Bedford Hospital NHS Trust Quality Improvement Strategy

Bedford Hospital NHS Trust Quality Improvement Strategy 2015-2018 Page 1 of 18

Section One: Strategic context 1. Introduction The following section provides an overview of the context that our Quality Strategy will be implemented within. Bedford Hospital has a vision to provide excellent acute and integrated services to the people of Bedfordshire, providing streamlined urgent care, core medical and surgical services and integrated services with primary, community and social care. This demands us to provide some services in new ways and to develop new services in partnership with others (health and social care providers) so that patients have better experiences of their care which is reliably provided in safe and effective ways. 2. Strategic Aims 2014-17 In order to realise our vision the Trust has developed four strategic aims which can be seen in figure 1 below and that underpin its Clinical Strategy. These are: Excellent quality and safety standards Effective emergency and ambulatory models of care Vertical Integration of secondary, community and primary care pathways Horizontal integration via networks and partnerships Since the publication of the Clinical Strategy, the Estates Strategy has been published, a Workforce Strategy is in development and an IM&T strategy has been commissioned. These strategies underpin the implementation of the Clinical Strategy. The Quality Strategy must support the broad organisational objectives and provide the framework for the delivery of the Trust vision for becoming a Modern District General Hospital. Figure 1: Clinical Strategy 2014-2017 Clinical Strategy 2014-2017 Effective emergency & ambulatory models of care Horizontal integration via networks and partnerships Vertical Integration of secondary, intermediate and primary care pathways Excellence in quality and safety Building Blocks Quality Strategy Workforce & Education Strategy IM&T Strategy Estates Strategy Communications & Engagement Plan Page 2 of 18

3. National Context a. Quality of care making progress on the Francis, Berwick and Keogh reports The emphasis on improving quality of care in the NHS has been supported by these three key reports, all published in 2013 and summarised in Appendix 1. The common themes and key implications affecting the development of our Quality Strategy include: Cultural change supporting an open culture, where people are unafraid to speak up, to raise concerns and to challenge custom and practice to improve care Patient-centred truly focusing service delivery and change on the needs of patients and their carers Safe staffing levels ensuring there are sufficient and appropriately trained and qualified staff to provide safe care Team working and engagement encouraging strong communication within and between teams and levels in complex organisations, supported by approaches including a duty of candour Consistency the need to provide more reliable care, consistent across settings, time of the day and days of the week b. Economic Climate and The NHS Five Year Forward view The NHS is facing an unprecedented period of resource constraint which is forecast to last at least until the end of this decade. NHS England projects that if current models of care continue, even if the health budget remains protected (after the election in 2015), the gap between funding and demand will increase to 30bn a year by 2021 (representing around 30% of the current NHS annual spend). The unsustainability of the current national models are described in the NHS Five Year Forward View. In particular it identifies three gaps : The health and wellbeing gap: if the nation fails to get serious about prevention then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness. The care and quality gap: unless we reshape care delivery, harness technology, and drive down variations in quality and safety of care, then patients changing needs will go unmet, people will be harmed who should have been cured, and unacceptable variations in outcomes will persist. The funding and efficiency gap: if we fail to match reasonable funding levels with wide-ranging and sometimes controversial system efficiencies, the result will be some combination of worse services, fewer staff, deficits, and restrictions on new treatments Page 3 of 18

c. The Equality Delivery System The Equality Delivery System (EDS) was launched by the national Equality and Diversity Council in 2011 to help NHS organisations improve the services they provide for their local communities and which meets the requirements of the Equality Act of 2010. Bedford Hospital has used the EDS system since 2011 and publishes the outcomes and objectives on its website annually. The Goals under EDS are: 1. Better health outcomes 2. Improved Patient Access and experience 3. A representative and supported workforce 4. Inclusive leadership 4. Local Context 2014/15 was a significant year for the Trust. The previous year had been particularly challenging for the organisation and for its staff and 2014/15 saw the impact of the responses to those challenges. Despite considerable operational pressures, especially during the winter period which included the closure of wards due to norovirus, the Trust achieved the key NHS Constitution waiting times standards for the year. It met national access targets including cancer and Referral to Treatment waiting times. It was one of a minority of Trusts in the east of England region to deliver the 95% A&E target and at regular times during the winter period was performing in the top 10% in the country. It met its targets for hospital acquired infection and made good progress in reducing incidents of harm (e.g. VTE, pressure ulcers) Our success in 2014/15 was due to the exceptional efforts of our staff to increase productivity and establish relationships with other health and social care providers to improve flow through the whole health and social care system. In2015/16 the challenge is to normalise this level of working and take it to the next level where the local health economy moves towards sustainability with Bedford Hospital at its core. Following the 2013 CQC inspection report and follow up the Trust received an unannounced CQC inspection in August 2014 and as a result received confirmation that it was meeting all national core quality and safety standards, one of the few local providers to be doing so. Following a positive review by Health Education England East of England in October 2014 paediatric junior doctors have returned to the Trust and the Trust now has a remodelled paediatric service providing excellent care. It was evident therefore that the Trust s aim for 2014/15 of prioritising quality and safety was successful. This though meant considerable pressure on the Trust s financial position, Page 4 of 18

