Background. The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY

QUALITY AND PATIENT SAFETY STRATEGY 2015-2018 1

Background 2 In 2008, Lord Darzi s High Quality Care for All set out a vision for an NHS with quality at its heart. The report led to an understanding that concentrating on three areas patient safety, clinical effectiveness and the patient experience would result in good quality care for patients. While this shaped the beginning of a new era in the NHS, regrettably it did not prevent failings in care at Mid Staffordshire NHS Foundation Trust. This led to a watershed moment for the NHS with a public inquiry and the publication of Robert Francis QC s extensive report in February 2013. The report described the appalling suffering of many patients within a culture of secrecy and defensiveness. The inquiry identified a whole system failure and the report made a total of 290 recommendations. The Government announced (Sir) Bruce Keogh would undertake an immediate review into 13 other struggling NHS Trusts with high patient mortality indicators and as a result, 11 of the 13 hospitals were put in special measures. The Government s response to the Francis Report Hard Truths in November 2013 was a commitment to fully implement 204 of the 290 recommendations. A number of further reports were commissioned which led to further actions, for example the National Quality Board s How to ensure the right people, with the right skills are in the right place at the right time ; ensuring all hospitals publish ward staffing levels and carry out biannual safe nurse staffing reviews; and the Cavendish Review which identified training requirements for health care assistants. The Government asked Don Berwick, an internationally respected patient safety guru, to undertake an independent review and a national advisory group was set up, led by senior experts (including Sir Robert Francis and Lord Darzi) which produced a series of recommendations in the Berwick Review. The Walton Centre has responded to these recommendations with a series of immediate and longer term action plans. These plans have led to a number of changes to strengthen the quality of patient care, including new ways to monitor and improve systems and processes. This strategy builds on those actions, moving from operational plans to a strategic approach. The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

Introduction The Quality and Patient Safety Strategy covers the next three years, with an overarching aim to ensure Excellence in Neuroscience. It builds on the work of the Quality Governance Strategy and other patient safety initiatives, to take this specialist Trust from good to great. 3 Leadership at all levels Culture of continuous learning Patient engagement at all levels Build capacity and skills Using measurement to predict

Strategy s organisational fit The Quality and Patient Safety Strategy will contribute to the achievement of the overall Trust Strategy, aims and objectives: I mproving quality by focusing on patient safety, patient experience and clinical effectiveness 4 Sustaining and developing our services Research and innovation for patient care Developing our hospital Recruitment, retaining and developing our workforce Maintaining our financial health It is a key enabling strategy, underpinning in particular the elements of quality, development of the Trust s services and The Walton Centre s workforce. In turn the Quality and Patient Safety Strategy has its own supporting strategies, in particular the Patient Experience Strategy and the Patient and Public Engagement Strategy. The Quality and Patient Safety Strategy brings together the learning from the Francis Report, the Keogh Report and the Berwick Review with the Trust s own programmes of work, for example our Sign Up To Safety pledges and the AQUA Advanced Board Programme for Quality and Safety actions. The strategy has five foundations and these are mapped to the learning from the Francis Report, Keogh Report and Berwick Review, as well as the five CQC domains, for ease of reference by staff. The CQC domains are: Are services safe? Are services effective? Are services caring? Are services responsive to people s needs? Are services well led? The Walton Way Values are included as they also support and underpin the Quality and Patient Safety Strategy. (See appendices A and B for details) The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

The five Foundations The Quality and Patient Safety Strategy sets out the way forward for the next three years using five Foundations which have been agreed following consultation with The Walton Centre s staff. These are based in particular from the learning from the Berwick Review and also the King s Fund in relation to collective leadership and culture in the NHS. The five Foundations are: Leadership at all levels Attention is the currency of leadership; staff pay attention to whatever leaders pay attention to and this creates the organisational culture 5 Culture of continuous learning How do we know we re as good as we think we are and how can we use this to improve further? Patient engagement at all levels Listening to our patients, partnership working. Build capacity and skills Close the gap between what we think happens and what actually happens by enhancing staff skills. Using measurement to predict See the ripples before the tsunami, understand our own data and identify areas to celebrate and areas to build on.

