Introduction. In this report. A Spotlight on Paediatrics page 3. Complaints page 4. A patient story page 5. Quality & Safety Indicators page 6

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1 1/13 Quarter 1

2 In this report A Spotlight on Paediatrics page 3 Complaints page 4 A patient story page 5 Quality & Safety Indicators page 6 Patient Revolution page 11 Bowel Cancer Screening Programme patient experience page 11 Introduction Quarter 1 report shines a spot light on paediatric services, it highlights the complaints received by the Trust over the last 3 months and describes Karen and Oliver s story in the paediatric outpatient clinic. Patient comments are used throughout the report to support the quantitative information relating to the Proud to Care standards. The report provides an update on the Trust s key Quality and Safety indicators and the results from the Friends and Family Net Promoter question. Patients views on the Bowel Cancer Screening Programme and comfort rounding are presented. The report also provides comments from our Commissioners when they visited the Accident and Emergency Department. Recent work with the Community Volunteers and with the Kings Fund and the Health Foundation is described. Comfort Rounding page 1 Real Time Quality Monitoring page 13 In A&E West Midlands Quality Review page 14 Service Working with Community page 14 Volunteers Patient and Family Centred Care page 14

3 A Spotlight on Paediatrics The Children s Centre at the University Hospital of North Staffordshire provides Children s Services for general paediatrics and sub-specialities. The service incorporates the following areas. Children s Emergency Care Centre Children s Outpatients Ward 16- Medical /High Dependency Unit and Children protection Ward 17- Orthopaedic surgery/diabetes/oncology and Day case surgery Children s Intensive Care Unit Neonatal Intensive Care Unit (situated within the Maternity Cancer Centre The Child Development Centre In March 1 The Children s services relocated to the New Hospital, and now all services are integrated to one area. The relocation has not only brought an improved environment and facilities but has also enabled the workforce to work within an integrated model of care to deliver services to our babies, children, young adults their parents and families Children s Emergency Care Centre (CECC) During 11/1 there were almost 18 attendances to the CECC. Children presenting urgently to the hospital, whether referred by GP or self-referrals, are seen in the Centre. All children are managed in a child-friendly, child-centred environment with physical separation from adult patients. Children s Outpatients During 11/1 there were over 15, new and follow up Children outpatient appointments. The Children s Clinic also provides care from visiting Consultants from such Tertiary Centres as Birmingham Children s, Manchester Children s and Alder Hey Children s Hospitals, Inpatient Wards The Trust has two inpatient wards both with 5 beds. In patient services include Medicine, Surgery, Orthopaedics, and Oncology The Children s intensive care unit is one of two regional units within the West Midlands. The unit provides intensive care for local children as well as for children across the region as a whole. The unit has eight beds. The Neonatal Intensive care unit is one of two level 3 units within the Staffordshire, Shropshire and Black Country Neonatal Network. It provides intensive care, high dependency care and special care for local babies and those across the Network. 3 babies can be accommodated which includes 6 intensive care, 4 high dependency and 13 special care cots. The Oncology Service hold an annual fun event for patients, families and staff, to raise funds for the oncology service and to thank staff for their work What our patients say about day We would just like to say that we found the ward, all staff and the care and service given excellent. All the staff within the Children s Out Patient Department were lovely. I thought the trolley being brought around with snacks for the children was a really good idea Fantastic support and excellent care for my daughter Waiting area is great, well thought out with toys. Bright, light, nice layout. Lovely and clean, very impressed. Good toys so children can play while waiting. I am pleased with new hospital. The environment and the excellent toys makes it so much easier to bring children to the hospital. It can be a really stressful experience to keep bored children entertained if the clinics are running late. 3