resulting in a worsening of its overall deficit, and a clear priority for 2015/16 and beyond, which this strategy will be critical in supporting, is a return to ongoing financial viability, aligned to the development of new models of care and future organisational forms. Healthcare Review In October 2014, the healthcare review, commissioned to look at health services across Bedford and Milton Keynes, published a progress report which set out the work undertaken during the review s study phase and made recommendations for developing robust options for local health services. These included the development of an Emergency Care Centre and Integrated Care centres at either of the two hospital sites. The Trust, Bedfordshire CCG, local GPs and partners obtained feedback from the public, patients and clinicians and have further assessed the options for local applicability. This has been developed through the North Bedfordshire Primary and Acute Care Programme. This programme of work has focused on developing the following: A model for a vertically integrated hospital and community system, enabling local services to better support vulnerable people to be cared for outside hospital and deliver swifter assessment, diagnosis, treatment and discharge from hospital. Defining core hospital services and networking of hyperacute services to develop sustainable and modern district general hospital services that can meet the clinical standards of the future. This next phase of the review is expected to make further recommendations in Summer 2015 that will in turn lead to public consultation on the future models of care across Bedford and Milton Keynes 5. SWOT analysis Having reviewed both the national and the local context the SWOT analysis of our quality baseline has been completed. This is presented below. Strengths Measurable improvements in quality and safety e.g. reduction in infections, pressure ulcers Meeting and outperforming NHS access and performance delivery targets, including A&E and 18 week wait Staff engagement, enthusiasm and efforts. Track record of listening to staff Quality Improvement skills taught to 13 clinical leaders and supported through the first year of our Patient Safety Programme SHMI within expected levels Delivery Support Unit experienced in facilitating project management methodologies Weaknesses Variation in service delivery and performance across days of the week and clinical areas Inconsistent organisational training in continuous improvements and change management Limited success with making improvements in patient experience organisation wide Unrealised benefits from use of IT systems Variable quality of ward environments Registered Nurse vacancies are still too high Fragmented electronic patient records Some constraints in the physical layout of our estate Page 5 of 18

Opportunities National funding awarded via Nurse Technology Fund to introduce aspects of electronic patient records Build on relationships with Bedford CCG and Bedford Borough Council to develop and implement new models of urgent care and integrated care Build on track record to deliver further improvements in quality and safety Reconfiguration of clinical business units into divisions to give a stronger focus on quality improvement Potential integration with community services to improve patient pathways Threats Level of financial constraint in the NHS and local health and social care economy is beyond any levels previously experienced Impact of financial constraint particularly in social care, could impact on patient experience, e.g. through delayed discharges or transfers Growth in activity levels outstrips capacity because initiatives fail to shift more activity away from acute hospital care Potential transformation may distract from delivery 6. Conclusions From the review of the strategic context, there are clear emerging priorities that form the building blocks of our Quality Strategy. The strategic aims of the trust begin with achieving the vision of excellent quality and safety resulting in better health outcomes for our patients. This is in the context of developing new sustainable services within an environment that is demanding economic efficiencies and the better use of technology to support clinicians. The key building blocks to achieving this aim reflect some of the organisation s strengths prioritising safe staffing, effective team working, sustained improvements in quality and the introduction of improvement methodologies through the Patient Safety Programme to achieve reliability in the care we deliver. But we also need to build on some of the current weaknesses. Particularly relevant is the need to improve how we put the patient s experience at the centre of how we work. This is reflected in the as expected scores that we have achieved in the 2014 CQC in-patient survey, where we consistently scored middle of the road but did not excel in any of the eleven sections. We also know from what our recent PLACE survey tells us that some of our ward environments do not provide a sense of wellbeing for our patients. These conclusions have directly informed the quality priorities that are described in section two. Page 6 of 18

