Integrated Performance Report August 2017

Transcription

1 Integrated Performance Report

2 Contents Section Page High Level Dashboard Balanced scorecard 3 Domain Scorecards and Director Commentaries Operational Performance 4 Quality and Patient Safety 9 Workforce 13 Use of Resources 15

3 Site Performance Balanced Scorecard 3

4 Operational Performance Liz Wells Director of Operations Urgent & Emergency Care Amanda Hallums Interim Director of Operations Planned & Scheduled Care 4

5 Emergency Care Performance Attendances Waits over 4 hours June 17 BTUH July 17 August % 88.2% 92.4% 11, ,384 1,232 1, Summary Improving care for emergency patients continues to be a Trust priority, has seen recent improvement but remains fragile. Performance in August was 92.4% of patients being seen and treated/admitted within 4 hours. Issues Staffing Remains a risk for Trust Breach analysis confirms that most breaches are due to lack of capacity and flow The high numbers of Medically Fit patients continues to be high and DTOCs fluctuate week on week Health and social care provision and capacity within the community Actions and Mitigations Increased capacity in Ambulatory care from 8 to 13 beds, this service continues to pull patients through from the A&E including GP referrals and supported improvement in A&E performance at month end Protection of 2 beds on AMU West for Frailty Ambulatory to enable specialist assessment at the front door and admission avoidance or admission to the right place for right care. Daily Breach analysis and weekly meetings to discuss issues and promote learning and solutions of recurrent themes and improvement in patient pathways and experience. Actions and Mitigations Cont. Bed modelling for surgery completed by Four Eyes Insight and Division has now signed off their footprint to enable planning and utilisation of the services now and winter. Dedicated manager of day in all specialities to enable check and challenge to promote flow. Revising bed management model including roles and responsibilities of all divisions to support performance. Red2Green(R2G), SAFER bundle and Clinical Utilisation Reviews (CUR) are now live and being utilised by staff on 18 wards on daily Board Rounds Continue to promote and embed use of Red2Green and SAFER bundle as best practice for discharge planning. Daily monitoring of MFFD and DTOC data to escalate delays to external partners Weekly LOS meetings for all patients over 7 and 14 days lead by the Heads of Nursing. Change of culture and practice within escalation RAG rating which now changes as per current status of the hospital, more Green days so far this year than in all previous year. Elective activity continues and steady improvement of theatre utilisation which is starting to address the RTT and Cancer demand and backlog Robust weekend planning which includes Consultants/therapies, social care/pharmacy in place which is now improving weekend discharge numbers Planning with community and social care partners via A&E Board and Stepping Up Board to review and develop a system wide approach to care in the right place. 5

6 18 Weeks Referral to Treatment Summary Improving access to treatment remains a priority. Performance in August was below the Planned trajectory at 82.3% v 88.8% Issues and Mitigation Capacity remains a risk Annual leave planning requires improvement and adherence to Trust policy CT capacity lost as machine was down for 2 weeks despite best efforts to reprovide Actions and Mitigations Theatre utilisation targets agreed with specialties Theatre list scheduling introduced using the 6:4:2: planning tool WLIs continue Insourcing increased for Endoscopy Weekly PTL and Access Board meetings restructured to monitor progress and identify solutions to recurring themes Plans for outsourcing cystoscopy to the Mayflower agreed to commence 1 st week of September Consultant annual leave policy reinforced CT and MRI capacity utilised at Chartwell Planning commenced for outsourcing at the Nuffield Hospital Meeting held with regulators to provide assurance will meet standard of 92% by February

7 Cancer - 62 Day Standard Summary August showed a continuing upward trend in performance at 72.9% v 76.2% Issues Diagnostic capacity remains a challenge Overall backlog continues to reduce Dermatology referrals high Actions and Mitigation Clearance of clinic letters backlog for Upper and Lower GI. Increase in One Stop Clinics for Dermatology. Further development with straight to test initiatives. Increase with CT and MRI in Chartwell. Improvement with diagnostic results to reduce delays in pathway. Harm review panels no incidences of harm from cases examined. Cancer PTL meetings held weekly format changed. Additional diagnostic sessions. Backlog decreasing. Reduction in delays 7

