Agenda item 3.4 2011/16 Board Meeting 27 April 2011 SUBJECT: Clinical Engagement - A Report from the Chief Professional Officers 1. Purpose of the report This paper provides an introduction to the activities of the Medical and Nurse Directors in Healthcare Improvement Scotland. Whilst this report focuses on engagement with clinicians and clinical groups, the Chief Professional Officers roles include leadership in quality improvement areas across Healthcare Improvement Scotland in addition to providing clinical advice to the broader evidence, scrutiny and assurance functions. Future Board reports will take the form of updates on recent activities and key outputs of these activities. 2. Recommendation Healthcare Improvement Scotland Board Members are asked to: Note the content to raise awareness of the Medical and Nurse Directors activities related to clinical engagement. Endorse the intention to provide a regular Chief Professional Officers report at subsequent Board meetings including detail of recent activities. 3. Background Healthcare Improvement Scotland s purpose is to support healthcare providers to deliver high quality care; and scrutinise those services to provide public assurance about the quality and safety of that care. Visible, active clinical leadership is critical to this purpose and the Chief Professional Officers, namely the Nurse Director and the Medical Director, are responsible for ensuring effective engagement with clinicians across NHSScotland and increasingly with the Independent Healthcare sector and Social Work and Social Care Improvement Scotland (SCSWIS). They are also responsible for clinical advice to the Board, the Chief Executive Officer, the Executive Team and ensuring appropriate clinical advice across Healthcare Improvement Scotland s work Programme. The Interim Chief Pharmaceutical Officer, Laura McIver reports to the Medical Director and provides the third professional officer for Healthcare Improvement Scotland. The paper outlines other key clinical leaders in the organisation. 4. Strategic objectives/work programme Clinical engagement is a key component of the Integrated Cycle of Improvement and underpins NHSScotland s approach to the three Quality Ambitions of Person- Centred, Safe and Effective Care in addition to providing clinical focus which is key to public assurance on the quality of healthcare services.
5. Measures for improvement Clinical input is a key feature of Healthcare Improvement Scotland s strategic and operational activities and a variety of mechanisms are in place to ensure appropriate input is achieved eg employed senior clinical leaders and clinical managers, contracted sessional Clinical Advisers, clinical advisory input etc. A forthcoming review of Healthcare Improvement Scotland board-wide clinical engagement strategic and operational plans will be presented to the Evidence, Improvement and Scrutiny Committee in June 2011. These plans will include measurable inputs and outputs. 6. Resource implications In addition to salaried clinical staff, a variety of mechanisms are in place to enable clinicians to support our core and programme work. 7. Legal implications NHS Scotland has placed a duty 1 on all Boards to have a Medical and Nurse Director in recognition of the central clinical nature of the services Boards provide or support. The Medical Director is the nominated Caldicott Guardian for Healthcare Improvement Scotland responsible for ensuring compliance with statutory guidance on the use of patient identifiable data. 8. Governance and risk implications The Nurse Director and Medical Director provide clinical advice and operational support for all Healthcare Scotland s clinical governance activities in addition to ensuring appropriate clinical risk management is in place. 9. Consultation Clinical engagement includes both formal and informal consultation with various clinical communities and professional societies. 10. Equality & Diversity An Equality Impact Assessment is carried out as appropriate in relation to clinical engagement activities. 9. Timeline for implementation and Lead Officer This report offers a high level overview of the key clinical responsibilities of the Nurse Director and Medical Director and key aspects of clinical engagement. Future Chief Professional Officers reports will be included as a standing business item on the Board meeting agenda. Eileen Moir, Nurse Director Dr Brian Robson, Medical Director 1 Reference HDL/CEL 2
Appendix 1: Outline of clinical engagement activities Active connection with and involvement of clinicians and clinical communities is recognised as a critical element of Healthcare Improvement Scotland s approach to ensuring that we provide the most appropriate evidence, improvement and scrutiny for NHS Scotland and the independent healthcare sector. Healthcare Improvement Scotland board-wide clinical engagement strategic and operational plans will be reviewed by end of June 2011and presented to the subsequent Evidence, Improvement and Scrutiny Committee. The Broader Clinical Leadership team These elements of clinical engagement are a key responsibility of the Nurse Director and Medical Director of Healthcare Improvement Scotland. However, it should be noted that clinical engagement is supported by other clinical leaders in the organisation (outlined below) and by developing an environment that promotes and fosters clinical relationships, especially across professional and organisational boundaries. This principle of multi-professional clinical engagement is fundamental to our future success, whilst recognising that there are unique profession specific elements which require a nuanced and multi-faceted engagement model. The Nurse Director