Section Two: Quality Vision 1. Trust Values Our values are the core of what Bedford Hospital NHS Trust is and what we cherish. They are beliefs that manifest in the behaviours our employees display in the workplace. Our Values were developed after listening to our staff. They bring the Trust closer to its vision to be the best hospital, providing the best care by the best people and ensure that our patients are at the centre of all we do. We are committed to promoting a culture founded on these values: Valuing people We care and value our patients and colleagues as individuals Leadership We take responsibility and are accountable for our actions Respect We respect our patients and our colleagues Honesty We are open, honest and fair in all we do Excellence We work together to deliver high quality sustainable standards of excellence The Trust values mirror and underpin the NHS Constitution. 2. Quality Vision The aim of the Quality Strategy is to ensure that; Patients of Bedford Hospital are able to access services of outstanding quality that are safe, effective and offer an excellent patient experience. We will demonstrate year on year improvement against our baseline and the final outcome will ensure that Bedford Hospital will be among the best and safest in the country. We also aspire to ensure that no preventable harm will happen to our patients. 3. Strategic Priorities It has been important to us that we build our vision for quality, with input from staff and patients and the public. A number of events have supported this including public listening events, workshops for staff, patients and the public, workshops with senior clinical leaders and discussion at key staff meetings. Our quality priorities can be summarised in the diagram overleaf. Each priority has a number of quality outcomes that will be achieved through the implementation of the strategy; these are outlined in the next section and can be found in full in appendix 2. A series of essential enablers are also outlined as they will also support the achievement of the strategy. Page 7 of 18

The following priorities have been identified through that engagement alongside the strategic review that was outlined in section 1. Specific outcomes are linked to each priority in appendix 2 and a pictorial representation of the priorities and the essential enablers can be found in figure 2. a. Deliver safe care and minimise harm The Keogh Report (2013) identified eight ambitions, which can be found in appendix 1, for tackling the underlying cause of poor care in hospitals and as such, set out the direction for improvement. Our priority for delivering safe care and minimising harm is based on these ambitions. Despite the hard work of healthcare professionals some patients come to harm in hospitals every day. Harm is suboptimal care which reaches the patient either because of something we shouldn t have done or something we didn t do that we should have done. Catastrophic harm events are rare, but unintentionally there are patients who experience some type of harm, for example hospital acquired infections, medication errors, surgical infections, and pressure ulcers. At Bedford Hospital, we measure harm in different ways; through Safety Thermometer, which is a national tool to monitor the prevalence of pressure ulcers, falls, catheter associated urinary tract infections and venous thromboembolism on a single day; and through tracking the numbers of harm events during each month. We want to improve patient safety across our services by: Identifying the baseline Set the ambition/ goals Introduce electronic ways of measuring harm wherever possible Continue to support clinical leaders through our Bedford Hospital Patient Safety Programme Reducing our reliance on agency and locum staff As a result we plan to make demonstrable progress towards reducing avoidable deaths and will continue with our Mortality Review process to identify necessary changes to achieve that. b. Deliver reliable care The Institute for Healthcare Improvement identify the importance of reducing variation in the way that we deliver healthcare services in order to deliver reliable care. There are many sources of variation along elective care pathways and these can affect the flow of patients through healthcare systems. Much of the variation is caused by the way we organise and provide services. Different statistical approaches help us with understanding this in more detail. The IHI has identified the reduction of variation as a key building block to support the improvement of patient safety. As such it forms the second strategic priority within our strategy. Traditionally healthcare has monitored care given to patients by looking at individual aspects of that care. An example of this might be the number of patients who have had a stroke who are given aspirin within 24 hours of the event. Often hospitals would report their performance against these aspects of care individually. We know however, that there are a series of interventions that should be given within 24 hours of a stroke, and unless the patient receives all of them then their chance of the best possible outcome is reduced. These series of interventions are known as care bundles. We plan to use the care bundle approach to reduce variation in our service and therefore improve patient safety. Page 8 of 18

