or statistical process control (SPC) charts to ","line":19,"x":224.18,"y":320.95,"width":"248.79","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":19,"change":"Addition","str":" photos, videos and stories.","line":21,"x":224.18,"y":297.29,"width":"123.40","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":19,"change":"Addition","str":"Measuring for improvement (Improvement Leaders’ Guide)","line":29,"x":109.1,"y":135.86,"width":"259.73","height":"9.96","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":19,"change":"Addition","str":"Handover and tran sfers of Care – Step - by - step measurement guide","line":30,"x":109.1,"y":112.7,"width":"295.81","height":"9.96","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 21 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"Choose your measures and start collecting your baseline data","line":1,"x":99.264,"y":523.66,"width":"468.22","height":"15.96","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"You should not be spending lots of time collecting data! From your long list of things you could measure , just pick a few. ","line":2,"x":99.264,"y":500.98,"width":"581.32","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"For your improvement project aim pick a process or outcome measure that will ","line":3,"x":99.264,"y":480.58,"width":"395.12","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"tell you wheth er you have achieved your aim. It should be something that is ","line":4,"x":99.264,"y":465.94,"width":"366.25","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"control. Process measures can appeal to patients and carers too e.g. the number ","line":7,"x":99.264,"y":422.23,"width":"397.19","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"of transfers of care in your weekly sample that are judged to be right – particularly ","line":8,"x":99.264,"y":407.71,"width":"396.44","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"if patients have been involved in creating the definition of ‘right’ e.g. the community ","line":9,"x":99.264,"y":393.19,"width":"398.54","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"rehabilitation therapists meet in the team office at 4.30pm and handover all ","line":10,"x":99.264,"y":378.55,"width":"363.59","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"planned actions for patients by completing the agreed online template.","line":11,"x":99.264,"y":364.03,"width":"341.83","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"So the choice on data collection is a balance between ease and reliability of collection and ","line":12,"x":99.264,"y":343.51,"width":"441.38","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"whether i t can inform your next action. What ever you deci de you should pick at least ","line":13,"x":99.264,"y":329.11,"width":"419.88","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"one and start collecting this data now . This will give you your baseline for the ","line":14,"x":99.264,"y":314.59,"width":"391.50","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"improvement project. If you don’t collect your baseline data now, it will be difficult to prove ","line":15,"x":99.264,"y":299.81,"width":"435.33","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"decide where to start (your first improvement focus ) . From all your change ideas you ","line":18,"x":99.264,"y":250.37,"width":"424.75","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"will then need to select the first change intervention . In the box below and on the next page we have given some examples of ","line":19,"x":99.264,"y":235.73,"width":"622.59","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":20,"change":"Addition","str":"that you can see the connection between your work and your organisation’s strategic ob jectives.","line":21,"x":99.264,"y":206.57,"width":"467.08","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":21,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 22 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":21,"change":"Addition","str":"Driver diagram showing process and outcome measures from management and frontline care perspectives","line":1,"x":99.264,"y":527.26,"width":"607.72","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":21,"change":"Addition","str":"You may not be able to collect ","line":2,"x":566.47,"y":481.54,"width":"147.32","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":22,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 23 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":22,"change":"Addition","str":"Plotting your data in a run chart is a simple way to see the variation in the system and if any improvements have been made. You ","line":2,"x":99.264,"y":503.86,"width":"632.23","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":22,"change":"Addition","str":"need 25 data points before doing any analysis, so using more frequent data (weekly or daily , in favour of monthly or quarterly) is ","line":3,"x":99.264,"y":489.22,"width":"621.59","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":22,"change":"Addition","str":"better. You can look for a ‘ r un ’ of seven points or more - all up, all down , or all above or below the median value . The run will tell you","line":4,"x":99.264,"y":474.7,"width":"629.39","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":22,"change":"Addition","str":"Example r un charts capturing project outcome data","line":6,"x":99.264,"y":434.62,"width":"294.04","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":22,"change":"Addition","str":"Number of times standard format followed Median","line":45,"x":158.09,"y":379.32,"width":"206.07","height":"9.96","fontName":["ABCDEE+Calibri"],"dir":["ltr"]}
{"page":22,"change":"Addition","str":"Staff survey - Level of preparedness to deliver care","line":57,"x":485.64,"y":393.82,"width":"247.67","height":"12.00","fontName":["ABCDEE+Calibri,Bold"],"dir":["ltr"]}
{"page":22,"change":"Addition","str":"Click here for more about using run charts and ","line":61,"x":512.35,"y":153.62,"width":"229.32","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":23,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 24 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":23,"change":"Addition","str":"Once you have mapped your current process and compared data about your transfers ","line":2,"x":99.264,"y":442.54,"width":"415.73","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":23,"change":"Addition","str":"of care with best practice , you need to decide where to start – this will be your initial ","line":3,"x":99.264,"y":428.02,"width":"399.58","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":23,"change":"Addition","str":"improvement focus . You may want to dig deeper into your current transfer of care ","line":4,"x":99.264,"y":413.59,"width":"404.04","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":23,"change":"Addition","str":"processes using process mapping and root cause analysis techniques such as the ","line":5,"x":99.264,"y":398.95,"width":"391.15","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":23,"change":"Addition","str":"‘Five whys’ to help you understand how your transfer fits into the bigger picture .","line":6,"x":99.264,"y":384.43,"width":"382.85","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":23,"change":"Addition","str":"Revisit the driver d iagram on page 15. The suggested improvement focuses are drawn from the good practice checklist ","line":7,"x":99.264,"y":158.42,"width":"581.72","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":23,"change":"Addition","str":"mentioned earlier in the guide ( for full list see p age s 45 - 46 ).","line":8,"x":99.264,"y":143.78,"width":"283.82","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":23,"change":"Addition","str":"F ocus your improvement effort on something in this list that you believe will help achieve your improvement project aim. For ","line":9,"x":99.264,"y":123.26,"width":"593.73","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":23,"change":"Addition","str":"example, you predict that fi nding a quiet place to communicate without interruptions will help speed up the handover or transfer of ","line":10,"x":99.264,"y":108.62,"width":"632.11","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":23,"change":"Addition","str":"care process. Working with your project team, choose one area as your first improvement focus . There are different ways of ","line":11,"x":99.264,"y":94.224,"width":"608.86","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":23,"change":"Addition","str":"doing this and you might choose to generate change ideas first b efore finally deciding where to focus .","line":12,"x":99.264,"y":79.56,"width":"489.61","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":24,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 25 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":24,"change":"Addition","str":"A ll the good practice elements are interlinked and they may all need to be worked on at some point . Some changes may b e ","line":1,"x":99.264,"y":528.22,"width":"596.06","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":24,"change":"Addition","str":"developed very quickly (e . g . moving the location of handover); others may take a longer (e . g . changing the culture to place a higher ","line":2,"x":99.264,"y":513.58,"width":"634.50","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":24,"change":"Addition","str":"value on transfers of care and give them priority over other tasks ).","line":3,"x":99.264,"y":499.06,"width":"317.03","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":24,"change":"Addition","str":"Where to s tart?","line":4,"x":99.264,"y":453.46,"width":"117.23","height":"15.96","fontName":[null],"dir":["ltr"]}
{"page":24,"change":"Addition","str":"Look at your current process map and data . W hich aspects of the process need improving first? You could use a bar chart to display ","line":5,"x":99.264,"y":430.78,"width":"642.19","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":24,"change":"Addition","str":"the results from a staff survey and then focus your initial improvement on the most commonly - reported problems. ","line":6,"x":99.264,"y":416.23,"width":"551.33","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":24,"change":"Addition","str":"Pareto analysis is a simple technique that helps ","line":7,"x":509.59,"y":339.67,"width":"231.72","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":24,"change":"Addition","str":"their relative freq uency or size in a descending ","line":10,"x":509.59,"y":301.85,"width":"234.67","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":24,"change":"Addition","str":"Pareto's principle , the ‘80/20’ rule , asserts that ","line":12,"x":509.59,"y":262.49,"width":"233.23","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":24,"change":"Addition","str":"from 20% of the causes. For example, if ","line":14,"x":509.59,"y":237.17,"width":"194.58","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":24,"change":"Addition","str":"takes longer and information may be missed or ","line":16,"x":509.59,"y":211.85,"width":"231.56","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":25,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 26 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":25,"change":"Addition","str":"You could u se a priority matrix to categorise your improvement ideas. Quick wins can be tested and implemented immediately. ","line":1,"x":99.264,"y":528.22,"width":"617.90","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":25,"change":"Addition","str":"High - p riority changes may take more planning and resources to achieve.","line":2,"x":99.264,"y":513.58,"width":"350.26","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":25,"change":"Addition","str":"Ease of testing and implementation","line":5,"x":164.056111440224,"y":285.94428777568,"width":"148.03","height":"9.99","fontName":["ABCDEE+Calibri,Bold"],"dir":["ltr"]}
