UNDERTAKING SITE VISITS. Guidance for Non-Executive Directors & Governors

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1 UNDERTAKING SITE VISITS Guidance for Non-Executive Directors & Governors 1

2 Guidance sheet for staff, Non-Executive Directors and Governors Roles and responsibilities of Non- Executive Directors and Governors Board of directors The board of directors is made up of executive directors and non-executive directors. The executive directors are employees, are led by the chief executive and are responsible for the day to day management of the foundation trust. The non-executive directors are not employees. They bring an independent perspective to the board meeting and have a particular duty to challenge decisions and proposals made by executive directors. The board is led by the chair who is also a non-executive director. The board will also have a deputy chair and a senior independent director (SID). What does a governor do? Governors have an important role in making an NHS foundation trust publicly accountable for the services it provides. They bring valuable perspectives and contributions to its activities The governors duty is to represent the interests of the NHS Foundation trust members and the public. They hold the non-executive directors, individually and collectively, to account for the performance of the board of directors does not mean that governors are responsible for decisions taken by the board of directors on behalf of the NHS foundation trust. Responsibility for those decisions remains with the board of directors, acting on behalf of the trust. From Ward to Board The case for effective interaction between Ward and Board (and vice versa) is well made and widely accepted within the NHS. This direct engagement allows the Board to directly experience quality of services, helps frontline staff to identify Board Members and allows those staff and their patients to speak honestly about their direct experiences, in particular about patient safety and quality issues. Two of the most commonly used ways of co-ordinating this direct experience are by: The Fifteen Steps Challenge This approach focusses on patient and staff experience and uses an agreed approach which also fits with the CQC essential standards. It can be used with by professionals and lay persons alike 2

3 Patient Safety Walkrounds A walkround focusses on a discussion based approach which looks at helping frontline staff to identify current and impending patient safety issues and to consider how they might go about tackling these. More information about the roles and responsibilities of Governors and non-exec directors, the Fifteen Steps challenge and patient safety walkrounds can be found on websites below. The relevant documents are also embedded into this guidance sheet An information leaflet is also available to distribute to Your duties: a brief guide for NHS foundation Trust Governors the fifteen steps challenge, quality from a patient s perspective Leadership for safety: Supplement 1 Patient safety walkrounds 15 steps challenge.pdf Safety first.pdf 3

4 Guidance sheet for Non- Executive Directors/Governors Walkround Patient safety first identifies three phases to a successful Walkround Phase 1 Preparation - Pre visit Identify governors/non execs who will undertake the visit Agree team to visit, schedule mutually convenient dates. Have local contact name and contact details. Identify who will provide the non-exec director or governor with information about the ward or team and also who will receive formal feedback about the visit on behalf of the clinical team Understand the ward / team function & purpose, be clear about health and safety requirements or considerations including infection control (workwear/jewellery etc.) that visiting team need to be aware of prior to visit Be provided with any relevant reports/data to inform visit Posters sent for display around ward/team advising of date/time of visit Staff & patient information leaflet provided walkrounds poster.docx walkrounds leaflet.doc Phase 2 The Walkround Day of visit Your role/ requirements of you should an emergency occur Attend in designated meeting point Follow signing in requirements Attend briefing/local induction; this should give consideration to the following: o Relevant patient factors o Environmental factors including hazards o Any safe systems of work to follow o Fire safety arrangements o Access and egress arrangements and restrictions 4

5 Follow Golden rules (page 6) Undertake visit, using sample questions or own areas for discussion as required Give immediate feedback to the nominated person for the team concerned Identify where relevant SMART actions for the visiting non-execs or governors to take away and agree how you will measure success or impact Identify and agree where relevant ward or team SMART actions and encourage or empower staff to act; again agree how you will measure success or impact Phase 3 Follow up Give more formal feedback to the nominated representative for the ward or clinical team through the previously agreed mechanism At any subsequent visits it is important to reflect on progress made against agreed actions If several visits take place, an evaluation of the walkround and the effect on the environment is very informative Identifying and agreeing a measure of success or intended outcome to actions allows these evaluations to take place Patient Safety First suggests possible measures of success which can be used are: 1. Number of walkround visits performed 2. Number of actions identified and completed 3. Response to safety culture assessment survey of staff 4. Increase reporting of patient safety incidents/prevented patient safety incidents 5. A noted decrease in risk/severity of outcome of adverse incidents It is important to remember that the essence of the visits is about visible leadership in safety and they are not intended to create a burden of data 5

