Quality Dashboard. September Graph Legend. Legend / key Forecasts. Shows whether next month s position will meet the standard

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1 Quality Dashboard September 213 Legend / key Forecasts R Shows whether next month s position will meet the standard raph Legend Underachieving Standard Performance Mean Control Limits

2 NUH at a lance (1/2) Clinical Effectiveness Patient Safety 213/14 National Clinical Audit Participation (1) (Numerator: Eligible National audits. Denominator: NUH participating). 213/14 Participation in External Best Practice Reviews (Numerator: External best-practice reviews in which NUH is participating. Denominator: External best-practice reviews for which NUH is eligible) 213/14 Response to External Best Practice (Numerator: Number of external best practice reports NUH has responded to. Denominator: Number of external best practice reports NUH should respond to 213/14). Summary Hospital-level Mortality Indicator (SHMI)- October September 212 HSMR [basket of 56 diagnosis] HSMR [all diagnoses] Eligible patients having Venous Thromboembolism (VTE) risk assessment No patients acquire MRSA bloodstream infection caused by our care Fewer than 74 patients acquire C. Diff in our care (<6 per month) (2) Patients screened for MRSA (Elective, Emergency and Daycase) Rate of falls per 1 occupied bed days (3) Rate of falls per 1 occupied bed days resulting in harm Target Set 95% Mar 98% 98% N 1% Aug 1% 1% L 1% Aug 1% 1% L 1 Apr N 1 Jun L 1 Jun L 95% Aug 94.% 94.9% N & C Aug 1 N & L 6 Aug 9 44 N & L 98% Jun 99% 99% N 6.2 Aug C 2.1 Aug C Ratio of falls per faller per 1 occupied bed days 1.26 Aug C Harm event rate /1 occupied bed days (4) TBA Apr L Patient Safety Conversations Unvalidated Stage 2 Total Pressure Ulcers (5) Validated Stage 2 Avoidable Pressure Ulcers Unvalidated Stage 3 Total Pressure Ulcers Validated Stage 3 Avoidable Pressure Ulcers 4 Aug 3 19 L 5 Aug C 5 Aug 2 12 C Aug C Aug 2 28 C Unvalidated Stage 4 Total Pressure Ulcers Aug 2 C Validated Stage 4 Avoidable Pressure Ulcers Aug 2 C Medication errors per 1 bed days (6) CLINICAL OUTCOMES Standard Standard not defined Current data month Month Actual YTD (April- March) Aug Trend LEEND 1- DoH Quality Accounts List for 213/14 published. Monitoring to begin in October against eligible audits- 48 for NUH. 2- The C diff testing methodology changed in August 211 and again from 1st April Quarterly report on falls presented to Trust Board 4- Harm event rate - Trust wide case note review during August / September to reset standard by October 5- Quarterly report on pressure ulcers presented to Trust Board 6- Standard under review with Chair of Medicines Safety roup. See escalation page 7- The proportion of harm free patients with no new Safety Thermometer defined harm events whilst under our care at NUH Awaiting national guidance 1&13 - Target agreed with Medical Director ( based on Q1 data). Reporting from October. 11 Target of 75 to be implemented January Target to be set in line with national guidance when available Harm-free care (Safety Thermometer) (7) 9% Aug 93% 94% C Clinical and Organisational Risk 1% Aug 91% 98% L SI investigations completed within given timeframe (6/45 days or as agreed with commissioners) Aug % L Never Events CAS alerts on target with delivery timescales 1% Aug 98% 87% N 1

