Clinical Governance in NHS Tayside Making the difference beyond The Keogh Review a new assurance approach for Tayside Dr Andrew Russell Medical Director
The shifting landscape of the past 12 months The Francis Report February 2013 Examined the commissioning, supervisory and regulatory organisations and other agencies, including the culture and systems of those organisations, in relation to their monitoring role at Mid Staffordshire NHS Foundation Trust between January 2005 and March 2009 and why problems were not identified sooner, and appropriate action taken. The Keogh Review July 2013 Review into the quality of care and treatment provided by 14 hospital trusts in England. The Berwick Report August 2013 A promise to learn a commitment to act: Improving the safety of
And still to come The Vale of Leven Hospital Inquiry due to report by 31 March 2014 The Inquiry was set up by Scottish Ministers to investigate the occurrence of C. difficile infection at the Vale of Leven Hospital from 1 January 2007 onwards. The Inquiry will also investigate the deaths associated with C. difficile between 1 December 2007 and 1 June 2008. It will also look at the management and clinical response, the actions of NHSGGC including informing patients and their relatives and the governance arrangements in relation to prevention and control of infection.
What Keogh looked at e was asked to review quality of care and treatment in Trusts with persistently high Hospital Standardised Mortality Ratios. He looked at information and data relating to: atient Experience afety orkforce
The Keogh findings No one indicator gave all the assurances. The review emphasised the importance of Boards making better use of data to identify potential problems. For example, high mortality rates must be treated with caution but they are an important warning sign. However, it is just as important to look at other indicators, especially feedback from patients and staff. Need to look at all the data in the round TRIANGULATION to build up a picture of clinically effective, quality and safe care
So, how can we put the learning from The Keogh Review into practice? Need an essential shift away from looking at individual bits of data to overall organisational intelligence This requires a fundamental change to how we ve operated before Medical and Nurse Director developed the Tayside Care Assurance Framework based on Keogh s five domains
The new Tayside Care Assurance Framework - What it is and what it will do whole system measurement and monitoring framework to support clinicians and managers use information collected to identify variation, monitor performance and support improvement. t will provide assurance to the Board and the public about the services they provide From the Point of Care to the Board in the form of an easily accessible report.
NHS Tayside assessment Mapping the measures Data availability, timeliness and gaps Comparative analysis and benchmarking Disparate reporting
How does the report show TRIANGULATION?
GMC Survey Staff Sickness Absence Grievance Nurse Capacity Re-admission Rate Treatment Time Guarantee Clinical Indicator Poor Staff Survey NMC Referrals Litigation Costs After 3 months After 6 months After 12 months After 18 months Complaints
The NHS Tayside Clinical Governance Strategy erson-centred, safe and effective clinical care Our ambition is that every day every one of us delivers, sees and experiences standards of care that we would want for our own loved ones. This can only happen by putting the patient at the centre of everything we do, working as a team and making sure we have the information and data we need to deliver excellent treatment r Andrew Russell Dr Margaret McGuire
The focus of the strategy is to: Promote and encourage appropriate patient and carer involvement in everything we do Deliver high-quality, evidence-based care Encourage and enable our staff to work in multidisciplinary and multi-professional (ie joined-up) teams and use reflective practice Anticipate and prevent harm through robust systems for clinical risk, patient safety and investigation of near misses Understand and minimise unnecessary variation by the intelligent use of data, measurement and improvement Demonstrate learning and sustainable change from adverse events
The scope of Clinical Governance Clinical Risk Management Clinical Effectiveness Person-Centredness Continuous Improvement Staff Focus The strategy describes the systems, escalation processes and triggers used to coordinate all of these elements which inform improvement, quality of care and risk management at all levels throughout the organisation. This system gives assurances From the Patient to the Board.
A final thought If there is one lesson to be learnt, I suggest it is that people must always come before numbers. It is the individual experiences that lie behind statistics and benchmarks and action plans that really matter, and that is what must never be forgotten when policies are being made and implemented. Robert Francis QC