4 Patient Experience Complaints Chart 1 shows the number and type of complaints received by quarter. During Quarter 1 the Trust has received 186 complaints, of which 83 relate to all aspects of clinical treatment. Whilst the graph shows no particular trends it demonstrates that there has been a gradual increase in the number of complaints received. What other patients said about the care they receive My care in hospital,very good indeed, both on the ward and in the recovery room. I would like to formally pass on our gratitude to all the staff that have actively cared for and encouraged my great aunt s recovery. Her quality of later life has ben considerably improved due to the treatment received from your Trust. Chart 1 Complaints received by quarter 9 8 Aids and Appliances, Equipment, Premises (including access) Admission, transfer & discharge arrangements 7 All aspects of clinical treatment Appointment, delay/cancellation (inpatients) 6 Appointment, delay/cancellation (outpatients) Attitude of staff 5 Communication/information to patients (written & oral) 4 General Nursing Hotel services (including food) 3 Other Patients privacy & dignity Patients' property and expenses 1 Personal Records (including medical and /or complaints) Transport (ambulance and other) 11/1 Q3 11/1 Q4 1/13 Q1 Complaints categorised within all aspects of clinical treatment include: Suitability of treatment/procedure Diagnosis Medication related Delay in providing results Delay in referral process Failure to follow up Cross boundary issues PALS PALS have been contacted on 99 occasions over the last 3 months (compared to 316 in Quarter 4). As with complaints the most common concern raised related to all aspects of clinical treatment, however, other concerns included appointment delays and communication/ information received by the patient and/or carers. Examples of actions taken in response to complaints during Quarter 1: Portable oxygen cylinders to be purchased and kept in a central location on the ward so that they are easily accessible to all staff. The Trust will work towards adopting a consistent approach to self-medication in patients with long term conditions. Training to be made available to all staff to enable them to deal with difficult situations in a more appropriate manner. A toilet within theatres near to the recovery suite has now been reallocated as a patient toilet for patients in recovery to use if appropriate and safe to do so. Matron to implement a review of documentation of the provision of food and drink. Matron to initiate further skin bundle training regarding the proper care of patients at high risk of developing pressure sores. Process for highlighting untoward findings in diagnostic imaging tests to be changed. 4

5 Karen and Oliver s Story In April 1 the Matron for Child Health met with Karen, a Mum who had recently visited the Children s Out Patient Department, with her son Oliver. Karen wished to discuss the observations she had made during the visit The Matron said Children s Outpatients is my passion and with the team we strive hard on a daily basis to ensure that our families and children receive an excellent service, I could only ponder about what was to be discussed and alarmed that potentially we may have got it so wrong in developing our clinics and services for the new build. Karen described her experience to the Matron who said that this was the beginning of one of the most informative meetings that I have been involved in it gave me a greater understanding of what our parents and children see when they are with us. This is how Karen described her journey. The department is well signposted and we found it easily without having to ask directions. We booked in at your reception (because I missed the great big machines in the atrium) and were asked to confirm Ollie s contact details. Our GP has recently closed down so I gave the new GP details to the hospital. However when my letter came through a copy had gone to the old GP Practice. When Oliver was weighed there were people doing this process, one reading out the measurements and the other recording them, this seemed to be a waste of resource. Our appointment was for 9.15am and the Consultant called another child in at 9.8am, meaning I knew we would then start late. I choose my appointment times very carefully so that my son takes as little time off school as possible and I also like to limit the amount of time I have off work. I would prefer to wait another couple of weeks and get the time I want so this was disappointing. In your waiting room there is little to occupy children of my son s age, 1 years old Each time we see the Consultant we are interrupted with someone bringing notes in to the room. This distracts attention from our consultation. Overall the experience was a positive one and I enjoyed the opportunity to discuss the above points at our recent meeting. What we learned from Karen and Oliver s Story The signage for the new department had caused us some concern but receiving the positive feedback gave us confidence that we had communicated it well. The new Saviance outpatient self- booking stations were introduced into the children s clinic during the transformation to the new build. It was felt that, this method of booking into the clinic would help the patients journey with through the department and enhance the quality of information. Even though Karen had missed the booking station, we talked about how this worked and asked Karen if she had any thoughts on the process. Karen reassured us that she felt the system would of benefit. We have worked with the Secretaries to ensure that all patient details are updated within the Trust s administration system. We reassured Karen that we would re-send the letter to her correct GP. On the day that Karen visited the clinic the newly inducted Nursing Assistants were being trained and therefore working in pairs. Karen understood why two Nurses would be working together, however now we displays information within the clinic saying when trainees are in the department. We asked Karen if she would like clinics to be offered in an evening and whether she thought this would be helpful to working parents and school children. Since meeting with Karen we have been collecting real time data from each attendance at the clinic to gain an understanding from all our parents regarding the length of time they wait to be seen. We have also implemented Comfort Rounds into the clinic setting. Whilst this is predominantly a ward based tool, we have adapted it to keep parents aware of any delays, guide them to toilet and baby changing facilities and ensure that the Children have received a drink or a light snack if required. We were already aware that the waiting area did not provide activities to occupy older children. Following the meeting with Karen, we gave comment cards to children 1 years and over asking where they would like to wait and what they would like available to occupy them whilst waiting for their appointment. A room is now available which is set away from the waiting area, providing organised games, magazines and game stations. Interruptions by brining notes into the consultation room has been raised frequently. This practice has been employed to ensure consultants are aware that there patient has arrived, has been assessed by the nurse and are waiting for their consultation. In order to avoid this in the future, we are exploring the availability of this information on a computer screen. 5