3 NUH at a lance (2/2) CLINICAL OUTCOMES PROMS: Hip and Knee replacement patients reporting better general health after surgery How likely are you to recommend our ward to friends and family if they needed similar care or treatment? (8) Sample size: How likely are you to recommend our ward to friends and family if they needed similar care or treatment? How likely are you to recommend our A&E department if they needed similar care or treatment? (9) Sample size: How likely are you to recommend our A&E department if they needed similar care or treatment? Standard Current data month Month Actual YTD (April- March) Target Set 54% Aug 88% 84% L TBC Aug N 15% Aug 36.5% 37.1% C TBC Aug N 15% Aug 19.2% 15.4% C Trend Patient Experience Did you feel safe during your stay in hospital? How likely are you to recommend the support our ward gave to you as a Carer (of patients with dementia) to friends and family if they needed similar support? How likely are you to recommend the support our ward gave to you as a Carer to friends and family if they needed similar support? Did doctors talk in front of you as if you weren t there? (High score is good-weighted score based on No and Yes sometimes responses) (1) Were you involved as much as you wanted in decision about your care and treatment? Did you feel you had enough emotional support from hospital staff during your stay? 95.2 Aug L 57. Aug L 63. Aug L 93. Aug L 9 Aug N 92. Aug L Were you ever bothered by noise at night? (score reflects No responses) TBC Aug L (11) In your opinion, how clean was the hospital room or ward that you were in? 93.2 Aug L How clean were the toilets and bathrooms that you used in hospitals? 89.6 Aug L 9% Aug 94.% 93.% L The staff were always friendly, caring and polite towards me? On the day you left hospital, was your discharge delayed for any reason?(score reflects No responses) 7.5 Aug L Number of Involvement events demonstrating engagement, partnership working 3 Aug L How likely are you to recommend the Outpatient Department to friends and family if they needed similar care or treatment? (12) TBC Aug L How likely are you to recommend the Outpatient Department to friends 5 per and family if they needed similar care or treatment? Sample size Dept Aug L Outpatients: In the reception area, could other patients overhear what you talked about with the receptionist? (Score reflects No responses) 44.8 Aug L Outpatients: Were you told how long you would have to wait? 53.6 Aug L Outpatients: Were you told why you had to wait? Outpatients: Did someone apologise for the delay? Outpatients: Did doctors talk in front of you as if you weren t there? (High score is good-weighted score based on No and Yes sometimes responses) (13) 55.9 Aug L 69.3 Aug L 96. Aug L Information overnance Other 1% Aug 85.% 92.9% N Freedom of Information requests processed within 2 working days Subject Access Requests processed within 4 days 1% Aug 99.% 94.9% N I incidents at or above Level 2 severity (target 2 per quarter) 2 Aug 4 8 L Mixed sex accommodation breaches Aug N 2

4 Performance Escalation (1/11) VTE (213-14) Numerator: Number patients assessed for VTE. Denominator: Number of eligible patients Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Issues causing underperformance The two clinical areas of non compliance are general surgery and trauma and orthopaedics. This has likely been contributed to by the commencement of new junior doctors in the month of August. CQUIN Target Overall Compliance Individually Assessed Latest performance % Agreed corrective actions 1. MSKN/DDT Clinical Director monitors directorate speciality compliance/ actions via speciality performance meetings. Distribution of monthly VTE patient level data figures will increase to weekly to each consultant from September 23 rd. League table of speciality performance established to create competition to drive improvement. 2. VTE covered in junior doctor trust wide induction. MSKN/ DDT DCD has further strengthened this by individual discussions with F1 s. 3. DDT/ MSKN Clinical Director will identify the need for discussion of VTE at consultant ward rounds via Heads of Service. 4. VTE performance continues to be discussed at performance meetings with DMT and at September Directors roup. 5. Patient Safety Newsletter (Sept) to highlight 1. requirement for assessment and 2. learning from RCAs around contributory factors to VTE events. To further include case studies/ use of PC desktop to highlight current compliance. Forecast reen Signed off by: Stephen Fowlie to meet standard: November 213 Plan for next Board report: Monthly 3

