The Optimise project at Cwm Taf Morgannwg University Health Board (CTM UHB) has seen remarkable success since attending the Spread & Scale Academy.
The Optimise project focuses on improving urgent and emergency care, specifically targeting goals five and six of the national framework. In 2023, Optimise, led by Emily Adams Improvement Programme Lead Nurse attended the Spread & Scale Academy. Initially, the team was uncertain about what to expect and faced challenges, including operational pressures and scepticism from other parts of their system. However, the Academy provided a pivotal moment of clarity and inspiration, leading to a significant shift in their approach.
Before attending the Spread & Scale Academy, the Optimise team had already completed an initial pilot on a ward in Princess of Wales Hospital, using frameworks such as Safer Red to Green and Discharge to Recover and Assess (D2RA). While the results were promising, including an increase of 20 discharges per week, the team felt uncertain about how to build on this progress and spread the work effectively. Their experience at the Academy became a turning point, helping them make sense of the pilot data, shift their thinking, and develop a clear strategy for sustainable spread. Following this, Emily was appointed full-time to lead the Optimise programme, and the team applied their new clarity and approach to a rollout across unscheduled care wards. Over four weeks, they tested the framework in these new settings, embedding daily board rounds, aligning with national quality measures, increasing staff engagement, and improving patient journeys.
One of the most significant impacts of the Spread & Scale Academy was the shift in the team’s mindset. They moved from being solutions-focused to identifying and addressing the root problems, such as patient deconditioning and communication issues between health and social care. The Academy emphasised the importance of recognising the harm caused by deconditioning and the need for a cultural movement to address these issues, rather than doing more of the same relentless firefighting. This approach became the foundation of the Optimise project, driving its success and sustainability.
Despite facing some initial barriers, the team persevered. The health board even created a dedicated role for Optimise, which Emily was successful in applying for, allowing her to lead the programme full-time. This role enabled her to begin to truly redesign the programme for spread, incorporating principles from what she had learnt at the Spread & Scale Academy and utilising a train-the-trainer model. The programme included champions who were trained to lead interventions across board rounds and other areas.
The Optimise project also faced unexpected challenges, such as a critical incident involving the collapse of a hospital roof. Despite this, the team applied the Optimise principles to support management of the crisis, demonstrating the project’s resilience and adaptability. This incident led to the development of a governance framework and performance structure, further embedding the Optimise principles within the Health Board’s operations.
The impact of Optimise has been extremely positive. On one respiratory ward, staff are reporting a decrease in time from admission to discharge of 56.5 to 11.3 days, and an average reduction in patients’ length of stay from 29 to 13 days. Further, there was an incredible increase in “What Matters” conversations and D2RA pathway recording compliance from 0% to 100%. These improvements mean patients experience less deconditioning and harm, and receive quicker, more efficient care.
One of the standout successes of the Optimise programme has been on Ward 5 at the Royal Glamorgan Hospital. The ward, which typically averaged around nine discharges per week, recently achieved a record-breaking 22 discharges in a single week — the highest number in over two years. This milestone reflects not only improved patient flow but also the effectiveness of the Optimise approach in supporting teams to deliver timely, person-centred care.
The success of the Optimise project has been recognised beyond CTM UHB. The NHS Executive has since funded roles for Optimise leads in three other health boards, creating a network of leaders dedicated to spearheading best practice and spreading the project’s principles. This expansion is a testament to the impact of Optimise and the foundational role of the Spread & Scale Academy in its development.
Optimise was also nominated for a prestigious NHS Wales Award in 2024, highlighting its achievements in reducing the time between admission and discharge on the respiratory ward. Although the team did not win the award, the nomination itself was a significant morale boost and recognition of their hard work.
Emily, reflecting on the experience, said, “It’s been a remarkable journey so far and the Academy provided us with the strength and courage to keep going. We’ve learnt so much about the potential impact of the project for patients and their families far and wide, but just as important, we learnt who we are as leaders and why this means so much. I believe that is the key to driving cultural change within such a complex but pivotal system.”
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