The Walton Centre s Quality achievements 6 The Walton Centre has a strong history of improving patient safety and enhancing the quality of care. Over recent months and years the Trust has made significant improvements in these fields and in its ability to measure improvement. The following examples of achievements during 2014/2015 align with the three Darzi themes of patient experience, clinical effectiveness and patient safety. Patient Experience Over 98 per cent of our patients were likely or extremely likely to recommend The Walton Centre to friends and family. Network services have been developed in the areas of major trauma, acute rehabilitation and spinal, to ensure joined up care which is delivering improved outcomes for patients. Satellite clinics are extending the reach of our specialist services, delivering care closer to patients homes. The Sid Watkins Building opened in January 2015 and patients were safely moved into a state of the art environment for outpatients, complex rehabilitation and pain management. Our specialist Pain Management Programme (PMP) is the largest in the UK, with all patients receiving an individualised end of programme plan. We are the only neuroscience centre that offers individualised PMP for patients with specific needs. Our patient outcomes for acute rehabilitation have been recognised as the best in the UK. More than 2000 patients have been recruited to clinical research studies, far exceeding an annual recruitment target of 1200. In July 2014 we invited patients who had participated in past and current research studies and their families to join us in celebrating our 20th anniversary of undertaking clinical research. The Roy Ferguson Compassionate Care Award was launched to support the delivery of compassionate care. The first recipient of the award established a specialist clinic to help patients suffering with claustrophobia to undergo an MRI scan, with nearly 100 per cent of patients feeling confident enough to progress to having a scan. The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

7 Clinical Effectiveness In more than 97 per cent of cases there is excellent compliance with Venous Thromboembolism (VTE) assessment of patients. There is 100 per cent compliance with VTE prophylaxis treatment for those patients that require it, keeping patients safe, preventing harm. There have been excellent peer reviews for both the major trauma and the acute rehabilitation services. There have been extremely good patient reported outcomes following spinal surgery, measured by Spine Tango. There is now added breadth and depth in ward and Board balanced scorecards, measuring improvement and triangulating elements of care in relation to patient safety, clinical effectiveness and patient experience. A monthly Quality Report has been introduced which shares good practice and improvements in quality; and highlights areas that require additional focus, to further enhance patient care. A Nursing Assessment and Accreditation System (NAAS) has been introduced to ensure that care is of the highest standard on every ward, by reviewing patients experiences and outcomes. Pioneering new treatments for patients with migraines have been introduced. We are one of the few trusts in the UK undertaking full thrombectomy surgery for stroke patients. Several members of clinical staff were supported to undertake Master in Research courses at university, investing in clinically led research projects to improve the effectiveness of care. Two prestigious National Institute for Health Research awards for clinical research have been secured, which will directly improve patient care.

Patient Safety We achieved over 325 days without a fall resulting in moderate or above harm; and a 17 per cent reduction in overall falls and a 51 per cent reduction in harm. We reached a total of 485 days without a grade 3 pressure ulcer and a 32 per cent reduction in grade 2 ulcers. We achieved over 1000 days without a grade 4 pressure ulcer (and still counting). We reached over 500 days without an MRSA bacteraemia (and still counting). Two biannual safe nurse staffing acuity reviews have been carried out, using best practice tools and triangulating these with professional judgement, nurse sensitive indicators and patient feedback. As a result there has been further investment in the number of frontline nursing staff in wards and units. Our mortality rate for patients with subarachnoid haemorrhage is the lowest in the UK. In collaboration with the CLARHRC NWC the Trust embarked on a project to improve the care of patients with a first seizure, to improve patient safety and the pathway of care. We achieved over 98 per cent of patients receiving harm free care. 8 The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