5 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Escalation Pages (2/11) Fewer than 74 patients acquire C. Diff in our care (<6 per month) Weekly clinical case reviews by the Infection Prevention and Control doctor have identified no delays in diagnosis or specialist referrals Neither have any incomplete treatments or significant shortcomings in antibiotic use been evident. None of the cases have been secondary, linked, clustered or in outbreaks i.e. from cross infection ( three C Diff ribotyping results are outstanding for august) and there have been no C.difficile deaths. We have made substantial reduction in C. Difficile over the past 5 years. We have demonstrated that we now have a healthcare environment which is near-free from C. Difficile contamination, and that cross-infection with C. Difficile has been virtually eliminated. We have wiped out completely the 3 hospital outbreaks strains (ribotypes 27, 1 and 16), and the pattern of C. Difficile infection we now see is virtually identical to that seen in community onset cases. Our antibiotic stewardship is of high standard and continuing to improve, and we design our antibiotic guidelines around antibiotics that minimise C. Difficile risks. August typing of cases to date shows all the cases to be community ribotype strains. We believe we have reduced to approaching the lowest possible rate and have agreed with CC to focus on drivers for improvement for any potential further reductions (rather than solely target numbers). C diff cases lower year to date than in 212/13 ( 44 v 61) There is a highly active C. Difficile programme at NUH which aims to reduce C. Difficile infection to the absolute minimum, including 2 separate weekly meetings looking in detail at each case in terms of epidemiology, risk factors, clustering, antibiotic use, treatment, and overall management. This is backed up by a comprehensive C. Difficile action plan New targets (quarterly increase in compliance level from Q2) for hand hygiene have been agreed and this has been rolled out and is monitored through ICO. We have agreed with commissioner colleagues a more sophisticated approach to measurement of our performance which focuses on the drivers for improvement namely an enhanced root cause analysis process, a rigorous approach to hand hygiene compliance and a limit to the number of cases caused by cross infection. We have demonstrated the achievement of all these criteria for quarter one performance Stephen Fowlie 4

6 Escalation Pages (3/11) Unvalidated Stage 2 Total Pressure Ulcers Stage 2 incident numbers continues to show improvement however a number of outstanding investigations remain and therefore prompt learning is hindered. The number of outstanding investigations varies by Directorate. Unvalidated Stage 3 Total Pressure Ulcers Key themes from initial investigations focus on skin assessments and repositioning of patients not having been performed in a timely manner. The 'react to red' campaign continues. The new sskin bundle is in place and continues to embed. The number of outstanding investigations is monitored and challenged through the bi-weekly PUO chaired by the CEO or the Deputy Director of Nursing and attended by the Clinical Leads. CLs are asked to ensure that investigations are completed promptly following reporting This target will not be met by year end Jenny Leggott RCAs show that avoidable pressure ulcers continue to be due to missed steps in care plans. Haywood House patients at the end of their lives continue to develop unstageable pressure damage despite all aspects of the tissue viability care plan being implemented. Non-compliance in this group of patients can be high. RCAs are reviewed at the weekly Pressure Ulcer roup. In addition subsequent RCA action plans now require formal discussion and sign off at the PUO chaired by the CEO or Deputy Director of Nursing. All actions plan are managed to tight timescales. Wards where there is no evidence of learning or improvement will be asked to attend PUO so that the group can understand any issues and help with resolutions. Work continues with the McKinsey Hospitals Institute to examine and share best practice from other hospitals. Work is on-going to understand whether unstageable pressure damage at the end of life may be considered and counted in a different way This target will not be met by year end Jenny Leggott 5

7 Escalation Pages (4/11) Validated Stage 3 Avoidable Pressure Ulcers 2 28 RCAs show that avoidable pressure ulcers continue to be due to missed steps in care plans. Haywood House patients at the end of their lives continue to develop unstageable pressure damage despite all aspects of the tissue viability care plan being implemented. Non-compliance in this group of patients can be high. RCAs are reviewed at the weekly Pressure Ulcer roup. In addition subsequent RCA action plans now require formal discussion and sign off at the PUO chaired by the CEO or Deputy DoN. All actions plan are managed to tight timescales. Wards where there is no evidence of learning or improvement will be asked to attend PUO so that the group can understand any issues and help with resolutions. Work continues with the McKinsey Hospitals Institute to examine and share best practice from other hospitals. Work is on-going to understand whether unstageable pressure damage at the end of life may be considered and counted in a different way This target will not be met by year end Jenny Leggott 6

