Nursing staff within the acute psychiatric unit in Monklands Hospital (NHS Lanarkshire) have taken part in "Releasing Time To Care" an initiative from the NHS Institute for Innovation and Improvement.

We have been working through The Productive Mental Health Ward Modules including the foundation modules:
Knowing How We are doing
Well Organised Ward
Patient Status at a Glance

We have also begun to work through the process modules:
Patient Wellbeing
Therapeutic Interactions
Ward Round
Safe and Supportive Observations
Admissions and Planned Discharge
Shift Handovers
Meals Medicines

There have been three members of staff (Senior Charge Nurse, a Deputy Charge Nurse and a Staff Nurse who agreed to attend training days facillitated by Practice Development Staff These days have both within and outwith the clinical area. We have received both training and support whilst working through the modules. However all other ward staff, in-patients, Acute Forum in-patient support worker and other disciplines have engaged in the project.

We have created a vision for our individual wards and carried out audits on many aspects of care and the environment including staff morale, complements, complaints, clinical quality indicators.

We have taken part in activities such as activity follows where the senior charge nurse, a staff nurse and a clinical support worker were tracked for 8 hours to look at how much time was spent in direct patient care and to identify time which is wasted eg. finding equipment, being interupted etc.

We have also been auditing our processes such as admission and discharge in order to identify aspect of these which are unnecesary, waste time or which could be changed to increase quality of care.

We have looked at the clinical environment and organised it using processes identified in the toolkit which help to streamline processes and help the environment work for staff. We now have equipment where it is easily located and stock levels which are appropriate and lessen clutter and therefore saving space and money. We have also used this system to streamline paperwork and to maintain the changes.

We have been able to develop systems which enable us to audit information such as staff morale, therapeutic activity, training, e-ksf Personal Development Planning and reveiw and complements and complaints.

Challenges have included staff believing in the project, engaging staff and others in the processes and ensuring that the changes were maintained.

Also finding the balance between support needs (from facillitators) and self directed work. Gaining a better grasp of statistics and use of IT systems in order to produce graphs of outcomes.

The aim of the project was to help us look at how much time was spent in direct patient care but there have been other benefits which have included the opportunity to increase quality of care and to increase the leadership skills of staff who have led on aspects of the work.