Research, Service Evaluation & Clinical Audit Strategy Evidence informed community healthcare improving patient outcomes

Transcription

1 Research, Service Evaluation & Clinical Audit Strategy Evidence informed community healthcare improving patient outcomes Date: January 2013 Author: Sarah Williams Version: v8 1

2 Version Date Author Amendments Distribution Version 1 April 2011 S Williams J Hillier Version 2 May 2011 S Williams Add in R&D Committee deliverables Version 3 June S Williams Edit following J Hillier comments at committee meeting Version 4 19 th June S Williams J Hillier Version 5 28 Nov S Williams Add in IP statement Version 6 4 th Feb 2012 S Williams Stronger emphasis on evaluation/ audit/ outcomes Tony Snell Version th Feb 2012 S Williams Proposed team Tony Snell & structure and KPIs Directors Version rd Feb 2012 S Williams Change in order of priorities NEDs Version th March 2012 S Williams Incorporate justification for centralised team. Incorporate paper Assurance Committee Version th March 2012 S Williams on Clinical Audit Comments from Judy Hillier Version 8 Jan 2013 S Williams Update to incorporate service evaluation and clinical audit; add in key deliverables Version 8.1 March 2013 S Williams Update with comments from consultation Assurance Committee, Trust Board R&D subcommittee, Clinical Audit and Service Evaluation subcommittee; research active staff, PPI Research, Service Evaluation & Clinical Audit Strategy v8.1 2

3 1. Executive statement Solent NHS Trust is committed to the promotion of evidence informed practice, continuous improvement to quality and patient outcomes, and to the delivery of effective research, service evaluation and clinical audit across all clinical services. Research is essential to the development of new knowledge and to innovation; evaluation ensures learning from innovation is captured and that the patient view is included; and clinical audit is the cornerstone of ensuring that we consistently deliver high quality patient centred services and sustained improvement. The evidence from research, service evaluation and clinical audit lies on a continuum from the measurement of service based achievements against defined standards through to the sourcing of new knowledge with opportunities for generalization across the health economy. Each source of evidence overlaps and feeds the other, and it is the collation of these difference types of information that together form a powerful platform from which to plan and deliver service delivery and improvement. This document sets out a four year strategy which aligns to Trust and clinical strategies and aims to embedding evidence informed practice, via research, clinical audit and service evaluation across the Trust. Within this it is committed to involving patients and the public in the whole spectrum of activity. It aims to place Solent NHS Trust as a leader in community healthcare research, and to lead the way in using evidence from clinical audit and evaluation to continuously improve services and patient health outcomes. The strategy will embrace five core strategic goals: 1. To provide an organisational hub for the collation of best evidence via research, evaluation and clinical audit activity and to ensure clinicians are enabled to deliver evidence based quality improvements into service delivery and improve patient outcomes 2. To prioritise research, evaluation and clinical audit projects that will provide a strong evidence base for continuous improvement in community based health care and support national priorities around transformation. To develop auditable evidence based clinical outcome measures across all services. 3. To increase the scope of research activity and the number of patients and staff who are engaged with research projects. 4. To engage in a programme of clinical audit and service evaluation across all clinical services which reflects key national and local drivers for quality improvement, as well as divisional/ service line priorities and the interest of service users, carers and clinicians. Every service will be able to demonstrate how evidence informs its practice and leads to quality improvement. 5. To embrace and lead the way in an embedded culture of patient and public involvement in research, service evaluation and clinical audit. Research, Service Evaluation & Clinical Audit Strategy v8.1 3

4 2. National Context Both research and clinical audit are core activities for the NHS, and act as the foundation for ensuring quality improvement and better patient health outcomes. Participation in clinical audit is a mandatory activity, laid out in the NSH standard contract, and the NHS Constitution (2012), places research at the centre of the guiding principles for the NHS through its commitment to innovation and to the promotion and conduct of research to improve the current and future health and care of the population. Current changes to the NHS landscape are resulting in an increased shift towards community-based health care, greater efficiencies, a need to evidence innovation and continuous improvement and a focus on patient centered clinical outcomes. The document NHS : From Good to Great sets out a vision of the NHS with quality at the centre, and the NHS Operating Framework for 2012/13 asserts that The promotion and conduct of research continues to be a core NHS function and continued commitment to research is vital if we are to address future challenges. Further action is needed to embed a culture that encourages and values research throughout the NHS. The draft report Quality in the New Health System (National Quality Board 2012) reiterates evidence around clinical effectiveness as a core dimension in ensuring quality. The Health and Social Care Act places a duty on the Secretary of State for Health, the NHS Commissioning Board, the Clinical Commissioning Groups and Monitor to ensure (evidenced) continuous improvement in the quality of services and the outcomes that are achieved from the provision of services. Clinical audit is cited as a key tool for the measurement of quality and improvement. The 2010 White paper, "Equity and excellence: Liberating the NHS", reaffirms the commitment of the government to the promotion and conduct of research and evidence based practice as a core NHS role. The outlines a vision for the NHS in which there is an increase in clinical audit activity to inform quality and clinical outcomes (including linking measures in national audits to payments) and a focus on implementing best practice to achieve improvements in outcomes supported by continued research, and an emphasis on evidence based medicine and policy making, within a culture of evaluation and learning. NHS Organisations are now required to include statements and summaries on research and clinical audit activity in their Quality Account Statements, and the use of clinical audit in particular is a priority concern of the Care Quality Commission (CQC), the NHS Litigation Authority (NHSLA), commissioning authorities and other regulatory agencies. 3. The local context On April 01 st 2011, Solent NHS Trust became an independent provider of community and specialist mental health service provider for Southampton, Portsmouth and parts of Hampshire. Solent NHS Trust supports the Department of Health s objective, within the Transforming Community Services Agenda to create:.modern, innovative community and mental health services that have direct benefits for patients, are responsive to local need, and promote seamless care through increased opportunities for integration of health and social care services Solent NHS Trust is an aspirant Foundation Trust. Its stated mission is to work in partnership to deliver health and local care and its vision is to lead the way in local Research, Service Evaluation & Clinical Audit Strategy v8.1 4

