1 Presenter – Supported by the NUTH Junior Doctors Leadership Programme
Introduction & Vision: Nutrition is critically important in older person’s medicine. Patients over 80 have five times the prevalence of malnutrition than those under 50 [1]. Malnourished older people stay longer in hospital, and have higher mortality rates [2]. Use of nutritional screening tools reduces length of stay in elderly malnourished patients [3]. Having identified anecdotally that there were challenges in MUST screening and nutritional care, I sought out a colleague with similar interests to share the leadership of the project with me and we conducted a stakeholder analysis to identify other individuals to form a multidisciplinary working group on the project. We formed an initial project plan consisting of multiple Plan-Do-Study-Act cycles and several interventions to aim to improve practice.
Methods
Model of Transferring Benefits
A systematic review of both published literature and grey literature was conducted. Content relating to costs or benefits to the UK at an Project Plan: individual, institutional or system level was extracted and analysed thematicdata synthesis. byBaseline (see graphs) to demonstrate areas for improvement
Process-mapping to identify areas were of poor practice and places for intervention The benefits of volunteering described mapped to the key outcome indicators forengagement five differentto UKshare professional development MDT Stakeholder problems & brainstorm solutions structures. Identification and engagement with key decision-makers approach across the sharing A Standardised further framework was developed todepartmentdemonstrate the link results & good practice between volunteer experience partnerships improved between wards Avoid overloading the MDTwithin but create friendlyand competition UK service delivery outcomes. Education: E-Learning & Face-to-face training by Dietitian Liaise with electronic record team for electronic MUST Sustainability plan: spot audits and nutritional link team to anchor change
Overview of Results
Time of MUST completion 0% 11%
MUST has been recorded at some point MUST not recorded
53% 36% Overview of Costs
Accuracy of MUST
The literature review (including citation mapping) returned 9 Progress & Challenges:
MUST recorded within 24 hours
MUST recorded weekly MUST is accurate
Domain Initial Codes according to published papers and 32 pieces of grey literature that met all documentation Project has not progressed as rapidly as originally hoped (everyone Financial is busy!) Financial cost inclusion criteria. Most literature does not meet high standards of Loss of Staff Loss of staff from other areas of work, Imposing upon others when 28% Stakeholders engaged and PDSA plan fully designed. Initial interventions (awarenessMUST calculated formal academic rigor. finding cover, Challenges of organising cover, Trained staff leaving their raising and E-learning competition during nutrition week) successfully implemented. incorrectly post following links,
- 95% sources cited benefits and 32% citedmeetings costs. Data hasofbeen presented at Department and at regional level to the Reputational 40 initial individual benefits codes were elicited. British Geriatric Society. However, it is taking time to implement subsequent Health and – - 10 Institutional and national benefits were extracted. Theseat senior nursing interventions – possibly due to lack of sufficient buy-in level Security seem to arise both directly from the existence of links (e.g. individuals with many responsibilities and quality improvement projects in progress. Improved reputation) and from workforce engagement in links.
Opportunity
- 15 initial cost codes arose, which were grouped into 5 domains: financial; reputational; health & security; loss of staff; and opportunity costs.
Personal Leadership Lessons:
Benefits to Individuals and Workforce
Negative perception of the UK Institution where links are run badly, Negative perception of the UK where links are run badly,MUST recorded
5% Accidents/Injury, Management of security risks, 67% Exhaustion/Burnout/Stress, Culture shock
but some parameters incomplete
Staff distracted from areas of UK work, Neglect of relationships/Burden of Family or friends, Loss of annual leave, Negative effects on career, Opportunity costs
Conclusions
In this project I have been able apply a lot of the learning from NUTH’s Leadership Programme. I have learnt There is intervention. little publishedThe or unpublished about the challenges of initiating and delivering a multi-faceted multidisciplinary complexityliterature on the impact of volunteering within health partnerships. of trying to transform a pathway which requires input from many different members of the team has taught me The existing evidence base is descriptive and focuses on the benefits. a lot about the need to coordinate and communicate effectively to implement and sustain meaningful change. More work isa required to quantify the costs and benefits of At times it has been difficult to get different members of the MDT together or to reach consensus. I now better volunteering within health partnerships for individuals and understand the different priorities and focuses of different staff members. We have sought to overcome this by institutions, and the associated challenges and barriers. focusing on the impact on the patient; a shared goal for us all. We have also learnt the value of communicating Despite these limitations analysis suggests that skills acquired regular updates to all our stakeholders and reviewing our plan in light of their feedback at everyour opportunity. through volunteering map closely to workforce development I have appreciated the value of joint leadership; working closely with my partner Alison has helped to maintain frameworks and can be theoretical linked to improved service both momentum and motivation through all the challenges, and we have brought the project. delivery different within theskills NHS. to Benefits could be maximised by formally embedding volunteering within health partnerships within continuing professional development processes. 1. 2. 3.
Malnutrition within an Ageing Population: A Call to Action, European Nutrition for Health Alliance, August 2005. Hungry to be Heard: The scandal of malnourished older people in hospital. Age Concern England, August 2006. Nutrition support in adults Evidence Update , NICE, August 2013, https://www.nice.org.uk/guidance/cg32/evidence/evidence-update-194887261