NHS Trafford Clinical Commissioning Group Quality and Performance Strategy S T rafford Clinical Commissioning Group

Transcription

1 De ce m be r NHS Trafford Clinical Commissioning Group Quality and Performance Strategy N H S T rafford Clinical Commissioning Group Version 2.0 Page 1 of 28 APRIL 2015 (RM)

2 POLICY DOCUMENT VERSION CONTROL CERTIFICATE TITLE Title: NHS Trafford Quality and Performance Strategy Version: 2.0 Supersedes: NHS Trafford Quality Strategy SUPERSEDES Description of Amendments: Revised following the release of several national reports and guidelines on quality to ensure the Quality Strategy reflected the learning from these and to align with the NHS Trafford CCG Strategic Plan ORIGINATOR EXECUTIVE APPROVAL Originator/Author: Kate Provan Designation: Quality Lead Lead Director: Michelle Irvine, Associate Director Performance and Quality. Dr Mark Jarvis, Clinical Director Quality, Finance and Performance Ratified by: Quality and Performance Committee Date Ratified: 14 th April 2015 EQUALITY ANALYSIS Date Completed: tbc CIRCULATION Issue Date: October 2015 (signed off by the Governance Team) Circulated by: Governance Team Issued To: All interested parties REVIEW Review Date: May 2016 Responsibility of: Quality Lead VERSION CONTROL Version Date Description of Change Author V1.0 December 2012 New Strategy ( ) - Approved by NHS Trafford Pathfinder CCG Committee V2.0 April 2015 Revised following the release of several national reports and guidelines on quality to ensure the Quality Strategy reflected the learning from these and to align with the NHS Trafford CCG Strategic Plan Quality Lead Quality Lead Version 2.0 Page 2 of 28 APRIL 2015 (RM)

3 Contents Content Page Executive Summary 4 NHS Trafford CCG revised Quality and Performance Strategy 5 Quality Strategy Achievements 6 Defining quality and performance 10 Embedding good quality in everything we do and achieving high levels of performance 11 Principles behind the revised Quality and Performance Strategy 12 Supporting strategies 13 Quality and Performance Strategy Aims 13 Safer Care: Objectives 14 Better Care: Objectives 15 Patients at the Heart of Care: Objectives 16 Quality and Performance Strategy Implementation Plan 17 Version 2.0 Page 3 of 28 APRIL 2015 (RM)

4 Executive summary The vision for NHS Trafford CCG is; To ensure that the health services we manage for the people of Trafford are provided at the right place and at the right time, and that services are safe, of a high quality and are value for money. The group will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties. The CCG has four strategic objectives, which, if we achieve, will ensure we deliver our vision. Our strategic objectives are to; 1. Consistently achieve local and national quality standards. 2. Deliver an increasing proportion of services from primary care and community services in an integrated way. 3. Reduce the gap in health outcomes between the most and least deprived communities in Trafford 4. Ensure a financially sustainable health economy The revised aims of the quality and performance strategy are: 1. Safer Care 2. Better Care 3. Patients at the heart of care As a CCG, this means that we will hold the patient at the centre of everything we do and seek out and listen to what they are telling us and what they need. We will ensure that the services we commission for patients are as safe as possible, in line with best practice in order to achieve the best reasonable outcomes for patients and a good patient experience. The values of Trafford CCG in respect of quality and performance are the same as those set out in the NHS Trafford CCG Constitution: Compassion, respect and dignity - We will treat everyone as we would expect to be treated; Commitment to quality care to improve lives - We are committed to ensuring our patients receive the best quality, co-ordinated care possible. To continually monitor and improve our services and how we commission them; Working together to meet the healthcare needs of Trafford - We will give patients, families and the public opportunities to be involved and have a voice. We will work together to make improvements for our population; Valuing each other - We support each other to be the best we can; Honour, integrity and openness - We will be transparent in all our actions and decision making; and, Objectivity and accountability in all we do - We will commission services that meet established and identified needs. The services we commission will be equitable, cost effective and our decisions will be open to scrutiny. Version 2.0 Page 4 of 28 APRIL 2015 (RM)