6 Dec- 11 Quality and Safety Indicators Adverse Incidents and Harm Free Care Chart : Patient Safety Incidents Chart opposite indicates to a positive reporting and safety culture at UHNS. The rate of Patient Safety Incidents per 1 admissions has increased slightly however, the severity of the incidents is reducing and Serious Harm (as defined by and reported to the National Patient Safety Agency) is decreasing Chart 3 shows that the trend in patients receiving harm free care, as measured by the monthly Safety Express surveys, has improved since Quarter 4. Over 95% of the patients surveyed were recorded as receiving harm free care. The Trust has not reported any Never Events during Quarter 1 1/13. Patient Safety Incidents (PSI's) PSI per 1 admissions Trend (PSI's) Chart 3: Harm Free Care 1.% 95.% 9.% Safety Express 85.% Within the Safety Express programme, Harm Free care 8.% is measured against 4 harms: Falls / Catheter associated UTI / PE or DVT / Pressure Ulcer. Summaries of these 4 harms can be seen below. % Harm Free Care (Safety Express) Trend (Harm Free Care) Blood Clots (VTE) National best practice guidance states that on Chart 4: VTE Risk Assessments and Prophylaxis admissions patients should be risk assessed to prevent the development of blood clots (VTE) and where necessary commenced on anti blood clot medication. 1.% 9.% 8.% 7.% The Trust s VTE Risk assessment completion 6.% performance continues to exceed the national (9%) 5.% and local (95%) targets with 99% during Quarter 1 1/13. VTE Risk Assessment Completion VTE Prophylaxis Compliance (Safety Express) VTE Prophylaxis compliance has also continued to improve with 96% during June 1. These correlate Chart 5: Hospital Acquired PE/DVT with the noted reductions in VTE readmissions. Chart 5 demonstrates the reduction in the percentage of patients recorded as having a new VTE via Safety Express % 7.% 6.% 5.% 4.% 3.%.% 1.%.% No of Hospital Acquired DVT and PE Safety Express % Patients with New VTE 6

7 % Scores Total Patient Falls Patient Falls per 1 bed days Quality and Safety Indicators Patient Falls Chart 6: Falls Trend Chart 6 shows that the number of patient falls recorded during Quarter 1 has reduced when compared to the previous quarter. There has been a continued reduction in the severity of these falls as a consequence of improved assessment and actions taken (i.e. use of ultra low beds, improved patient footwear and enhanced hourly observations). Falls Rate per 1, Bed Days Trend (Falls) Chart 7 shows that the number of patients being risk assessed for falls is increasing, however, compliance with the Falls Bundle has fallen. These are key to reduce harm as a consequence of falls. Work is ongoing with Matrons and Ward Managers to improve the recent decrease in compliance with the Falls Bundle. This is now monitored via the Trust s Falls Steering Group. Chart 7: Falls Risk Assessments 1% 8% 6% 4% % % Falls Risk Assessments Completed Falls Bundle Score Trend (Falls Assessments) Pressure Ulcers Chart 8: Hospital Acquired Pressure Ulcers Chart 8 Shows the decrease in hospital acquired Grade 6 3 Pressure ulcers. There were no Grade 4 pressure ulcer reported. The target is to reduce all 'avoidable' hospital acquired pressure ulcers. The Trust completes a full RCA on all hospital acquired pressure ulcers Chart 9 Shows that over 99% of admitted patients have Pressure Risk Assessment completed on admission during Quarter 1 11/1. Reportable Grade 3 and 4 Pressure Ulcers Rate per 1, Bed Days Trend (Pressure Ulcers) A package of care called a SKIN Bundle is being used on all high risk patients. Chart 9:Pressure Ulcer Risk Assessment The Trust is currently undertaking an audit to establish current compliance with the Skin Bundle and will be reported in Quarter Report. A Pressure Ulcer Campaign to raise awareness across the Trust is planned for September 1. 1% 99% 98% 97% 96% 95% 94% 93% Pressure Ulcer Risk Assessments Completed Trend (Assessments) 7

