You are Grace Adeyemi, Deputy Director of Quality Improvement at Riverside Vale, a 620-bed NHS hospital in the English Midlands. A coroner has just found that failing to give the sepsis bundle in time contributed to the death of a 34-year-old mother. You have 90 days to show a credible plan, and by Friday the Medical Director wants to know what is really stopping staff from using a bundle everyone knows works.
The situation
The Sepsis Six bundle is six steps to be given within the first hour: oxygen, blood cultures, antibiotics, fluids, lactate and urine output monitoring. The evidence is not in question: Riverside Vale's own sepsis team helped publish it nationally. Even so, in the emergency department and the two acute medical wards, about 240 staff across day, evening and night shifts, it is completed on time in only 28% of cases. The median time from recognising sepsis to antibiotics is 127 minutes; the standard is 60.
It is not the first attempt. In 2024, under your predecessor, a launch took compliance up to that 28% and then quietly lapsed; the night shift still remembers it as "another initiative from management". The regulator expects a credible trajectory to at least 75% by day 90; the national reliability benchmark is 90%. You have a fixed budget of £180,000 and 0.6 whole-time equivalents of protected clinical time, not a pound or an hour more.
Three explanations came up at the first meeting. An emergency consultant thinks the wards miss the early signs. The practice educator thinks the steps were never drilled on every shift in 2024. The night-shift charge nurse thinks the problem is workload and that nobody owns the bundle on shift. Each explanation spends the budget a different way.