SALFORD ROYAL NHS FOUNDATION TRUST Board of Directors

Transcription

1 SALFORD ROYAL NHS FOUNDATION TRUST Board of Directors 17 Subject Patient Experience Report Date of Meeting 31st March 2014 Author Presented by Summary Fiona Morris, Acting Corporate Assistant Director of Nursing Elaine Inglesby Burke, Executive Nurse Director The Patient Experience Report provides information about feedback received from Salford Royal s patients and includes: 1. Near Real-time Patient Feedback question changes Highlighting the reduction of questions asked 2. Friends and Family Test (FFT) overview and update. 3. The Nursing Assessment and Accreditation System (NAAS) Continually improving picture. 25 wards now at status. The Community Assessment and Accreditation System (CAAS) recommenced January 2014 following the recruitment of a Corporate Matron. The Outpatient Assessment and Accreditation System (OPAAS) commenced in May areas assessed, 5 green, 1 amber. 4. Staffing Overview Update - link to patient experience, SRFT approach and current actions described within the paper. Recommendation(s) The Board of Directors is asked to review this report and confirm suitability of current actions. FOIA Status: This document is for full publication. 1

2 Introduction The purpose of this paper is to update the Board of Directors on the progress and outcomes gained from feedback by people who use the services of Salford Royal NHS Foundation Trust. The aim of gathering this data is to assure the Trust that it is providing care that is valued by service users and also inform colleagues of issues that need to be improved upon. The Trust gathers data on patient experience from a number of both national and local sources. This paper focuses upon the feedback gained from: - Near Real-time Patient Feedback ( formerly CRT ) - Nursing Assessment and Accreditation System (NAAS) - Community Assessment and Accreditation System ( CAAS ) - Outpatients Assessment and Accreditation System ( OPAAS ) 1.0 Near Real-time Patient Feedback Near Real-time Patient Feedback enables the Trust to identify patients experiences of their care by asking them to answer a series of questions. A total of 9284 inpatients have participated in the survey from April 2013 to the end of February 2014 and 5641 outpatients during the same period. Aspects of the inpatient and outpatient feedback exercise currently included in the Trust s performance measures (April 2013 February 2014, 11 months data) are shown in tables 1 and 2 in appendix 1: 1.1 Inpatients Results From January 2014 the Trust revised the number of questions asked to patients from fifteen to focus on seven inpatient questions. This was in response to complaints from patients and staff about the length of the survey. The questions are now: Overall rating of care When had important questions to ask doctor, did you get answers you understand? Did you have confidence and Trust in doctors treating you? When had important questions to ask a nurse, did you get answers you understand? Did you have confidence and Trust in nurses treating you? Were you involved as much as you wanted in decisions about your care? Did we deliver what matters most to you? ( new question ) 1.2 Outpatients Results As advised by Picker Institute the Trust has reviewed Outpatients (as with inpatient) questions and criteria for response inclusion. A number of questions therefore show 2

3 reduced % of positive responses (previously combined) as only the most positive responses have been reported to enable improvement to be the best. As with inpatients, a review of outpatient questions has been agreed by the Outpatients Improvement Board. These will start from the 1 st April Further work is required to sustain continuous improvement in results in both inpatient and outpatient experience results. Ward and departmental action plans are also being scrutinised to identify where further support is required to implement actions to improve. 1.3 What Do the Results Tell Us? There are a number of areas where there is room for improvement. The table below outlines those areas for both the inpatient and outpatient settings together with work being developed. Setting Measure Work Developed Inpatient Inpatient Inpatient & Outpatient Outpatient Outpatient Were you involved as much as you wanted to be in decisions about Your care and treatment? Did we deliver what matters most to you? If you had important questions to ask a doctor do you get answers you understand? When you arrived at OP how would you rate courtesy of receptionist? How likely are you to recommend our OP department to friends and family? Area of focus for Patient Family and Carer (PFCE) Collaborative Current tests include: - Pad and pen by the bedside (used by patients to record any questions they may have, and also can be used by staff to note key information for patients and relatives) - Teach back to help understand how well information has been learned by patients - Open visiting hours - Ward Managers / Ward Matron s undertaking nurse led ward rounds at visiting time to explain treatment plans to patients and relatives What matters most to me now forms part of the behind the bed board above every inpatient bed in the Trust. As part of NAAS process behind bed boards are observed to ensure compliance that staff have asked patients what matters most to you? This continues to be something that is focussed on as part of the PFCE collaborative Customer service training has been completed throughout outpatients Teams from outpatients are in the PFCE collaborative and continue to contribute to Learning Sessions and develop tests of change aiming to improve overall patient experience, examples of these tests include: - Staff photographs will be displayed in areas 3