{"page":25,"change":"Addition","str":"Record the idea – but ","line":8,"x":216.114790901432,"y":282.880735889488,"width":"87.72","height":"10.02","fontName":["ABCDEE+Calibri,Bold","ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":25,"change":"Addition","str":"(easy) Nice to have","line":17,"x":159.87306565666398,"y":386.96479842639997,"width":"75.07","height":"10.02","fontName":["ABCDEE+Calibri","ABCDEE+Calibri,Bold"],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 27 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"W ork ing with your team and using all the data and observations you already have, you can now focus more fully on generating","line":2,"x":99.264,"y":494.98,"width":"608.14","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"ideas for changes . These help you select your ‘ change interventions ’ . There are lots of examples of change interventions in the ","line":3,"x":99.264,"y":480.46,"width":"613.93","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"many handover resources that already exist ( see U seful resources on Page 40 ). Use these to stimulate discussion about what is ","line":4,"x":99.264,"y":465.94,"width":"617.47","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"possible in your setting . Remember improvement is context specific, so solutions that work for one team in one place don’t easily ","line":5,"x":99.264,"y":451.42,"width":"628.29","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"transplant to another team in another place. Some adaption is often required in order for adoption to follow. The approach de scribed ","line":6,"x":99.264,"y":436.78,"width":"644.48","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"in this guide can be used to ‘check out’ of test a proven intervention and optimise its effe ct in a different place.","line":7,"x":99.264,"y":422.23,"width":"533.12","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"A s an example , we have used the development of a standardised process to illustrate how you could develop and test some ","line":8,"x":99.264,"y":401.83,"width":"609.49","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"of care? Identify the pieces of information that ","line":11,"x":495.55,"y":322.63,"width":"204.69","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"the information you need to include in your ","line":13,"x":495.55,"y":295.97,"width":"188.05","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"standard information template (see ","line":14,"x":495.55,"y":282.89,"width":"165.93","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"standardised wa y? You will need to agree ","line":17,"x":495.43,"y":227.09,"width":"194.19","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"the way in which you want to standardise the ","line":18,"x":495.43,"y":213.65,"width":"200.97","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"transfer of your information .","line":19,"x":495.43,"y":200.42,"width":"122.01","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"Documented process : H ow will your new ","line":21,"x":495.55,"y":170.9,"width":"190.37","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":26,"change":"Addition","str":"standardised process be documented and ","line":22,"x":495.55,"y":157.58,"width":"186.07","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":27,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 28 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":27,"change":"Addition","str":"Design your change intervention ( s )","line":1,"x":99.264,"y":523.66,"width":"268.18","height":"15.96","fontName":[null],"dir":["ltr"]}
{"page":27,"change":"Addition","str":"Design your own ‘ standard transfer of care ’ template","line":2,"x":99.264,"y":500.02,"width":"297.18","height":"12.00","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":27,"change":"Addition","str":"Let’s take one of these change interventions - standard transfer of care template – and look at how you might go about ","line":3,"x":99.264,"y":479.26,"width":"582.59","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":27,"change":"Addition","str":"developing, testing and implementing it. Below is an example of an information template sheet that could be used in a hospital ward ","line":4,"x":99.264,"y":464.62,"width":"638.64","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":27,"change":"Addition","str":"for a transfer of care . Y ou may want to trial this one, but it is better if your transf er of care template includes information which is ","line":5,"x":99.264,"y":450.1,"width":"616.63","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":27,"change":"Addition","str":"specific and relevant to your own care environment. A similar approach may be used in general practice for referral letters.","line":6,"x":99.264,"y":435.46,"width":"591.02","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":27,"change":"Addition","str":"Example information template for nursing shift handover (more examples in Appendix K )","line":7,"x":99.264,"y":413.95,"width":"484.49","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 29 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"Now create your own standard information template.","line":2,"x":99.264,"y":500.98,"width":"251.81","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"The quality of care you give is reflected in the quality of communicat ion ","line":3,"x":99.264,"y":480.46,"width":"347.74","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"the right information. This information is called the minimum data set .","line":5,"x":99.264,"y":451.54,"width":"336.15","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"During the planning stage of your project you will have chosen your ","line":6,"x":99.264,"y":430.78,"width":"326.96","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" communicate the right information","line":9,"x":117.26,"y":380.47,"width":"170.87","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" focus on the goals of the patient/client","line":10,"x":117.26,"y":365.11,"width":"189.77","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" clarify any significant changes easily","line":11,"x":117.26,"y":349.87,"width":"182.36","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" be action focused – what need s to be done , by when and by ","line":12,"x":117.26,"y":334.63,"width":"299.77","height":"11.04","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" prioritise patients /clients with the most time - critical needs","line":14,"x":117.26,"y":304.85,"width":"284.58","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" Include only information which is essential and adds value ; try to ","line":15,"x":117.26,"y":289.37,"width":"315.15","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"stay focused on the information that is essential to be transferred ","line":16,"x":135.26,"y":274.85,"width":"315.58","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"at that point .","line":17,"x":135.26,"y":260.33,"width":"60.63","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" your identity and role","line":19,"x":514.63,"y":495.22,"width":"97.27","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" patient/client identifying information (at least 2 ","line":20,"x":514.63,"y":471.34,"width":"210.08","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"pieces is recommended, e . g . name, date of birth, ","line":21,"x":532.63,"y":458.14,"width":"216.51","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" immediate clinical situation of the patient","line":23,"x":514.63,"y":420.91,"width":"183.75","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" most recent observations/MEWS score (status of ","line":24,"x":514.63,"y":397.15,"width":"224.01","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" reason for admission/referral/discharge","line":27,"x":514.63,"y":346.63,"width":"177.74","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" relevant medical history, results of investigations, ","line":28,"x":514.63,"y":322.87,"width":"224.33","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" current safety/risk factors and associated care plans ","line":30,"x":514.63,"y":285.77,"width":"237.66","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":" r ecommended actions, timeframes and who is ","line":33,"x":514.63,"y":235.37,"width":"211.00","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"responsible (tests/investigations, specialist re ferrals, ","line":34,"x":532.63,"y":222.05,"width":"233.05","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"discharge etc). This is really important: What do ","line":35,"x":532.63,"y":208.97,"width":"225.85","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"Remember to clarify/confirm understanding and transfer ","line":38,"x":514.63,"y":159.26,"width":"249.43","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"A Clinician’s Guide to Record Standards","line":41,"x":514.63,"y":109.58,"width":"178.05","height":"9.96","fontName":[null,"Arial,Italic"],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"The emis health eHandover electronic handover system has been ","line":43,"x":109.1,"y":169.7,"width":"317.26","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"Hospitals NHS Trust Community Services . Based on standard ","line":45,"x":109.1,"y":140.66,"width":"304.99","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"Microsoft tools that are readily available in most trusts, i nitial ","line":46,"x":109.1,"y":126.02,"width":"295.87","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":28,"change":"Addition","str":"studies have demonstrated that eHandover is delivering an ","line":47,"x":109.1,"y":111.5,"width":"289.79","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":29,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 30 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":29,"change":"Addition","str":"Use ‘d ot v oting ’ to define your ‘ minimum data set ’","line":1,"x":99.264,"y":523.66,"width":"374.53","height":"15.96","fontName":["Arial,Bold",null],"dir":["ltr"]}
{"page":29,"change":"Addition","str":"on dot voting, see Appendix G .","line":5,"x":99.264,"y":449.98,"width":"150.28","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":29,"change":"Addition","str":"Now think about where else thi s information is found. Does it ","line":6,"x":99.264,"y":420.91,"width":"300.84","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":29,"change":"Addition","str":"need to be included in the transfer of care template , or is it ","line":7,"x":99.264,"y":406.39,"width":"283.56","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":29,"change":"Addition","str":"readily available elsewhere , e . g . on a patient whiteboard which ","line":8,"x":99.264,"y":391.75,"width":"304.99","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":29,"change":"Addition","str":"organise this information u sing a structured communication tool","line":12,"x":99.264,"y":159.02,"width":"308.30","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":29,"change":"Addition","str":"such as SBAR ( see page 31 ) .","line":13,"x":99.264,"y":144.5,"width":"138.79","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":29,"change":"Addition","str":"should aim to reduce, not ","line":19,"x":200.3,"y":320.59,"width":"126.60","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 31 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"Using ‘structured communication t ool s","line":1,"x":99.264,"y":523.66,"width":"293.07","height":"15.96","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"S tructured communication tools are easy - to - remember ","line":2,"x":99.264,"y":500.98,"width":"269.28","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"mechanism s that you can use to frame conversations , especi ally ","line":3,"x":99.264,"y":486.46,"width":"314.29","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"critical ones, requiring someone’s (e . g . a clinician’s) immediate ","line":4,"x":99.264,"y":471.94,"width":"304.95","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"attention and action. These tools enable you to clarify what","line":5,"x":99.264,"y":457.54,"width":"285.12","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"team, and how . They can also help develop teamwork and foster ","line":7,"x":99.264,"y":428.38,"width":"316.58","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"SBAR i s one example. It stands for : Situation, Background, Assessment, Recommendation.","line":9,"x":99.264,"y":385.39,"width":"467.71","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"The tool consists of standardised prompt questions within four key sections, helping to ensure","line":10,"x":99.264,"y":370.63,"width":"449.58","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":" encourages staff to communicate assertively and effectively, r educing the need for ","line":13,"x":117.26,"y":312.19,"width":"408.57","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":" helps staff anticipate the information needed by colleagues","line":15,"x":117.26,"y":282.41,"width":"291.21","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":" prompts