8 Escalation Pages (5/11) Medicines Safety 213/14 Medication errors per 1 bed days Current process/ background information Medicines incidents are the second highest reported incident group (by volume) in the Trust. The current metric reported to the board regarding medicines safety (medication errors per 1 bed days) does not provide insight into the degree of resultant patient harm (or preventability). Our main risks relating to medicines are around medicines reconciliation, insulin and omitted doses (particularly antiepileptic's and insulin). The Medicines Safety roup (MS) is a multidisciplinary group that meets monthly and provides a written and verbal report to the Clinical Risk Committee every 2 months. Its objective is to identify medication-related hazards, assess appropriateness and strength of mitigations, and oversee action plans to reduce risk. The Safe Use of Injectables roup is a sub-group of MS. The MS has a clear programme of work which includes an assurance framework / dashboard against high risk medicines. Clinical Audit of omitted doses across the organisation has resulted in a clear action plan, forming part of the MS programme of work. Proposal N/A The Medicines Safety roup have requested to be a pilot site for a proposed national Medicines Safety Thermometer. Local data supports the need to gather this information these risks have been identified by MS in their quarterly medication incident report presented at MS and highlighted to CRC with associated actions (Launch due early 214). This would provide monthly information on: whether reconciliation was undertaken for all medicines within 24 hours of admission? whether the medicine allergy status documented in the clinical record whether the patient had an omitted dose of any medication in the last 24 hours The project suggests acute trusts complete the survey on all patients on 5 surgical wards and 5 medical wards each month. 2. The Medicines Safety roup have been asked to define what metrics should be reported to the board each month at their September meeting. 3. Whilst the Safety Thermometer is established and the MS suggestions considered, it is recommended that the board consider a metric in relation to reported medicines incidents and the degree of harm caused e.g. the standard is zero for severe / death related medication incidents. Each Directorate currently receives a medication report that includes detailed information on medicines related incidents. The MS have recently engaged informatics support with a view to developing a set of safety metrics for use in the trust. 7

9 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Escalation Pages (6/11) SI investigations completed within given timeframe (6/45 days or as agreed with commissioners) 1% 91% 98% 23 SI investigation reports were due for completion in August Of those, 3 ( falls RCA s) were out of time frame by between 1 and 6 days due to late return to governance team for oversight and sign off prior to submission to commissioners. Commissioners have acknowledged significant improvement in timely completion of SI reports ( letter from Chief Operating Officer received September 213). Timeframe for investigators to complete investigation reports has been reduced to provide the governance team time to review and challenge. Implemented September 213 Appointment of governance administrator post will enable a strengthened process for monitoring and tracking progress with RCA completion. Commenced September % 8% 6% 4% 2% % October 213 Stephen Fowlie 8

10 Escalation Pages (7/11) % of CAS alerts on target with delivery timescales NUH process for managing alerts;- All alerts are robustly logged and reviewed at either ORC or CRC on a monthly basis. Where there are any gaps in delivery to fully meet the requirements of the alert, these are highlighted and actions agreed ( with timescales) to rectify. Where sufficient assurance is not received, key leads report to either committee for further discussions and as necessary support with actions to meet compliance and recorded in the minutes of the meetings. To further strengthen the arrangements any alerts which are likely to go over the due dates will be formally escalated to Directors roup (D) as part of the update reports from the Sub-committees of D. There were 43 alerts due for completion by the end of August. 1 is overdue- NPSA/29/PSA4Part B All epidural, spinal (intrathecal) and regional infusions and boluses are performed with devices that use safer connectors that will not connect with intravenous luer connectors or IV infusion spikes. Deadline 1st April 213. There are a number of aspects to this alert, i)administration of medicine by epidurals- there are no non luer giving sets available for the type of infusion devices currently used at NUH. This necessitates NUH changing its infusion devices. ii) Caudal needles used to inject into the lower epidural space must have a non luer fitting. Currently there are no non luer caudle needles available nationally, iii) Luer locks for nerve block injections. Equipment to meet this aspect not yet available for procurement ( anticipate in next 6 months). iv) No non luer fittings available nationally for extra- ventricular drains.. The Trust continues to progress this alert (as far as possible) led by a consultant anaesthetist The Trust Lead will be discussing progress on national solutions with Professor David Cousins, National Lead NHS Commissioning Board The alert has been broken down into key parts and NUH aim to adopt each part when equipment and resources for implementation become available. Procurement tender process underway for infusion pumps ( 2-3 month process) to meet epidural requirement. Staff training will be required (around 6 months) NUH is dedicated to adopting the NPSA Alert in its entirety, but are currently hampered as some of the equipment is not yet available (example caudal needles luer locks for nerve block injections and ventricular drains). Robust competency assessment in place for consultants and SPR administrating via ventricular route. CRC continues to monitor progress carefully against a detailed action plan. Current Risk assessment score of 1 agreed at the Clinical Risk Committee. The open alert is a national issue. Lack of available equipment prevents full closure of this alert 1% 98% 87% April 214 in part Stephen Fowlie 9

