Why The Last 1000 Days?
Despite the hard work of caring staff, patients, particularly older people, get ‘stuck’ in hospitals, and the systems and silos in healthcare conspire to make this worse. This Website is about the most valuable currency in healthcare – patients’ time. It would be fair to say that a significant proportion of people who get stuck in the health care system are in the last 1000 days of their life, so they are the very people who do not have time to waste.
By focussing on the last 1000 days, our aim is to help draw attention to where time is wasted, what could be done differently and to share some examples of successes. Time really is the key; if you are against the clock, trying to get several things actioned, looking at when various services are open, competing for theatre slots, investigation times or outpatients appointments, there is rarely enough time. On the other hand if you, or one of yours, is waiting for any of the above it’s very easy to lose precious days.
However much we individually agree with the last 1000 days philosophy, nothing changes unless someone changes it. It’s very easy to think you can’t make a difference to a system, an organisation or a healthcare culture, and true you possibly won’t impact the whole system in one go. The thing is, big changes – cultural shifts – all start somewhere, usually by one person, and then the next, making a stand of a small change to something they have influence over. All it takes is for each of us to be brave enough to make a stand about the things that matter to us. The TODAY model has been created to help you to make that stand.
TODAY – A Model For Change
TIME Is the most important currency in healthcare. How to maximise time, minimise wasted time and prioritise patients’ time.
OWNERSHIP Is about taking responsibility, understanding what you can influence and gaining support
DIAGNOSTICS Is understanding what good looks like then being able to assess care and activity against that and identify potential problems
ACTIONS Identifies some of the things that are already prioritising patients’ time. How to engage others in meaningful change
YOU Is about understanding yourself, the impact you can have and how to influence others to make change
About The Authors
Professor Brian Dolan
FRSA, MSc(Oxon), MSc(Nurs), RMN, RGN
Brian has a 30+ year career in various nursing, leadership, academic and consulting roles focusing on system redesign, culture change and patient flow. He is Director of Health Service 360 and works in New Zealand (where he is Director of Service Improvement in Canterbury District Health Board), the UK and Australia.
Brian is the originator of #Last1000days and #EndPJparalysis. He was awarded a Fellowship of the Royal Society of Arts in 2016 and is Honorary Professor of Leadership in Healthcare at University of Salford, Manchester and Visiting Professor of Nursing at Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford.
Contact Brian – firstname.lastname@example.org Tel +44 7977 226151
MA, RGN, FInstLM
Lynda is CEO Health Service 360, and a champion for brave leaders and difference makers. Her message is unequivocal, ‘show up, be brave and do what you believe in’. She leads people towards making their own impact – big or small.
For the past decade, Lynda has supported health organisations to make tangible change through empowering people and focusing on patient experience. During her clinical and managerial career in the NHS – which spanned nearly two decades – she was also the RCN Chair of the Emergency Care Association.
Contact Lynda – email@example.com Tel +44 1789 801190
Professor Brian Dolan and Lynda Holt are founding Directors of Health Service 360
Health Service 360 is an award winning consultancy company who have helped 1000’s of health professionals to lead well, change practice and put patients first. we have been delivering results in health organisations for 16 years and our mission is simple:
“To help you deliver health care that lives up to your aspirations, that your people feel proud of, and that your patients deserve.”
We work with you to:
- Improve patient experience
- Develop your people
- Identify and implement solutions
- 360 feedback for the health sector
- Develop leadership
- Coach individuals and teams
- Support organisational objectives
What is The Last 1000 Days?
The Last 1000 Days is a vehicle for drawing attention to patients’ time. It is widely recognised that the elderly, the chronically ill, and those with life limiting conditions are the same people who spend the most time in healthcare settings. These are the very people who have the least time to waste.
The Last 1000 days concept has been developed to help draw attention to where & how time is wasted, to reinforce the positioning of patient’s time as the most important currency in health care and to create a sense of urgency.
By creating a sense of urgency, we prioritise what can be done, what’s in the way and what needs to be different. Making an issue out of the Last 1000 Days is important because it galvanises us to act. It creates a cause, a thing we can all get behind and a common language for change that we can share.
Of course, creating models and talking about things doesn’t change them, but raising awareness, giving people a compelling reason to change and the tools to make a difference does enable change to happen. As nurses, doctors, therapists or other people involved in the patient’s journey through the health system, we strive to do the best by patients on a daily basis. Sometimes we fall short because we are paying attention to the wrong thing – the system and processes we are used to, the way things are currently done and the time scales we have come to accept. By putting patients’ time at the centre of everything, by making it our most important currency, we create a new value system that enables us to pay attention to different things – the things that may get in the way of the care we want to give.
Two examples of this are #EndPJparalysis and #Red2Green. These will be discussed and used as examples as we showcase the TODAY model.
#EndPJparalysis (originated by Professor Brian Dolan 2016) is a simple concept that encourages patient to get up, dressed and moving while in hospital. Thus preventing complications of being immobile, including chest infections, muscle degeneration, clotting; as well as shifting patient’s perceptions ‘I’m sick’ to ‘I’m getting better’
#Red2Green (originated by Dr Ian Sturgess 2007) makes visible any delays in the patient’s journey through the system, identifies fixes and values patients’ time by not wasting it. Each is a compelling story that connects us to doing the right thing for patients, valuing their time and in doing so valuing staff time too.
West Coast District Health Board, New Zealand
Murrumbidgee Local Health District, New South Wales, Austrailia
Far West LHD, New South Wales, Austrailia
Royal United Hospitals Foundation Trust, Bath, England
James Paget Hospital, Great Yarmouth, England
Send your pictures of #EndPJparalyisis to firstname.lastname@example.org if you want to share your successes here (with permission of the picture owner of course)
References and Recommended Reading
Asher RAJ (1947) The Dangers of Going to Bed. British Medical Journal 2,967
Clark D, Armstrong M, Allan A et al (2014) Imminence of death among hospital patients: Prevalent cohort study. Palliative Medicine, 28, 6, 474-479
Gill TM, Allore HA, Guo Z (2004) The deleterious effects of bed rest among community-living older persons. Journal of Gerontology, 59a, 7, 755-761
Kortebein P, Symons TB, Ferrando A et al (2008) Functional impact of 10 days of bed rest in healthy older adults. Journal of Gerontology, 63a, 10, 1076-1081
Dolan B (2016) What happens when patient time becomes the most important currency in health care?
Fab NHS stuff website (http://fabnhsstuff.net/2016/07/04/the-last-1000-days-what-happens-when-patienttime- becomes-the-most-important-currency-in-healthca/)
Gawande A (2015) Being mortal, Profile Books Ltd
Gawande A (2011) The checklist manifesto, Profile Books Ltd
Grant A (2016) Originals: How non-conformists change the world, WH Allen
Heath C, Heath D (2011) Switch: How to change things when change is hard, Random House Business
Lodge C et al (2016) The new age of ageing: How society needs to change, Polity Press
Marquet LD (2015) Turn the ship around! A true story of turning followers into leaders, Portfolio Penguin
Patterson K et al (2011) Crucial Conversations: Tools for talking when stakes are high, McGraw Hill Education
Sinek S (2014) Start with Why: How great leaders inspire everyone to take action, Penguin
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