Next steps We want to build on these successes and move from good to great, to achieve excellence in neuroscience. We are using information and intelligence including patient feedback and surveys, patient outcomes and data from incidents and complaints to identify areas for further improvement. This is the basis of our Sign Up To Safety Improvement Plan which outlines the next steps in the five driver areas (see page 10). Furthermore we have used this learning approach in setting our annual Quality Account priorities with our stakeholders. We will measure our progress through tangible milestones on each of these elements milestones that are specific to each aspect and detailed in the Sign Up To Safety Improvement Plan, which will be reported quarterly through the Quality Report to the Board of Directors and the Quality Committee. Progress will also be monitored annually through the publicly available Quality Account. The Sign Up to Safety plan details the timescales for each aspect, starting with the introduction of the Sepsis six campaign to improve care for deteriorating patients; the therapeutic specialling for our most vulnerable patients; the launch of our Always events; and the #hellomynameis campaign. We will measure the success of this Quality and Patient Safety Strategy and the overriding culture and leadership ambitions outlined in its foundations. This will be done by selecting wide ranging goals to demonstrate we have embedded these elements in day to day care and activity. For example, in seeing measurable improvement in the largest patient feedback survey, the national in-patient survey and the largest staff feedback tool the national staff survey, we will look beyond the results, to determine: does this demonstrate that both patients and staff believe we are providing great quality care, that leadership is present and tangible at every level? Other important considerations are whether we have the right leadership and culture, with staff with the right skills and patient focused approach delivering great quality care. We want to demonstrate a year on year improvement in Quality and to be in the top percentage of all trusts in every category of these national surveys. 9

Quality and Patient Safety Strategic Goals 10 Each year the Quality Account will outline The Walton Centre s priorities for the coming year in relation to the three Darzi themes for quality care patient experience, clinical effectiveness and patient safety. The Strategy s aim is to consolidate these further and over the next three years to achieve the following measurable milestones. Our ambitions are: Patient Experience To be in the top quartile of all Trusts for every category in the national Inpatient survey Outpatient survey Staff survey Furthermore we will strive to achieve more better than expected answers within each category of our Inpatient survey Outpatient survey Staff survey We expect all clinical staff to model The Walton Centre s Always Events for patients, continuing our patient centred focus. We will strive to achieve all our Sign Up To Safety Pledges in each of the five categories (see Appendix B which links each of the pledges to the Strategy s foundations) All staff will model #hellomynameis campaign values, introducing themselves, welcoming patients, putting them at ease and being patient focused. Clinical Effectiveness We will aim to achieve high reliability in best care bundles, for example the sepsis six prevention bundle and pressure area care bundles. We will strive to be in the top quartile of Trusts with patient related outcomes measures for all neuroscience conditions measured in this way. We will aim to succeed in all areas in our Sign Up To Safety Improvement Plan priorities: Reducing medication errors by ensuring safer systems and processes. Increasing the reliability of the WHO surgical checklist application in surgery. Increasing the reliability of earlier detection and treatment of Cauda Equina Syndrome Increasing the reliability of early detection and treatment of the deteriorating patient Reducing clinical nurse indicator avoidable harms. These include: Sustaining a zero tolerance for grade 3 and 4 pressure ulcers and focusing on device related pressure ulcer prevention in grade 2 pressure ulcers. Sustaining best practice for the prevention of healthcare associated infection Preventing falls with moderate or above harm keeping patients safe. We will embed all our Aqua Advanced Board Programme Quality and Safety commitments (see Appendix B for all our commitments and how these link to the Strategy s foundations) We will create a culture where all staff feel supported to speak out safely, welcoming comments and staff who raise patient safety concerns (rewarding good catches). The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

11 Patient Safety Our target is no preventable deaths and we will review all patient deaths and ensure a culture of continuous learning. We will reduce repeated causes of serious incidents, by ensuring a culture of continuous learning by making changes to our systems and processes to make care safer. We will consistently achieve over 95 per cent of harm free care in our NHS Safety Thermometer, ensuring the majority of patients receive the best care. We will strive to be in the top quartile of neuroscience services for every clinical outcome measure collected nationally, leading the pack, ensuring best practice for our patients. We will expand our ability to benchmark care and outcomes across neuroscience specialist hospitals. We will aim to be in the top quartile of Trusts nationally for our safe nurse staffing performance. We will carry out biannual safe staffing reviews, using best practice tools.