We also know that when patients move from service to service their care can become fragmented and it can often feel as though there is a lack of communication. Agreed care pathways for patients with a particular healthcare condition or under-going a specific intervention are tools that direct the best practice care that should be given to an individual patient. Over the next three years we will continue to introduce new care bundles to improve care where needed and improve processes. As we develop our models we will also introduce new care pathways to support new services and ensure that best practice, such as named consultants and named nurses are consistently allocated for each patient during their stay. c. Deliver an excellent patient experience The Berwick Report (2013) identifies the need for patients and their carers to be present, powerful and involved at all levels of healthcare organisations for wards to boards of trusts. We have embraced this principle as our third strategic priority as during the development of our strategy our teams, members of the public and our stakeholders told us that the experience our patients have whilst under the care of our organisation was of utmost importance to them. We understand that many of our patients are often undergoing life changing diagnoses and treatments and it is our ambition that we make that experience the best that it can possibly be. We know that our staff satisfaction and engagement levels are in the top 20% of the country and this is a key building block to ensuring that our patients are well cared for. Over the next three years we will build on that by giving better information to patients, both verbally and in written form and ensuring that the experience of being discharged from our service is amongst the top in the country. It is of utmost importance to us that patients are prepared for their operation or procedure and that they have a very good experience of their care at Bedford Hospital, we will therefore strengthen our leadership of patient experience by introducing Lead Nurses into the our two new divisional leadership teams who are responsible for leading improvements in the patient s experience and introduce a facilitator role to support improvements across the organisation. d. Embed a Learning and Quality Culture In A promise to learn a commitment to act, Berwick (2013) identifies the need for the NHS to be devoted to continual learning and improvement of patient care, top to bottom and end to end. The report outlined ten recommendations, which are listed in appendix 1, the majority of which underpin the need to embed a learning and quality culture. Organisational culture is very difficult to measure but is vital to address if our ambition to deliver outstanding quality services is to be realised. Organisational culture means that staff share views on the way they should work together and treat each other and their patients. We have an ambition to be an organisation that has an excellent safety culture. The main elements of a safety culture are: Open and frequent communication High functioning multidisciplinary teams Just culture (understanding of system vs. individual errors) Robust error reporting systems that close the loop HR practices that support a culture of safety Organisational leadership that: o Focuses on never events and serious incidents Page 9 of 18

o o Is willing to address bad behaviours Is accountable for improving and safety at all levels Over the next three years we will embark on a series of projects aimed at fostering a culture of safety. These initiatives include training and coaching in teamwork and communication, Executive and Non-Executive Safety Walk Rounds, and the integration of quality improvement into every day workings of the Divisions. e. Deliver Effective Quality Governance and leadership We know that the leadership, management and governance of our organisation needs to work effectively to not only ensure the delivery of sustainable high quality person-centred care but also to support learning and innovation, and promote an open and fair culture. This is important not only at Board level but also throughout the whole organisation. The CQC inspected Bedford Hospital in 2014 and judged us as compliant with how we assess and monitor the quality of service provision, which incorporated the way led quality governance throughout the organisation. With our new divisional structure, it will be important for us to translate this achievement into ways of working that reflect the CQC s well-led domain. We want to ensure that our new divisions: Demonstrate an understanding of our risks to the quality, sustainability and delivery of current and future services Develop the capability of delivering safe and sustainable care through an open, transparent and quality-focused culture Have reporting lines and accountabilities that work within the new structure and that our teams understand processes for escalating and resolving issues and managing performance Measures our quality in a way that supports the leadership of the division and enables quality performance to be analysed and challenged Page 10 of 18

Figure 2: Quality Priorities and Essential Enablers Trust Vision To provide excellent acute and integrated care serves to the people of Bedfordshire Strategic Aims Excellence in quality and safety Effective emergency & ambulatory models of care Horizontal integration via networks and partnerships Vertical Integration of secondary, intermediate and primary care pathways Quality Vision Patients of Bedford Hospital are able to access services of outstanding quality that are safe, effective and offer an excellent patient experience. Quality Priorities 2015-2018 Deliver safe care and minimise harm Deliver reliable care Deliver an excellent patient experience Embed a learning and quality culture Deliver effective quality governance & leadership Enablers Estates Workforce & Education Organisational Development IM&T and Informatics 4. Essential Enablers The Trust has identified four essential enablers that are critical to achieving our vision and delivering on the Strategic Priorities: IT systems and informatics, our estates and the hospital environment, education, and organisational development. The following briefly summarises our organisational strategy for the four essential enablers and our approach to the underpinning areas. More detail is given in Section 3, Development Plans. a. IT systems and Informatics Better use of data and technology has the power to improve health, transform the quality and reduce the cost of health and care services. It can: give patients and citizens more control over their health and wellbeing empower carers reduce the administrative burden for care professionals support the development of new medicines and treatments The trust has commissioned the development of an IT strategy which will underpin the Quality Strategy. It will be important that this includes an approach to electronic patient records; the use of technology to support clinical teams in current and future service delivery. b. Our estates and the hospital environment The quality of care delivered to patients, the ability of staff to deliver that care and the experience of patients and their families is all impacted by the hospital environment. Page 11 of 18