8 Quality and Safety Indicators Continence and Nutrition Chart 1: Nutrition Risk Assessments 1.% During Quarter 1 the Trust has achieved 1% of 8.% 6.% patients receiving nutrition risks assessments within 6 hours of admission.. 4.%.%.% Feedback received as part of our Proud to Care Nutrition Risks Completed Patients Weighed standards shows a marginal decrease regarding helping patients to eat. This is being continually Chart 11: Meal Assistance and Replacement monitored through the meal time audits and actions 1% 95% agreed. However, there has been a positive improvement in replacement meals being provided if the main meal is missed. 9% 85% 8% 75% PC Feedback - Helped to eat if required PC Feedback - Replacement meal given if missed Chart 1 shows the number of Catheter Associated Chart 1: Catheter Associated UTIs Urinary Tract Infections as monitored through our monthly Safety Express audits during Quarter 1 is the same as Quarter CAUTI's (Safety Express) Trend Privacy and Dignity Chart 13: Single Sex Breaches Chart 13 demonstrates a continued downward trend in single sex breaches with no breaches reported during Quarter 1 1/ Single Sex Breaches Trend (Single Sex Breaches) Chart 14: Share room/bay on Admission Chart 14 demonstrates that the Trust continues to receive positive patient feedback regarding sharing mixed sex rooms/bays on admission. 1% 8% 6% 4% % % PC Feedback - Not shared a bay/room with patients of opposite sex when admitted Trend However Chart 15 shows improving results for mixed sex room/bays when being moved. This continues to be monitored at the Privacy & Dignity Working Group as part of the Trust's Single Sex programme. 1% 8% 6% 4% % % Chart 15:Share room/bay when moved PC Feedback - Not shared a bay/room with patients of opposite sex when moved Trend 8

9 Quality and Safety Indicators Administration of Medicines Chart 17 shows that Medication incidents are reducing overall. The Safe Medications Groups, at a corporate and divisional level, monitor and review the individual incidents and where necessary issue alerts to share learning Chart 17:Medication Related Adverse Incidents Medication Incidents Reported Rate per 1, Bed Days Trend (Medication Incidents) Chart 18 shows that overall when asked patients stated that their pain had been kept under control during their stay in hospital. 1% 95% 9% 85% 8% 75% Chart 18: Patients Pain Under Control PC Feedback - Comfortable & pain kept under control Trend Chart 19: Patients received Written Information Chart 19 shows an overall improvement in the number of patients receiving written information about their medications. 1% 8% 6% 4% % % PC Feedback - Explanation/written info about medication Trend Mortality Chart : Hospital Standardised Mortality Rate Chart shows that current mortality rates are decreasing and are back in line with expected levels. The current figure for May is 76.8 which shows the Trust is performing well compared to like Trusts During April 1 the Trust has also introduced a new procedure for responding to any mortality alerts to ensure a prompt and proactive response along with sharing of any potential learning both internally and externally with our key stakeholders HSMR Trend 9

10 Quality and Safety Indicators Infection Prevention and Control Chart 1 shows a small reduction in the positive feedback from patients in relation to the cleanliness of the wards and staff washing their hands during Quarter 1 Chart 1: Patient Feedback on Cleanliness 1% 95% 9% 85% PC Feedback - Wards/Clinics were clean PC Feedback - Staff washed their hands Infection Prevention continues to be a high priority for the organisation. There were no cases of MRSA during Quarter 1. Occurrences of C-Difficile has increased during Quarter 1. The Infection Prevention and Control Team have met with key Trust staff to promote further infection prevention and control practices. Chart : MRSA Trend Chart 3: Clostridium Difficile Trend MRSA MRSA Rate per 1, Bed Days C.Diff C.Diff Rate per 1, Bed Days Chart 4: MSSA Trend Chart 5: E Coli Trend MSSA MSSA Rate per 1, Bed Days E.Coli E.Coli Rate per 1, Bed Days 1