Making it happen Foundation 1 Leadership at all levels 12 Leadership development and clear accountability for safety and quality will be embedded at all levels, recognising that attention is the currency of leadership. The leadership Foundation will complement and complete the Organisational Development (OD) Strategy s leadership ambitions to build on a collective leadership approach. Why is leadership important? Berwick and Francis recommendations noted: The need to have strong visible leaders at all levels in healthcare. All leaders should place the quality of care and patient safety in particular at the top of their priorities for investment, inquiry, improvement, regular reporting, encouragement and support. Organisations and leaders must ensure that staff are present in appropriate numbers to provide safe care at all times and are well supported by leaders at all levels. Leadership underpins the Trust s strategic aims and objectives by: Embedding leadership development and clear accountability for patient safety, patient experience and clinical effectiveness at all levels. Sustaining and developing services by developing our leaders and working in partnership with other hospitals as noted in our Sign Up To Safety Pledges (see Appendix B). Developing our hospital by securing a high reputation for The Walton Centre with patients, public and partners through strong, visible leaders. Recruiting, retaining and developing the workforce by embedding a high performance culture, supporting The Walton Centre as a great place to work and ensuring the Trust can respond to changes through innovation and collective leadership. Walton Way Values Leadership reflects the Walton Way value Dignity enabling all staff to achieve their potential and lead within their field of expertise, being passionate about delivering dignity to all. The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

13 Overview Appendix A outlines how Foundation 1 Leadership follows learning from Francis, Keogh and Berwick; how it reflects both the CQC domains and the Walton Way Values. Furthermore, Appendix B gives tangible examples of embedding leadership in the Sign Up To Safety Pledges and the AQUA Board Programme for Quality and Safety Implementation plans. The Trust Board led by example with the whole Board of Directors undertaking the AQUA Advanced Leadership Programme for Board members on quality and safety. This improved awareness of measuring improvement in patient experience, clinical effectiveness and patient safety and led to agreeing an ambitious programme of actions to improve quality at The Walton Centre. We are investing in leadership at all levels, for example with our PRIDE leadership programme, coaching opportunities and a Collective Leadership Programme for the senior nursing team and ward managers, helping staff to maximise their own leadership capabilities. Staff at all levels are being supported in leadership development, for example through AQUA patient safety and quality programmes to complement Sign Up To Safety Improvements Plans, so that they feel equipped and empowered to lead their teams in patient safety and quality initiatives. We are leading by example through commitment, encouragement, compassion and having a learning approach that infuses positivity, pride and joy in work the Walton Way. Leaders are being supported to champion research, identify research questions and apply research findings to lead, inform and change clinical practice.

Foundation 2 Culture of continuous learning 14 We will develop an open culture for quality and safety encompassing candour, transparency, internal challenge and continuous improvement; ie how do we know we re as good as we think we are and how do we use this to improve further? This will complement the approach of the OD Strategy and support our aspiration to develop and embed a high performing organisational culture, underpinning our value set the Walton Way. Why is culture important? Berwick and Francis recommendations noted: Trusts can consistently reduce patient harm by embracing wholeheartedly an ethic of continuous learning. Organisations should be learning organisations. Their leaders should create and support capability and a culture for learning and therefore change at scale. The need to have a culture of transparency is complete, timely and unequivocal. All data on quality and patient safety assembled by organisations must be shared in a timely way with all parties who want it and in an accessible form for the public. Culture underpins the Trust s strategic aims and objectives by: Improving quality We will focus on patient safety, patient experience and clinical effectiveness. We will develop an open culture for quality and safety encompassing candour, transparency and internal challenge and continuous improvement. Sustaining and developing our services There will be a culture that promotes productive ways of working to make best use of our clinical capacity and capability and there will be a culture of partnership working with other hospitals and care settings. Research and innovation for patient care There will be a culture of embedding research, development and innovation in daily patient care. Recruiting, retaining and developing our workforce We will embed a high performance culture that is based upon our Walton Way Values as well as a culture of a great place to work. Walton Way Values A continuous improvement culture reflects our Walton Way Value, Pride. All staff will feel proud to work in an environment that has a continuous improvement culture in providing quality care for our patients and by being part of one big team. The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