5 care. Three core strategic objectives (to enable improved healthcare outcomes, to deliver care pathways that are integrated with partner organizations, and to offer best value alternatives to acute hospital admissions) are supported by seven core values - Nurturing, Striving for Excellence, Passionate, Innovative, Empowered and Respectful. Research, Service Evaluation and Clinical Audit activity are integral to each of these values and objectives. Evidence, via research, service evaluation and clinical audit (and the triangulation with other sources) underpins and facilitates each of the strategic aims and values of the Trust. Moreover, successful transformation will require a strong evidence base to support the bid for Foundation Trust Status, and meet the requirements of local commissioners and national reporting requirements, particularly around quality and clinical outcome measures. A strong evidence base will also afford: the delivery of successful cost improvement programs; the meeting of contractual requirements; a driver for continual service improvement; and success in national programmes such as the revalidation of doctors and in future, nurses and Allied Health Professionals. In 2011/12 Solent NHS Trust was the second most active research Care Trust nationally which is testament to the increasing value placed on research activity in recent years. Furthermore, the ambition to be recognised as a leading community and mental health research Trust is a core quality Improvement objective for the Trust. Nonetheless, there is considerable room for growth, and increase in activity. As a healthcare provider that spans acute, community and primary care services, the Trust is in a unique position to host research in priority areas, such as integrated care pathways, hospital avoidance and community based care. It faces significant challenges however, as a result of the funding models currently employed by the National Institute for Health Research, and as a result of a dramatically changing health research landscape, including the introduction of Academic Health Science Networks (AHSNs). The Wessex AHSN outlines a programme of work which will draw on research and innovation to improve clinical outcomes and commits itself to translating evidence into the improvement of the local healthcare system. It is critical that Solent becomes a central part of this programme, and exploits it in the promotion and delivery of a culture whereby evidence is used to inform practice and continuously improve clinical outcomes. In May 2012, a new team was created in Solent NHS Trust, to oversee all Research, Service Evaluation and Clinical Audit activity. The creation of this team was born out of a desire to provide a centralised source of evidence to satisfy local and national reporting requirements, contractual obligations and to support continuous improvement in service delivery. It will also create efficiencies in terms of the skills and expertise around evidence based approaches, and will ensure clarity for staff. A recent review of the clinical audit systems and processes in the Trust highlighted a lack of clarity around priorities and process in some clinical areas. Furthermore, it noted that a need to better assure clinical audit and evaluation activity, to increase the engagement of and oversight by the Trust Board and better celebrate the impact of audit in terms of outcomes. Solent NHS Trust has the potential to be a leader in community based care, and in promoting the use of research, service evaluation and clinical audit to provide a firm evidence base for this care and for continuous improvement in service delivery and patient outcomes. This strategy outlines details around the five core priorities and plans for their delivery over the next four years. Research, Service Evaluation & Clinical Audit Strategy v8.1 5

6 4. Key Strategic Goal 1: To provide an organisational hub for the collation of best evidence via research, evaluation and clinical audit activity and to ensure clinicians are enabled to deliver evidence based quality improvements into service delivery and improve patient outcomes It is proposed that a central, co-ordinated approach to these areas of activity will provide an invaluable resource for the Trust embracing a culture of evidence informed practice. It is also critical that staff feel empowered and enabled to draw upon and use evidence in their everyday practice to ensure safety and improve patient outcomes. Specific Objectives 1. Motivate staff to be involved in evidence informed practice: ensure all staff and services understand how research, evaluation & clinical audit fit into their clinical practice; processes around governance of these activities, and ways of sourcing support. i. Celebrate success ii. Regular communications via team brief and the intranet iii. Attendance at clinical team meetings and divisional governance meetings iv. Production of reports for each clinical division/ service line highlighting open and outstanding projects, key findings, actions and improvements v. Production of an Evidence Based Practice Pack, available to staff and services with guidelines on governance processes vi. Continuous information via a website vii. Regular auditing of adherence to clinical audit policy 2. Offering regular and accessible training for staff on evidence based practice, research, evaluation and clinical audit i. Deliver a series of face to face training workshops which focus on applied skills ii. Link to programmes for medical trainees and preceptorship iii. Provide access to training via University, research network or HQIP schemes iv. Provide online training modules in evidence informed practice v. Invest in clinical academic posts 3. Ensure that there is adequate expertise for support with data collection and analysis and associated training for staff i. Ensure the correct skill mix in the Research, Service Evaluation & Clinical Audit team to provide expertise in methodology, data analysis and in the translation of evidence into actions/ service and cost improvement. Research, Service Evaluation & Clinical Audit Strategy v8.1 6

