Patients First and Foremost Priorities and Other Appendix 1 Themes from Keogh Review Ambitions, Berwick Keogh Ambition 1 We will have made demonstrable progress towards reducing avoidable deaths in our hospitals, rather than debating what mortality statistics can and can t tell us about the quality of care hospitals are providing. Berwick Recommendation 5 Mastery of quality and patient safety sciences and practices should be part of initial preparation and lifelong education of all health care professionals including managers and executives. Patients First and Foremost - Theme of preventing problems Francis - Themes around information and quality of data and Clinical Outcomes Group continually monitors HSMR figures, working in conjunction with Dr Foster. Red Bell Alerts are investigated when appropriate. Investigations are conducted by the Medical Director, Associate Medical Director and Divisional Clinical Leads in conjunction with the appropriate specialty clinicians. Particular areas of interest which impact on mortality rates are used to inform the priorities for the forthcoming year. The Quality Account focus for 2013/14 is on sepsis. Other The Trust monitors mortality rates in the public domain. The Medical Director holds a monthly meeting of senior doctors and nurses to look at our performance. The Trust takes data from Dr Foster and other national sources so that we can compare how well we are doing. Integrated performance dashboard presented to the Trust Board each month. The Trust hosts the South West Patient Safety Forum. Development within the Divisions on approaches to quality improvement. Strengthen governance arrangements within clinical specialities and the Divisions. Improve and increase reporting of adverse events and near misses, underpinned by strong route cause analysis and sharing of learning. Version: 1.3 Agenda Item: 8 Page 1 of 10
Ambitions, Berwick openness, transparency and candour Keogh Ambition 2 The boards and leadership of provider and commissioning organisations will be confidently and competently using data and other intelligence for the forensic pursuit of quality improvement. They, along with patients and the public, will have rapid access to accurate, insightful and easy to use data about quality at service line level. Berwick Recommendation 2 All leaders concerned with NHS Healthcare should place quality of care and patient safety at the top of their priorities The Associate Medical Director and Patient Safety Lead conduct twice-yearly structured reviews of patients who die in hospital and this informs the Trust s Patient Safety Programme. The Trust Board receives regular feedback of HSMR figures and the outcome of structured mortality reviews. A structured quality dashboard for the Trust Board has been developed. Other Meridian system provides real-time patient feedback All staff are encouraged to report incidents and there is a Raising Concerns Policy. The aim of the policy is to ensure staff are empowered to raise concerns without fear of victimisation. Staff are encouraged to record incidents onto the Datix system. Ward boards display information about quality and safety for the public using safety crosses to make the information clear and accessible. Better reporting of incidents to maximise the opportunities for learning. The balanced performance scorecard and quality reports presented to the Trust Board can be re-aligned to better reflect the progress of the Trust s work on patient safety and the patient experience. Ward quality dashboards are being developed to make ward level data accessible to support ward sisters, matrons and clinical leads to understand their data and Agenda Item: 8 Page 2 of 10
Ambitions, Berwick Berwick Recommendation 7 Transparency should be complete, timely and unequivocal. All nonpersonal data on quality and safety should be shared in a timely fashion with all parties who want it, including, in accessible form, with the public. Patients First and Foremost Theme of detecting problems early Francis Theme of openness, transparency and candour Keogh Ambition 3 Patients, carers and members of the public will increasingly feel like they are being treated as vital and equal partners in the design and assessment of their local NHS. They should also be confident that their feedback is being listened to and see how this is impacting on their Quality Improvement Pillar Improve patient and Carer Experience Quality Accounts Priority 2013/14 To improve the experience of patients at the end of their life and Other The Trust s Patient and Carer Experience Strategy 2012-2015 See it My Way programme has national recognition and was included in the Patients First and Foremost report as an example of good practice to take appropriate actions. The dashboards will also enable the Trust to be aware of any areas of underperformance in a timely way and where necessary take remedial action. Further work to be undertaken to provide quality data for the public Strengthen complaints and incident policies around openness and duty of candour Themes from complaints, PALS issues and incidents to be published. There needs to be closer links between the patient experience work and Communications. More work required to share You Said, We Did with patients and the public The Trust s Complaints Policy and whole Agenda Item: 8 Page 3 of 10
Ambitions, Berwick own care and the care of others. Berwick Recommendation 3 Patients and their carers should be present, powerful and involved at all levels of healthcare organisations from wards to the boards of trusts. Berwick Recommendation 8 All organisations should seek out the patient and carer voice as an essential asset in monitoring the safety and quality of care. Patient First and Foremost Theme of preventing problems Francis Theme of fostering a common culture shared by all and developing a set of fundamental standards. Other to support their carers Caring for You events for members provide an opportunity for the Trust to engage with its members and to seek their views Monthly patient, family and staff stories at Trust Board meetings Patient Experience Group has been running since 2007 Library of patient stories used for training purposes Friends and Family Test - substantial patient feedback now available to be used to make service improvement Every Patient Matters Transformation Programme Carer organisation has based staff at the Trust to work with families and carers The shadow governors are starting to hold constituency meetings so approach to responding to and learning from complaints is under review. The role of the public/staff governors need to be developed so they can engage with the Trust s membership Greater analysis and triangulation of patient feedback to be undertaken. Development of matrons and senior sisters about standards and responding to concerns. Agenda Item: 8 Page 4 of 10
Ambitions, Berwick Other they can seek the views of member and the public. Daily reviews of patients by the duty Matron/Site team are being undertaken to ensure that criteria is being applied and that the patient s care needs continue to be met and if this is not possible that they are moved to an appropriate area. This is monitored at the daily site meetings Qulturum one of the first centres of its kind in the country, brings together teams such as patient safety, patient experience, quality improvement and audit to work together to improve patient care. The Neo-natal Intensive Care Unit (NICU) was designed with help from the parents of neonates. Cancer patients and RNHRD staff and users Agenda Item: 8 Page 5 of 10