st aff to formulate information with the right level of detail.","line":16,"x":117.26,"y":267.05,"width":"322.78","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"‘ HAND ME AN ISOBAR ’ is another example of a ","line":17,"x":201.98,"y":226.85,"width":"239.42","height":"11.04","fontName":["Arial,Bold",null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"structured communication tool . Developed by the ","line":18,"x":201.98,"y":212.21,"width":"238.60","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"several examples featured in the OSSIE Guide to ","line":20,"x":201.98,"y":183.02,"width":"243.33","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"Clinical Handover Improvement ( Australian ","line":21,"x":201.98,"y":168.5,"width":"208.93","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":30,"change":"Addition","str":"Commission on Safety and Quality in Healthcare ). ","line":22,"x":201.98,"y":153.98,"width":"246.41","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 32 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":"y ou need to arrange your minimum data set accordingly.","line":2,"x":99.264,"y":513.58,"width":"271.55","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":" p ut al l the pieces of information you want to communicate onto sticky notes","line":4,"x":117.26,"y":471.82,"width":"366.96","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":" p ut up flipcharts on the wall – one for each letter of the tool you have ","line":5,"x":117.26,"y":456.58,"width":"352.61","height":"11.04","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":31,"change":"Addition","str":"chosen , e . g . SBAR, ISOBAR, RSVP etc .","line":6,"x":135.26,"y":442.06,"width":"194.69","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":" i n the case of shift handovers, include a flipchart for a safety briefing at the ","line":7,"x":117.26,"y":426.7,"width":"366.88","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":" a sk the team to move the sticky notes to the flipchart they think is most ","line":9,"x":117.26,"y":396.79,"width":"346.26","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":"help you use SBAR in several different ","line":13,"x":551.35,"y":471.1,"width":"188.27","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":"settings (i ncluding acute, primary care and ","line":14,"x":551.35,"y":456.46,"width":"203.84","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":"protocols in the OSSIE Guide to Clinical ","line":17,"x":551.35,"y":388.27,"width":"197.46","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":"The ABC of handover is another model ","line":19,"x":551.35,"y":349.15,"width":"190.15","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":"RSVP is a similar structured communication ","line":22,"x":551.35,"y":295.49,"width":"213.96","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":"Use a flipchart to capture data for ","line":24,"x":337.85,"y":127.1,"width":"159.63","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":"chosen, e . g . S ituation,","line":26,"x":337.85,"y":98.064,"width":"105.98","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":31,"change":"Addition","str":"B ackground, A ssessment, ","line":27,"x":337.85,"y":83.52,"width":"132.36","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 33 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"The next step is to design your template based on these information groups.","line":1,"x":99.264,"y":528.22,"width":"367.55","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":" Decide how you will indicate which patients are priorities and add this to your template. ","line":2,"x":117.26,"y":506.86,"width":"429.90","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":" Prompt the person receiving the transfer of care to clarify and read back the information an d confirm they are taking over ","line":3,"x":117.26,"y":491.74,"width":"584.44","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"Don’t worry about getting too technical with document function and layout for your initial testi ng of the template. Try finding ","line":5,"x":99.264,"y":456.46,"width":"587.54","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"someone in your team or organisation with some spreadshe et or word processing skills to mock one up for you. Or simply draw ","line":6,"x":99.264,"y":441.94,"width":"617.90","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"Document y our s tandard p rocess","line":8,"x":99.264,"y":402.31,"width":"255.06","height":"15.96","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"As well as standardising the information you are going to communicate, you need to also standardise the process for ","line":9,"x":99.264,"y":379.63,"width":"563.69","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"communication. You will develop this process and test your change interventions for the other areas of good practice . You will ","line":10,"x":99.264,"y":365.11,"width":"616.58","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"also need to test the best way to document your sta ndard process and communicate it to everyone involved. An example of a ","line":11,"x":99.264,"y":350.59,"width":"608.72","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"documented p rocess is attached at Appendix K.","line":12,"x":99.264,"y":336.07,"width":"232.84","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"Choose and review your measures ","line":13,"x":99.264,"y":310.85,"width":"268.19","height":"15.96","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"Once you have developed your change interventions, y ou will need to decide","line":14,"x":99.264,"y":288.29,"width":"374.10","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"which measures will be most helpful . Choose just a couple of measures that you ","line":15,"x":99.264,"y":273.77,"width":"389.93","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"Whatever you choose , make sure the data can be collect ed quickly and easily , e . g .","line":17,"x":99.264,"y":244.61,"width":"394.09","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"if you choose to measure whether or not something happens in a particular way , ","line":18,"x":99.264,"y":230.09,"width":"389.98","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"the answer can be simply ‘yes ’ or ‘ no’.","line":19,"x":99.264,"y":215.57,"width":"182.25","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"Appendix H uses the ‘good practice checklist’ and shows","line":20,"x":465.31,"y":165.86,"width":"266.96","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"some suggested measures that you might want to ","line":21,"x":465.31,"y":151.34,"width":"245.70","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"consider for each improvement interventi on. You will ","line":22,"x":465.31,"y":136.82,"width":"254.81","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"notice that these often overlap.","line":23,"x":465.31,"y":122.3,"width":"147.28","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"iterative pr ocess. In s ome cases, you will only be able ","line":25,"x":114.98,"y":132.38,"width":"264.64","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"to refine your measures once you have designed your ","line":26,"x":114.98,"y":117.86,"width":"265.24","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"test of change . For example, you can’t measure ","line":27,"x":114.98,"y":103.34,"width":"229.36","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"Think of measurement of ","line":30,"x":572.95,"y":291.53,"width":"124.74","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"change interventions as ","line":31,"x":572.95,"y":277.01,"width":"119.28","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":32,"change":"Addition","str":"snapshot of each test .","line":33,"x":572.95,"y":247.85,"width":"107.64","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 34 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"This is where you use the ‘plan, do, study, act’ (PDSA) cycles in the Model for Improvement. ","line":2,"x":99.264,"y":440.74,"width":"447.88","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"The tests are repeated until a reliable change has been established (see Appendix I & J for worked ","line":3,"x":99.264,"y":426.22,"width":"480.50","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"Plan : P lan which change interv ention you will test ( e . g . structured transfer of care sheets ), where ","line":5,"x":99.264,"y":387.19,"width":"461.59","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"you will test them, who will support you and how you will train and inform all staff .","line":6,"x":99.264,"y":372.55,"width":"393.62","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"Do : Tr ain your test team and start using the tools. Experience has shown that implementation ","line":7,"x":99.264,"y":348.07,"width":"454.32","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"works best when staff are fully involved and encouraged to develop or modify their own version of ","line":8,"x":99.264,"y":333.43,"width":"476.66","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"your change intervention (see ‘Flexible standardisation’ on p age 37 ) .","line":9,"x":99.264,"y":318.91,"width":"330.21","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"Study : A ssess the impact of the intervention using the measures you have agreed and refined . One ","line":10,"x":99.264,"y":294.41,"width":"485.27","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"Act : Is your intervention ready to be implemented? If not you will need to run the PDSA test cycle ","line":12,"x":99.264,"y":255.41,"width":"469.17","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"again. If it is ready for implementation, you will need to plan how you will rol l it out to the wider ","line":13,"x":99.264,"y":240.65,"width":"452.24","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"department or organisation and, crucially, how you will sustain the improvement in the long term.","line":14,"x":99.264,"y":226.13,"width":"465.77","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"Click here for more on the Model for ","line":16,"x":525.91,"y":120.74,"width":"178.43","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":33,"change":"Addition","str":"Improvement and PDSA : ","line":17,"x":525.91,"y":106.22,"width":"124.68","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 35 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":"Example : PDSA cycle to test a sta ndard transfer of care template (form)","line":1,"x":99.264,"y":527.26,"width":"401.16","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":"Keep your initial testing small. T est on:","line":3,"x":104.9,"y":481.06,"width":"185.03","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":" one patient, resident or client","line":4,"x":122.9,"y":461.74,"width":"146.22","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":" one bay or unit","line":5,"x":122.9,"y":448.3,"width":"77.87","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":" half a ward, or a floor","line":6,"x":122.9,"y":434.98,"width":"108.41","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":" one shift","line":7,"x":122.9,"y":421.51,"width":"46.78","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":" variety of transfers of care ( early / late shift / nights).","line":8,"x":122.9,"y":408.19,"width":"258.08","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":"TIP: You may need to repeat the test cycle a few ","line":18,"x":435.89,"y":405.91,"width":"254.18","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":"results and feedback . From this da ta, you can then work out your ","line":24,"x":104.9,"y":287.45,"width":"316.24","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":"next action and plan your next test. Consider these questions:","line":25,"x":104.9,"y":274.85,"width":"294.81","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":" Are the fields on the documentation all adding value for ","line":26,"x":122.9,"y":255.53,"width":"273.50","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":" Has everyone been involved?","line":28,"x":122.9,"y":229.49,"width":"149.90","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":" How will information be updated in the templ ate and ","line":29,"x":122.9,"y":216.05,"width":"260.69","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":" Do those people have the appropriate technical skills to ","line":31,"x":122.9,"y":189.98,"width":"277.82","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":" What training is needed to roll this out further?","line":33,"x":122.9,"y":163.94,"width":"230.11","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":" Does the layout help staff find information easily?","line":34,"x":122.9,"y":150.5,"width":"244.59","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":" Do we print the transfer of care documentation as a ","line":35,"x":122.9,"y":137.18,"width":"258.20","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":"for a long er period on its own and not alongside the ","line":44,"x":435.89,"y":272.81,"width":"252.98","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":34,"change":"Addition","str":"See Appendix I for a detailed ","line":46,"x":488.47,"y":170.06,"width":"145.22","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 36 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"Once you are confident that your design is about right, start to plan your tests for implementation .","line":2,"x":99.264,"y":501.1,"width":"478.77","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"W e have used the development of a standard information template as our change intervention example . But, of course, this is just ","line":3,"x":99.264,"y":471.94,"width":"627.03","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"one change that could help you to meet your improvement project aim. Y ou may now want to look at other change interventions","line":4,"x":99.264,"y":457.42,"width":"607.34","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"before rolling out to whole teams or your wider organisation. Consider wh at works best for your project :","line":5,"x":99.264,"y":442.78,"width":"496.73","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"Either way, b efore you implement your new transfer of care process , you will need to plan tests to manage any risks associated ","line":6,"x":99.264,"y":413.71,"width":"618.54","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"with stopping the old process . You will also need to engage and educate the teams involved.","line":7,"x":99.264,"y":399.19,"width":"446.78","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"As you plan your tests for implementation, think about:","line":8,"x":99.264,"y":370.03,"width":"255.27","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":" Tr aining – Training will be required for initial implementation and will be ","line":9,"x":117.26,"y":344.95,"width":"350.79","height":"11.04","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":35,"change":"Addition","str":" Documentation – W hat documentation , policies and procedures are required","line":11,"x":117.26,"y":315.07,"width":"373.80","height":"11.04","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"and who will be responsible for updating documentation over time ?","line":12,"x":135.26,"y":300.41,"width":"322.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":" Resourcing – What resources are required to implement the change (e . g .","line":13,"x":117.26,"y":285.17,"width":"359.98","height":"11.04","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":35,"change":"Addition","str":" Measurement – P lan which measures will be used during and after ","line":15,"x":117.26,"y":255.41,"width":"330.38","height":"11.04","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"implementation and make sure these are visible to stakeholders .","line":16,"x":135.26,"y":240.65,"width":"313.73","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":" Engaging s takeholders – Continue to engage stakeholders and commun icate ","line":17,"x":117.26,"y":225.53,"width":"386.78","height":"11.04","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"the rationale for change (s ee page 16 ) .","line":18,"x":135.26,"y":210.89,"width":"189.67","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"( A dapted from Langley, Moen et al, The Improvement Guide 2nd Edition (2009) )","line":19,"x":99.264,"y":196.34,"width":"387.02","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"To reduce risk and increase user acceptance you might ","line":20,"x":99.264,"y":161.3,"width":"278.72","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"want to use a Simulation – this could involve staff trying ","line":21,"x":99.264,"y":146.78,"width":"271.43","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":35,"change":"Addition","str":"out the new sys tem using a case study? See Appendix J for a detailed ","line":22,"x":99.264,"y":129.14,"width":"338.61","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":36,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 37 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":36,"change":"Addition","str":"You may need to run small tests with each team so that they can make small adjustments that work for them. Instead of a rigid ","line":2,"x":99.264,"y":506.26,"width":"617.46","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":36,"change":"Addition","str":"approach, consider ‘flexible ’ sta ndardisation . This allows teams or departments to make small changes of their own that are shown ","line":3,"x":99.264,"y":491.74,"width":"634.62","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":36,"change":"Addition","str":"(by measurement) to improve things in their setting. B ut there still need to be a control in place to avoid ad - hoc changes and many ","line":4,"x":99.264,"y":477.22,"width":"629.68","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":36,"change":"Addition","str":"different versions being used across yo ur organisation . ","line":5,"x":99.264,"y":462.7,"width":"269.72","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":36,"change":"Addition","str":"One method is to implement a control group to decide what can be changed and what has to stay. This decision may be linked to ","line":6,"x":99.264,"y":442.06,"width":"617.38","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":36,"change":"Addition","str":"the priorities outlined in your project plan which reflect the organisation’s big issues . For example, if you have linked the transfer of ","line":7,"x":99.264,"y":427.54,"width":"634.97","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":36,"change":"Addition","str":"care project to length of stay, you may want to ensure that expected date of discharge stays in all documents.","line":8,"x":99.264,"y":412.99,"width":"531.93","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":36,"change":"Addition","str":"As you achieve improvements in your transfer of care process it is really important t o spread your good practice throughout the ","line":10,"x":99.264,"y":351.31,"width":"618.45","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":36,"change":"Addition","str":"Think about which teams, departments or communication processes you could target next. For example, if you started by improv ing ","line":12,"x":99.264,"y":316.27,"width":"645.03","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":36,"change":"Addition","str":"communication when transferring patients between wards or departments within your organisation, could you adapt the same ","line":13,"x":99.264,"y":301.73,"width":"611.33","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":36,"change":"Addition","str":" For more information on how to do this, see Sarah W Fraser, Accelerating the S pread of Good Practice: A Workbook for ","line":15,"x":117.26,"y":265.85,"width":"588.35","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":37,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 38 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":37,"change":"Addition","str":"initiatives leading to increased quality and patient experience at lower cos t.’","line":3,"x":99.264,"y":418.15,"width":"465.90","height":"14.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":37,"change":"Addition","str":"We have already said at the start of this guide that s ustaining your improvements should ","line":5,"x":99.264,"y":355.27,"width":"432.33","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":37,"change":"Addition","str":"never be an afterthought , but something to consider at the very beginning of your ","line":6,"x":99.264,"y":340.75,"width":"396.87","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":37,"change":"Addition","str":"improvement work. N aturally, however, s ustainability is something you will want to ","line":7,"x":99.264,"y":326.23,"width":"398.39","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":37,"change":"Addition","str":"consider as you roll out and share the new p rocesses you have developed and refined.","line":8,"x":99.264,"y":311.71,"width":"419.33","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":37,"change":"Addition","str":"The Sustainability Model and Sustainability Guide are valuable resources which will ","line":9,"x":99.264,"y":229.61,"width":"415.88","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":37,"change":"Addition","str":" The Sustainability Model is a diagnostic tool that will help you identify strengths ","line":11,"x":117.26,"y":193.7,"width":"391.27","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":37,"change":"Addition","str":"sustainability for the improvement initiative. ","line":13,"x":135.26,"y":164.54,"width":"209.68","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":37,"change":"Addition","str":" The Sustainability Guide provides practical advice on how you might increase ","line":14,"x":117.26,"y":143.42,"width":"390.11","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":37,"change":"Addition","str":"the likelihood of sustainabil ity for your improvement initiative.","line":15,"x":135.26,"y":128.78,"width":"295.30","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":37,"change":"Addition","str":"Click here to access the Sustainability Model and Guide","line":16,"x":99.264,"y":100.1,"width":"271.56","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":38,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 39 August 2015","line":0,"x":99.264,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":38,"change":"Addition","str":"Share and celebrate success","line":1,"x":99.264,"y":523.66,"width":"215.03","height":"15.96","fontName":[null],"dir":["ltr"]}
{"page":38,"change":"Addition","str":"Tell people how well the new handov er or transfer of care is working. Not only do those doing it need ","line":2,"x":99.264,"y":500.98,"width":"492.25","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":38,"change":"Addition","str":"to know, but tell other wards , teams, departments, directors and the whole organisation to spread the ","line":3,"x":99.264,"y":486.46,"width":"493.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":38,"change":"Addition","str":"good practice and gain recognition for the hard work the team and all the staff have done . Consider ","line":4,"x":99.264,"y":471.94,"width":"485.08","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":38,"change":"Addition","str":"how you can spread the word using :","line":5,"x":99.264,"y":457.42,"width":"176.04","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":38,"change":"Addition","str":" team meetings and existing transfer of care meetings","line":6,"x":117.26,"y":436.06,"width":"263.75","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":38,"change":"Addition","str":" one - to - one conversations","line":7,"x":117.26,"y":422.71,"width":"129.38","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":38,"change":"Addition","str":" posters (see Appendix L )","line":8,"x":117.26,"y":409.27,"width":"124.38","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 40 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":"U seful r esources","line":1,"x":53.88,"y":509.38,"width":"227.01","height":"27.96","fontName":[null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":" Communication During Patient Hand - Overs , World Health Organisation Collaborating Centre for Patient Safety Solutions ( 2007) ","line":7,"x":71.88,"y":398.35,"width":"632.50","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":" Safe handover: safe patients - Guidance on clinical handover for clinicians and managers, BMA Junior Doctors Committee, www.bma.or g.uk","line":9,"x":71.88,"y":368.59,"width":"681.36","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":" Acute Care Toolkit: 1 Handover, Royal College of Physicians (2011) http://www.rcplondon.ac.uk/resources/acute - care - toolkit - 1 - handover","line":10,"x":71.88,"y":353.23,"width":"665.91","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":" A Clinician’s Guide to Record Standards – Part 2: Standards for the stru cture and content of medical records and communications when ","line":11,"x":71.88,"y":337.99,"width":"662.85","height":"11.04","fontName":["Symbol","Arial",null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":"patients are admitted to hospital , Academy of Medical Royal Colleges (2008) https://www.rcoa.ac.uk/sites/default/files/FPM - clinicians -","line":12,"x":89.88,"y":325.27,"width":"642.89","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":" 'Passing the Baton - A Practical Guide to Effective Discharge Planning' , National Leadership and Innovation Agency for Healthcare ","line":14,"x":71.88,"y":299.21,"width":"637.16","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":" Clinical Handover Literature Review , The eHealth Services Research Group, University of Tasmania for the: Australian Commission on Safety ","line":16,"x":71.88,"y":273.29,"width":"698.43","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":"and Quality in Health Care (ACSQHC) 2008 . MC Wong , K C Yee , P Turner . http://www.safetyandquality.gov.au/wp -","line":17,"x":89.88,"y":260.57,"width":"543.