4 Setting Measure Work Developed - Feedback boxes available in every area - Shadow coaching will form part of the second year of the Patient Family and Carer Experience Collaborative 2.0 Friends and Family Test From 1st April 2013, all organisations providing acute NHS services were required to implement the Friends and Family question across adult acute inpatients (who have stayed at least one night in hospital) and adult patients who have attended A&E and left without being admitted. SRFT implemented the FFT across these patient groups, initially via SMS and landline voice messaging with the addition of post cards at the point of discharge in August 2013 across a limited number of wards to improve response rates. Patients must be surveyed at discharge or within 48 hours of discharge and the standardised question format must be used, as follows: FFT Question How likely are you to recommend our ward (or A&E department) to friends and family if they needed similar care or treatment? Response Scale 1. Extremely likely 2. Likely 3. Neither likely nor unlikely 4. Unlikely 5. Extremely unlikely 6. Don t know National Reporting Requirements and Response Rates The Trust is required to report on total numbers of patients within the specified groups and all patients must be given the opportunity to respond. Results are submitted, as set out in the National Reporting Guidance through the Unify2 data return system. Returns are required on a monthly basis and responses must be collected at organisational level and by ward and ward speciality. The minimum response rate for Trusts was expected to be an average of 15% in quarter 1, with significantly higher rates expected for the majority of Trusts. Response rates at quarter 4 are expected to be increased and reach a minimum of 20% Scoring and Publication of Results The Friends and Family Test results are calculated at ward and Trust level using the Net Promoter Score methodology as set out in the Department of Health publication guidance (DOH February 2013). 4

5 Net Promoter Score Calculation Scores are Calculated as the: Proportion of respondents who would be extremely likely to recommend, (response category : extremely likely ), minus Proportion of respondents who would not recommend ( response categories: neither likely nor unlikely, unlikely and extremely unlikely ) Inpatients Summary From April 2013 to January 2014 the Trusts monthly net promoter scores have ranged between 62 and 74. Response rates have been steadily improving and are currently 40.6% for inpatients in January A&E Summary A&E net promoter scores have ranged from 55 to 65 during the same period. Response rates continue to be monitored and are currently 26.7%. Quarterly Overall Response Rates At the end of quarter 1, the Trust achieved an average return rate of 18.4% against a minimum requirement of 15% for the quarter. Quarter 2 average showed further improvement with a Trust response rate of 28.4%. Quarter 3 average showed improvement again with a Trust response rate of 31.7% Appendix 7 shows inpatient scores and Appendix 8 shows A&E scores since April February Monitoring and Assurance Whilst the Trust is currently exceeding the minimum response rate requirement set, further work is required to ensure on going improvement to meet future increases required. Local services are key in checking patients phone numbers are correct, encouraging patients to respond to the FFT question to improve both response rates, net promoter scores and in acting on comments received from patients for improvement. Efforts focused on publicising FFT, ensuring explanation to patients, will promote and sustain improvement. From June 2013, results have been circulated to ward areas, Matrons, Lead Nurses, and Deputy Directors of Nursing to cascade to all relevant staff and take appropriate action where results or response rates are poor on a monthly basis. The overview of results will be maintained monthly by the Corporate ADNS in order to highlight to Divisions where further action is required. 2.5 Community Patient Experience Community patient experience surveys have commenced with Bowel and Bladder service. Questions have been verified by Picker and a hand held device is being used in clinic. Results have been, as with inpatients and outpatients uploaded to the Picker frequent survey website. 5