8 Diagnostics BTUH Apr-17 May-17 Jun-17 Jul-17 Aug-17 99% 99% 99% 99% 99% Performance 98.5% 99.0% 99.0% 98.9% 98.7% 6w diagnostic waits Waiting List Size 5,531 5,679 5,580 5,673 5,830 Waits over 6 weeks Summary Diagnostic capacity in Endoscopy, Urology, CT remain an ongoing issue Issues Endoscopy working to full capacity Move of cystoscopy from the endoscopy unit awaited Actions and Mitigations Weekend and evening working in endoscopy Session utilisation improved Business plan completed for cystoscopy move from Endoscopy to be agreed early October Additional CT and MRI sessions Cystoscopy capacity to be improved through outsourcing at Mayflower 8

9 Quality & Patient Safety Dawn Patience Director of Nursing Dr Tayyab Haider Medical Director 9

10 Quality MRSA Bacteraemia Hospital Acquired 0 Dec-14 Apr-15 Jul-15 Oct-15 Jan-16 May-16 Aug-16 Nov-16 Mar-17 Jun-17 Sep-17 Dec Value Mean UNPL LNPL C. difficile Infections Hospital Acquired 0 Dec-14-2 Apr-15 Jul-15 Oct-15 Jan-16 May-16 Aug-16 Nov-16 Mar-17 Jun-17 Sep-17 Value Mean UNPL LNPL Harm Free care MRSA Bacteraemia There were two case of MRSA Bacteraemia in both July and August. All four Post Infection Review (PIR) investigations are completed. To date three cases were attributed to BTUH, one is awaiting arbitration decision. Clostridium difficile Two cases of C. difficile Toxin positive were identified, one in July and one in August. Actions and Mitigations Action plans have been developed and are in progress. Issues concerning Peripheral line management and documentation were raised and are being addressed with further training, trust wide communication (Message of the Week,) local audit and monitoring. One case was associated with a small cluster of MRSA acquisitions in Linford ward. IP&C interventions and recommendations are in place and continue to be implemented. Ongoing close monitoring continues with no further acquisitions. The CCG has been involved in all investigations. No lapses in care or patient safety issues were identified for the July case. The August case showed no lapses in care however Octenisan antiseptic agent to be used for Social washing for incontinent patients within theatre suite prior to surgery. VTE Screening As previously reported, compliance with VTE screening remains challenging. Current Trust level compliance at 89.06% A pilot completed on Horndon Ward has improved compliance to 100% as shown in the graph. VTE Actions- Each division has a weekly report of their compliance with the Trust standard. QI project on Horndon ward has showed continued sustainability. This has now progressed to Surgical Referral unit from w/c 25/9/17. Thrombosis Committee reinstated first meeting 25/9/17 King College Exemplar Trust visit to BTUH during October

11 Quality Preventable Pressure Ulcers 0 Dec-14-2 Apr-15 Jul-15 Oct-15 Jan-16 May-16 Aug-16 Nov-16 Mar-17 Jun-17 Sep-17 Dec Value Mean UNPL LNPL Moderate-Severe Injurious Falls 0 Dec-14 Apr-15 Jul-15 Oct-15 Jan-16 May-16 Aug-16 Nov-16 Mar-17 Jun-17 Sep-17 Dec-17-2 Value Mean UNPL LNPL Harm Free Care Pressure Ulcers 5 new pressure ulcers were declared during August. There has been staffing challenges within the Tissue Viability Service. Falls with harm In August, there were 2 moderate harm falls. Mortality HSMR This remains below the target line and within the statistically-expected limits. There was an increase for the 12 month rolling period June 2016 to May 2017 to 99.21, however this may reduce down to a degree following the next HED data refresh later in September. Actions and Mitigations There have been staff shortages with staff sickness, however this is improving and will continue through October. Meetings between Linford's Ward Manager and the Tissue Viability Nurse have occurred to determine an action plan to increase compliance of SSKIN. Competency training has been completed with the Clinical Practice Facilitator (Surgical Orthopaedic ) for cascade of training and competencies to the staff and future arrangements are in the process of being made for further in ward training sessions. Ward managers are continuing with feedback on RCA findings to ward staff and reminders on heel floatation, repositioning and appropriate mattress selection. Falls Actions August one was non compliant with advice from staff and the other slipped in urine by their bedside. They had all the relevant nursing interventions given. Mortality Monthly monitoring group for the mortality work stream. The reviews per division are monitored, medicine and surgery complete these electronically however CTC mange these within a group review therefore a template has been agreed for data collection. Trust Mortality group meets quarterly with Divisional and CCG attendance. Developments are in place for a Group mortality review system. 11