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":"content/uploads/2008/01/Clinical - Handover - Literature - Review - for - release.pdf","line":18,"x":89.88,"y":247.97,"width":"374.82","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":" Safe Clinical Handover. A resource for transferring care from General Practice to Hospitals and Hospitals to General Practice","line":19,"x":71.88,"y":234.53,"width":"615.67","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":" An experimental comparison of handover methods Bhabra G, Mac keith S, Monteiro P, Pothier DD, Ann R Coll Surg Engl. 2007 Apr;89(3):298 -","line":21,"x":71.88,"y":208.49,"width":"695.41","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":" The Improvement Guide, Langley , Moen et al. Jossey - Bass, 1996 , 2nd Edition 2009","line":24,"x":71.88,"y":123.5,"width":"410.56","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":" The trouble with handovers video http://www.focusbiz.co.uk/the - trouble - with - handovers/","line":25,"x":71.88,"y":108.26,"width":"428.08","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":" NSW [New South Wales] Health Implementation Toolkit, Standard Key Principles for Clinical Handover ","line":26,"x":71.88,"y":92.904,"width":"504.35","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":39,"change":"Addition","str":" Quality and service improvement tools (process mapping, patient perspectives) http://www.institute.nhs.uk/qualitytools","line":28,"x":71.88,"y":63.12,"width":"575.26","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 41 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" The Productive Series: http://www.institute.nhs.uk/productives","line":1,"x":71.88,"y":510.1,"width":"303.26","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":"o The Productive Ward (s hift handovers module )","line":2,"x":107.9,"y":495.46,"width":"234.26","height":"11.04","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":"o The Productive Mental Health Ward ( shift handover s module)","line":3,"x":107.9,"y":480.94,"width":"302.14","height":"11.04","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":"o The Productive Operating Theatre (handover and teamworking module s )","line":4,"x":107.9,"y":466.42,"width":"360.69","height":"11.04","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":"o The Productive Community Hospital (handover module)","line":5,"x":107.9,"y":451.78,"width":"277.30","height":"11.04","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" Th e Care Homes Wellbeing Programme http://www.institute.nhs.uk/carehomes","line":6,"x":71.88,"y":436.54,"width":"383.14","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" Experience Based Design Toolkit http://www.kingsfund.org.uk/projects/ebcd","line":7,"x":71.88,"y":421.27,"width":"373.72","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" Model for Improvement (including PDSA ) http://www.institute.nhs.uk/pdsa","line":8,"x":71.88,"y":405.91,"width":"353.36","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":"o Process Mapping , Analysis and Redesign http://www.nhsiq.nhs.uk/media/2594717/ilg_ - _process_mapping__analysis_and_redesign.pdf","line":10,"x":107.9,"y":376.15,"width":"664.41","height":"11.04","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":"o Measuring for improvement http://www.nhsiq.nhs.uk/media/2541082/improvement_leaders_guide_ -","line":11,"x":107.9,"y":361.51,"width":"487.03","height":"11.04","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" The 7 steps to measurement video https://www.youtube.com/watch?v=Za1o77jAnbw","line":13,"x":71.88,"y":331.75,"width":"414.35","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" R un charts and simple statistical measures (including a video guide) www.institute.nhs.uk/spc","line":14,"x":71.88,"y":316.51,"width":"456.99","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" Root cause analysis (including the ‘Five whys’) http://www.institute.nhs.uk/rca","line":15,"x":71.88,"y":301.13,"width":"378.47","height":"11.04","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" Structured communication s tools","line":17,"x":71.88,"y":270.53,"width":"164.75","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":"o The ABC of handover http://emj.bmj.com/content/early/2012/01/03/emermed - 2011 - 200199.full","line":19,"x":107.9,"y":241.49,"width":"458.53","height":"11.04","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":"o HAND ME AN ISOBAR http://www.safetyandquality.gov.au/our - work/clinical - c ommunications/clinical - handover/ossie - guide/","line":20,"x":107.9,"y":226.97,"width":"603.36","height":"11.04","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" Sustainability Model and Guide http://www.evidenceintopractice.scot.nhs.uk/media/135265/sustainability_model.pdf","line":22,"x":71.88,"y":197.06,"width":"566.18","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" Accelerating the Spread of Good Practice: A Workbook for Healthcare Sarah W Fraser, (2002) . Via Amazon .","line":23,"x":71.88,"y":181.82,"width":"529.62","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":"Cas e s tudies and p resentations","line":24,"x":53.88,"y":160.22,"width":"177.52","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" Using a communication framework at handover to boost patient outcomes, Christie, P and Robinson, R , Nursing Times , 1 December , 2009 , Vol ","line":25,"x":71.76,"y":134.66,"width":"692.43","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":"105 , No 47 www.nursingtimes.net","line":26,"x":89.52,"y":120.02,"width":"161.32","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" Improving hospital weekend handover: a user - centered, standardised approach Mehra A and Henein C. BMJ Qual Improv","line":27,"x":71.88,"y":104.78,"width":"591.34","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":40,"change":"Addition","str":" Improving the safety of patient transfer from AMU using a written checklist, Hindmarsh D, Lees L, Acute Med. 2012;11(1):13 - 7. ","line":29,"x":71.88,"y":78.72,"width":"623.16","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":41,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 42 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":41,"change":"Addition","str":"Appendix B: Good practice checklist – examples of questions to prompt discussion and generate ideas ................................ ................................ ...... 45","line":3,"x":53.88,"y":388.75,"width":"726.40","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":41,"change":"Addition","str":"Appendix C: The Model for Improvement ................................ ................................ ................................ ................................ ................................ ....... 47","line":4,"x":53.88,"y":364.87,"width":"731.41","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":41,"change":"Addition","str":"Append ix H: Good practice checklist – suggested measures ................................ ................................ ................................ ................................ ......... 52","line":9,"x":53.88,"y":244.97,"width":"727.68","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":41,"change":"Addition","str":"Appendix I: Example PDSA for testing a new handover template ................................ ................................ ................................ ................................ .. 53","line":10,"x":53.88,"y":220.97,"width":"729.72","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":41,"change":"Addition","str":"Appendix J: Example PDSA for testing new transfer of care process ................................ ................................ ................................ ............................. 54","line":11,"x":53.88,"y":196.94,"width":"731.84","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":41,"change":"Addition","str":"Appendix K: Examples of standardised communication templates ................................ ................................ ................................ ................................ . 55","line":12,"x":53.88,"y":172.94,"width":"731.50","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":41,"change":"Addition","str":"Appendix L: Example of how a poster can be used to spread the word about new processes ................................ ................................ ....................... 58","line":13,"x":53.88,"y":149.06,"width":"730.08","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":41,"change":"Addition","str":"Appendix M: Summary of the six step improvement process for transfer of care ................................ ................................ ................................ ........... 59","line":14,"x":53.88,"y":125.06,"width":"726.27","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 43 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"This case study tells the story of a real NHS patient. The patient did not die as a result of ","line":2,"x":53.88,"y":481.78,"width":"464.99","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"a series of errors and was thankfully not ‘clinically harmed’. But he could have been, as ","line":3,"x":53.88,"y":467.26,"width":"460.33","height":"11.04","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"his care was compromised more than once through poor handover practices . ","line":4,"x":53.88,"y":452.62,"width":"407.88","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"Over a one year period Ollie, as he was known to his friends, was admitted to hospital at least 3 ","line":6,"x":53.88,"y":403.39,"width":"468.07","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"times. As well as the condition he was admitted for, Ollie had epilepsy which was well controlled ","line":7,"x":53.88,"y":388.87,"width":"465.85","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"with medicine. After the first admission , h e and his wife , Georgette, go t to know the routine . ","line":8,"x":53.88,"y":374.35,"width":"443.09","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"Georgette would hand a copy of Ollie’s current prescription record to th e Ambulance Crew , t hey ","line":9,"x":53.88,"y":359.83,"width":"467.67","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"would take notes and hand it back to her. By the time she met up with Ollie in A&E , his ","line":10,"x":53.88,"y":345.19,"width":"423.58","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"prescription record would have disappeared, and so she went armed with a nother copy to hand ","line":11,"x":53.88,"y":330.67,"width":"462.87","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"ward, and his prescription record would once again be incomplete. So Georgette would provide ","line":13,"x":53.88,"y":301.61,"width":"465.08","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"a further copy of his current prescription .","line":14,"x":53.88,"y":287.09,"width":"193.80","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"On one occasion , the prescription was wri tten, but Georgette and Ollie knew that the dose of his epilepsy medication was wrong. They pointed this out ","line":15,"x":53.88,"y":237.89,"width":"733.07","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"twice on the first day, and again on the second day . It was eventually corrected. ","line":16,"x":53.88,"y":223.37,"width":"390.37","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"Georgette is clear that t hese poor practices were not the result of bad clinicians, but on gaps ","line":17,"x":53.88,"y":198.89,"width":"448.85","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"in information transfer and lack of clarity and/feasibility for task completion amongst team ","line":18,"x":53.88,"y":184.22,"width":"432.19","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"members. Georgette continues to share this story and hopes that one day there will be no ","line":19,"x":53.88,"y":169.7,"width":"438.93","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"for his regular epilepsy medicine. ","line":29,"x":539.71,"y":314.11,"width":"221.41","height":"14.