5 NHS Trafford CCG revised Quality and Performance Strategy NHS Trafford CCG has an existing three year quality strategy, however with the publication of additional national guidance and reviews on quality in 2014/15, it was felt prudent to refresh the existing quality strategy. In addition, the CCG has decided to widen the scope of this strategy to include performance. It is recognised that quality and performance go hand in hand, hence this revised strategy incorporates performance alongside quality to ensure that patient safety, effectiveness and patient experience is considered in every aspect of what we do as a CCG. An integrated Quality and Performance Strategy reflects the CCG s approach to integrating the quality and performance functions of the organisation. In 2014/15, the newly establish Quality and Performance Improvement Team was working in an integrated way to implement a Quality and Performance Framework. Once fully implemented, this framework will ensure the CCG will work in a systematic way to deliver the three aims set out in this strategy. The publication of the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry led to NHS Trafford CCG publishing its own Francis Action Plan. With the refresh of this strategy any outstanding actions have been incorporated into this document. National guidance and publications influencing this strategy include: The Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published in February 2013, which called for a fundamental culture change across the health and social care system to put patients first at all times. Robert Francis QC, the Inquiry Chair, called for action across six core themes: culture, compassionate care, leadership, standards, information, and openness, transparency and candour. The Government s initial response, Patients First and Foremost, which set out a radical plan to prioritise care, improve transparency and ensure that where poor care is detected, there is clear action and clear accountability. This document and its accompanying volume build on this to provide a detailed response to the 290 recommendations the Inquiry made across every level of the system. Review into the Quality of Care and Treatment Provided by 14 Hospital Trusts in England, led by Professor Sir Bruce Keogh, the NHS Medical Director in NHS England. The Cavendish Review: An Independent Review into Healthcare Assistants and Support Workers in the NHS and Social Care Settings, by Camilla Cavendish. A Promise to Learn A Commitment to Act: Improving the Safety of Patients in England, by Professor Don Berwick. A Review of the NHS Hospitals Complaints System: Putting Patients Back in the Picture by Rt Hon Ann Clwyd MP and Professor Tricia Hart. Challenging Bureaucracy, led by the NHS Confederation. The report by the Children and Young People s Health Outcomes Forum, co-chaired by Professor Ian Lewis and Christine Lenehan. The 5 Year Forward View. The CCG Assurance Framework. Quality Premium Guidance. CCG Outcome Indicator Set. NHS Outcome Indicator Set. NHS Constitutional Standards. Better Care Fund. Version 2.0 Page 5 of 28 APRIL 2015 (RM)

6 This strategy has also been revised to align it with the NHS Trafford CCG Strategic Plan. NHS Trafford CCG aims to ensure that the Trafford population has the best possible healthcare outcomes by buying high quality, equitable and integrated services. This refreshed quality and performance strategy is aligned to this aim and sets out progress to date on objectives achieved and the plans for the future. The aims of the current quality strategy were: 1. Ensure and improve quality throughout the patient journey 2. Develop innovative approaches to quality improvement with a focus on improving outcomes for patients 3. Work in partnership to develop and support a culture of quality improvement across the whole healthcare economy 4. Ensure and improve quality in primary care With the refresh of the quality and performance strategy these aims have also been refreshed, NHS Trafford CCG now has three main ambitions in respect of quality and performance these are: 1. Safer Care: We will ensure the care we commission is safe 2. Better Care: We will ensure that the care we commission is clinically effective delivering better health outcomes for our patients and NHS constitutional obligations. 3. Patients at the heart of care: We will ensure that we will engage, listen and respond to what our patients want at every stage of the commissioning process, to ensure our patients have a voice in everything we do. 1.0 QUALITY STRATEGY ACHIEVEMENTS Over the past year there has been significant progress towards achieving the aims set out in the 2014/15 Quality Strategy. An assessment of this progress is below: 1.1 Aim 1: Ensure and improve quality throughout the patient journey Objective1: The Francis Suite initiative for contracts (specific sections reviewed and renewed on an annual basis that ensure the quality assurances commissioners need, as outlined in the Francis report, are embedded in every contract we hold. This would include quality key performance indicators and quality information requirements within contracts) This objective is partially completed: There are Quality Standards in all contracts and these have been piloted through the procurement process. Further work is on-going to standardise these. This objective will continue in the refreshed Quality Strategy but will be called Quality Standards Objective 2: Continuation of the Early Warning System currently in place, including further development of the quality dashboard to include primary care, community services, nursing homes, and mental health This objective is partially completed: There is a Quality Surveillance Group in place and Quality Dashboards for acute providers. Further work needed to develop community, mental health and small provider dashboards. This objective will continue in the refreshed strategy but will be called Quality and Performance Assurance and Improvement Framework. Version 2.0 Page 6 of 28 APRIL 2015 (RM)

