Using an action team improves patient care
As part of the Action stage of the CAREFUL programme, we help to set-up cross-functional action teams to improve operations and solve tricky organisational problems. A complex example of one of these problems is management of pain,which requires good co-ordination between clinical and non-clinical leaders. The following abstract is taken from a forthcoming academic paper.

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Objective
To improve the management of pain for inpatients of a hospital for women and children by improving the effectiveness of interventions by ward staff.

Methods
We created a voluntary cross-functional team, headed by a full-time nurse specialist, to deliver training to all ward-based staff in the provision of advice, assessment and control of pain in women and children. All staff were instructed to assess pain using a simple pain score on each routine visit ot the patient’s room and to act upon the answer. All staff were trained in the use of pain-relief equipment as well as in the use of pharmaceutical and non-pharmaceutical methods of pain relief. Outcome measures were assessed through an existing patient satisfaction questionnaire filled in by patients or their parents after leaving hospital.

Results
The results cover a period of two years, approximately one year before and one year after implementing these measures. “Satisfaction” was defined as answering ‘Excellent’ or ‘Very Good’ to a five point likert scale of opinion. Three questions were asked regarding advice, assessment and control of pain. In the monthly scores from the beginning to the end of the study period, advice improved from 75.4% satisfaction to 94.0% ; assessment improved from 76.2% to 87%; control from 79.3% to 89.7%. Marked improvements in trends are shown within this. Measures of satisfaction within the paediatric environment improved most.

Conclusions
We estimate that the cost of implementing this strategy is less than £5 (US$7) per patient. We found that taking a structured and simplified approach markedly improved patient satisfaction scores in the area of pain relief. We also discovered that ‘bulk’ training helped the organisation to learn more effectively than a ‘cascade’ approach. This has wider implications for service development and change within the hospital environment.