Overview Appendix A outlines how Foundation 2 Culture uses learning from Francis, Keogh and Berwick; and the CQC domains and the Walton Way Values. Furthermore, Appendix B gives tangible examples from Sign Up To Safety Pledges and the AQUA Board Programme for Quality and Safety Implementation Plans of how The Walton Centre will embed a culture of continuous learning. We will ensure a culture of continuous improvement by monitoring and improving our compliance with duty of candour to patients and relatives. 15 We are committed to creating a culture where staff are supported and have the skills to speak with patients/ their families after an incident, it s ok to ask, it s ok to tell. We will support all staff to speak up and raise any concerns with each other, their line managers or more senior staff, ensuring a culture that is dedicated to improving and learning when we don t get things right, understanding the impact of blame on staff and ultimately on patient safety. We will think about how we will respond when things go wrong - learning from all serious incidents and sharing that learning widely, understanding the role played by human factors, other contributory factors and systems and processes. We will encourage and welcome all staff and patients to speak out, taking all concerns seriously and acting upon them. We will learn from our successes and our failures. We will seek out and listen to staff about what keeps them awake at night; we will ensure we hear the quietest of voices. We will ask five people whether we have succeeded in making the culture change (to measure reliability). This will involve either staff or patients and will follow a Sign up To Safety initiative to ensure we have embedded the culture change and it is apparent to all. We will create a culture which raises the awareness of the value of research that underpins practice and facilitates high quality research aligned to strategic objectives. We will work in partnership to deliver high quality research to underpin evidence-based high quality care.

Foundation 2 Patient engagement at all levels 16 We will strengthen patient and public engagement so that patients and carers are present, empowered and involved at individual, service and Trust level (listening to our patients). Why is patient engagement important? Berwick and Francis recommendations noted: Patients and their carers should be present, powerful and involved at all levels - ward to board All organisations should seek out patient and carer voices as an essential asset in monitoring the safety and quality of care Importance of putting patients first and having common values Engagement underpins the Trust s strategic aims and objectives by: Improving quality. We will involve and empower patients and carers at individual, service and Trust level to use their experiences to improve patient safety, patient experience and clinical effectiveness. Sustaining and developing our services. We will promote productive ways of working and a culture of partnership working with others including patients, carers, patient representatives and the voluntary sector. Research and innovation for patient care. We will strengthen patient and public engagement in research. Developing our hospital. By achieving high standards of care we will maintain an excellent reputation with patients, public, partners and throughout the NHS. Recruiting, retaining and developing our workforce. By focussing on patient engagement we will ensure our staff remain patient-centred, aligned with Walton Way Values and a culture of a great place to work. Maintaining our financial health. We will make the best use of resources for patient care and enhance the financial awareness of staff. Providing excellent care will maintain the confidence of NHS regulators and commissioners. Walton Way Values Patient Engagement supports the Walton Way Value Respect. We will always show courtesy and professionalism, respecting patients and their wishes. Good quality care is all about respect. The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

17 Overview Appendix A outlines how Foundation 3 Engagement reflects learning from Francis, Keogh and Berwick, the CQC domains and the Walton Way Values. Furthermore Appendix B gives tangible examples of how we will embed engagement, through the Sign Up To Safety Pledges and the AQUA Board Programme for Quality and Safety Implementation Plans. Patient experience and patient engagement are so important that there are two further strategies which will outline detailed approaches in these areas. The Trust s continuing improvement work in relation to safeguarding our most vulnerable patients and those not able to advocate for themselves is detailed in a Safeguarding work plan.

Foundation 4 Build capacity and skills 18 We will build on the organisation s capability and skills for managing and improving quality and safety, closing the gap between what we think happens to what actually happens. This will involve enhancing staff skills from good to great. Why is building capacity and skills important? Berwick and Francis recommendations noted: Mastery of quality and patient safety sciences and practices should be part of the initial preparation and lifelong education of all healthcare professionals, including managers and executives. Training and supporting staff all the time, building capability, using the science of improvement and networks of learning is the key to high quality, patient centred care. All staff must be trained and motivated. Building capacity and skills underpins the Trust s aims and objectives by: Improving quality focusing on patient safety, patient experience and clinical effectiveness. We will build the organisation s capacity and skills for managing and improving quality and safety. Sustaining and developing our services. We will undertake clinical and service developments and related skills to support the Trust s position as a leading neuroscience centre. Recruiting, retaining and developing our workforce. We will provide a high standard of education and training so that we employ the highest calibre of health care staff for future NHS patients. We will promote flexible and innovative ways of working. Establishing the right infrastructure to facilitate clinical and academic research careers across all professions. We will develop opportunities to lead research in patient safety and quality of care which will benefit patients. Walton Way Values Building capacity and skills supports the Walton Way Value Caring. We will enable all staff to maximise the ability to perform in their roles and provide good quality care to patients. We will care enough to put the needs of others first. The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