7 1.1.3 Objective 3: The learning lessons once initiative (an initiative to ensure that lessons learned from serious incidents only need to be learnt once and that this learning is spread across the wider healthcare economy) This objective is partially completed: There is a CQUIN in all contracts across Greater Manchester which promotes the use of change improvement methodology to eliminate root causes from serious incidents. This will continue in the refreshed Quality Strategy but will be called Doing things differently Objective 4: The eight C s initiative (ensuring the national vision for nursing, midwives and care givers is embedded, implemented and monitored in local health services.) This objective is partially completed: The CCG has been monitoring the implementation of the national strategy for nursing in all commissioned providers. This will continue in the refreshed Quality Strategy and will be encompassed within the quality standards work with a focus on the CCG developing metrics to measure the six C s in practice Objective 5: The expert commissioner (specialised clinical input into all specialist clinical contracts) This objective is completed. There are expert commissioners identified for all health care sectors Objective 6: The pressure ulcer zero ambition (eliminating grade 2,3 and 4 pressure ulcers in all inpatient settings by 2015) This objective is partially completed: This year has seen a decrease in the number of pressure ulcers reported as serious incidents in all providers. This objective will continue in the refreshed strategy but will fall under Harm Free Care Objective 7: Falls prevention promotion (a commitment to the National Osteoporosis Society and Age UK to reducing the rate of hip fractures and falls related injuries in older people over the next five years through adhering to six steps including better partnership working and patient involvement.) This objective is partially completed: This year has seen providers maintain positive harm free care figures in relation to falls. This objective will be more closely aligned to the CCG s work plan around falls and will continue in the refreshed strategy under Harm Free Care Objective 8: Quality transfers of care (ensuring transfers of care between health services, between age groups and across the health and social care economy are safe, efficient and positive for patients and carers) This objective is partially completed: This objective is partially completed through local CQUINs that were achieved in 2013/14. This will continue in the refreshed strategy but will focus on developing metrics to measure safe transfers of care. 1.2 Aim 2: Develop innovative approaches to quality improvement with a focus on improving outcomes for patients Objective 1: Commissioning for change improvement (change improvement methodology is effective at delivering and sustaining long term change improvements, commissioning for a Version 2.0 Page 7 of 28 APRIL 2015 (RM)

8 culture within providers that supports this, ensuring providers have the skills in change Version 2.0 Page 8 of 28 APRIL 2015 (RM)

9 improvement methodology and focusing on outcomes with providers as opposed to dictating changes are the three key strands of this work) This objective has been achieved with change improvement methodology introduced into all providers through a Greater Manchester CQUIN Objective 2: Commissioning for innovation (embedding of the eight key themes within the CCG and through our contracts with our providers as set out in the Innovation, Health and Wealth Paper December 2011) This objective has been achieved with all providers meeting the pre-qualification criteria for CQUIN achievement related to this area Objective 3: Commissioning for quality of life (with a focus on quality of life at the end of life and the exploration of the tension between decisions to treat versus quality of life, this objective aims to open a new dialogue about active treatment at end of life) This objective will continue in the refreshed strategy. This was a difficult objective to progress in 2013/14 due to the phasing out of the Liverpool Care Pathway of the Dying Objective 4: Commissioning for integrated care (with a focus on the move to integrated care this objective is about ensuring that patients receive the right care at the right time at the right place) This objective has been achieved. NHS Trafford CCG is well engaged and active in all local, regional and national initiatives in relation to integrated care Objective 5: Adoption of Digital First (this publication sets out ten easy win initiatives which will enhance how we serve patients by improving quality, widening access through multiple channels and increase value. This links directly with feedback from clinicians in relation to the importance of communication) This objective has been achieved: Technology and innovation are factored into the development of all commissioning plans Objective 6: Championing of best practice initiatives (promotion of NICE quality standards and best practice recommendations within contracts and service specifications and continuation and adoption of programmes such as QIPP Quality, Innovation, Productivity and Prevention, evidence based design and shared decision making. This objective also links directly with the Trafford CCG Medicines Management Strategy) This objective is partially achieved: NICE implementation is well embedded in the CCG Commissioning Cycle and in acute and community providers. Further work needs to be undertaken in relation to this objective to embed it within small providers and care homes. This objective will continue in the refreshed strategy. 1.3 Aim 3: Work in partnership to develop and support a culture of quality improvement across the whole healthcare economy Objective 1: Innovative engagement with patients and carers on a continuous cycle and in everything we do (this objective links to and will be delivered through the Trafford CCG communication and engagement strategy) Version 2.0 Page 9 of 28 APRIL 2015 (RM)