7 ii. Create supporting posts to work across clinical divisions in respect to evaluation and clinical audit planning, implementation and action planning. This will afford the necessary support for the revalidation of doctors, nurses and allied health professionals and for the identification of appropriate clinical outcome measures. 4. Ensure that evidence from research and innovation is fed back into services i. Consolidating partnerships between services and academic institutions. It is important that there are tangible links between academic leads and relevant innovation. In particular link with Wessex AHSN ii. iii. iv. Ensure access to research publications and findings (as per condition of research approval) in the Trust is achieved Ensuring these publications and evaluation/ clinical audit findings are available on the intranet Hosting an annual Solent NHS Trust Research, Evaluation and Clinical Audit Conference. Trust staff and students will be encouraged to present at this conference. v. Setting up evidence based practice forums for staff involved in research, service evaluation and clinical audit to share learning 5. Ensure that this evidence is linked to outcomes and feeds into service improvement plans i. As part of the evaluation registration and governance process, ensure a system is in place for translating evaluation and clinical audit findings into service improvement plans, cost improvement plans or refined outcome measures. ii. iii. Develop forward plans for service evaluations and clinical audits to provide the evidence base needed and to support the cycle of continuous improvement through PDSA (Plan, Do, Study, Act) cycles. Engage with Trust Board via the monitoring of research, service evaluation and clinical audit findings and subsequent implementation of innovation and improvement. Research, Service Evaluation & Clinical Audit Strategy v8.1 7

8 5. Key Strategic Goal 2 To prioritise research, evaluation and clinical audit projects that will provide a strong evidence base for continuous improvement in community based health care and support national priorities around transformation and to develop auditable evidence based clinical outcome measures across all services. The national agenda for patient care is to promote more community based health care and patient choice. Solent NHS Trust offers a huge range of specialist and often innovative services. To support and further promote these services and interventions, and to underpin the national agenda, there is a need for a better evidence base around the impact and outcomes of these interventions and the whole system benefits of the transformed community services. Solent NHS Trust will therefore prioritise research, service evaluation and clinical audit projects that can support the provision of this evidence base (and by implication, support profitable transformation schemes) and the individual Divisional Clinical Strategies. They will also prioritise research, evaluation and clinical audit projects that can offer value added evidence to priority improvement areas identified by the Trust, for instance in its annual Quality Account. These can be reviewed and identified annually, but examples include: Avoidance of hospital admission, via initiatives such as Virtual wards Community services for the older patient and end of life care Community services for children and young people Outcomes and impacts of substantial service delivery areas within the Trust such as sexual health, substance misuse and offender health Management of long term conditions Outcomes associated with patient centred integrated pathways of community based healthcare The use of telehealth Specific DH initiatives such as the Dementia Challenge Specific Objectives 1. Secure funding to invest in research staff posts within clinical divisions/ service lines to support National and Trust objectives (for example the Dementia Challenge) i. Meet annual CLRN business objectives to secure activity based funding and negotiate support for posts in priority areas ii. iii. iv. Utilise Research Capability Funding to invest in posts Maximise commercial income from research for investment in research capability Seek joint funded posts across the Trust and Universities and the Health Sector Research, Service Evaluation & Clinical Audit Strategy v8.1 8

9 2. Produce an annual programme of Clinical Audit and Evaluation in consultation with the Board and Clinical Divisions/ Service lines to align to local and national priorities 3. Establish a clear link between the Business and Marketing team and the Research, Service Evaluation and Clinical Audit team i. To ensure that research, service evaluation and clinical audit objectives each year feed into and support Trust business objectives ii. To ensure that products generated as a result of research are supported in terms of commercial activity and possible income generation, via marketing, licensing etc. 4. Increase the number of research projects hosted in priority areas i. Investing in staff to identify relevant studies on the NIHR portfolio ii. iii. iv. Enhancing partnerships with HEIs to consolidate understanding of Solent NHS Trust services. In particular establish clear partnerships with the Wessex Academic Health Science Network, link with education and ensure website is current. Proactively engage with Industry with an information pack about research capacity and opportunities at Solent NHS Trust. Working in partnership with other Trusts to secure projects across integrated care pathways 5. Engage with commissioning groups to incorporate the collection of best evidence into contractual arrangements and to adopt identified clinical outcomes measures as key performance indicators. 6. Key Strategic Goal 3: Facilitate and increase the scope of research activity and the number of patients and staff that are engaged with research projects. There is considerable scope for extending the number of services involved in research studies, and the number of studies that Solent NHS Trust hosts. There is also considerable scope for increasing access to clinical trials for our patients. Access to clinical trials is an NHS constitutional right of patients and allows them the chance to benefit from new treatments, interventions and medicines. Evidence suggests that patients who receive care in research active institutions have better health outcomes. The opportunity to engage in research also attracts high quality staff and productive external stakeholder relationships. Specific Objectives Research, Service Evaluation & Clinical Audit Strategy v8.1 9