is supported in clinical engagement by Penny Bond, Nursing Advisor, Fiona Dagge-Bell, Midwifery Advisor and June Wylie, AHP Advisor who network with clinical communities and influence professional agendas from a quality improvement perspective. These Clinical Advisors have joint roles as Development and Improvement Team Leaders and their clinical engagement activities relate to the work programme. The Medical Director is supported in clinical engagement with the medical and pharmacy community by the Interim Chief Pharmaceutical Officer, Laura McIver, and our Consultant in Public Health Medicine, Dr Peter Christie. The activities and specific engagement responsibilities of this wider clinical leadership team are not listed in this report however key aspects may feature in future Board clinical engagement reports. In addition, Healthcare Improvement Scotland contracts with a range of Clinical Advisors (10-12 at any one time) providing speciality or field expertise eg Mental Health, Cardiology and Primary Care. Engagement with individuals The Nurse Director provides coaching to a number of senior nurses across Scotland. These change over time but usually number around five. This provides an opportunity to influence leadership for improvement but also brings intelligence (used anonymously) to inform our work. 3
The Medical Director provides informal coaching and mentoring to a range of individual clinicians through the year. Advice is sought on particular projects on an ad-hoc basis from both NHS Boards and Scottish Government. Local NHS Board Engagement The Nurse and Medical Director engage with individuals, groups and teams at NHS Board level (eg Area Clinical Fora) and increasingly going forward with staff from the Independent Sector. Examples include: The Nurse Director visited NHS Lothian in February to meet staff taking forward the Compassionate Care Programme alongside Releasing Time to Care (using Lean methods to reduce waste and importantly, time away from the patient). Next month, the Nurse Director will meet senior team members at NHS Ayrshire and Arran to discuss (and learn from) how they are organising for quality. A visit is also being made to Independent Healthcare providers in the area ie Ayrshire Hospice and Partners in Care (Mental Health facility). The Medical Director, through Scottish Patient Safety Programme (SPSP) activity, regularly engages with multiprofessional teams and individuals at local hospital and Board level and in Primary Care. Engagement at a National Level The Nurse and Medical Director raise the profile of Healthcare Improvement Scotland and quality Improvement at national events across Scotland through Scottish Association of Medical Directors (SAMD) and Scottish Executive Nurse Directors (SEND) Groups. Other examples include: Last month the Nurse Director chaired the final Conference of the national mental health nursing review (Rights, Relationships and Recovery) which was held to celebrate the achievements of the 5 years of the programme. Over 200 nurses and others from the NHS and Independent Sector attended. The Medical Director was invited to speak at the British Medical Association (Scotland) annual strategy day in March 2011 attended by all the senior BMA committee chairs to explore links with the BMA and Healthcare Improvement Scotland. In March 2011, the Medical Director chaired the national Hospital Standardised Mortality Ratio (HSMR) review group engaging with senior clinicians, statisticians and service managers to explore variation in HSMR and links with relevant Medical Directors of outlier hospitals in order to agree improvement planning. 4
Engagement at UK Level The Nurse Director is currently a Fellow of the GenerationQ Programme which is a Health Foundation funded improvement leaders Fellowship to study with 17 others from all sectors across the UK. The Nurse Director will lead a national conversation on 26 April with over 30 multidisciplinary clinical leaders trained in improvement methods to explore with them the successes of improvement programmes using Appreciative Inquiry and Dialogue. This work will inform the further development of our Quality Improvement arrangements. The Medical Director is a Health Foundation Quality Improvement Fellow and a Fellow of the Institute for Healthcare Improvement and is actively engaged with a UK and US Fellowship Alumni giving access to UK and international clinical engagement approaches. Influencing at Government Level The Nurse Director and Medical Director influence a number of groups within Scottish Government Health Directorates and actively promote and inform Healthcare Improvement Scotland s activities as a result. Many of these groups are comprised largely of clinical representatives or address clinical issues and may impact upon Healthcare Improvement Scotland purpose and objectives. These include: Nurse Director: Person Centeredness Ambition Delivery Group Healthcare Associated Infection National Advisory Group Long Terms Conditions Programme Board Quality Strategy Infrastructure Delivery Group NMAHP Coordinating Council The Improving Nutritional Care National Board NHS Education for Scotland National Advisory Board Medical Director: Safe Ambition Delivery Group Acute Adult Action Group (Chair) National ehealth Strategy Group National Clinical Change Leadership Group (ehealth) HSMR Review Group ( Chair) Surgical Profiles Review Panel Overarching Medicines and Technologies Group ( Chair) National Clinical Data for Quality Improvement Group Primary Care Data Intelligence Working Group (Chair) Delivering Quality in Primary Care ( Deputy for CEO) Scottish Council of Royal College of General Practitioners Area Clinical Forum Chairs Group (2011) 5