Ambitions, Berwick Keogh Ambition 4 Patients and clinicians will have confidence in the quality assessments made by the Care Quality Commission, not least because they will have been active participants in inspections. Berwick Recommendation 10 We support responsive regulation of organisations. Patient First and Foremost Theme of ensuring robust accountability The CQC s feedback from inspection visits is incorporated as a priority area of the Trust s work. Other will be closely involved with the design of the new cancer and therapies centre. The Chief Operating Officer and the Associate Medical Director were part of the Keogh Review Inspection Team and are part of the inspection team for the first wave CQC inspections. The Trust has offered the CQC the services of its relevant staff to be part of the new CQC inspection regime. will be undertaken to ensure that the Trust learns from the CQC s inspection process which will help when undertaking its own robust assessments and in formulating action plans to address areas requiring improvement The Trust has a programme of internal mock inspections to assure itself about the standards of care being delivered Francis Theme of ensuring that relentless focus of the healthcare regulator is on policing compliance with the fundamental standards of care. Keogh Ambition 5 The RUH hosts the The Trust hosts the South Development within the Agenda Item: 8 Page 6 of 10
Ambitions, Berwick No hospital, however big, small or remote, will be an island unto itself. Professional, academic and managerial isolation will be a thing of the past. Berwick Recommendation 1 The NHS should continually and forever reduce patient harm by embracing wholeheartedly an ethic of learning. Berwick Recommendation 6 NHS should become a learning organisation. Its leaders should create and support the capability for learning and therefore change within the NHS. Patients First and Foremost Theme of preventing problems Francis Theme of fostering a common culture South West Patient Safety Forum which provides opportunities to learn and share good practice across the South West. Quality Accounts Priority 2013/14 To promote organisational learning Other West Patient Safety Forum The Trust hosts the South West Academic Health Science Network All 18 acute Trusts in the South West agreed to participate in this ambitious 5 year programme Oct 2009- Oct 2014 which have used established evidence based practice to accelerate a step change in safety improvements. As part of the programme, the Trust has continued to provide monthly progress reports and data on each of the 68 data sets. This is uploaded on a monthly basis through the IHI extranet - a web based progress and data reporting system. The Trust hosts the South West Academic Science Health Network Divisions on approaches to quality improvement. Strengthen governance arrangements within clinical specialities and the Divisions. Improve and increase reporting of adverse events and near misses, underpinned by strong route cause analysis and sharing of learning. Agenda Item: 8 Page 7 of 10
Ambitions, Berwick Keogh Ambition 6 Nurse staffing levels and skill mix will appropriately reflect the caseload and the severity of illness of the patients they are caring for and be transparently reported by trust boards. Berwick Recommendation 4 Healthcare organisations should ensure that staff are present in appropriate numbers to provide safe care at all times and are wellsupported. Patients First and Foremost Theme of ensuring staff are trained and motivated force Development Pillar Planning effectively for future work Quality Improvement Pillar Improve patient and Carer Experience Other Members of the Trust participate in a number of regional and national fora to share and disseminate good practice and to learn from others Integrated board performance dashboard force assurance tool brings to together data from multiple sources into an easy to understand single system and allows assessments to be made regarding the current and planned workforce and the likely impact on quality and patient safety of any proposed changes The data collated by the workforce assurance tool highlights not only current workforce issue but can also be used as an early warning to Management of problems when reviewing proposed workforce changes. Nursing workforce skill mix and staffing numbers to be further reviewed and benchmarked Ward by ward assessment of nurse staffing has commenced. Baseline report due to the Board in November. Further work needs to be done on how to link compassion into the appraisal process Escalation plans for staffing being revised Recruitment and retention to be reviewed Effectiveness of rostering to be monitored using the e-rostering KPIs. Agenda Item: 8 Page 8 of 10
Ambitions, Berwick Francis Theme of compassion linked to reward Keogh Ambition 7 Junior doctors in specialist training will not just be seen as the clinical leaders of tomorrow, but clinical leaders of today. The NHS will join the best organisations in the world by harnessing the energy and creativity of its 50,000 young doctors. Patients First and Foremost Theme of ensuring staff are trained and motivated Other Staff engagement programme. Daily process overseen by senior nurses to ensure safe staffing on a shift by shift basis, with an escalation process if safety issues arise. All F1 and F2 doctors receive quality and safety training as part of a structured training programme. Development of the first comprehensive e- induction package for junior doctors includes all the Trust s mandatory training Out of hours visits by matrons to commence from October Implementation of the National Nursing Strategy and 6Cs Review of clinical skills training and monitoring of competence to commence. To ensure ideas and projects developed by junior doctors are supported and incorporated into working patterns across the Trust. Francis Theme of leadership Keogh Ambition 8 All NHS organisations will force Development Pillar Staff engagement programme Leadership Strategy to be reviewed in the context of Agenda Item: 8 Page 9 of 10
Ambitions, Berwick understand the positive impact that happy and engaged staff have on patient outcomes, including mortality rates, and will be making this a key part of their quality improvement strategy. Patients First and Foremost ensuring staff are trained and motivated Francis Themes of developing fundamental standards of care and compassion. Developing the workforce for success Quality Improvement Pillar Improve patient and Carer Experience Other Implementation of new internal professional standards that support patient flow across the Trust Spring to Green and the Winter Evergreen initiatives actively involve staff Privacy and dignity ambassadors CEO clinical conference and clinical reference groups established. the requirements of Service Level Management Values and behaviours to be linked to pay progression Agenda Item: 8 Page 10 of 10