NHS Greater Glasgow and Clyde: getting it right one ward at a time

Exemplar Ward

The hospital was keen to implement the Daily Dynamic Discharge model as a way of enabling Senior Charge Nurses to manage patient flow more effectively. However, there were not sufficient resources to implement the different components on all 40+ wards simultaneously. It had tried previously to implement an Exemplar Ward approach with limited success. Although the process began well, when winter pressures hit it was harder for the wards that had not been Exemplar Wards to develop their processes.

The hospital learned some important lessons from this and the second time around, the team leading the project was proactive in sharing improvement data from the Exemplar Wards and using staff from these wards as ambassadors for the process. It also made greater use of its Service Improvement Manager, Peter McInnes to support the follow-on wards and Unscheduled Care Clinical Lead, Dr Alisdair MacConnachie to provide clinical input. The approach is pioneered by each Exemplar Ward, which then role model it to other wards on their floor. There are four wards on each inpatient floor. This new way of implementing Exemplar Ward has proved to be far more successful than the first time around.

"It was important to establish the authority of Senior Charge Nurses as quickly as possible and to empower them to take charge of their wards."

Service Improvement Manager,
Peter McInnes

Queen Elizabeth University Hospital utilised all of the component parts of the Daily Dynamic Discharge model which include: Golden Hour structured ward rounds, EDDs (Estimated Date of Discharge), criteria-led discharge and use of the discharge lounge. However, it has also introduced a degree of flexibility, giving individual wards the autonomy to make minor adaptations to suit their particular circumstances, such as moving the time of the board rounds to fit around peak activity times.

Alisdair MacConnachie is Consultant Physician and Unscheduled Care Clinical Lead at the hospital. He said:

"Providing the core elements of the approach are implemented, we are pragmatic about wards making adjustments as we believe it is important for them to feel ownership of the approach."