10 Objective achieved: With a Communication and Engagement Strategy in place and being implemented this objective is achieved Objective 2: Primary Care Quality Partnership (development of a memorandum of understanding with the National Commissioning Board (NCB), Local Area Teams (LAT) to ensure and improve primary care in line with the aims set out within this strategy) Objective achieved: There are now clear frameworks in place that set out the responsibilities of all parties in improving primary care Objective 3: Transparent commissioning (this objective links to and will be delivered through the Trafford CCG communication and engagement strategy) Objective achieved: With a Communication and Engagement Strategy in place and being implemented this objective is achieved Objective 4: Collaboration with key partners at all levels (where patient flow dictates the CCG will further develop relationships with key partners such as the local authority, the police, third sector providers, other CCGs, NCBs, Public Health England etc) Objective achieved: There are now clear frameworks in place that set out the responsibilities of all parties in improving quality across the health and social care system. 1.4 Aim 4: Ensure and improve quality in primary care NHS Trafford CCG now has a Primary Care Quality Strategy and all the objectives listed below have been incorporated into this. i) Optimising Community Resilience (the success of integrated care is dependent on Trafford CCG ensuring that as we move care from the acute sector to the primary care sector that the services are in place and are robust across general practice, social care, community care, intermediate care and the third sector) ii) Shared vision, shared goals (there continues to be a tension between the desire to commission and provide for local needs versus the desire to eliminate the post code lottery, this objective describes the CCGs aim to establish a common ground for provision of primary care with the space to commission and provide for local needs) iii) Continuing Education (this objective relates directly to promoting peer review and iv) similar methodologies to encourage GP education and move towards best practice.) Tackling variation (working with the NCB and GP members to help GP members move towards national standards v) Revalidation and registration (working with GP member practices to promote and support revalidation and registration with the Care quality Commission) Version 2.0 Page 10 of 28 APRIL 2015 (RM)

11 2.0 DEFINING QUALITY AND PERFORMANCE What is Quality? 2.1 Quality means different things to different people and the NHS is the only healthcare system in the world with a single definition of quality. 2.2 The NHS definition of quality as defined by Lord Darzi in High Quality Care for All in 2008 sets out three dimensions to quality: 2.3 Patient Safety: commissioning high quality care which is safe, prevents all avoidable harm and risks to the individual s safety; and having systems in place to protect patients; 2.4 Clinical Effectiveness: commissioning high quality care which is delivered according to the best evidence as to what is clinically effective in improving an individual s health outcomes. Making sure care and treatments achieve their intended outcome; 2.5 Patient Experience: commissioning high quality care which looks to give the individual as positive an experience of receiving and recovering from the care as possible, including being treated according to what the individual wants or needs, and with compassion, dignity and respect. It s about listening to the patient s own perception of their care. 2.6 As a CCG we see quality as meaning that we will hold the patient at the centre of everything we do and seek out and listen to what they are telling us and what they need. We will ensure that the services we commission for patients are as safe as possible, in line with best practice in order to achieve the best reasonable outcomes for these patients and a good patient experience 2.7 The Care Quality Commission (CQC) s new inspection approach goes further to build on the three dimensions of quality two additional dimensions: Organisational Culture & Leadership: commissioning high quality care which is well-led; Responsiveness: commissioning high quality care which is responsive to the needs of patients. 2.8 Quality is not an abstract term or concept relevant only in policy debates. In order for commissioned services to be considered as providing a high quality service, being good in one or two of the above five dimensions of quality is simply not good enough. What is Performance? 2.9 Performance can be described as the accomplishment of a given standard or ambition measured against a present threshold. Version 2.0 Page 11 of 28 APRIL 2015 (RM)

12 3.0 EMBEDDING GOOD QUALITY IN EVERYTHING WE DO AND ACHIEVING HIGH LEVELS OF PERFORMANCE 3.1 The links between good quality services and attaining high levels of performance are at the heart of national legislation including the NHS Outcomes Framework. 3.2 The NHS Outcomes Framework is a set of indicators which measure performance in the health and care system at a national- level. Those that can be measured at a CCG level are included in the CCG Outcome Indicator Set. Delivering improvements against these indicators will be a sign of improving quality. 3.3 The NHS Outcome Framework is not an exhaustive list of indictors and measurables. However, all our improvement work can be mapped back to the 5 outcome domains of the Framework and the 3 quality dimensions. 3.4 The model below sets out the architecture of quality and performance. Quality Dimension 1: Patient Safety Safer Care Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm. Quality Dimension 2: Clinical Effectiveness Better Care Domain 1 Preventing people from dying prematurely Domain 2 Enhancing quality of life for people with long term conditions Quality Dimension 3: Patient Experience Patients at the heart of care Domain 4 Ensuring people have a positive experience of care Domain 3 Helping people to recover from episodes of ill health or injury Organisational Culture & Leadership: commissioning high quality care which is well-led; Responsiveness: commissioning high quality care which is responsive to the needs of patients. Version 2.0 Page 12 of 28 APRIL 2015 (RM)