10 1. Increase the number of patients recruited to research studies& the number of studies open to recruitment by: i. Horizon scanning and proactively approaching study managers to increase numbers of studies opened by 100% over four years. ii. iii. iv. Ensuring processes for gaining consent maximise access to patients for invitation to participate in trials Improve awareness of research opportunities for patients via improved communications in all clinical areas. Increasing the number of services involved in research by 20% over four years v. Increasing the numbers of patients involved in studies to meet annual targets set by the NIHR vi. Establishing agreements with research networks and other NHS Trusts for sharing accruals equitably 2. Focus on commercial studies In line with a national drive to increase research associated with the life sciences industry, and new targets to increase commercial trials in NHS Trusts, this will be a priority for Solent NHS Trust. This is vital to meet local performance management targets, and to provide income for research within the Trust. To attract commercial trials to the Trust, Solent NHS Trust will: i. Ensure there is clinical engagement and willingness to carry out commercial trials. ii. iii. iv. Work with the CLRN and other research networks to identify suitable trials for Solent NHS Trust. Engage directly with pharmaceutical and medical device companies and CROs working on their behalf to promote Solent as a preferred research site. Facilitate trials with support and resource in terms of admin support, protected time and research staff (for instance research nurses). v. Incentivise staff via the development of an income distribution policy to enable investigators to reinvest earnings from research back into the development of further research capability. Ensure that investigators are aware of the policy vi. Ensure there are adequate patient numbers to meet delivery targets set by commercial companies via partnerships with neighbouring NHS Trusts. Research, Service Evaluation & Clinical Audit Strategy v8.1 10

11 vii. Ensure governance processes are streamlined to guarantee approvals do not cause unnecessary delay. Where suitable, adopt co-ordinated and consistent approaches to approval (such as single point of negotiation) with partner Trusts. 3. Invest in protected research time for staff Of prime importance is the need to focus on the research strengths of staff employed by Solent NHS Trust and identify potential areas of growth. There is a particular need to engage with clinical leads to encourage research activity within their service area. It is also essential that Solent NHS trust increases the capacity to support research by focusing on training and development across its staff base. Support for staff to undertake research or research training can serve as a key driver to develop capacity, encourage activity and foster a culture of research in the Trust. It can also help to improve retention of staff and attract high caliber applicants to the Trust. Specifically, we will: i. Invest in a network of research nurses/ therapists who work in a clinical and an academic capacity from within clinical divisions/ service lines ii. iii. iv. Invest in clinical academic posts (medical, nursing and AHP) at doctoral and post doctoral level to work within services and identify studies open in their service area. As a Trust demonstrate a clear commitment to supporting staff on a clinical academic career pathway. Engage with medics, medical trainees, nurses, AHPs and other clinicians to encourage and facilitate research activity in their service area. Provide training in clinical research and in the use of evidence in practice for new and developing investigators. v. Include research in the appraisal and objective setting process. vi. vii. Improve financial incentives for staff and services to participate in research Celebrate and promote achievement. 4. Increase research income for the Trust Research income can be maximized by achieving the above, and by meeting performance metrics set by the NIHR, and monitored by the Hampshire and IOW CLRN. Specifically: i. The annual target for numbers of patients recruited into studies must be realistically negotiated and then achieved. ii. The numbers of studies approved must increase and must be approved within national metric timeframes. In addition attracting NIHR funded grants as an NHS host organisation will increase our Research Capability Research, Service Evaluation & Clinical Audit Strategy v8.1 11

