• Project led by North Bristol NHS Trust.
  • Focused on acute surgical wards.
  • Aimed to improve patient care and outcomes by supporting staff to use the trust's early warning score system effectively, while also generating cost savings and improving staff morale.
  • Introduced role-play training to help teams of nurses, health care assistants and doctors understand and respond to patients' early warning scores, and take action to prevent deterioration.

The North Bristol NHS Trust team developed a training programme to support effective use of an early warning score system that was in use on acute surgical wards. The system produces a score based on a patient's blood pressure, pulse rate, breathing rate, oxygen level and temperature, to help staff recognise when someone is becoming unwell and requires intervention.

The team devised two role-play scenarios based on incidents that had happened in the trust. Groups of trainees worked through the scenarios and discussed what went well and what went less well. The project aimed to show that training teams of staff in a realistic work environment could improve patient care at the same time as boosting staff morale and saving money for the hospital and the primary care trust. 

Who was involved

Staff working on acute surgical wards took part in the training in small groups made up of nurses, health care assistants and doctors who would normally work together.


After the training was introduced, it was twice as likely that a doctor would attend to review a deteriorating patient within 15 minutes, in line with hospital policy.

The project changed staff attitudes to training and other departments in the trust, including elderly care and staff development, showed interest in taking a similar approach to training. 


Nurses and health care  assistants were initially worried that the training was being used to assess them and select people for redundancy, while doctors felt that the training was a waste of their time. However, most participants felt very differently after taking part.

Further reading

Learning report

Shine: Improving the value of local healthcare services

February 2014

Successes and lessons from the first two rounds of the Health Foundation’s Shine programme: annual...

About this programme


Shine 2010

This programme ran from 2010 to 2011 and awarded 18 teams with up to £75,000 for projects aimed at...

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