6 For other community services, questions are currently being agreed and the proposal is that the community service surveys will be available for patients to complete as a paper version that will be entered via the Hospedia link retrospectively by staff. Results will then be available direct to the service managers / team leaders on a weekly basis allowing more frequent review and opportunity for improvements. The community service survey will also contain the question: Has a member of staff explained medication side effects? This question was removed from the inpatient version as it was felt that it would be more appropriately asked post discharge completely. 3.0 Nursing Assessment and Accreditation System (NAAS) This performance assessment framework is based on the Trust s Safe, Clean, Personal approach to service delivery and provides evidence for the Care Quality Commission s essential standards of quality and safety. The NAAS is designed to support nurses in practice to understand how they deliver care, identify what works well and where further improvements are needed. Each ward has an assessment completed and will be accredited with a level 0 to 3. Wards will only achieve a green if there is demonstrable evidence of success on each of the three systems. Wards will only be given a blue rating ( status) after achieving green for three consecutive assessments and meeting a set of additional criteria. To date, 25 wards have achieved status (safe, clean and personal every time). They are shown as blue in the summary table below, having demonstrated consistently high standards of care. The current results to date show: Red Level 0 0 Amber Level 1 1 C2 Green Level 2 20 Blue Level 3 25 HCU/MIU/L6/B1/MHDU/B4/H4/ASU/DSU/B2/HU/SHDU/M3/B7/C1/ L3/B5 / M2 / ICU / L2 / SRU/ L8 / H2 / Recovery 1&3 / B8 3.1 Wards Awaiting Panel NAAS has been in operation at the Trust since 2008 with the first wards achieving status in

7 The following wards are currently at treble green and are awaiting Panel Ward Treble green Panel Date H5 Treble Green Deferred from October 2013 Panel reapplying May 2014 NHDU Treble Green May 2014 Panel H7 Treble Green May 2014 Panel Maples Treble Green Proposed September 2014 Panel B6 Treble Green Proposed December 2014 Panel Wigan Renal Unit Treble Green Proposed December 2014 Panel 3.2. Wards Not Yet at Status A further more detailed NAAS breakdown of wards that have yet to reach treble green status is attached as Appendix CAAS (Community Assessment and Accreditation System) The CAAS was commenced in November 2012, and then due to employment of a full time Corporate Matron reintroduced in January There are approximately 40 areas to be assessed (this figure might change due to service reconfiguration). The majority of community services are within Salford Health Care Division although there are some that sit within other divisions. To date, 25 community services have been assessed. Results are as follows: Red Level 0 Amber Level 1 Green Level 2 25 Blue Level 3 A breakdown of the individual community services assessed is shown as Appendix 4 7

8 3.4 OPAAS (Outpatients Assessment and Accreditation System) Red Level 0 Amber Level 1 1 Green Level 2 5 Blue Level 3 A breakdown of individual Outpatient services is shown as Appendix 4. There is a Ward Matron supporting and completing the outpatient assessments and as such has ward clinical demands, hence there have been no assessments this year so far. 4.0 Safe Staffing/ Nursing Establishments. The Trust has a dual approach to setting safe staffing levels. Based on available evidence, the Trust has taken the decision to adopt a standard whereby the available patient to nurse ratio never exceeds every 8 patients (inpatient beds) per registered nurse, and that both the shift coordinator and Ward Manager function in a supervisory capacity. In addition to the above, the Trust is currently utilising the Safer Nursing Care acuity and dependency tool to further understand what the optimal staffing levels are for individual areas. Appendix 5 reflects the current staffing position for close down of 2013/14. All areas are established for 1 registered nurse to 8 patients on day time shift, with a supernumerary shift leader, they are recruiting to this position and or using bank and agency nurses as a short term measure. All wards and departments publicly display expected vs actual staffing levels for the forthcoming 24 hours to provide a transparent and open approach for patients, visitors and staff and to highlight that the issues around safe nurse staffing is a key priority for the organisation. Senior oversight of staffing levels is achieved through four touch points throughout the day, beginning with a daily safe-staffing teleconference of senior nursing staff from the four clinical Divisions and chaired by a DDN and continued at the three formal bed capacity meetings throughout the day. The Trust is currently developing a daily electronic data capture system which will more easily provide aggregated Trust-wide data, with an ability to drill-down to individual ward/department level and provide assurance around our ability to reliably deliver safe staffing levels. This information will also provide the evidence around staffing for external reporting requirements. The senior nursing teams in conjunction with Managing Directors and colleagues from finance are currently finalising ward/department based establishments for the financial year 2014/15. This paper will be presented at the appropriate assurance committees and signed off by the Board of Directors. 8