6 Golden rules Beware of assumptions if in doubt ask Comply with infection control requirements within clinical areas bare below the elbows at all times, and hand hygiene requirements i.e. no jewellery, nail varnish Dress appropriately no high heels, shorts or short skirts, no necklaces Ensure you uphold and maintain confidentiality and anonymity of all concerned Be aware of where conversations take place and if anyone may overhear Don t interrupt staff undertaking any medicine rounds Also raise any compliments/ queries/concerns initially with the nurse in charge or team leader in order for them to give explanation/set context to your observation. It might be that your visit has taken place on an uncharacteristically busy or difficult day or conversely a quiet day. If this is not possible, report your observations or concerns to the clinical director again ensuring you maintain confidentiality / Information governance requirements Always check out if it is a convenient time to talk for staff, patients and carers Follow instructions or directions given in local briefing / induction 6

7 Using open and closed questions can help in gathering relevant information about patient safety. Documenting salient points can be a helpful way to identify themes. In general these could fall under the following headings: Communication, Environment, Training, team work, incident reporting, equipment, staffing, process Sample questions - Patients 1. Do staff introduce themselves to you? 2. Do you get asked what is your preferred name and are you called by this? 3. Do you feel safe here? 4. How do you feel being here / supported by this team helps you? 5. Do you have any examples of how staff treat you with respect? 6. How would you change the care you receive here? 7. Can you make a drink when you want to? Are there plenty of choices of drinks available? 8. What kind of opportunities do you get to talk with a named member of staff on a 1-1 basis? Sample questions - Carers 1. How do you feel you are involved and informed about your relatives/friends care? 2. Do you feel your opinion or experience is respected and listened to? 3. Do you have any concerns re your relative s safety and wellbeing on this ward? 4. Do staffs introduce themselves to you? 5. Is visiting your relative/friend flexible and suitable to your needs? 6. What kind of information about support for carers or carer s assessment have you been offered? 7

8 Sample questions - Staff 1. What is your banding/job role? 2. What do you enjoy most about your role/ward/team? 3. What do you enjoy least? / OR/ If I could grant you 1/2/3 wishes, what would you change? 4. How long have you worked for the Organisation/ in this area? 5. What do you think your biggest achievement has been? 6. What other jobs have you done before you came into healthcare? 7. How did they compare? 8. If a patient wants a drink during the day, can they help themselves to them? 9. How do you ensure patients are receiving adequate food/fluids? 10. If a patient or carer approached you and said they wanted to complain about an aspect of their or their relatives care, how would you deal with this? 11. If they wanted to pass on a compliment, how would you deal with this? 12. Notice boards on the unit how often are they updated? Who by? 13. Are the views of patients/carers sought about what information might be useful for them? 14. What do you think patients would say about the service they receive from this ward/unit/team? 15. Would you be happy for a member of your family to be treated in this area? And would you be happy to share with me a little bit about why you feel this way? 16. How would you report any incident you were concerned about? 17. We know near misses happen in most large and small organisations; hopefully they give us a chance for learning. Can you tell us about any near misses you are aware of that almost caused patient harm but didn t? 18. Do you feel free to go and discuss any concerns you have? 19. What was the last training you took part in? Did you enjoy it? 8

9 Feedback sheet Completed by non- executive director/governor Name of team or Date of visit ward Names of staff (1) (2) present at visit (3) (4) Non-exec (1) (2) director/governors undertaking visit (3) (4) Areas of good practice noted Were these observations discussed with the team leader/charge nurse or nominated deputy at the time of the visit- YES/NO Areas for development - We understand a visit in isolation gives a snapshot and may not be representative of the team or ward visited Were these issues discussed with the team leader/charge nurse or nominated deputy at the time of the visit - YES/NO Any concerns to be raised as a result of the visit, either from direct observations or discussions with patients, carers and /or staff Signed on behalf of visiting team PRINT NAME Date of report SIGNATURE Return completed form to Angela Gleadhill Nursing, AHP and Quality Directorate 9

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