11 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Escalation Pages (8/11) How likely are you to recommend the support our ward gave to you as a Carer to friends and family if they needed similar support? Directorates have undertaken further analysis into under performance. Root causes include: MSKN: No surveys completed for August so nil response. DDT: 23 surveys completed. 1% gave no response to this question. Training for staff on how to support carers being piloted in September for B5/F2 staff - continues Directorate actions vary and include: Alter target minimum response rate to ensure greater numbers per ward. Alert system to be introduced. Pre-op to identify patients with carers with a coloured sticker on front of admission document. Ward receptionist to keep a log of patients with carers and completed survey to be marked on log November Were you involved as much as you wanted in decision about your care and treatment? Jenny Leggott Standard 93% Aug YTD Forecast Reasons for underperformance vary by Directorate: DDT 82. AM 84.2 H&N 85.5 FH 86.4 MSKN 87.1 DIRC 89. CAS SSD Directorate teams continue to examine root causes and develop action plans. Actions vary by Directorate and continue as previously described. Further actions include: Directorate matrons and PDM S to follow up discharge numbers ensure Fabio data collection when doing daily CQC rounds. Matrons to discuss performance by ward at ward managers catch up. Clinical lead to discuss performance at monthly specialty meetings. Clinical lead to ensure performance is discussed at monthly ward managers meetings. Include on specialty performance reports number of discharges compared to number of responses Variable by Directorate Jenny Leggott 1

12 Escalation Pages (9/11) Outpatients: In the reception area, could other patients overhear what you talked about with the receptionist? This is an improvement target based on performance from Q1 Directorates have been asked to identify root causes for under achievement and to implement local actions plans to improve performance. Process to be led by Neville Wright March Outpatients: Were you told how long you would have to wait? Jenny Leggott Standard 93% Aug YTD Forecast This is an improvement target based on performance from Q1 Directorates have been asked to identify root causes for under achievement and to implement local actions plans to improve performance Process to be led by Neville Wright 2 March Jenny Leggott 11

13 Escalation Pages (1/11) Outpatients: Did someone apologise for the delay? This is an improvement target based on performance from Q1 Directorates have been asked to identify root causes for under achievement and to implement local actions plans to improve performance. Process to be led by Neville Wright March Jenny Leggott 12

14 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Escalation Pages (11/11) % of Freedom of Information processed with 2 working days There were 6 underperformances for August 213: (NUH and 14417) These were as a result of a delayed response from the Clinical Quality Risk and Safety FOI Lead. Relevant Directorate: Corporate (NUH and 14388) These were as a result of a delayed response from the Finance FOI Lead. Relevant Directorate: Finance (NUH 14174) This was as a result of difficulties encountered by the FOI Administrator in contacting the FOI Lead to progress the request. Relevant Directorate: Family Health (NUH 1449) This delay was a result of inaccurate information supplied to the FOI Lead which needed to be rectified/checked. Relevant Directorate: Ophthalmology % of Subject Access Request process within 4 days There were 5 underperformances for August 213: 3 were as a result of awaiting health records from the Physiotherapy Department, 1 was as a result of a delay in obtaining copy health records from the Mobility Centre, 1 was as a result of difficulties encountered in locating the original health record. There were 48 underperformances for July 213 as a result of an unprecedented number of applications(81) by a Nottingham firm of Solicitors in connection with child abuse allegations from the 198 s. This number of applications has had a knock on effect on the overall timeliness of disclosures being dealt with. NUH has also received an increase in requests from NUH s Claims Manager (for claims against the Trust) and from other NHS hospitals for disclosures relating to the on-going care of patients. A deputy FOI Lead to be identified for Family Health None further required Process review completed to ensure optimum efficiency. A meeting has been arranged with Physiotherapy Department to discuss issues further. All work submitted in July has been now been completed. Analysis of legal application for disclosure requests identifies year on year (21-13)increase and options/ proposal paper in development on resources required to meet increased demand and timescales. To be submitted to ICT DMT in next 3 months. 1% 1% 95% 9% 85% 8% 75% 7% 85.% 92.9% Immediate Immediate Andrew Fearn 1% 1% 98% 96% 94% 92% 9% 88% 86% 84% 99.% 94.9% Immediate Immediate Andrew Fearn 13