12 Quality Cardiac Arrest inpatient wards BTUH There continues to be a reduction in the number of inpatients with a cardiac arrest. With August being 0.62 per 100 admissions Actions and Mitigations Deteriorating work stream has been refreshed to include paediatrics and adults. The adult group has combined cardiac arrests, Treatment escalation plans, Acute Kidney Injury and Sepsis. 100% 90% 80% 70% Complaint responses sent in target (90%) Patient Experience Complaints The data demonstrates improvement towards meeting the 90% response target with 80% in August (75% in July). There has been a 23.6% reduction in new complaints received in August, July. Data shows a 12.6% reduction year to date when compared to April to August 2016/17 Thematic review of the complaints received in July-August demonstrates:- medical care/treatment (28), medical judgement and diagnosis (20) nursing care/treatment (14) communication (11) 60% Dec-14 Apr-15 Jul-15 Oct-15 Jan-16 May-16 Aug-16 Nov-16 Mar-17 Jun-17 Sep-17 Dec-17 Value Mean LNPL 12

13 Workforce & Organisational Development Danny Hariram Director of Workforce & Organisational Development 13

14 Workforce Vacancies August 10.31% vs 7% target Development of the apprenticeship programme across the Group as an entry point into nursing. Areas of constant high turnover have rolling adverts to reduce time to hire. Recruitment action plans and trajectories in place for divisions. Procurement process now complete for the recruitment of 100 overseas nurses agreed for 17/18. Turnover August 15.41% vs 10% target Mini staff surveys held within divisions to gather feedback and implement actions e.g Pharmacy, CCU Improving engagement and staff recognition at team and divisional level e.g employee of the month Retention issues have gained focus at Divisional level where areas are looking at various strategies to retain their staff. Mandatory Training August 83% vs 85% target Divisional trajectories are used to better monitor compliance and to increase rates in hot spot areas. In some areas focus is placed on particular courses to increase compliance and once achieved attention moved to the next course. Low compliance continues to be picked up in Divisional Performance Reviews and CSU meetings. 14

15 Finance & Use of Resources Stephanie Watson Interim Director of Finance 15

16 2017/2018 I&E Position Month 5 Month 5 Year to date Plan Actual Variance Income Pay (90.2) (91.6) -1.4 Non Pay (43.9) (46.2) -2.3 Financing (6.8) (6.0) 0.8 I&E deficit pre STF (8.6) (12.8) -4.2 STF I&E deficit inc STF (5.6) (12.8) -7.2 As at, the Trust is 7.2m behind its agreed control total of 5.6m planned deficit ( 12.6m planned deficit for the full year, which includes an STF allocation of 10.7m). Income is slightly behind budget in the month and is 1.3m adrift ytd. This is in the areas of Elective, Critical Care and high cost drugs and devices. Pay is overspent in the month by 0.3m and 1.4m ytd. This continues to be driven by overspends on medical and Nursing pay groups. Non Pay is overspent by 0.8m in month and 2.3m ytd. Much of this relates to undelivered CIPs, but also clinical supplies and other non pay. The Trust's CIP programme is behind plan but due to a stronger CIP governance process has pulled back the level of underperformance in the last couple of months. Due to the Trust being behind plan to date, the STF has not been achieved, but as the forecast is to delivery the control total for the year, this will be achieved in full at the end of the year. Actions and Mitigations Vacancy Control strengthened focus on s as well as WTE Stepping up CIP programme commenced QAG established Continued push to deliver pipeline Stepping up grip and control work programme commencing Director sign off of all discretionary spend from September Commissioning opportunities being explored for recovery of income eg pathology Budget accountability being tightened through PRM s. Financial metrics developed and implemented. Used to escalate to FR&PC. Forecast based on recovery actions by month. Tracking established. Month 5 Year to date Budget Actual Variance Acute Medicine 308 (283) -591 Clinical Support Services (4,609) (4,456) 153 CTC 3,140 3, Medicine 9,022 6,854-2,167 Surgical Services 2, ,956 Womens & Children 7,163 5,697-1,466 Division Total 17,075 11,229-5,846 Corporate (22,753) (24,095) -1,342 Total (5,678) (12,867) -7,188 16