12 Funding Allocation (previously Flexibility and Sustainability Funding). iii. Studies must be monitored to ensure they are recruiting to time and to target. iv. The number of commercial trials opened in Solent NHS Trust must increase to maximize direct earnings and indirect performance management associated funding from the CLRN. v. The costing of studies must ensure that all direct costs incurred are covered, and that there is some allocation for overhead and research development costs. vi. Exploit opportunities for innovation in its research partnerships. In this regard protect Intellectual Property Rights of the Trust were relevant, and seek to encourage and support staff to participate in the generation of Intellectual Property (IP) as part of its commitment to encourage innovative practice and to deliver excellent healthcare These measures will be monitored by a set of Key Performance Indicators, which will be presented to the Board. These are outlined in Appendix 4. Key strategic goal 4: To engage in a programme of clinical audit and service evaluation across all clinical services which reflects key national and local drivers for quality improvement, as well as divisional/ service line priorities and the interest of service users, carers and clinicians. The aim of this strategy is to use clinical audit (and where appropriate service evaluation) as a process to embed clinical quality at all levels in the organisation over the next four years, and deliver demonstrable improvements in patient care through the development and measurement of evidence based practice. 1. Develop an annual clinical audit and service evaluation plan to fit with corporate objectives, national priorities and clinical need i. Engage with Trust board, Clinical Leads, Divisional Governance Leads and clinicians to identify and approve an annual programme of Clinical Audit and Service Evaluation ii. Prioritise the activity within this programme into Priority 1: National Audits that are mandatory Priority 2: Clinical Audits and Service Evaluations outlined in commissioning and quality contracts; and audits around compliance with NICE guidelines. Clinical Audits that are required in response to incidents or complaints. Priority 3: Trust priorities such as audits and evaluations on Integrated Care Pathways, Record Keeping, Consent, Discharge and Infection Control Priority 4: Service identified audits, and those forming part of educational qualifications. Research, Service Evaluation & Clinical Audit Strategy v8.1 12

13 2. Meet statutory and mandatory obligations with respect to clinical audit It is critical that the Trust complies with statutory and mandatory requirements for clinical audit, and can evidence this. This must be achieved in full by. relevant Acts and Policies are: a. The Health and Social Care Act 2008 b. Care Quality Commission (Essential Standards of Quality and Safety) c. Department of Health Standard Contract (from 2012) d. Department of Health Act 2009 (Duty to provide information in Quality Accounts) e. Monitor Compliance Framework f. NHSLA Risk Management Standards (and support for progression through Levels two and three) g. General Medical Council revalidation of doctors 3. Support the Trust Board to meet the standards of an Exemplar Trust according to the Framework outlined by the Good Governance Institute in all ten dimensions. The full framework with an action plan can be found in Appendix 4 but specifically this will include: i. Ensuring that clinical audit is used as a tool in strategic management, led by the Board which is supported by an appropriate committee structure, The Medical Director and the Director of Nursing and Quality ii. Ensuring that the Board has sight of progress against the annual programme of clinical audit and evaluation, and reviews action plans and improvements via the completion of audit cycles (reaudit) iii. That the Board has the ability to use clinical audit as a tool for identifying and addressing areas of concern via a network of clinical audit champions within clinical divisions/ service lines. iv. Maintain a local and national profile in improvements in quality and patient outcomes via clinical audit and service evaluation for the organisational lead, the Medical Director (with support from the Director of Nursing and Quality) v. Engage with our patients and the public, our members and governors to inform clinical audit prioritisation and monitoring. Use the Healthwatch to inform priorities vi. Ensure that clinical audit is an integral part of planning, performance management and the operating process of the organisation, providing assurance to the Board. vii. Facilitate a whole systems approach across patient pathways Research, Service Evaluation & Clinical Audit Strategy v8.1 13

14 viii. Provide evidence that clinical audit and evaluation is leading to improved outcomes. 4. Institute streamlined policies for clinical audit and registration i. Update the clinical audit policy to reflect new governance arrangements and to incorporate service evaluation ii. Develop a registration process that combines clinical audit and service evaluation for clarity to support front line staff iii. Develop a reporting system for tracking completion of audits, implementation of actions and completion of the cycle via re-audit. iv. Link the policy around mandatory registration and monitoring to appraisal, revalidation and training programmes (for medics, nurses and AHPs) v. Ensure clarity around the policy for all staff and audit against adherence to the policy 5. Ensure governance and tracking of action plans identified from clinical audit and service evaluation i. Ensure that each clinical division/ service line is tracking its audit programme in terms of timely completion of audits, and completion of the audit cycle via a programme of re-audit ii. Ensure that governance structures within clinical divisions/ service lines support and can evidence the monitoring of action plans iii. Ensure that the governance structures within clinical divisions/ service lines can support training and communication to clinical staff around processes for clinical audit and service evaluation. 6. Ensure clinical audit is linked to incident reporting, complaints etc and findings triangulated with other evidence such as from outcome measures (to include PROMS) and patient feedback i. Institute systems for identifying audit need as a result of incidents and complaints, and quality priorities. ii. Assure triangulation of information from incident reporting, patient experience and other quality indicators to inform programmes of clinical audit and service evaluation 7. Ensure adequate training for clinical audit for all staff, in terms of methods, reporting and translation into quality improvement i. Insure that all staff are empowered to undertake clinical audit and service evaluation via training. This will take the form of A series of face to face workshops which have demonstrable translation into clinical audit activity and quality improvement. At least three workshops each year Research, Service Evaluation & Clinical Audit Strategy v8.1 14