9 5.0 Monitoring and Assurance Whilst the methods of capturing the patients experience, provide measurable data on the quality of care provided; it is clear there are a number of areas where the Trust should focus efforts to improve. Patient experience measures have been reviewed and reduced and progress will be monitored through the work of the Patient, Family and Carer Collaborative. Further work is ongoing to ensure safe staffing across the Trust and is being continuously monitored. Future assurance reports will detail progress over time. 9

10 Data Collection: Appendix 1 Patient experience data is collected via the bedside television system (Hospedia) and through the hand held Patient Experience Trackers (PET). Comparative Results April 2013 February 2014 Table 1 Inpatients Question Apr 13 May 13 Jun 13 Jul 13 Aug 13 Sept 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb When you have important questions to ask a doctor, do you get answers that you could understand? 70% 71% 67% 71% 76% 67% 71% 73% 74% 70% 66% 2. Do you have confidence and trust in the doctors treating you? 82% 82% 78% 85% 86% 82% 85% 86% 82% 80% 80% 3. When you have important questions to ask a nurse, do you get answers that you could understand? 78% 78% 74% 77% 81% 77% 78% 78% 79% 74% 72% 4. Do you have confidence and trust in the nurses treating you? 86% 83% 83% 84% 87% 86% 87% 87% 86% 83% 81% 5. Were you involved as much as you wanted to be in decisions about Your care and treatment? ( yes definitely ) 67% 65% 65% 69% 73% 67% 67% 68% 66% 65% 61% 6. Did we deliver what matters most to you during your stay? % 73% 7. Overall, how would you rate the care you received on this ward (Excellent, Very Good, Good) 93% 89% 90% 93% 93% 94% 93% 93% 92% 91% 88% Question 6 was commenced January

11 Table 2 Outpatients April 2013 February 2014 Question Apr 13 May 13 June 13 Jul 13 Aug 13 Sept 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb How clean was the Outpatient Dept? ( Very 100% 100% 100% 99% 99% 100% 100% 80% 82% 84% 85% Clean/fairly clean ) 2. Cleanliness Toilets ( very clean/fairly clean ) 99% 100% 98% 97% 99% 98% 99% 74% 82 % 81% 77% 3.Privacy discussing condition ( yes definitely ) 94% 91% 91% 88% 88% 91% 94% 93% 93% 92% 92% 4.Privacy being examined ( yes definitely) 95% 92% 93% 89% 90% 89% 93% 93 % 92% 93% 91% 5.Staff answered questions about results in ways understood (Strongly Agree, Agree, I did not ask any questions) 6. How likely are you to recommend our OP dept to friends and family? ( extremely likely ) 85% 88% 86% 96% 84% 83% 89% 92 % 93% 92 % 70% 71% 56% 57% 63% 71% 72% 72% 76% 73% 77% 90% Questions 1 &2 - From November 2013 only the top positive response (very clean) is given rather than as previous a combination of top two positive responses. NB All inpatients and outpatients question response criteria advised by Picker Institute. 11

12 Appendix 2 NAAS Updated Status February st Assessment 2 nd Assessment 3 rd Assessment B th Assessment 6/10/10 B th Assessment 6 th Assessment 7 th Assessment 27/09/ /01/12 26/07/ th Assessment M /09/ B th Assessment B B B C C H /05/ H H H /10/ H H H HU(Haem unit) /05/11 29/01/ SRU L /10/ L L4 (formally L7) L L /10/ L7 (now B3) (new th Assessment 12