15 Appendix 1: National Quality Dashboard (1/1) Indicator Description Reporting Period National Average NUH Lowest 25% Highest 25% Summary Hospital-level Mortality As Mar-1- Dec-12 Indicator (SHMI) Expected Amenable Mortality ICD Codes Number of deaths as a proportion of all from ONS definition admissions 1.4% 1.7%.98% 1.81% Quality of Life for Adults with a Emergency admissions for patients with a LTC as a Long Term Condition proportion of all unplanned admissions 6.3% 6.4% 4.86% 6.84% Emergency admissions for under 19s due to Quality of Life for Under 19s with asthma, diabetes or epilepsy as a proportion of all a Long Term Condition unplanned admissions for under 19s 5.79% 4.3% 4.3% 7.34% Net Promoter Score [from NHS choices] Feb A&E > 4Hrs [Type 1] Proportion of people waiting more than 4hrs in A&E w/e 11/8/ % 3.57% RTT> 18 weeks Proportion of patients on an admitted pathway waiting over 18 weeks 7.54% 5.9% Suspected Cancer Waits > 2 Weeks Readmissions within 3 days of discharge from index elective or emergency admission Emergency admissions for acute condition not usually requiring admission Proportion of patients who have suspected cancer who are seen by a professional more than 2 weeks after referral Number of readmissions to hospital within 3 days of discharge as a proportion of all admissions Patients with an emergency admission and with any of selected primary diagnoses as a proportion of all unplanned admissions Mar % 6.39% 17.34% 16.46% 9.5% 8.32% 7.82% 1.29% Infections Notified (MRSA, MSSA, C Diff & E Coli) per 1, beds Number of infections notified in a month as a proportion of inpatient bed days Mar Serious Incidents (per 1, beds) Never Events (per 1, beds) Harm Free Care [No pressure ulcer, VTE, Catheter UTI, fall on safety thermometer ] Staff Sickness Bed Occupancy Nurses to Bed Ratio Doctor to Patient Ratio * National Quality Dashboard figures taken 6/9/13 Number of serious incidents notified in a month as a proportion of inpatient bed days Number of Never Events notified in a month as a proportion of inpatient bed days Proportion of patients surveyed not experiencing apressure ulcer, VTE, UTI in patients with a catheter or a fall Total number of days taken sick as a proportion of total days Average beds occupied overnigh' as a proportion of beds available overnight Number of nurses (Full Time Equivalent) as a proportion of number of beds available Number of qualified doctors (headcount) as a proportion of inpatient stays Mar Mar % 92.87% Mar % 3.26% 3.61% 4.67% 85.54% 82.42%

16 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Appendix 2: Friends and Family Test (1/2) The Friends & Family Test score has been obtained by asking patients a single question, How likely is it that you would recommend this service to friends and family? Based in their responses, patients have been categorised into one of three groups: Promoters (Extremely likely), Passives (Likely), and Detractors (Neither Likely nor Unlikely, Unlikely, Not at all, Don t Know). The number of Detractors is then subtracted from the number of Promoters and divided by the number of responses. Chart 1: Inpatient Friends & Family Test per Month Chart 2: Inpatient Friends & Family Test per Month % 8% 6% 4% 2% % Detractors Passives Promoters Friends & Family Test score Table 1: Directorate Inpatient Friends & Family Test per Month and YTD May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 NUH Acute Medicine Cancer & Associated Specialties Diabetic, Renal & Cardiovascular Digestive Diseases & Thoracic Family Health Head & Neck Musculoskeletal & Neurosciences Unknown / Other

17 Appendix 2: Friends and Family Test (2/2) Chart 1: A&E Friends & Family Test per Month Chart 2: A&E Friends & Family Test per Month 74 1% % 6% % % 6 % Detractors Passives Promoters Friends & Family Test score 6 Table 1: A&E Friends & Family Test by ED/Eye Cas per Month and YTD Total ED Eye Cas