13 4.1 PRINCIPLES BEHIND THE REVISED QUALITY AND PERFORMANCE STRATEGY Outlined below are core principles that are the foundation of the Quality and Performance Strategy and are considered in every aim and objective described in this strategy refresh. These principles are considered fundamental and our ambition is that they underpin everything we do. 4.2 Patient Experience Patient experience, complaints and PALS are integral to understanding and improving the patient s overall experience of health care and help to assure safe, high quality care. At the CCG we need to ensure we achieve our aims around putting patients at the heart of everything we do To contribute towards and support that, we want to understand how people feel about the services they receive and understand what matters to them so that we can embed that intelligence into our service design and commissioning cycle. We also want to know when providers do exceptional work that can be shared as good practice and celebrated along with those occasions where things could be done better or have gone wrong and need to be resolved Steps need to be taken to continually improve patient experience by working together across health and social care and with providers, to ensure a seamless, accessible, safe, high quality, efficient and effective patient journey which inspires confidence from those who use it, delivers best outcomes, improves how people feel about the services that they receive, health outcomes and quality of life The CCG is working towards ensuring that people are supported to make informed decisions about and successfully manage their own health and care, including choosing when to let others act on their behalf. Our aim is to ensure that care and treatment is accessible to all, based on wants and needs and is responsive to individual needs and preferences - a bespoke approach where people feel that they really matter with a focus on complexity and vulnerability We focus on integration of care and much of the work being progressed is concentrated around that strategy, this includes work to understand how patient experience mechanisms can be designed to measure, understand and analyse pathways and co-ordination of care with intelligence being utilised to feed into the commissioning cycle. 4.3 Safeguarding Safeguarding is a core principle that is threaded through every element of what we do as a commissioning organisation. There are well developed plans and strategies in relation to safeguarding and robust frameworks for monitoring these NHS Trafford CCG also has a statutory responsibility to ensure that the organisations from which we commission services provide a safe system that safeguards children and adults at risk of abuse or neglect NHS Trafford CCG has a clear line of accountability within the organisation for safeguarding vulnerable adults and children. As such, ultimate accountability for safeguarding sits with the Chief Officer. NHS Trafford CCG is responsible for safeguarding quality assurance through contractual arrangements with all provider organisations it commissions care from. Version 2.0 Page 13 of 28 APRIL 2015 (RM)

14 4.4 Equality, Diversity and Human Rights We have a responsibility as a CCG that the health services that we commission are fair and meet the needs of everyone, whatever their background or circumstances. This principle is considered throughout this refreshed strategy and also has its own individual objective. 4.5 Collaborative working Improving quality is not something we can do in isolation. As a CCG we are committed to working with our patients, our partners and our providers to improve the quality of care for our patients. This principle is central to everything we do. 4.6 Trafford CCG as a learning organisation Learning organisations exhibit several common characteristics and are underpinned by distinctive organisational cultures which the NHS needs to adopt if it is to achieve substantial improvements Trafford CCG is committed to working as a learning organisation, working in innovative ways to improve quality and performance and ensure the best outcomes for our patients. 4.7 Principle of accountability For each quality and performance indicator there will be an accountable lead who will be held to account through the CCG governance structure for delivery against that indicator. 5.0 SUPPORTING STRATEGIES 5.1 The overarching ambition of the quality and performance strategy is to ensure key aspects of quality and performance are embedded in everything we do as a CCG and considered at every step of the commissioning process. 5.2 In line with that ambition, elements of every strategy the CCG has in place support the Quality and Performance Strategy, as elements of the Quality and Performance Strategy support and enhance these. 6.0 QUALITY AND PERFORMANCE STRATEGY AIMS 6.1 The revised aims of the quality and performance strategy are: 1. Safer Care As a CCG we will commission safe, high quality care, we will reduce avoidable harm and actively promote patient safety cultures within our providers. 2. Better Care As a CCG we will ensure that the care we commission is clinically effective delivering better health outcomes for our patients. 3. Patients at the heart of care As a CCG we will ensure that we will engage, listen and respond to what our patients and carers want at every stage of the commissioning process, to ensure our patients have a voice in everything we do. Version 2.0 Page 14 of 28 APRIL 2015 (RM)