15 Access to online training packages for clinicians, the Board and members of the public Delivery of training for students via the medical trainee and preceptorship programmes Specialist training arranged as part of the Learning and Development portfolio of training courses 8. Link audit to medical revalidation and the appraisal process To support their revalidation, doctors have to have systems and the skills to enable them to provide evidence of quality improvement initiatives and success. Processes and priorities around the registration and completion of clinical audit and service evaluation/ quality improvement can both provide a framework for this and be consolidated through it. i. Systems will be put in place to ensure that doctors have the tools and recording systems to support their quality improvement portfolio ii. Software will be rolled out to support this process, as well as patient feedback for revalidation iii. Service Evaluation and Clinical Audit which is not registered with the Clinical Audit and Evaluation team will not be accepted as evidence for appraisals or revalidation. iv. Ensure these processes and systems can be extended to nurses and AHPs when their programme of revalidation is launched in Key strategic goal 5: Embrace and lead the way with a culture of patient and the public involvement in research, evaluation and clinical audit Patient and public involvement is a vital part of research, evaluation, clinical audit and service improvement and will be a key tenet of the evidence based practice culture at Solent NHS Trust. User involvement ensures that work is: useful, relevant and of high quality; it helps us to ensure equality and diversity in participant recruitment, particularly in accessing harder to reach communities; it helps to ensure that findings are published and communicated in ways that are appropriate and accessible for the participants and target audiences. User and public involvement is now a necessity for the granting of many funding opportunities and for approval by Research Ethics Committees. Increased involvement will be delivered via: a. A dedicated post to promote patient and public involvement in research, service evaluation and clinical audit b. Formalised partnerships with the Research Design Service, INVOLVE, HQIP and networks to promote PPI c. Lay membership in all significant or strategic events such as Research, Service Evaluation & Clinical Audit Strategy v8.1 15

16 i. Membership on the R&D Committee ii. iii. iv. Membership in evidence informed practice forums Representation at the annual conference Membership on panels for awarding funding/ prizes etc v. Input into changes to strategy vi. Active contribution to the website d. Revisions to the R&D approval process to: i. ensure support for staff and external researchers to increase patient involvement in projects ii. iii. Monitoring of public involvement across all studies Monitoring of appropriateness of materials and methods for the dissemination of findings e. Revisions to the Clinical Audit and Service Evaluation registration and monitoring process to increase public and patient involvement in quality improvement. f. Guidance on the website and support for lay members and researchers in the form of regular and appropriate training g. Appropriate literature and marketing material in clinical areas to promote research and patient and public involvement. h. Establishment of a network of PPI representatives/ service users who can support evidence informed practice i. Support for PPI representatives to have access to local and national networks and forums in which they can share and disseminate best practice and success. j. Identification of funds to support PPI activity as per national guidance, k. Production and agreement of a policy to facilitate the appropriate renumeration of lay members as per national guidance. Research, Service Evaluation & Clinical Audit Strategy v8.1 16

17 References Academy of Medical Sciences (2011) A New Pathway for the Regulation and Governance of Health Research Audit Commission/ Monitor (2012) Delivering Sustainable Cost Improvement Programmes DH (2012) NHS Standard Contract 2012/13 e/dh_ DH (2010) Equity and Excellence, Liberating the NHS (White Paper) e/dh_ DH/ NHS Finance, Performance and Operations (2010) The Operating Framework for the NHS in England 2011/12 e/dh_ DH (2010) The NHS Constitution for England (2009 Edition) e/dh_ DH/ NHS Finance, Performance and Operations (2010) Revision to the Operating Framework for the NHS in England 2010/11http:// Guidance/DH_ DH (2009) Transforming Community Services: Enabling New Patterns of Provision e/dh_ DH (2009) NHS : From Good to Great. Preventative, People-Centred, Productive e/dh_ DH/ NHS Finance, Performance and Operations (2008) The Operating Framework for 2009/10 for the NHS in Englandhttp:// Guidance/DH_ DH (2006) Best Research for Best Health: A New National Health Research Strategy e/dh_ DH (2005) Research Governance Framework for Health and Social Care, 2 nd Edition e/dh_ HM Treasury (2010) Spending Review General Medical Council (2011) The Good Medical Practice Framework for Appraisal and Revalidation Research, Service Evaluation & Clinical Audit Strategy v8.1 17

18 General Medical Council (2011) Supporting Information for Appraisal and Revalidation NHS Commissioning Board (2013) Everyone Counts: Planning for Patients 2013/14 NHS Commissioning Board (2013) NHS Standard Contract 2013/14 NHS Portsmouth, Clinical Commissioning Group (2012) Portsmouth Clinical Commissioning Group: Principles of Business and Provider Management Solent NHS Trust (2012) A report of a review of Solent NHS Trust s clinical audit systems and processes (internal report written by Carol Bailey) Solent NHS Trust (2011) Strategy for Quality Improvement Solent NHS Trust (2012) Clinical Strategies: Adult Services; Adult Mental Health; Child and Family Services; Sexual Health Services Research, Service Evaluation & Clinical Audit Strategy v8.1 18