19 Overview Appendix A outlines how Foundation 4 Building skills includes learning from Francis, Keogh and Berwick, the CQC domains and the Walton Way Values. Furthermore Appendix B gives tangible examples from the Sign Up To Safety Pledges and the AQUA Board Programme for Quality and Safety Implementation Plans of how The Walton Centre will embed staff learning and skill enhancement. In the Sign up to Safety Improvement Plan we have detailed the importance of creating a team which is trained to deliver improvement. We have identified a senior leader and a leader for each part of the Sign Up To Safety programme and each will be offered access to a development programme to enhance their skills and ability in safety improvement, measuring quality and understanding human factors, for example via AQUA and AHSN training courses. We will identify a team to provide development in improvement, safety and human factors for certain projects. For example a multidisciplinary team in Theatres is leading on the World Health Organisation (WHO) project care checklist and all are undertaking AQUA skills courses covering improvement methodology, human factor training and leadership behaviours.

Foundation 5 Using measurement to predict 20 We will improve intelligent measurement and use of information to predict, prevent and evaluate as well as monitor and investigate see the ripples before the tsunami. Why is measurement important? Berwick and Francis recommendations noted: Complete timely and unequivocal transparency is essential. All data on quality and safety must be assembled and shared promptly with all parties who want it and in an accessible form for the public, to ensure improvement. By measuring accurately, problems can be detected and acted upon quickly. Measurement enables organisations to identify and respond to variation in results. Measurement underpins the Trust s strategic aims and objectives by: Improving quality. We will improve intelligent measurement and use of information to predict, prevent and evaluate as well as to monitor and investigate. Sustaining and developing our services. We will develop productive ways of working and learning by analysing information and constantly developing our staff. Maintaining our financial health. We will improve efficiency and effectiveness in providing high quality care and patient safety by making the best use of resources for patient care. Walton Way Value Measurement supports the Walton Way Value Openness. We will be clear and transparent about where we are and where we have an ambition to improve quality further. We will be open and honest in all that we do. The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

21 Overview Appendix A outlines how Foundation 5 Measurement for improvement, uses learning from Francis, Keogh and Berwick, the CQC domains and the Walton Way Values. Furthermore Appendix B gives tangible examples from Sign Up To Safety Pledges and the AQUA Board Programme for Quality and Safety Implementation Plans of how The Walton Centre will embed measurement for improvement. We will focus on near misses and no harm incidents, identify trends so that we know where to focus and enhance care. We will assess what we have learnt, what more we can learn and what we can change to make further improvements. We will triangulate our measurement data with soft data to enhance our learning and ability to measure and predict. For example we will cross reference our safe nurse staffing percentages with our Friends and Family Feedback, our nurse sensitive indicators, complaints and NICE staffing red flags; ensuring a greater understanding of the wider picture and enabling earlier prediction of challenges ahead and areas of improvement focus.

Monitoring progress and staff engagement. 22 The Sign Up To Safety Improvement Plan forms much of the strategy s operational approach and progress will be shared quarterly in the Quality Report, with a quarterly update at the Quality Committee and at Trust Board. The annual Quality Account will detail progress on our yearly priorities and this and other key publications will be made available to the public on the website and through other online channels. The Trust Board will consider financial support and any investments required to implement quality improvements and take us from good to great, ensuring excellence in neuroscience. The Trust Board agenda reflects the importance of Quality by always placing it first on the agenda; the Quality Account and monthly Quality Report are scrutinised as the main context for operational decisions, capital investment and other financial decisions, recruitment and training. We will continue to display patient feedback and nurse sensitive indicators on our in-patient ward Quality boards, being transparent about our progress. Finally the Quality and Patient Safety Strategy will be brought to life in Quality Berwick sessions planned for 2015. There will be an open invitation to all staff to an interactive forum, looking at what we have achieved in quality and patient safety, celebrating success, sharing progress and being open and honest about the challenges ahead and where there is more to do. Staff will be encouraged to share their experiences - good and bad; sharing thoughts such as what keeps them awake at night where will the next incident come from, as well as what they are most proud of. These sessions will also review with staff our current processes and procedures and whether these are still serving our patients and quality of care well. For example it is recognised that future patient and staff feedback and data on incidents and complaints may require a change in priority or an additional area of focus. These will be considered by the Sign Up To Safety implementation group; discussed with staff in the Berwick sessions and with patients and their representatives through the Patient Experience Group; and agreed by the Board of Directors. The Berwick sessions will ensure we are learning as a Trust and have an open culture, promoting interaction and leadership at all levels. They will enable us to share milestones reached and they will be a platform to agree our stretch targets together. These sessions will also allow us to share our progress annually on our goals and look at progress on embedding our enabling strategies of: 1. Leadership at all levels 2. Culture of continuous learning 3. Patient engagement 4. Build capacity and skills 5. Using measurements to predict The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