15 6.2 To achieve these aims there are three essential elements that need to be in place these are: Well developed and embedded governance structures for quality Robust data about all providers Identification of SMART objectives 7.1 SAFER CARE: OBJECTIVES As a CCG we will commission safe, high quality care, we will reduce avoidable harm and actively promote patient safety cultures within our providers. The specific objectives that underpin this aim are as follows: 7.2 Quality and Performance Assurance and Improvement Framework (This aim replaces the Continuation of the Early Warning System) We will develop a robust Quality and Performance Assurance and Improvement Framework for all providers. This Framework will also describe how the CCG will measure progress towards improving outcomes for the CCG s population We presently have a Quality and Performance Assurance and Improvement Framework in place for our acute providers, but this needs to be further developed in relation to the community sector and our small providers A core cornerstone of this which is now in place is a resource dedicated to the improvement of performance and quality which will intervene in a structured way developing and delivering against project plans agreed with providers when providers are off trajectory and usual interventions have failed This objective is particularly important when looked at in line with the CCGs strategic objective; Deliver an increasing proportion of services from primary care and community services in an integrated way We need to ensure any new services small or large that are developed are safe and continue to be safe. A vital aspect of this is the patient experience of care, and the development of systems for capturing the soft data from our patients, carers and the residents of Trafford is the cornerstone of our quality assurance process. We also need to effectively engage and understand the needs of our population. 7.3 Quality Standards: (This objective replaces the Francis Suite initiative and incorporates the 8 C s initiative) We will have quality standards in place with every provider against which we will measure care. These will be embedded through every stage of the commissioning cycle We acknowledge the challenges in setting and monitoring quality standards for the various services we commission and plan to commission. We need to be innovative in our approach to doing this if we want to achieve our strategic objective; Constantly achieve local and national quality standards. This is particularly important for the community providers and smaller providers where there are not as many national quality standards in place. Version 2.0 Page 15 of 28 APRIL 2015 (RM)

16 7.3.3 Through the Quality Standards we will also will adopt and embrace the national vision for nursing midwives and care staff; Compassion in Practice, making this part of everything we do as a commissioning organisation 7.4 Harm Free Care: We will work collaboratively to reduce avoidable harm in the following areas: Pressure Ulcers Falls Catheter acquired urinary tract infections Venous Thromboembolism (VTE) Medication safety Nutrition and hydration Sepsis Acute kidney Injury Infection Control 7.5 Quality transfers of care: We will develop metrics to measure safe transfers of care and work collaboratively to improve transfers of care between health services, age groups and across the health and social care economy This objective is particularly important when looked at in line with the CCGs strategic objective; Deliver an increasing proportion of services from primary care and community services in an integrated way, as transfers of care between providers could increase. 7.6 Doing things differently: We will work collaboratively and use innovative approaches to ensure that when serious harm occurs the learning and any quality improvements needed are embedded and sustained. We will identify themes and trends when serious harm occurs and report and measure our progress against the reoccurrence of these Monitoring, measurement, and work to reduce harm within the secondary care sector is well developed this work needs to continue. The focus for development now needs to be the smaller providers and the primary care sector especially in line with our strategic objective; Deliver an increasing proportion of services from primary care and community services in an integrated way A cornerstone of this work is the promotion and leadership of collaborative working across the healthcare economy to ensure shared learning in relation to harm Conversely it is also equally important to share good practice. Promotion and leadership around collaborative working will also support this. 8.0 BETTER CARE: OBJECTIVES As a CCG we will ensure that the care we commission is clinically effective delivering better health outcomes for our patients. The specific objectives that underpin this aim are as follows: Version 2.0 Page 16 of 28 APRIL 2015 (RM)

17 8.1 Joint vision, joint aims: We will agree a joint vision and aims for quality with our key partners working collaboratively across health and social care. 8.2 Best practice, innovative, clinically effective care: We will ensure that clinically evidenced practices and pathways and innovative approaches both in technology and research are built into every step of our commissioning cycle. We will horizon scan to ensure we can incorporate where appropriate new approaches, new ideas so we commission the most effective care for our patients. 8.3 Benchmarking: We will develop a programme of routine benchmarking for all providers against their peers to better understand variation between providers and explore opportunities for improvement. 9.0 PATIENTS AT THE HEART OF CARE: OBJECTIVES As a CCG we will ensure that we will engage, listen and respond to what our patients and carers want at every stage of the commissioning process, to ensure our patients have a voice in everything we do. The specific objectives that underpin this aim are as follows: 9.1 Walk rounds We will have a fully developed programme of walk rounds in all commissioned providers. Through these we will seek out real time patient and care feedback. We will also involve patient representatives in these walk rounds. 9.2 Listening and responding We will ensure that there is a robust system in place for bringing together all sources of information in relation to the patient experience of care. 9.3 Equality in commissioning: We will promote equality and equity and ensure that we understand and commission for all the diverse groups under our care. This will be visible in our commissioning process To be able to achieve strategic objective; Reduce the gap in health outcomes between the most and least deprived communities in Trafford, we need to have clear systems in place to identify how our services are impacting on the various protected groups within our community. Development of data in relation to this is essential. Version 2.0 Page 17 of 28 APRIL 2015 (RM)