19 Appendix 1: Glossary CIP CLRN CQC CRN CRO DH e-dge ETCs GMC H&IOW CLRN IG IP IRAS NIHR Non-PF NRES PCRN PF PIC PPI R&D RDS RM&G SLA SOP SSCs Cost Improvement Plan Comprehensive Local Research Network Care Quality Commission Clinical Research Network Clinical Research Organisation Department of Health Online database system for research management Excess Treatment Costs General Medical Council Hampshire and IOW Comprehensive Local Research Network Information Governance Intellectual Property Integrated Research Application System National Institute for Health Research Non-portfolio National Research Ethics Service Primary Care Research Network Portfolio Participant Identification Centre Patient and Public Involvement Research and Development Research Design Service Research Management and Governance Service Level Agreement Standard Operating Procedure Service Support Costs Research, Service Evaluation & Clinical Audit Strategy v8.1 19

20 Appendix 2: Defining Research, Service Evaluation & Clinical Audit Research Service Evaluation Clinical Audit The attempt to derive generalizable Designed and conducted solely to new knowledge including studies define or judge current care that aim to generate hypotheses as well as studies that aim to test them. Designed and conducted to produce information to inform delivery of best care Quantitative research designed to test a hypothesis Qualitative research identifies/ explores themes following established methodology Designed to answer: What standard Designed to answer: Does this does this service achieve? service reach a predetermined standard? Addresses clearly defined questions, Measures current service without aims and objectives reference to a standard Measures against a standard Quantitative research may involve evaluating or comparing interventions, particularly new ones Qualitative research usually involves studying how interventions and relationships are experienced Involves an intervention in use only. The choice of treatment is that of the clinician and patient according to guidance, professional standards and/or patient preference Involves an intervention in use only. The choice of treatment is that of the clinician and patient according to guidance, professional standards and/or patient preference Usually involves collecting data that are additional to those for routine care but may include data collected routinely. May involve treatments, samples or investigations additional to routine care. Usually involves analysis of existing data but may include administration of interview or questionnaire. Usually involves analysis of existing data but may include administration of interview or questionnaire. Source: National Patient Safety Agency Research Ethics Service: Defining Research leaflet Research, Service Evaluation & Clinical Audit Strategy v8.1 20

21 Appendix 3: Key Performance Indicators, Research Accountabl e to Measure Assessment Criteria (to be used at year-end) Supporting information & source 1 Increase in patients Trust Board Patients Meet or participating in all studies recruited to all exceed studies against target target : 10% increase p.a 90-99% of target <90% of target Monthly performance report; Quarterly reports Via e-dge, tracker and CLRN reports 2 To increase the number of recruiting studies Trust Board Number of studies active against target by 20% pa Meet or exceed target 75-99% of target <75% of target Monthly performance report; Quarterly reports Via e-dge, tracker and CLRN reports 3 To increase the number of commercial studies Trust Board Number of new contracts against target (2 studies pa) Meet or exceed target 80-99% of target <80% of target Quarterly reports Via tracker 4 Proportion of sites recruiting to target Trust Board % of study sites recruiting to target 80% 70-87% <70% of target Monthly monitoring Quarterly reports Via tracker 5 % studies receiving NHS permission letter within 30 days of receipt of valid document pack Trust Board H&IOW CLRN % studies receiving NHS permission letter within 30 days of receipt of valid document pack 90% 80-99% <80% of target Monthly performance report; Quarterly reports Via e-dge, tracker and CLRN reports Research, Service Evaluation & Clinical Audit Strategy v8.1 21

22 Research, Service Evaluation & Clinical Audit Strategy v8.1 22

23 Appendix 4: HQIP Clinical Audit Maturity Matrix for Trust Boards Position statement and action plan Key Elements Basic Principle accepted Developing Working Well Exemplar 1. Use clinical audit as a tool in strategic management; Measure Clinical audit is integral to the core strategy the Board is seeking to address Clinical Audit programme is resourced to provide assurance against risks to strategic objectives There is a capable and confident team leading and delivering audit The Audit committee oversee the clinical audit programme focussing on topic selection, gaps, completeness & supporting the skills of NEDS to seek assurance of service compliance to standards The Board directors lead as part of a unified board supported by appropriate sub- Committees, Commissioners and the Nursing or Medical Director 2. Develop an annual programme of work Current position Actions to improve Measure Core to strategic objectives particularly evidence around improving health outcomes and integrated care pathways; and evidence that nonacute care is effective and safe Clinical audit objectives included in Trust Annual Business Plan; Clinical Audit Strategy to align to Trust and Clinical strategies; evidence from audit to inform progress against strategy There is a confirmed direction and focus for clinical audit Audit team in post to support services; audit leads identified in each clinical division/ service line Deliver training across services; ensure audit is fully resourced and prioritized in transition to SLM There is clarity on how / which clinical audit activity will be supported? Experienced team in place Recruit to remaining facilitator posts; support skills development across services An annual programme is prioritised and resourced Assurance Committee supported by Divisional Governance and Clinical Audit and Effectiveness sub committee oversee audit programme and monitor completion, adherence to standards. NEDS provided with training in clinical audit. Resources and correct skillbase have been identified for each audit Medical Director has lead, supported by Director of Nursing and Quality. Trust Board supported by committee & governance structure There is an expectation and commitment from Board to see action plans arising from clinical audit implemented.. Current position In place Audit programme is banded according to Annual audit programme in place, clinical audit Resources and skill mix checked as part of Action plans are a requirement following all Research, Service Evaluation & Clinical Audit Strategy v8.1 23