23 Conclusion The Quality and Patient Safety Strategy builds on previous good progress in relation to national and local learning, improving quality of care further. The five Foundations will ensure we continue that journey going from strength to strength and from good to great, to achieve excellence in neuroscience for all our patients.

Appendix A The Strategy s 5 Foundations and how they fit internally and externally 24 Foundation 1 Foundation 2 Foundation 3 Foundation 4 Foundation 5 Using measurements to predict Building skills and capacity Patient engagement National context: Leadership at all levels Culture of continuous learning Using accurate, useful and relevant information The importance of fundamental standards and skills Putting patients first and having common values Francis Report Patient centred leadership Openness, transparency and candour culture change Detecting problems quickly taking actions promptly Ensuring staff are trained and motivated Non tolerance of noncompliance, preventing problems, speaking up. Ensuring robust accountability Fundamental standards and measurement of compliance Improvement in compassionate, caring and committed staff Stronger health care leadership Board and leadership teams use data and other intelligence confidentially and competently to inform quality improvement Demonstrable progress in reducing avoidable deaths in hospital Listen to patient and carer feedback and act upon it Happy and engaged staff positively affect patient outcomes Keogh Report Junior doctors and student clinicians will be listened to by senior staff Patients and clinicians are actively involved Staffing levels and skill mix reflect patient needs Transparency complete, timely and unequivocal. All data on quality and safety assembled by organisations should be shared promptly with all parties who want it and in accessible form for the public Mastery of quality and patient safety science and practice. Part of initial preparation of lifelong education of all health care professionals Patients and carers will be present, powerful and listened to, involved and heard at every level of the service all levels Reduce patient harm by embracing ethic of learning through continuous culture of learning Berwick Report Leaders place quality and patient safety at the top of priorities The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

Understand and address variation Constantly monitor the quality and safety of care Organisations should seek out the patients and carers voices as essential asset in monitoring the safety and quality of care Organisations should be learning organisations, with leaders supporting cultures for learning and change at scale Leaders ensure staff are present in appropriate numbers to provide safe care Use evidence based tools to ensure adequate staffing levels Train and support all staff all the time. Build capability. Improvement science and network learning Patient safety above all, patient centred care and quality first Having a culture of transparency. All data on quality and patient safety shared promptly in accessible forms Leaders respond directly, openly and rapidly to early warning indicators CQC Domains Responsive and well led Responsive and well led Caring Safe Effectiveness Internal context: Improving Quality Improving Quality Improving Quality Improving Quality Improving Quality Sustain and developing services Sustain and developing services Sustain and developing services Sustain and developing services Trust Strategy Sustain and developing services Research and innovation for patient care Research and innovation for patient care Developing our hospital Recruiting, retaining and developing workforce Recruiting, retaining and developing workforce Recruiting, retaining and developing workforce Recruiting, retaining and developing workforce Maintaining our financial health Maintaining our financial health Walton Way Values Dignity Pride Respect Caring Openness 25