18 10.0 QUALITY AND PERFORMANCE STRATEGY IMPLEMENTATION PLAN This plan will be refreshed every year. Safer Care Objective 1: Quality and Performance Assurance and Improvement Framework Outcome Measure Lead Target date Framework for managing Michelle Irvine June 2015 performance and quality in community providers Quality and Performance Kate Provan June 2015 Report for community providers. Zoe Mellon Framework for managing Michelle Irvine June 2015 performance and quality in small providers Quality and Performance Kate Provan June 2015 Report for small providers Framework for managing progress towards achieving improved outcomes SOP in place for the refresh of the Q&P Assurance and Improvement Framework Objective 2: Quality Standards Zoe Mellon Kate Provan Zoe Mellon Jason Hughes Kate Provan Zoe Mellon Jason Hughes September 2015 November 2015 Outcome Measure Lead Target date Quality standards for PQQ Kate Provan July 2015 stage for contracts on CCG intranet Quality standards for ITT Kate Provan July 2015 stage for contracts on CCG intranet Quality standards for small Kate Provan July 2015 contracts on CCG intranet Quality standards for Kate Provan December 2015 community provider contracts on CCG intranet Quality standards for acute Kate Provan May 2015 provider contracts on CCG intranet SOP outlining the process for the refresh of quality standards agreed and implemented. Kate Provan June 2015 Version 2.0 Page 18 of 28 APRIL 2015 (RM)

19 Objective 3: Harm free care Outcome Measure Lead Target date Agreed trajectory for Mark Jarvis June 2015 improvement for Grade 2,3 and 4 Pressure ulcers in place with acute and community providers Achievement of agreed Kate Provan April 2016 trajectory for pressure ulcers in 2015/16 Agreed trajectory for Mark Jarvis June 2015 improvement for falls in place with acute and community providers Achievement of agreed Kate Provan April 2016 trajectory for falls in 2015/16 Agreed trajectory for Mark Jarvis June 2015 improvement for Cather acquired urinary tract infections in place with acute and community providers Achievement of agreed Kate Provan April 2016 trajectory for Cather acquired urinary tract infections in 2015/16 Achievement of agreed Leigh Lord April 2015 trajectory for improvement in reporting medication safety incidents in place with acute and community providers Identification of themes in Leigh Lord June 2015 relation to medication safety in the community Action Plan in place to Leigh Lord September 2015 address themes as identified through CQUIN for medication safety in the community Identification of themes in Mark Jarvis June 2016 relation to malnutrition and dehydration that may have led to a preventable admission or an adverse patient outcome in acute and community providers Action Plan in place to address themes as identified through CQUIN for nutrition and hydration Kate Provan August 2016 Version 2.0 Page 19 of 28 APRIL 2015 (RM)

20 Agreed trajectory for the improvement of the early detection of sepsis in acute providers Mark Jarvis June 2015 Version 2.0 Page 20 of 28 APRIL 2015 (RM)

21 Outcome Measure Lead Target date Achievement of agreed Kate Provan April 2016 trajectory for sepsis in 2015/16 Agreed care bundle in relation Mark Jarvis June 2015 to the treatment of acute kidney injury (acute providers) Agreed trajectory for the Mark Jarvis July 2015 improvement on the baseline for the care of acute kidney injury (acute providers) Achievement of agreed Kate Provan April 2016 trajectory for AKI in 2015/16 Achievement of key performance indictors relating to infection control Zoe Mellon April 2016 Objective 4: Quality Transfers of Care Outcome Measure Lead Target date Audit undertaken of transfers Kate Provan January 2016 of care identifying care and service delivery problems Metrics developed to measure Kate Provan June 2016 care and service delivery problems that positively and adversely affect transfers of care Reporting requirements against metrics for transfers of care agreed in contracts with acute and community providers Kate Provan November 2016 Objective 5: Doing things differently Outcome Measure Lead Target date Agreed plan in place with all Kate Provan June 2015 providers to measure, monitor and improve (reduce) root causes from serious incidents Program of workshops on Kate Provan June 2015 governance and safety for small providers developed and agreed Program of workshops for April 2016 small providers delivered Service improvement plan in place with all providers to improve their National Learning and Reporting System Patient Safety profile with an improvement Kate Provan August 2015 Version 2.0 Page 21 of 28 APRIL 2015 (RM)