13 ward)** L EAU ANU Renal Unit HCU MIU ASU A&E PANDA /10/10 23/05/11 20/09/11 07/10/ /07/ /07/ /01/ /07/ DSU /09/ SHDU /01/ NHDU SAL ICU /09/ /08/2013 Recovery 1 & Maples M /01/12 TAU * Bolton RU Wigan RU 23/08/2012 Rochdale RU Heartly green

14 Appendix 3 Ward Current Previous assessments Mitigation NAAS status C2 Amber New Ward Manager now in post / change of senior ward staff EAU 1 green Move to 55 bedded area L5 1 green New Acting Ward Manager in post ANU 1 green NIL same Ward Manager since 2008 Salford Renal Unit 1 green New senior team from 2013 new Matron / Lead Nurse Rochdale 1 green Awaiting re-assessment Renal Unit B3 1 green New ward in 2013 TAU 2 green New ward in 2012 H3 2 green 2 renal wards amalgamated in 2011 Bolton 2 green Awaiting re-assessment Renal Unit A&E/PANDA 2 green Awaiting specific competencies to be developed L4 New Ward Manager now in post 14

15 Appendix 4 Community Assessment and Accreditation System (CAAS) February 2014 Area 1 st Assessment 2 nd Assessment 1 Discharge Assessment Team 2 Eccles Integrated DN Care Team Irlam Integrated DN Care Team Walkden / Little Hulton Integrated DN Care Team & Swinton Integrated DN Care Team Claremont Integrated DN Care Team Ordsall Integrated DN Care Team Lower Broughton Integrated DN Care Team Out of Hours DN Team Intermediate Rehab Team Diana Palliative chronic needs & long term ventilation Team Community Tissue Viability Integrated with Acute Tissue Viability Service & Rapid Response 14 Community IV therapy team 15 Community diabetes 16 Bladder and bowel service Cardiac rehabilitation 18 Higher Broughton Health Visitors & Eccles Health Visitors Walkden Health Visitors Irlam HV Team Lance Burn HV Team Swinton HV Team Little Hulton HV Team Langworthy Health Visiting Community Vulnerable young person s service Swinton School nursing

16 28 Irlam School Nursing 29 Little Hulton School Nursing Paediatric Integrated Unscheduled Care Children s Community Nursing team Childrens community nursing special schools and learning disabilities 32 Childrens community nursing Diana Team 33 Paediatric Asthma service Childrens community nursing outpatients 35 Family liaison nurse 36 Paediatric physio and OT service 37 Community paediatrics 38 Paediatric speech and language 39 Orthoptics 40 GPOOH 41 Salford Care Health Practice Non Salford Healthcare Divisions 42 Anticoagulant 43 Audiology 44 MSK CATs and osteoporosis 45 Neurology 46 Occupational therapy 47 Orthotics 48 Physiotherapy / CNRT 49 Podiatry 50 Adult SALT 51 Palliative Care Counsellors 52 Community dental 53 Sexual health 16

17 Appendix 5 Outpatients Accreditation and Assessment System February 2014 Area 1 st Assessment 1 Main Out Patients Area Dermatology outpatient clinic CDIU Contact Dermatitis Investigations Unit Bury ICAT - Fairfield Hospital 5 Dermatology Bury ICAT - Radcliffe Primary Care Centre 6 Photobiology 7 Urology out patients clinic Diabetes centre 9 Renal outpatients Chest Clinic 11 Oral Surgery 12 Cardio Respiratory investigations - CRI 13 Audiology 14 Radiology 1 15 Radiology 2 16 Level 3 Angiogram 17 Neuro radiology 18 General ultrasound 19 Obstetric ultrasound 20 Discharge lounge Pre-operative 22 Orthopaedic and Fracture clinic 23 GIU/ Endoscopy 24 Ante natal clinics 25 Podiatry ( PCT) 26 Anticoagulant clinic 27 Immunology / allergy clinic 28 Nuclear Medicine Radioisotope Department 29 Elderly Day Services Unit 30 Pain centre 31 Gynaecology clinic 32 Orthotics ( CSB ) 33 Neurophysiology outpatient clinic 17