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"Even Although Ol lie understood that going one day ","line":33,"x":538.99,"y":198.14,"width":"280.12","height":"14.04","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"trigger a seizure, he still got anxious – and he ","line":35,"x":537.67,"y":166.34,"width":"241.27","height":"12.00","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"knew that t his anxiety COULD make a seizure ","line":36,"x":534.43,"y":150.5,"width":"247.86","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":42,"change":"Addition","str":"more likely . T his worried Georgette too! ","line":37,"x":569.71,"y":134.78,"width":"212.84","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":43,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 44 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":43,"change":"Addition","str":"Both Oll ie and Georgette were reassured by staff that they had been heard and that the error would be corrected. But when it remained unchanged for ","line":2,"x":53.88,"y":496.18,"width":"729.78","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":43,"change":"Addition","str":"a second day Georgette felt she had to stay, all day as it turned out, until it was put right. Whilst they both kne w and understood that a small delay ","line":3,"x":53.88,"y":481.66,"width":"714.01","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":43,"change":"Addition","str":"would not trigger a seizure, their confidence was dented, and they remained anxious throughout the hospital stay. ","line":4,"x":53.88,"y":467.14,"width":"554.67","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":43,"change":"Addition","str":"For many staff this story will not be unusual . It may even be common place. But it is unlikely ","line":6,"x":53.88,"y":408.91,"width":"448.67","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":43,"change":"Addition","str":"that many instances will be reported or counted as service failures as the outcome is ","line":7,"x":53.88,"y":394.39,"width":"413.60","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":43,"change":"Addition","str":"classified as ‘patient received medicine and no ad verse event’. Negative impacts on patients ","line":8,"x":53.88,"y":379.87,"width":"451.77","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":43,"change":"Addition","str":"We can become accustom ed to the way things are , and frequently accommodate shortcomings by ‘working around’ the barrier s to deliver what is most ","line":11,"x":53.88,"y":321.67,"width":"731.16","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":43,"change":"Addition","str":"urgently needed. Although evidence shows that the human brain has a limited memory capacity, meaning that an existing task must be dr opped to ","line":12,"x":53.88,"y":307.01,"width":"713.96","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":43,"change":"Addition","str":"If you haven’t already done so, you could start thinking about what you might change and how you will know if this results in an improvement! ","line":14,"x":53.88,"y":263.45,"width":"688.29","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":43,"change":"Addition","str":"again and expecting different results.","line":16,"x":583.63,"y":383.11,"width":"196.10","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 45 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":"Appendix B : Good practice c hecklist – examples of questions to prompt discussion and generate ideas ","line":1,"x":53.88,"y":524.38,"width":"589.22","height":"12.00","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":44,"change":"Addition","str":"What do we need? What does it mean? Think about...","line":2,"x":124.34,"y":479.98,"width":"298.84","height":"12.00","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":44,"change":"Addition","str":"Leadership There is a nominated leader ","line":3,"x":124.34,"y":441.58,"width":"191.22","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" Who should have overall responsibility for the transfer of care? This would ","line":6,"x":402.89,"y":442.78,"width":"334.45","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":"members ; prioritising urgent elements of transfer of care.","line":8,"x":420.89,"y":416.23,"width":"248.18","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":"Values Transfer and handovers are ","line":9,"x":124.34,"y":374.95,"width":"164.76","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":"care and preparation for ","line":11,"x":243.14,"y":349.15,"width":"109.36","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" How can we ensure information transfer is confidential and non - judgemental?","line":13,"x":402.89,"y":376.15,"width":"346.75","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" How is the importance of transfer of care reinforced in the team, dep artment ","line":14,"x":402.89,"y":362.23,"width":"340.07","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" What training is required to ensure staff understand their accountability in ","line":16,"x":402.89,"y":335.11,"width":"327.74","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":"relation to giving and receiving information? Who will design and deliver this ","line":17,"x":420.89,"y":321.91,"width":"340.41","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":"training? How will staff be released from clinical duties to at tend training?","line":18,"x":420.89,"y":308.57,"width":"324.81","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" How will pati ents or clients understand their role in transfer of care?","line":19,"x":402.89,"y":294.77,"width":"302.21","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" Do staff and pat ients or clients have guidelines on transfer of care?","line":20,"x":402.89,"y":280.73,"width":"300.56","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":"Right people The appropriate people are ","line":21,"x":124.34,"y":243.29,"width":"195.96","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" Who needs to attend the transfer of care (think about multidisciplinary ","line":23,"x":402.89,"y":244.49,"width":"311.55","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":"handover ) ? Do they need to be present for whole transfer or just part of it ? ","line":24,"x":420.89,"y":231.17,"width":"333.58","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" At what points do patients, clients and carers want to be involved in the ","line":25,"x":402.89,"y":217.37,"width":"315.34","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" How will students and junior staff get the mos t learning opportunities from ","line":27,"x":402.89,"y":190.22,"width":"331.74","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" Who will cover the unit while transfer of care occurs? ","line":29,"x":402.89,"y":163.1,"width":"240.57","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" What happens in emergencies?","line":30,"x":402.89,"y":149.18,"width":"145.03","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" How can interruptions be prevented?","line":31,"x":402.89,"y":135.26,"width":"167.82","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" Who will be involved in regular review and audit of transfer of care ","line":32,"x":402.89,"y":121.46,"width":"299.03","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":44,"change":"Addition","str":" Who will prepar e information and documentation for transfer of care ?","line":34,"x":402.89,"y":94.224,"width":"309.01","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 46 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":"What do we need? What does it mean? Think about...","line":1,"x":124.34,"y":511.9,"width":"298.84","height":"12.00","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" When should the transfer of care happen? ","line":9,"x":402.89,"y":470.02,"width":"196.70","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" How does this relate to time of shift change?","line":10,"x":402.89,"y":456.1,"width":"201.11","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" How long should the transfer of care take? ","line":11,"x":402.89,"y":442.18,"width":"195.12","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" How can we ensure it starts on time?","line":12,"x":402.89,"y":428.26,"width":"165.59","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" Does the transfer of care process need to be different depending on the time ","line":13,"x":402.89,"y":414.43,"width":"345.61","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" Where should the transfer of care happen?","line":15,"x":402.89,"y":387.31,"width":"194.43","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" Is the environment quiet with no interruptions? If not, how can interruptions","line":16,"x":402.89,"y":373.39,"width":"337.10","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" Does any part of transfer of care happen with the patient or in a public area? ","line":18,"x":402.89,"y":346.27,"width":"344.50","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" How and where is confidential information transferred?","line":19,"x":402.89,"y":332.35,"width":"240.64","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":"a structured way , is action -","line":28,"x":243.14,"y":212.69,"width":"118.86","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" What information would be included in a standard transfer of care template or ","line":33,"x":402.89,"y":292.73,"width":"343.18","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":"electronic handover record ? (T he minimum data set .)","line":34,"x":420.89,"y":279.41,"width":"234.63","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" How much of this information overlaps with other disciplines? How could ","line":35,"x":402.89,"y":265.61,"width":"323.82","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" How and when in the process will the person receiving the transfer of care ","line":37,"x":402.89,"y":238.49,"width":"334.44","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" Do you want to use structure d communication tool s ( eg SBAR, ISOBAR, ","line":40,"x":402.89,"y":198.14,"width":"321.51","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":"RSVP etc. ) or develop your own?","line":41,"x":420.89,"y":184.82,"width":"142.14","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" What happens to documentation following the transfer of care? How could it ","line":42,"x":402.89,"y":170.9,"width":"344.98","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":45,"change":"Addition","str":" How is the agreed transfer of care process documented? How d o new staff ","line":44,"x":402.89,"y":143.78,"width":"341.19","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 47 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":"Appendix C : The Model for Improvement","line":1,"x":53.88,"y":524.38,"width":"231.29","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":"T he Model for Improvement give s you a simple, adaptable and thorough framework for developing, testing and implementing changes . Using the ","line":2,"x":53.88,"y":481.42,"width":"700.28","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":"Model for Improvement means your changes are more likely to lead to the improvement you set out to make . ","line":3,"x":53.88,"y":466.9,"width":"531.21","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":"assessing its impact. The key to PDSA cycles is to repeat them; ","line":8,"x":404.09,"y":277.61,"width":"279.37","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":" P lan the change and how you will test it .","line":11,"x":422.09,"y":227.45,"width":"180.63","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":" Do the change and tests .","line":12,"x":422.09,"y":213.53,"width":"113.40","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":" Study