Bedford Hospital s Estates Strategy 2014-19 identifies the estate priorities aligned with each of the trust s strategic priorities and clinical strategy priorities. The first strategically significant scheme in the strategy is the development of an appropriate and modern Accident and Emergency Department. Plans for this have begun and will include a co-located Primary Care Walk-in Centre In addition there are Business As Usual schemes including Ward Upgrades to manage the future expected risk in the infrastructure and backlog investment at high and significant risk in the ageing estate. The Strategy also identifies supporting schemes; improving the facilities to in diagnostics, additional Laminar Flow theatre capacity, appropriate inpatient ward accommodation, access and way-finding c. Workforce and Education The Trust is currently developing a Workforce strategy and an education strategy which will underpin the Quality Strategy. It will be important to ensure that this includes a clear plan to recruit the numbers of staff that are needed to deliver safe care as well as ensuring that the workforce is prepared to deliver excellent patient experience and we will need to consider how we can best support staff at all levels in the organisation to achieve this. The trust has developed its reputation over the last year for providing good education for medical staff and along with the leadership that has been established for nursing, midwifery and allied health professionals the trust will continue to achieve good quality external education reviews by all professional bodies as well as Health Education England. d. Organisational development The implementation and launch of our Trust values is underpinning our organisational development activity as well as enabling the achievement of the quality priorities within the Quality Strategy. It will also be important to have a plan for leadership development across the trust as well as continuing to commission organisational programmes to prepare and support staff to lead and implement safety and quality improvements. Page 12 of 18

Section Three: Delivery Plans 1. Our approach to delivery In order to deliver our Quality Strategy a Plan, Do, Study, Act (PDSA) approach will be taken. This approach has been championed by the Institute of Healthcare Improvement (IHI) to drive improvements in patient safety. It provides a structured approach for testing a change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act). The Trust s patient safety programme will teach this change methodology and support clinical leaders to use this approach in practice. There will also be a strong emphasis on incorporating human factors within our approach to enabling behavior change through the patient safety programme. 2. Milestones for Implementation year 1 Action to be achieved Date for completion Responsible lead Approve Quality Strategy by Trust Board July 2015 Director of Nursing and Patient Services New divisional structure July 2015 Chief Operating Officer goes live Launch programme of Non- July 2015 Director of Corporate Affairs Executive ward and department visits Launch programme of July 2015 Chief Operating Officer executive director in your shoes programme Agree capital plan for July 2015 Director of Finance development of the wards in the Main Ward Block Communication plan agreed August 2015 Director of Corporate Affairs to support implementation Continue to launch initiatives to embed the Trust s Values August 2015 Director of Workforce and OD New quality reporting format agreed to demonstrate progress towards quality priorities Bedford Hospital Patient Safety Programme commences Board review of Well-led domain Q2 Quality Strategy Progress Board Report Complete organisational patient safety culture survey Patient experience facilitation strengthened September 2015 September 2015 July Sep 15 October 2015 October 2015 October/ November 2015 Associate Director of Nursing - Quality Associate Director of Nursing - Quality Director of Corporate Affairs Director of Nursing and Patient Services Associate Director of Nursing - Quality Director of Nursing and Patient Services Page 13 of 18

Action to be achieved Date for completion Responsible lead Review of existing Patient November 2015 Director of Corporate Affairs Information complete with resourced plan agreed at Quality Board IT strategy approved by December 2015 Director of Finance Trust Board Workforce Strategy approved by Trust Board December 2015 Director of Workforce and OD Nurse Technology Fund phase 1 goes live January 2016 Associate Director of Nursing - Quality Q3 Quality Strategy Progress Board Report January 2016 Director of Nursing and Patient Services Q4 Quality Strategy Progress Board Report April 2016 Director of Nursing and Patient Services 3. Our approach to governance Every year the Trust is required to produce a Quality Account, which is subject to external audit and is published on the trust s website and on the NHS Choices website. The Quality Account monitors progress over the previous year and sets out plans for the coming year. The Quality Account will also report on progress with implementing the Quality Strategy and the quality priorities identified within the Quality Account will link to the trust s Quality Strategy. The trust s Executive Management Committee (EMC) has responsibility for the operational delivery of the trust s strategic objectives as all accountable managers and directors are members of the EMC. Quarterly reports identifying progress, issues and risks will be submitted to the EMC. The trust s Quality Board has responsibility for monitoring quality in its widest sense across the organisation. An exception report with a monthly set of metrics (found in appendix 2) which report on progress with the strategic priorities will be reported to the Quality Board. Page 14 of 18

