4-276 / Developing a transformed model of acute comprehensive geriatric assessment

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
Sheffield Teaching Hospitals Foundation Trust


Quality management system
Quality improvement project
System resilience
GOP Description
Implementation level
Clinical settings
Geriatric & Stroke Medicine
High quality model of acute hospital geriatric care focussing on efficiency
All geriatric patients within the city of Sheffield
We adapted the Toyota Oobeya methodology to use in a health care setting. We coupled this with the use of a variety of methods loosely aligned with Deming’s Theory of Profound Knowledge. These included the Institute for Health Improvement (IHI) model for improvement, process and value-stream mapping, multiple Plan Do Study Act (PDSA cycles), theory of constraints, Statistical Process Control. The multi-disciplinary, multi-organisational teams met for 1 hour every Monday to feedback and plan the tests.
Timeframe implementation
Over eighteen months and still implementing further redesign
Implementation tools available
The implementation was built on team ownership of the problem and the potential solutions. From this the teams undertook tests of change using PDSA starting with a test of 1, moving to 3, then to 5 and then to roll-out. Various tools were used as part of this and these are mentioned in the above section
Implementation cost
Mainly staffing costs – time to meet and redesign over the period. Quality improvement expertise from a central Service Improvement team was also prioritised to support the clinical team to undertake this work.
Method used to measure the results
Reduced bed occupancy by over 60 beds
34% increase in discharge by day 0 or 1.
13% reduction in raw mortality
Analysis of the results
16% reduction in readmission
Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
There is no specified text here
Describe the strategies used to overcome the barriers (If needed)
There is no specified text here
Other information
Other information about the GOP that you would like to add (Link or attached document)
The improvements we have achieved cannot simply be copied by other organisations but there is a wealth of learning and ideas that could be translated into the local context.
We are already receiving many requests for more information on our work from across the UK and beyond.
The potential benefits are:
?    Efficiency – lower bed usage
?    Safety – reduced mortality
?    Timeliness – less ‘waste’ of waiting in hospital
?    Equity – achieving a more easily accessed NHS for frail older patients
Effectiveness – correct care being delivered in the right place, at the right time so readmission is reducedThis work has been presented at a series of local, national and international meetings. We would be happy to provide additional information on this work.