Appendix A The Strategy s five Foundations in areas of focus for Quality and Patient Safety 26 Foundation 1 Foundation 2 Foundation 3 Foundation 4 Foundation 5 Using measurements to predict Building skills and capacity Patient engagement National context: Leadership at all levels Culture of continuous learning Committing to reduce harm year on year, understanding where we are improving and where we need to improve further Participating in patient safety research led by our R&D team, eg via AHSN, improving capability and skills through research and learning Engaging and working collaboratively with Healthwatch and other local stakeholders in improving patient experience Publish safety data alongside staffing levels culture of transparency 2 new staff awards for quality impact of leaders Sign up to Safety examples Having a zero tolerance to grade 3 and 4 pressure ulcers and utilising RCA and learning from grade 2 pressure ulcers or near misses to improve our care further Introduce NAAS to measure skills and improve care across our wards in essentials of nursing care Build on our rehab network role, safely moving patients and service to a purpose built rehab environment Nurses and doctors Always Events, ensuring a culture of improvement to patient experience Leading by example publicly, displaying our progress on electronic ward Quality boards By continuing our leading role in outcome measures for neuroscience specialities, understanding our data and how we can improve on this further Openly publish our patient feedback and responses and actions on our ward electronic notice boards Work with organisation across Merseyside to ensure electronic access to tests, avoid delays or repeat investigations for patients Doctors will always: Ensure they introduce themselves to patients on first meeting. Follow bare below the elbows policy at all times. Follow hand washing policies fully. Ensure every inpatient will be seen by a doctor every day. Action learning set for newly qualified nurses investing in future leaders Adopting the Medication Safety Thermometer, identifying areas to improve from near misses, our own thermometer data and reducing medication errors through good systems and processes Actively encourage all staff to challenge each other regarding practice if concerned about patient safety, building on current skills Enthusiastic partner in regional networks improving patient experience and engagement, eg rehab network role Nurses will always: Introduce themselves and call patients by their preferred name (#hellomynameis). Give patients timely pain relief, ask about their comfort and ensure they know who the nurse is in charge of their care. Communicate with patients and carers; listen to patients and review their care needs. Ask patients what is important to them today. Involve patients and carer in their discharge/transfer process Investing in new ward based practice facilitators increasing leadership at the frontline The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018

27 AQUA Advanced Board Quality & Safety Actions - examples Mentorship for new consultants, valuing future leaders Episode of care and harm campaign leading improvement in care Executives and senior nursing team leading reality ward rounds with scripted questions focusing on safety Culture where staff are supported and have skills to speak out safely Work in partnership with patients and provide patient briefings Culture of compliance with duty of candour Stretch improvement culture setting big goal stretch targets and publicly displaying these Valuing the patient s voice in development and improvement. Reward good catches where staff raise patient safety issues or near misses Publish on our website last day since commitment to continuous improvement Address variation and micro culture standardise best practice We will ask five people, patients or staff, have we made the culture change, to measure reliability, following a Sign Up to Safety initiative to ensure we have embedded the change and it is apparent to all Form a junior medical staff safety forum to raise concerns and highlight where safety can be improved, honing our skills and capability Implement what s important to me patients own words on their bedside board Increasing the capacity within the Trust for routine collection of data analysis for clinical outcome assessments Selected 3 areas to improve reliability and skills from 21 patient safety processes ready to adopt Review how patient stories are shared at Trust Board Select one area to improve reliability and skills from organisational risks (medical documentation in case notes) We have committed to the AQUA advanced Team Training Programme (ATTP) skills investment in areas for improvement. EG WHO MDT project teams Pilot patient helpline to empower loved ones on Caton Ward We have committed to having AQUA Patient Safety Champions investing in skills for our patient safety champions Reviewing the WHO checklist following the never event in 2014, embedding MDT working and improving further our safety culture in our operating theatres Reviewing the appropriateness of triggers using the modified NEW (neuroscience version of national early warning score) system, identifying our deteriorating patients earlier leading to timely interventions. Moving our focus to near misses incidents not just focusing on actual harm incidents, what have we learned, what more can we learn, what can we change (systems/ processes) Triangulation of the hard with soft data to enhance our learning and ability to measure and predict Ensure consideration in our root cause analysis on that day what were the conditions that made that seem like a reasonable thing to do. Finding the Swiss cheese holes. Commitment to understanding variation standardise the science of medicine/nursing not the art Learning how to master and apply improvement methods, how to use data accurately to support a culture of improvement

28 The Walton Centre NHS Foundation Trust Lower Lane Fazakerley Liverpool L9 7LJ Tel: 0151 525 3611 Fax: 0151 529 5500 www.thewaltoncentre.nhs.uk enquiries@thewaltoncentre.nhs.uk The Walton Centre NHS Foundation Trust QUALITY AND PATIENT SAFETY STRATEGY 2015-2018