11 The Patient Revolution The Board will recall that the Friends and Family Test was introduced by acute trusts across NHS Midlands and East cluster region in April 1 as part of the launch of the Patient Revolution. The Patient Revolution is one of five ambitions being rolled out by the NHS Midlands and East cluster. There are three core elements to this concept, customer services culture, community and citizen participation and clinical and patient experience. Chart 6: UHNS Current Performance NET Promoter Score - Would you Recommend this Service to Family and Friends The combined Net Promoter Score for the cluster region for May 1 was 6. Individual trust scores ranged from 9 to 89. The average individual trust score is 63 and the lower quartile for the month is 53, while the upper quartile is 74 (please note, this does not affect the top quartile target for CQUIN which was confirmed using April data as 71). The score for UHNS in June 1 is 75. What our Patient really think of us I think the staff in this hospital are absolutely wonderful, understanding caring people...perfectly suited to the job they do.. Each and every staff member has dedicated so much time to me. Dispensing from pharmacy when discharged was very slow The staff on the ward provided an outstanding service...they were friendly and showed compassion. All our questions were answered. The discharge procedure is not co-ordinated very well and is overly long a more efficient system is needed All staff were absolutely brilliant help, made me feel relaxed and able to ask questions Bowel Cancer Screening Programme Patient Experience All patients entering the Bowel Screening Programme who go onto investigation or intervention are sent a questionnaire 3 days after their episode of care has closed. Between March 11 and April questionnaires were distributed and 381 were returned. This is what the patient said about our service: This is the best service I ve ever had from the NHS. It was faultless from receipt of the first letter inviting me to take part, to the follow up call after the colonoscopy. Every stage has been courteous and considerate of my concerns As I suffer from Parkinson s disease I am very slow and needed assistance with some activities. At no time did I feel that I was being rushed, I felt that I was given time and help. All the staff were extremely professional, helpful and friendly. I cannot praise the staff strongly enough. They were all fantastic; everything was fully explained at all stages. Unfortunately cancer was found and I am about to go for surgery. This problem has been found early so I hope all will be OK. Without this test I may have developed an extremely bleak outlook. I am greatly impressed with the whole process. The speed in which I received a letter stating there were abnormalities, the prompt appointment to see the Bowel Cancer Nurse were incredible and then the arrangements for the colonoscopy. My colonoscopy was delayed for reasons which were unavoidable and were explained to me. However, it was very unsettling to be prepared in a gown ready for examination and having to wait alone with no book or means of passing the time. 11

12 Survey of patient satisfaction of comfort rounding in the UHNS Comfort rounding, also known as intentional rounding, was rolled out across the UHNS in 11. Comfort rounds are where staff proactively ask patients on a regular (one or two hourly) basis whether they have any needs and these needs are immediately addressed. Comfort rounds have been shown to: Reduce the use call bells for non-emergency needs Promote a positive patient view of the timeliness of the care being provided Increased patient satisfaction Reduce the number of patient falls Reduce the number of pressure ulcers Reduce the length of time a patient s skin is wet due to incontinence Reduce the workload for nursing staff Provide documented evidence of care provided The minimum elements of a comfort round include: Positioning: Making sure the patient is comfortable and assessing the risk of pressure ulcers. Personal needs: e.g. scheduling patient trips to the bathroom to avoid unsafe conditions. Pain: Asking patients to describe their pain level on a scale of zero to 1. Placement: Making sure the items a patient needs are within easy reach, such as meal trays, water, tissues and the call bell. A patient questionnaire was distributed on 1 adult inpatient wards between March and May 1 with 131 questionnaires completed. The results shown in table 1. below demonstrate their positive reaction to the comfort rounds. What our Patients said about Comfort Rounds Credit due to all I would like more time to talk to staff as no family visit Standard of nursing is first class I think the staff are great and very pleasant I have nothing but praise for the team The staff on this ward are very busy and work extremely hard, therefore they cannot always come to you straight away. We have had quite a few laughs Staff do their best with their time I cannot speak highly enough about the attitude and professionalism of the staff Nurses, care assistants, ward assistants could not be any better although they are all really busy. Nothing is too much trouble The care given by the nursing staff, of all grades is exemplary. They always have a positive, polite, encouraging attitude When they have the time the staff often ask you about your life and family. This informal attitude can be very reassuring Some nurses are very nice and some don t speak to you 1