24 3. Instigate clinical audit as a direct result of mortality ratios, adverse clinical events, critical incidents & breaches in patient safety. Actions to improve Measure Appropriate processes in place to respond to incidents, complaints and SMR trends Board is able to identify and anticipate priority areas of concern. priority and this is agreed by Assurance Committee, Trust Board, Divisional Governance Audit process linked with clinical leaders who initiate data collection and report on the findings. strategy is in place (both currently under consideration by services) Both to be ratified by Board Audits are designed to check alignment to complaints and incident recording with resources in place for prompt response to adverse events governance and registration process Additional training for staff to increase skill base across Trust Agreed structure of audit champions in place who have received appropriate training to promote and initiate audit and ensure actions are followed through audits, and resultant improvements (evidenced by re-audit) recorded. Tracked by Divisional Governance and in turn, Assurance Committee Evidence around implementation and improvement assured via re-audit in all cases Board is able to identify and anticipate priority areas of concern. Current position Actions to improve Processes in place for audit to be undertaken where there are a series of incidents Strategy outlines plans to improve triangulation of evidence. Governance leads and Quality & Risk team to work with CA team to improve links between incidents and audit activity Clinical leads chair Divisional Governance groups; overview of incidents etc Formal process to instigate audit/ data collection required across all clinical divisions Resources in place, process for responding promptly Needs Development as in previous box Audit leads identified in SHS, Dental & Pharmacy. Non medical governance leads in all Divisions. Research nurses/ therapists across Trust to act as audit champions Audit leads/ champions to be identified in each division. Network events to be instigated for training/ shared learning. Increased training across clinical services Board has identified areas of concern (eg prison healthcare, Section 17 leave) in current year. Audit requested for future assurance. Concerns fed into annual audit programme Consolidate ability to identify areas of concern via better triangulation of evidence. Increase use of outcomes measures to facilitate early identification of areas of concern. 4. Ensure the Measure Board has rehearsed The clinical audit Board challenge focuses itself subject to audit for The audit programme is Research, Service Evaluation & Clinical Audit Strategy v8.1 24

25 clinical audit programme is relevant to board strategic interests and concerns. priorities and can match audit programme to its priorities programme should be aligned to the strategic objectives through the board assurance framework generated by the board & used as an ongoing working document on clinical compliance with standards and better practice & asks the appropriate assurance questions about clinical audit. materiality, completeness and return on investment. Results are always turned into action plans, followed through and re-audit completed 5. Ensure there is a lead clinician who manages clinical audit within the trust, with partners / suppliers outside, 6. Ensure patient involvement is Current position Actions to improve Measure Current position Actions to improve Measure Audit programme linked to strategic and annual objectives. Clinical Audit strategy aligned to Trust objectives Trust Boart sign off of Clinical Audit Programme & Strategy Lead clinician identified who is clearly Accountable at Board level Medical Director identified as lead clinician accountable at Board Level Share with patients priority setting, means of engagement, Strategy objectives tracked for completion as a working document; Report on this quarterly to Assurance Committee Track strategic objectives related to Clinical Audit in line with those in Trust Business Plan Lead clinician is clear of role and resources available and has access to the corporate board. In place Patients influence is recorded and has impact Assurance committee reviews compliance and improvement via Divisional Governance structures Embed new reporting and monitoring process. Update training for Board in Clinical Audit and Assurance Lead clinician has adequate resources and commitment is supported through CQUINs, job descriptions, induction, job plans & merit payments. New team in place to support clinical audit across services; Clinical audit etc written into job plans of Clinical Leads Increase resource for audit in job plans/ appraisal etc Patients and health and social care partners involved in priority setting Annual report to review programme completeness/ improvements Annual report to be drafted Lead clinician is strategically linked, with high level leadership skills and is delivering on key outcomes. Linked nationally, delivering on outcomes Evidence outcomes as part of EBP Users have direct access and influence over audit selection, planning and Process in place for ensuring action plans are produced and audit cycle is completed to ensure improvement/ completion of action plans. Embed new process; increase % of audits with action plans and that are re-audited through 2013/14 Lead clinician has national as well as a local profile and networks to drive integrated audit possibly as a shared post across a healthcare economy. Lead clinician driving ICPs and audit to demonstrate quality/ safety across healthcare sector. For FTs share the development audit strategy with governors so Research, Service Evaluation & Clinical Audit Strategy v8.1 25