18 Division of Clinical Support & Tertiary Medicine Division of Neurosciences & Renal Services Division of Surgery Division of Salford Health Care Division Ward Speciality Beds Budgeted Establishment wte Registered Nurses Un-registered Nurses Registered Nurses Un-registered Nurses Registered Nurses Un-registered Nurses Nurse to bed ratio Appendix 6 Current Skill Mix % Wte Ratio per bed L2 Gastrology % 36% L3 Cardiology % 39% L5 Care of Elderly % 36% L6 Endocrinology % 37% L4 Care of Elderly % 35% L8 Care of Elderly % 38% H2 Respiratory % 29% MIU Investigations unit % 28% HCU Heart Care Unit % 14% EAU Assessment Unit % 30% MHDU High Dependency Unit % 21% B1 General Surg % 37% B2 General Surg % 37% B5 Elective Ortho % 42% B6 Ortho Trauma % 43% H4 Urology % 45% H5 Short Stay surgery % 30% H8 IFU % 21% DCU Day case unit % 21% ICU Critical Care % 12% SHDU Critical Care % 23% NHDU Critical Care % 16% CHU Haematology % 26% M3 Dermatology % 32% B7 Acute NSU % 40% B8 Acute NSU % 40% TAU Trauma assess % 38% Spinal Unit Short Stay surgery % 50% Spinal Unit Complex Spine % 45% H7 Elective Neuro surg % 23% H7 High Care Beds % 31% ASU Acute Stroke % 37% SRU Stroke Rehab % 50% C1 Neurology invest % 26% C2 Neuro Rehab % 50% The Maples Continuing Care % 55% H3 Renal Med % 37% INRU Intermediate Neuro Rehab % 50% ANU Acute Neuro Unit % 43% Totals / Average #DIV/0! #DIV/0! 18

19 % -Extremely Likely 6 - Don't Know 5 - Extremely unlikely 4 - Unlikely 3 - Neither likely or unlikely 2 - Likely 1 - Extremely Likely Friends and Family Test - Inpatient 2013/14 Appendix 7 Hospital Site Details Month Site Total responses in each category for each ward Total Number of people eligible to respond Total number of responses for each ward Response rate for each ward Apr-13 Inpatient % 71.96% 63 May-13 Inpatient % 74.51% 67 Jun-13 Inpatient % 71.14% 62 Quarter Inpatient % 72.86% Jul-13 Inpatient % 71.40% 65 Aug-13 Inpatient % 77.08% 70 Sep-13 Inpatient % 77.80% 72 Quarter Inpatient % 75.81% Oct-13 Inpatient % 75.34% 70 Nov-13 Inpatient % 78.49% 74 Dec-13 Inpatient % 76.61% 72 Quarter Inpatient % 76.95% Jan-14 Inpatient % 75.43% 70 Feb-14 Inpatient % 76.32% 72 Net Promoter Score 19

20 % -Extremely Likely 6 - Don't Know 5 - Extremely unlikely 4 - Unlikely 3 - Neither likely or unlikely 2 - Likely 1 - Extremely Likely Friends and Family Test - A&E 2013/14 Appendix 8 Hospital Site Details Month Site Total responses in each category for A&E Department Total Number of people eligible to respond Total number of responses for each A&E department Response rate for each A&E department Apr-13 A&E % 68.85% 55 May-13 A&E % 69.60% 59 Jun-13 A&E % 68.98% 60 Quarter 1 A&E % 69.20% 59 Jul-13 A&E % 73.30% 65 Aug-13 A&E % 68.39% 57 Sep-13 A&E % 68.57% 57 Quarter 2 A&E % 69.99% 60 Oct-13 A&E % 68.38% 56 Nov-13 A&E % 68.64% 58 Dec-13 A&E % 67.84% 58 Quarter 3 A&E % 68.29% 57 Jan-14 A&E % 66.70% 56 Feb-14 A&E % 69.21% 58 Net Promoter Score 20

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