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Patient safety

Freeing up Time to Care

Prof Rebecca Lawton, Prof Robbie Foy, Prof David Alldred and Daisy Halligan

Freeing up time to Care

Thank you to everyone who took the time to complete our short survey. We received more than 39 suggestions in response to the question:

Please tell us what you have had to get rid of, do less of or workaround to free up ‘time to care’.

We received responses from managers, doctors, nurses, dentists, pharmacists and volunteers from England and Scotland. They told us about many different things they had had to stop, or do less of, to free up time to care and to get through the day. Some of the things they had stopped doing were seen as vital for patient safety and they felt worried about not doing them. These comments are referred to as those things that staff ‘need to do but can’t’. There were other practices that staff felt were important and that not doing them could compromise patient care. These are referred to as ‘had to stop/reduce’. Finally, there were some were things that staff felt had little value and should be stopped permanently. These are referred to as ‘things that should stop’. Here are the frequency of responses in each of these categories. Below, we give some examples of the types of things that people told us under each of these headings.

Need to do, but can’t. People referred to NOT:

  • having training, even vital life support courses or having to do them in own time
  • having lunch and team breaks
  • attending or organising multi-disciplinary or multi-service meetings
  • finishing work on time
  • documenting patient history, examining patients or doing investigations thoroughly
  • collecting and providing data for local or national audits

This is summarised in the words of one respondent who said:

‘It is an extreme pressure to feel that it is not possible to do our work as we know it should be done’

Have had to stop/reduce. People referred to NOT:

  • reporting in Datix
  • doing audits
  • doing or supporting quality improvement
  • offering student placements
  • providing the same frequency of appointments for patients
  • writing up notes thoroughly
  • covering appointments
  • producing statutory reports
  • looking at patient records
  • having detailed discussions about end of life choices
  • providing retainers (dental) for patients

One person expresses their opinion about the long-term impact as follows:

‘Many of the initiatives (I have had to stop) would save time, money and/or avoid patient distress longer term so its heartbreaking not to be able to move forward, but at some point I have to see my family too

Things that should stop included

  • Paperwork, particularly duplicating or having to complete multiple forms
  • Meetings, Monitoring, reporting, auditing, producing plans and updates
  • Datixing and making changes based on things that sometimes go wrong

As one responded puts it it is ‘Time to reinvest the time from meetings, reporting and planning into safety actions and improvement’

We also received a range of other comments, not directly related to the question about the challenges of providing care (not just care of high quality) in some settings e.g. how distressing it was to work in the Emergency Department and other ideas about how services could be improved to make them more patient friendly e.g. piggy backing one visit (e.g. eye appointment) onto another (e.g. diabetes appointment).

We would like to express our thanks to everyone who shared their ideas when finding time to do this was difficult. We @yh_pstrc will be using these ideas in planning our research on ‘reducing safety clutter’ within our new research centre – The NIHR Yorkshire and Humber Patient Safety Research Collaboration. We will continue to share our findings.