Thinking Differently Acting Differently Higher staff satisfaction = better patient outcomes & better patient experience
Staff Satisfaction is the best indicator of a High Quality Culture Nursing contribution is well received in this unit I would feel safe here being treated as a patient I enjoy working here Disagreements are resolved appropriately It s difficult to speak up if I perceive a problem with patient care I receive appropriate feedback about my performance I m encouraged to report any patient safety concerns It s difficult to discuss errors here Morale is high I feel supported by my manager I feel enabled to provide high quality care
What Does Research Tell Us? Michael West, Linda Aiken & others Boorman Report + Robertson Cooper Ltd Discretionary Effort Matching Michigan
Teamwork Climate Across Michigan ICUs No BSI = 5 months or more w/ zero No BSI 21% No BSI 31% No BSI 44% The strongest predictor of clinical excellence: caregivers feel comfortable speaking up if they perceive a problem with patient care Attribution: J. Bryan Sexton
Salford Royal has an ambition: - to be the safest organisation in the NHS
Understanding what will drive change Culture & Leadership Measurement Projects Building Capability
Method, Measure & Accountability Salford Royal Hospitals NHS Foundation Quality strategy for management of the acutely unwell Culture, teamwork & accountability Leadership attention Clearly defined protocols Root cause analysis & learning Psychological safety Simulation How good is our care? 50% reduction in arrests outside units By March 2010 Assessment & observation Response High risk patients identified Standardised processes for essential obs 100% compliance with observation policy Uninterrupted observations De-escalation policy adherence Care of the dying Immediate response to deterioration Increased ward level capability Optimal patient management step up / down Routine review of step down patients Support strategy for assistance Open and receptive to all queries Is our care Patient flow & communication Right patient, right place, right time Efficient handovers & transfers Increased understanding of systems Cascade of command Patient engagement in redesign improving? Principles for all stages: System wide education & training for each primary driver Measurement & feedback Adherence to NICE guidance How do we compare?
Building Capability Learning Collaborative Deep Engagement with Staff
Reset the System
Improvements Developed Solely by Frontline Staff Improving analgesia for Elderly with Hip Fractures Structured ward rounds Gastro Team home visits to reduce readmissions One Stop Service for thyroid lump patients Manual Observations ICU Standards of Care Renal Improvement Collaborative Stand up time to alleviate pressure areas Spinal team stds of care - high volume procedures
Creating Unity of Purpose for Patient Safety Leadership Visibility Deference to Expertise not Hierarchy Reluctance to simplify Supporting Teamwork You can t do this without: Agreeing Values and Aligning Objectives 11
Connecting the Individual to their contribution to the Annual Plan Aligning Goals, Objectives, Behaviours and Attitudes
VALUES supporting motivation RESPECTFUL: to colleagues, through teamwork to patients & customers, putting their interests before their own to the organisation, observing policies and procedures ACCOUNTABLE: have high standards of integrity and honesty are open to challenge use evidence of best practice FOCUS ON NEEDS OF PATIENTS AND CUSTOMERS: contribute to Safe, Clean, Personal care provide care and services which are effective and reliable provide services efficiently and without waste CONTINUOUS IMPROVEMENT: motivated to find solutions to problems have a spirit of enquiry are resourceful and can do are comfortable with change Focus Groups on Values: 270 attendees Focus Groups on Reward: 280 attendees Discussion groups and presentations: 1,000+ Attendees
NHS tends to support the Mediocrity
Performance Supporting Performance and Contribution Accountability reinforces culture Exceeds expectations Dev. Needed Excellent Role Model Consistently meets expectations Dev. Needed Strong contributor Excellent Does not always meet expectations Unsatis - factory Development needed Development needed Does not always meet expectations Consistently meets expectations Values Exceeds expectations
Performance Assessment - supporting excellence
Leadership and Engagement Clinical Leaders stepped down Development Programme and Assessment Appointment + new roles with Accountability Learning Collaboratives 2500+ staff participating Improvement Directorate Clinical Quality Academy
ACCOUNTABILITY Clinical Financial Integrated Responsibility Safety & Quality Operational
Salford Royal: Cultural Development 5 year Strategy PATIENT Trusted by our patients to provide the highest standards of safe, clean & personal care VALUES ACTION QI M M M SERVICE PLANS OD & PEOPLE INNOVATION & ADOPTION Safe, Clean, Personal Leadership Perf Mgt & & Assurance Accountability Reward & Consequences Engagement & Capability Building
Patient and Staff Satisfaction 2007-2011 2011/12 Survey Results Key findings: 34/40 ratings top 20% Best score to what extent do you feel supported to provide high quality care
2010 Pascal Metrics Inc. 21
2010 Pascal Metrics Inc. 22
Results 80% reduction in hospital acquired pressure ulcers 95% of patients receive harm free care