the data before and after the change and learn ","line":13,"x":422.09,"y":199.61,"width":"241.29","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":"from it .","line":14,"x":440.09,"y":186.26,"width":"30.58","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":" Act on the learning by refining the change and planning ","line":15,"x":422.09,"y":172.46,"width":"250.49","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":"Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP, The ","line":18,"x":53.88,"y":152.78,"width":"258.59","height":"9.00","fontName":[null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":"Organizational Performance (2nd Edition). Jossey Bass, San ","line":20,"x":53.88,"y":132.02,"width":"241.87","height":"9.00","fontName":[null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":"Francisco (2009) v More online...","line":21,"x":53.88,"y":120.74,"width":"161.45","height":"14.04","fontName":[null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":" Quality and service improvement tools","line":23,"x":464.71,"y":93.744,"width":"173.84","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":46,"change":"Addition","str":" Improvement Leaders’ Guides – Process Mapping , Analysis and ","line":24,"x":464.71,"y":80.04,"width":"288.72","height":"9.96","fontName":["Symbol","Arial",null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 48 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"Appendix D : SMART aims","line":1,"x":53.88,"y":524.38,"width":"147.30","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"SMART aims are a good way to ensure your project aim is clearly defined .","line":2,"x":53.88,"y":481.42,"width":"361.21","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"Specific: Have a clear and specific improvement aim , e.g.","line":4,"x":78.24,"y":415.87,"width":"280.54","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"‘ structured transfer of care, right each time ’.","line":5,"x":78.24,"y":401.11,"width":"212.09","height":"11.04","fontName":["Arial",null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"Measurable: Ensure data is available to measure the scale of the ","line":6,"x":78.24,"y":380.71,"width":"322.83","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"problem and your success in addressing it .","line":7,"x":78.24,"y":366.07,"width":"208.48","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"Achievable: Set a suitable challenge and d on’t be afraid to set ","line":8,"x":78.24,"y":345.67,"width":"302.47","height":"11.04","fontName":[null,"Arial"],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"your aim high . Resist setting your aim too low just to improve your ","line":9,"x":78.24,"y":331.03,"width":"320.51","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"chances of succeeding .","line":10,"x":78.24,"y":316.39,"width":"115.05","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"Realistic: Consider the factors beyond your control which may limit ","line":11,"x":78.24,"y":295.97,"width":"330.60","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"the impact of the project, e.g. closure of a unit for refurbishment;","line":12,"x":78.24,"y":281.33,"width":"311.69","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"major staff changes ; availability of sponsor. ","line":13,"x":78.24,"y":266.81,"width":"213.38","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":47,"change":"Addition","str":"Time: Set a deadline and stick to it , e.g. by December 2015.","line":14,"x":78.24,"y":246.29,"width":"290.37","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":48,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 49 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":48,"change":"Addition","str":"Appendix E: Team Selection Grid Examples","line":1,"x":53.88,"y":524.38,"width":"248.65","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":49,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 50 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":49,"change":"Addition","str":"Appendix F : Example project t emplate","line":1,"x":53.88,"y":524.5,"width":"218.04","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":49,"change":"Addition","str":"Adapted from outline in the OSSIE Guide to Clinical ","line":2,"x":373.61,"y":455.62,"width":"254.20","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":49,"change":"Addition","str":"Handover Improvemen t. Available on Slide Share at ","line":3,"x":373.61,"y":441.1,"width":"256.18","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":50,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 51 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":50,"change":"Addition","str":"Appendix G : Dot v oting","line":1,"x":53.88,"y":524.38,"width":"130.62","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":50,"change":"Addition","str":"Dot voting is a simple way to collect input from the whole team about the information that should be included ","line":2,"x":53.88,"y":484.9,"width":"528.82","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":50,"change":"Addition","str":" Using your observation of the current transfer of care process, create a list of all the information which ","line":4,"x":71.88,"y":446.14,"width":"502.56","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":50,"change":"Addition","str":" Add any additional information that should perhaps be included ; either because it is recommended ","line":6,"x":71.88,"y":420.07,"width":"480.25","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":50,"change":"Addition","str":"best practice or becaus e staff/patients/clients want to see it included.","line":7,"x":89.88,"y":405.55,"width":"334.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":50,"change":"Addition","str":" Let all staff have the opportunity to vote by sticking or drawing a dot next to the information they feel is ","line":8,"x":71.88,"y":390.31,"width":"500.68","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":50,"change":"Addition","str":"most important in enabling them to provide good quality care.","line":9,"x":89.88,"y":375.67,"width":"297.54","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":50,"change":"Addition","str":" Remember to include both the staff who are delivering and receiving the transfer of care. This might ","line":10,"x":71.88,"y":360.55,"width":"498.24","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":50,"change":"Addition","str":" Use different colour pens to identify different roles , e . g . different colours for trained and untrained ","line":13,"x":71.88,"y":316.03,"width":"473.00","height":"11.04","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 52 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":"Appendix H : Good practice checklist – suggested measures ","line":1,"x":53.88,"y":524.38,"width":"338.68","height":"12.00","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":51,"change":"Addition","str":"What does it mean? Suggested measures","line":4,"x":166.7,"y":479.98,"width":"234.08","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":"Leadership There is a nominated leader for each ","line":5,"x":74.76,"y":425.74,"width":"230.09","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Staff survey – is leadership clear and does leader fulfil role?","line":7,"x":361.85,"y":432.94,"width":"265.95","height":"9.96","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Do new team members understand the process?","line":8,"x":361.85,"y":420.79,"width":"220.56","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Is leader indicated on transfer of care process checklist (if used) ?","line":9,"x":361.85,"y":408.55,"width":"292.80","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":"Valued Transfer and handovers are valued ","line":10,"x":74.76,"y":380.23,"width":"197.64","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Number of interruptions","line":12,"x":361.73,"y":387.43,"width":"108.84","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Staff/patient/client s urvey - do individuals value & understand the transfer of care process?","line":13,"x":361.73,"y":375.31,"width":"398.67","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" How many patients/clients know who is in charge of their care?","line":14,"x":361.73,"y":363.07,"width":"282.62","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Do transfer of care guidelines exist and are they visible?","line":15,"x":361.73,"y":350.95,"width":"250.07","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Number of staff trained in transfer of care process","line":16,"x":361.73,"y":338.71,"width":"224.56","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Is documentation completed?","line":17,"x":361.73,"y":326.59,"width":"132.28","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":"Right people The appropriate people are involved. Staff time invested in transfer of care (including preparation time)","line":18,"x":74.76,"y":294.65,"width":"526.52","height":"12.00","fontName":[null,"Symbol"],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Staff/patient/client satisfaction with transfer of care process","line":19,"x":361.85,"y":289.73,"width":"265.05","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Number of incidents in unit/on floor during transfer of care","line":20,"x":361.85,"y":277.49,"width":"259.46","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Is documentation completed?","line":21,"x":361.85,"y":265.37,"width":"135.11","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":"agreed where transfers of care can ","line":26,"x":166.7,"y":220.25,"width":"157.56","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Number of interruptions","line":29,"x":361.85,"y":240.05,"width":"108.84","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Staff /patient/client survey – are timing and location appropriate?","line":30,"x":361.85,"y":227.93,"width":"286.61","height":"9.96","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Time transfer of care - does it start on time and h ow long does it take?","line":31,"x":361.85,"y":215.69,"width":"308.93","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Staff time invested i n transfer of care","line":32,"x":361.85,"y":203.57,"width":"167.24","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":"transfers of care . This includes an ","line":36,"x":166.7,"y":153.62,"width":"155.41","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":"structured way, is action - focused, ","line":40,"x":166.7,"y":100.7,"width":"150.94","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":"assigns responsibility for actions and ","line":41,"x":166.7,"y":87.504,"width":"165.35","height":"9.96","fontName":[null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Is documentation complete? y/n","line":43,"x":361.85,"y":173.42,"width":"142.78","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Length of time for transfer of care","line":44,"x":361.85,"y":161.3,"width":"152.29","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Staff/patient/client survey – is appropriate information included in transfer of care? Is ","line":45,"x":361.85,"y":149.06,"width":"379.32","height":"9.96","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Audit of transfer of care – is standard communication process followed each t ime?","line":47,"x":361.85,"y":125.42,"width":"364.50","height":"9.96","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Number of pieces of information in minimum data set which are communicated","line":48,"x":361.85,"y":113.18,"width":"351.63","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Number of pieces of documentation filed in patient notes (or wherever process says they ","line":49,"x":361.85,"y":101.06,"width":"398.08","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":51,"change":"Addition","str":" Number of outstanding actions not completed at end of shift.","line":51,"x":361.85,"y":77.4,"width":"271.27","height":"9.96","fontName":["Symbol",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 53 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"Appendix I : Example PDSA for testing a new handover template","line":1,"x":57.36,"y":524.5,"width":"359.69","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"Plan We plan to.... in order to (aim)","line":2,"x":59.468935107136,"y":481.11385157773,"width":"139.29","height":"8.58","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"Aim Get staff input to improve the design of the new handover template .","line":3,"x":174.329911705504,"y":470.89406268204993,"width":"267.50","height":"8.58","fontName":[null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" Use the new ISOBAR handover template for 1 bay of patients at afternoon shift handover.","line":5,"x":174.329911705504,"y":440.20427995663,"width":"341.03","height":"8.58","fontName":["Symbol",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" Feedback will be gathered during the test and via a flipchart in the nurses office.","line":6,"x":174.329911705504,"y":429.98449106095,"width":"304.16","height":"8.58","fontName":["Symbol",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" All staff will have copies of both the old and new handover templates for the chosen bay. ","line":8,"x":174.329911705504,"y":399.32512437390994,"width":"337.96","height":"8.58","fontName":["Symbol",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" Suggestions to improve the template? Content, layout, design?","line":12,"x":174.329911705504,"y":348.36305206822,"width":"240.35","height":"8.58","fontName":["Symbol",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" Any other information needed during the shift ? Or not needed?","line":13,"x":174.329911705504,"y":338.14326317253995,"width":"239.24","height":"8.58","fontName":["Symbol",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" What support would you like to help you use the template ?","line":14,"x":174.329911705504,"y":327.92347427685996,"width":"224.48","height":"8.58","fontName":["Symbol",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"Do: What we did was..... (brief description of actions)","line":15,"x":59.468935107136,"y":307.78805686929996,"width":"212.20","height":"8.58","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" Bay 3 was handed over by Staff Nurse KS to Staff Nurse YB.","line":16,"x":174.329911705504,"y":297.56826797362,"width":"232.30","height":"8.58","fontName":["Symbol",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" Time to handover Bay 3 – 5:45 minutes","line":17,"x":174.329911705504,"y":287.34847907794,"width":"149.75","height":"8.58","fontName":["Symbol",null,"Arial"],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"o Addition of mobility and dietary needs is good","line":19,"x":202.26018732462398,"y":266.90890128658,"width":"176.02","height":"8.58","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"o Expected Date of Discharge is not required","line":20,"x":202.26018732462398,"y":256.6891123909,"width":"167.04","height":"8.58","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"o Include patient age as well as date of birth","line":21,"x":202.26018732462398,"y":246.42369943765,"width":"163.65","height":"8.61","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"o Increase font size for recommended actions column","line":22,"x":202.26018732462398,"y":236.20391054197,"width":"199.14","height":"8.58","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"o With suggested changes it will be better than current template","line":23,"x":202.26018732462398,"y":225.98412164628996,"width":"236.93","height":"8.58","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"o Guidelines for completing the template on the computer are required","line":24,"x":202.26018732462398,"y":215.765853552529,"width":"262.00","height":"8.58","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"o More practice using SBAR and readback is required for it to feel comfortable","line":25,"x":202.26018732462398,"y":205.728560887129,"width":"289.61","height":"8.58","fontName":["ABCDEE+Courier New",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"Study Looking at what happened, what we learned from this was..... ( lessons learned)","line":26,"x":59.468935107136,"y":185.434980079993,"width":"348.15","height":"8.58","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" Handover per patient using the new template is quicker than the current process. This may be because it ","line":27,"x":174.329911705504,"y":175.215191184313,"width":"401.41","height":"8.58","fontName":["Symbol",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" The template is popular, with some changes to be made.","line":29,"x":174.329911705504,"y":154.775613392953,"width":"217.00","height":"8.58","fontName":["Symbol",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" Although the team asked to remove expected date of discharge, Senior Sister wants to keep to encourage ","line":30,"x":174.329911705504,"y":144.555824497273,"width":"404.55","height":"8.58","fontName":["Symbol",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":"Act What we plan to do next is .... (state next plan )","line":32,"x":59.468935107136,"y":115.21043066824899,"width":"203.28","height":"8.58","fontName":[null,"Arial,Bold"],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" Make agreed changes and test template again with night staff for 2 bays .","line":33,"x":174.329911705504,"y":104.99064177256899,"width":"276.91","height":"8.58","fontName":["Symbol",null],"dir":["ltr"]}
{"page":52,"change":"Addition","str":" Deliver more training and practice opportunities using SBAR with readback","line":34,"x":174.329911705504,"y":94.770852876889,"width":"285.08","height":"8.58","fontName":["Symbol",null],"dir":["ltr"]}
{"page":53,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 54 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":53,"change":"Addition","str":"Appendix J : Example PDSA for testing new transfer of care process","line":1,"x":53.88,"y":524.38,"width":"386.54","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":54,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 55 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":54,"change":"Addition","str":"Appendix K : Example s of standardised com munication templates","line":1,"x":53.88,"y":524.38,"width":"370.61","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":54,"change":"Addition","str":"Dr S ebastian Yuen","line":3,"x":719.14,"y":461.02,"width":"89.42","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":55,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 56 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":56,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 57 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":56,"change":"Addition","str":"Procedure - HAND ME AN ","line":2,"x":127.46,"y":422.59,"width":"134.20","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":57,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 58 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":57,"change":"Addition","str":"Appendix L : Example of how a poster can be used to spread the word about new processes","line":1,"x":53.88,"y":524.5,"width":"522.58","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 59 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"Appendix M: Summary of the six step improvement process for tran sfer of care","line":1,"x":53.88,"y":524.5,"width":"451.98","height":"12.00","fontName":[null],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Start out (page 10)","line":3,"x":144.74,"y":487.49,"width":"98.83","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri,Bold"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Refer to existing policies and procedures for transfers of care in your organisation","line":4,"x":153.77,"y":472.13,"width":"400.22","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Observe, measure and process map the current communication process","line":5,"x":153.77,"y":456.77,"width":"355.31","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• What does good look like? Compare your policy and communication process with the good practice checklist. ","line":6,"x":153.77,"y":441.26,"width":"541.97","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Define and scope (page 13)","line":9,"x":144.74,"y":415.3,"width":"140.64","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri,Bold"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Begin to answer the three questions of the model for improvement (Appendix C)","line":10,"x":153.77,"y":399.94,"width":"397.63","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Set your project aim and scope and link this to your organisational big issues on a driver diagram (page 22)","line":11,"x":153.77,"y":384.58,"width":"522.42","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Engage staff, patients, clients and residents using patient stories and evidence from useful resources","line":12,"x":153.77,"y":369.1,"width":"491.89","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Choose your project team, include senior and frontline staff and patients/clients/residents","line":13,"x":153.77,"y":353.74,"width":"444.55","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Document your project plan (Appendix F) and use the sustainaiblity guide to think about long term impact of change","line":14,"x":153.77,"y":338.38,"width":"571.55","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Measure and understand (page 19)","line":16,"x":144.74,"y":322.27,"width":"179.99","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri,Bold"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Choose and define your outcomes and process measures, collect baseline data and display on run or SPC charts","line":17,"x":153.77,"y":306.91,"width":"552.29","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Design and plan (page 24)","line":19,"x":144.19,"y":285.19,"width":"134.04","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri,Bold"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Design your standard transfer of care template and test using Plan Do Study Act (PDSA) cycles (Appendix I & J)","line":20,"x":153.19,"y":269.83,"width":"539.16","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Use dot voting to define your minimum data set (Appendix G)","line":21,"x":162.19,"y":254.47,"width":"305.46","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Select a standardised communication tool (e.g. SBAR) to organise your minimum data set","line":22,"x":162.19,"y":238.99,"width":"438.29","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Generate and test other change ideas using the good practice checklist (Appendix B) and examples (Appendix K)","line":23,"x":153.19,"y":223.63,"width":"549.47","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Choose process measures (Appendix H) collect data and display on run or SPC charts","line":24,"x":153.19,"y":208.27,"width":"418.36","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Pilot and implement (page 34)","line":26,"x":144.74,"y":191.59,"width":"156.48","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri,Bold"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Document your new standardised transfer of care process","line":27,"x":153.77,"y":176.23,"width":"287.10","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Plan your tests for implementation using PDSA cycles. Plan training, measurement, resources & stakeholder ","line":28,"x":153.77,"y":160.87,"width":"533.48","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Consider 'flexible standardisation' and spread good practice to other teams, departments and organisations","line":30,"x":153.77,"y":132.17,"width":"528.46","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Sustain and share (page 38)","line":32,"x":143.64,"y":113.33,"width":"141.57","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri,Bold"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Use the sustainability guide to ensure your changes will be sustained","line":33,"x":152.64,"y":97.968,"width":"339.64","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":58,"change":"Addition","str":"• Celebrate and spread your success through conferences, posters, journal articles etc. (Appendix L)","line":34,"x":152.64,"y":82.608,"width":"480.70","height":"12.00","fontName":["ABCDEE+Calibri","ABCDEE+Calibri"],"dir":["ltr"]}
{"page":59,"change":"Addition","str":"Quality Improvement Clinic Ltd. P a g e | 60 August 2015","line":0,"x":53.88,"y":30.84,"width":"267.35","height":"11.04","fontName":[null],"dir":["ltr"]}
{"page":59,"change":"Addition","str":"2011 - 2012 - First learning phase","line":2,"x":111.07,"y":465.96,"width":"143.46","height":"11.04","fontName":["ABCDEE+Calibri,Bold"],"dir":["ltr"]}
{"page":59,"change":"Addition","str":"2013 - 2014 - Second learning phase","line":9,"x":111.07,"y":257.5,"width":"156.68","height":"11.04","fontName":["ABCDEE+Calibri,Bold"],"dir":["ltr"]}
{"page":59,"change":"Addition","str":"2014 - 2015 - Second design and testing phase","line":12,"x":111.07,"y":157.46,"width":"202.63","height":"11.04","fontName":["ABCDEE+Calibri,Bold"],"dir":["ltr"]}