Appendix 1: Summary of Francis, Keogh and Berwick reports Mid Staffordshire NHS Trust Public Inquiry 2013 The Francis Report The report of the review chaired by Robert Francis QC into the failings of care at Mid Staffordshire in relation to NHS leadership and culture. The report highlighted the need to do more to tackle pockets of poor practice, but support reform the wider NHS culture to ensure it consistently supports high quality, compassionate care. A particular emphasis was given to fostering a more open and transparent NHS with staff able to raise concerns and have honest conversations with patients. A summary of the themes behind the 290 recommendations is as follows: Values clarity and commitment to putting patients first, making the NHS constitution the shared reference point and ensure all NHS staff and contractors commit to NHS values Fundamental standards visible to the public, accepted by professionals and enshrined through regulation and monitoring (e.g. prescribed medication is given, patients and equipment kept clean) Openness, transparency and candour to raise concerns without fear, make accurate and useful information available, and inform patients where they have been harmed Compassionate, caring and committed nursing with support from assessment on entry to training standards, having a named nurse (and doctor) for each patient and rewarding goo practice Strong patient centred healthcare leadership recruit and train for values, leading by example Culture change supported but not dependent on the Government Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report the Keogh Report Professor Sir Bruce Keogh, National Medical Director, was asked by the Prime Minister to conduct a review into the quality of care and treatment at 14 hospitals with persistently high mortality rates. The review identified eight ambitions for tackling the underlying causes of poor care, clearly setting the direction for improvement: 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. 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. 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 own care and the care of others. 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. 5. 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. Page 15 of 18

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. 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. 8. All NHS organisations will 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. A promise to learn a commitment to act National Advisory Group on the Safety of Patients in England 2013 the Berwick Report Professor Don Berwick was asked by the Prime Minister to carry out a review of patient safety in the NHS following on from publication of the Francis Report. The report emphasised above all else the need for the NHS to become a system devoted to continual learning and improvement of patient care, top to bottom and end to end. It highlighted the extent of extent of new thinking and behaviours required across the health and care system including public, professionals and those using services. It also emphasised how fear works against both safety and improvement. The report provided the following brief statement in its Executive Summary and made ten recommendations. Place the quality of patient care, especially patient safety, above all other aims. Engage, empower, and hear patients and carers at all times. Foster whole-heartedly the growth and development of all staff, including their ability and support to improve the processes in which they work. Embrace transparency unequivocally and everywhere, in the service of accountability, trust, and the growth of knowledge. 1. The NHS should continually and forever reduce patient harm by embracing wholeheartedly an ethic of learning. 2. All leaders concerned with NHS healthcare political, regulatory, governance, executive, clinical and advocacy should place quality of care in general, and patient safety in particular, at the top of their priorities for investment, inquiry, improvement, regular reporting, encouragement and support. 3. Patients and their carers should be present, powerful and involved at all levels of healthcare organisations from wards to the boards of Trusts. 4. Government, Health Education England and NHS England should assure that sufficient staff are available to meet the NHS s needs now and in the future. Healthcare organisations should ensure that staff are present in appropriate numbers to provide safe care at all times and are well-supported. 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. 6. The NHS should become a learning organisation. Its leaders should create and support the capability for learning, and therefore change, at scale, within the NHS. 7. Transparency should be complete, timely and unequivocal. All data on quality and safety, whether assembled by government, organisations, or professional societies, should be Page 16 of 18

shared in a timely fashion with all parties who want it, including, in accessible form, with the public. 8. All organisations should seek out the patient and carer voice as an essential asset in monitoring the safety and quality of care. 9. Supervisory and regulatory systems should be simple and clear. They should avoid diffusion of responsibility. They should be respectful of the goodwill and sound intention of the vast majority of staff. All incentives should point in the same direction. 10. We support responsive regulation of organisations, with a hierarchy of responses. Recourse to criminal sanctions should be extremely rare, and should function primarily as a deterrent to wilful or reckless neglect or mistreatment. Page 17 of 18

Appendix 2: Quality Outcomes associated with each Strategic Priority Page 18 of 18