22 Outcome Measure Lead Target date trajectory agreed for acute providers Service improvement plan in Kate Provan August 2015 place with all providers to improve their National Learning and Reporting System Patient Safety profile with an improvement trajectory agreed for community providers Service improvement plan in place with all providers to improve their National Learning and Reporting System Patient Safety profile with an improvement trajectory agreed for small providers Kate Provan December 2015 Service improvement plan in place with all providers to improve their National Learning and Reporting System Patient Safety profile with an improvement trajectory agreed for primary care Improvement of National Learning and Reporting System Patient Safety profile in line with agreed trajectory acute providers Improvement of National Learning and Reporting System Patient Safety profile in line with agreed trajectory community providers Improvement of National Learning and Reporting System Patient Safety profile in line with agreed trajectory Small providers Improvement of National Learning and Reporting System Patient Safety profile in line with agreed trajectory primary care Forum established for all providers for the sharing of learning from serious incidents Kate Provan Jason Swift March 2016 Kate Provan April 2016 Kate Provan April 2016 Kate Provan April 2017 Kate Provan Jason Swift April 2017 Kate Provan April 2016 Version 2.0 Page 22 of 28 APRIL 2015 (RM)

23 Standardisation of reporting of serious incidents across all commissioned providers Kate Provan April 2017 Version 2.0 Page 23 of 28 APRIL 2015 (RM)

24 Better Care Objective 1: Joint vision, joint aims Outcome Measure Lead Target date Indicator set for measuring quality and performance agreed with acute providers Kate Provan Zoe Mellon August 2015 Indicator set for measuring quality and performance agreed with community providers Indicator set for measuring quality and performance agreed with small providers Kate Provan Zoe Mellon Kate Provan Zoe Mellon Objective 2: Best practice, innovative, clinically effective care February 2016 November 2015 Outcome Measure Lead Target date Horizon scanning process in Kate Provan June 2015 place Process in place for Kate Provan July 2015 monitoring implementation of best practice within small providers Process in place for Kate Provan December 2015 monitoring implementation of best practice within primary care Jason Swift Care bundles for high risk, Mark Jarvis June 2015 high volume areas agreed with acute providers Agreed trajectories for Kate Provan April 2016 improvement against each care bundle agreed with acute providers Development of care bundles Mark Jarvis June 2016 for community services utilising NICE standards Agreed trajectories for Kate Provan April 2017 improvement against each care bundle agreed with community providers Process for clinical audit Kate Provan August 2015 review by clinical senate developed and embedded Agreed prioritisation of clinical audits oversight agreed with CCG Clinical leads Kate Provan August 2015 Version 2.0 Page 24 of 28 APRIL 2015 (RM)

25 Objective 3: Benchmarking Outcome Measure Lead Target date Clinical Audit benchmarking Kate Provan April 2016 tool developed Benchmarking tool developed Jason Hughes April 2016 for acute providers Benchmarking tool developed Jason Hughes April 2017 for community providers Benchmarking tool developed for small providers Jason Hughes April 2017 Version 2.0 Page 25 of 28 APRIL 2015 (RM)

26 Patients at the heart of Care Objective 1: Walk rounds Outcome Measure Lead Target date Walk round program in place Kate Provan June 2015 for all providers Reports to committee/ board highlighting key findings from walk rounds Kate Provan July 2015 Objective 2: Listening and responding Outcome Measure Lead Target date Agreed process in place with Kate Provan August 2015 the patient experience lead for capturing and reporting all sources of patient experience SOP for capturing and acting Kate Provan November 2015 on GP concerns and queries SOP in place relating to how concerns about providers from all sources are managed (this is to include when concerns are raised by associate commissioners) Kate Provan November 2015 Objective 3: Equality in commissioning Outcome Measure Lead Target date Specific requirements within Kate Provan April 2015 all contracts requiring quarterly reports on incidents/complaints/ serious incidents/ patient experience to include information against each of the nine protected characteristics Set trajectory for improvement Kate Provan March 2016 on reporting against each of the nine protected characteristics in place with acute providers Achievement of agreed trajectories against each of the nine protected characteristics by acute providers Kate Provan April 2017 Version 2.0 Page 26 of 28 APRIL 2015 (RM)

27 Set trajectory for improvement on reporting against each of the nine protected characteristics in place with community providers Kate Provan March 2016 Version 2.0 Page 27 of 28 APRIL 2015 (RM)

28 Outcome Measure Lead Target date Achievement of agreed Kate Provan April 2017 trajectories against each of the nine protected characteristics by community providers Set trajectory for improvement Kate Provan March 2016 on reporting against each of the nine protected characteristics in place with small providers Achievement of agreed trajectories against each of the nine protected characteristics by small providers Kate Provan April 2017 Version 2.0 Page 28 of 28 APRIL 2015 (RM)