13 Real Time Quality Monitoring (RTQM) Visit to Accident and Emergency In June the Commissioning Support Services visited the A&E department as part of their planned programme of monitoring. The purpose of the visiting programme is to provide assurance and review the quality of the services within the Trust and to explore the views of staff and patients on the care they receive/deliver. During the visit 3 patients and 4 members of staff offered their views on the care they received/delivered in A&E. The main themes are highlighted below: Reception staff were observed to be kind and courteous The Nursing Sister in A&E was articulate, approachable, professional, well presented, highly motivated and had a clear understanding of her Clinical Leadership role and responsibilities in relation to patient care, patients dignity, respect, safety and privacy. Staff were observed to be, polite, friendly, supportive and very helpful both to patients and their colleagues and acted in a professional manner at all times. All staff had their ID badges within view. The Staff were observed speaking to patients in a sensitive, caring and respectful manner. Patients reported that the staff treated them with kindness and respect and they were well informed of what was happening to them The overall length of stay in the Department is monitored by a Lead Nurse on every shift. The department works very closely with the Site Manager to avoid 4 hour breaches. There was no unnecessary clutter and the areas where clean and tidy and had an atmosphere of calm and caring although they were relatively busy, which would provided a level of reassurance for both patients and families. Patients reported that staff responded promptly to requests and provided assistance when required. West Midlands Quality Review Service Care of People with Long term Conditions The Trust will be having a Peer review on the 9 th, 1 th and 11 th of October 1. The aim of the review is to help organisations to improve the quality of clinical services in a developmental and supportive way. The process is not an inspection or a performance management tool. The Quality Standards and the peer review programme will ensure that: People with long term conditions and their families and carers will know more about the services they can expect Commissioners will be supported in assessing and meeting the needs of their population with long term conditions, improving health and reducing health inequalities, and will have better service specifications. Service providers and commissioners will work together to improve service quality Service providers and commissioners will, have external assurance of the quality of local services Reviewers will learn from taking part in review visits Good practice is shared Service providers and commissioners will have better information to give to the Care Quality commission and Monitor. 13

14 Working with Community Volunteers The Trust recognises and values the huge contribution the Community Volunteers make to our local population and is committed to developing stronger partnerships. In April the Trust and Community Voluntary Organisations contributed to a joint Listening into Action Event to explore how together we could support avoiding admission to hospital, where appropriate, and safe and timely discharge. The event was attended by 59 staff representing 17 organisations. The group was presented with 3 real scenarios relating to an elderly patient with dementia, a patient with alcohol related problems and withdrawal symptoms and a patient with mental health problems. In smaller groups staff answered the following questions: Could admission have been avoided? What could have assisted the delayed discharge? What on-going support is available to prevent readmission In responding to the questions several key themes became apparent : Simple arrangements can make a difference e.g. recognising the role of good neighbours and support from partners and family Support in the community needs to be tailored to the needs of different people A single number to access services would be useful Public and professional awareness needs to be raised about what services are available and how they can be accessed The criteria for accessing some services needs to be reviewed, a few can sometimes be too restrictive and exclusive Not all services are available out of hours or at weekends which can directly disadvantage people. Voluntary services need longer term funding, A up to date directory of services is required to help raise the awareness of services available As a consequence of this event a further workshop has been delivered. 5 members of UHNS staff attended the workshop. All staff rated the event excellent or good and expressed a view that further events would be useful particularly focused on the work of the Discharge Facilitators and Discharge Co-ordinators. What our staff said about the workshop Exceptionally useful, I did not know so much support was provided and available. Thank you. Please provide this day again more nurses need this awareness Absolutely fabulous morning. I feel I have gained so much knowledge about the private sector. Please put on regular Roadshows possibly every 6 1 months I think that all the information that was available today should be made available in a leaflet and on the intranet. Continue promoting the work of the Voluntary ser- Patient and Family Centred Care Programme Patients experience is higher on the agenda than ever, with 11 seeing reports from the Health services Ombudsman, The Care Quality Commission, and the Francis Inquiry. The Department of Health Operating Framework 1-13 restates the spirit of the NHS Constitution with a key theme being putting patients at the centre of decision making. We have recently joined a high profile service improvement programme in partnership with the Kings Fund and the Health Foundation. The Patient and Family Centred Care Programme offers tested techniques to improve both processes of care staff patient interactions, which together affect patients and staff experience of care. This programme will support us in: Delivering high quality patients experience in the broadest sense, incorporating all dimensions of quality including clinical processes Promote improvements in the experience of staff Promote patients experience and build on the synergies that exist between safety and patients experience. We have chosen the asthma in children and stroke as 14

15 Conclusion In conclusion, the report shows the focus the Trust has on improving the quality of patient care and patient experience. The wide range of quality indicators summarised within this report and used on a weekly basis by clinical managers demonstrate the improvements in practice. 15