Quality Strategy and Improvement Plan

Quality Strategy and Improvement Plan 2015-2018

STRATEGY DOCUMENT DETAILS Status: FINAL Originating Date: October 2015 Date Ratified: Next Review Date: April 2018 Accountable Director: Strategy Authors: 4 November 2015 (Quality Committee) Gail Briers, Chief Nurse and Executive Director of Clinical Operational Services Julie Chadwick, Assistant Director of Integrated Governance Jackie Hughes, Head of Compliance CONTENTS PAGE PART ONE: QUALITY STRATEGY Introduction What does quality mean to North West Boroughs Healthcare? Why have a quality strategy? What quality means to our staff How the quality strategy was developed 3 3 4 4 5 How we monitor and report progress and achievement of quality 6 PART TWO: QUALITY IMPROVEMENT PLAN Culture of Care 10 Sign up to Safety 11 CQUIN 12 Quality Priorities 13 Quality Improvement Cycle 16 Quality Big Dots 17 Lessons Learned 18 2

PART ONE QUALITY STRATEGY 1. Introduction: North West Boroughs Healthcare NHS Foundation Trust provides mental health, learning disability and community health services to people in Halton, Knowsley, Sefton, St Helens, Warrington and Wigan, as well as criminal justice liaison services across Greater Manchester. The Trust has a turnover of approximately 140m a year (covering alongside GPs, providing primary care support to patients and a number of independent sector providers population of approximately 700,000). The Trust is the primary public sector provider of mental health services on this footprint. We are committed to providing the highest quality services possible for the patients we serve. This quality strategy incorporates the listening from our patients, carers, families and stakeholders into a framework where we can identify quality initiatives and goals, take action and not only meet but exceed their expectations for what matters most to them. In conjunction with the Quality Strategy the Trust has developed the Living Life Well strategy that ensures our approach to peoples care is equitable, inclusive and reflects strong social values for anyone who requires our services at any point in their lives, based on the following set of principles. We commit to the users of our service having their basic needs identified and addressed Compassion in practice will be evidenced by all users of our service having their goals identified and addressed Our care quality is underpinned by all our teams providing personalised services We will courageously ensure that all services are strengths based, concentrating on what can be done rather than what the problem may be. The way that we communicate across organisational boundaries will promote social inclusion We are committed to working in partnership with patients and carers as equals We recognise carers as partners in what we do. The competencies of our staff enable promotion and encouragement of advanced planning and self-management. We support and value our staff We are committed to evidencing the above principles in the way we deliver our services and work with our partners Our strategic intentions reflect our commitment to supporting our communities to live their lives well. Further details about our Living Life Well Strategy and approach are available on the Trust s internet site. http://www.5boroughspartnership.nhs.uk/ 2. What does quality mean to North West Boroughs Healthcare? Good quality healthcare depends on getting the basics right; safe, effective harm free care, at home or in a clean and pleasant environment, where people feel welcome, and are treated with dignity and respect. We believe that it is every patient s right to receive high quality care by a well-trained and supported workforce. 3

Quality is at the heart of everything we do at North West Boroughs Healthcare, this strategy is linked directly to the Trust s Purpose, high level objectives, values and with the quality definition at its heart. Quality Definition The users of our services are the first priority in everything we do, ensuring that they receive effective care from caring, compassionate, and committed people, working within a common culture and protected from harm. Trust Governance Principles: We deliver our services safety We have sufficient, highly motivated and skilled staff We deliver to our patients and users We are financially viable We are delivering our strategy Our stakeholders support what we do Trust Purpose: We will take a lead in improving the wellbeing of our communities in order to make a positive difference throughout people s lives Our Values: We value people as individuals ensuring we are all treated with dignity and respect We value quality and strive for excellence in everything we do We value, encourage, and recognise everyone s contribution and feedback We value open, two-way communication, to promote a listening and learning culture We value and deliver on the commitments we make 3. Why have a quality strategy? This quality strategy is available publically. It demonstrates how the Trust identifies and makes continuous improvements to the quality of care we provide. It outlines the key drivers to identifying our quality improvement work and how we engage with our staff, patients, their families and stakeholders in identifying what is important to them. It also outlines the strategy, using objectives and different quality 4 initiatives that form our Quality Improvement Plan, as well as how we will achieve measure and monitor them. The Quality Improvement Plan is included in Part 2 of this strategy; it contains details of each quality improvement initiative in more detail and is updated annually to reflect the current work being undertaken. 4. What quality means to our staff The Trust recognises the connection between the quality of care our patients receive, and the values, aspirations, and skills of our staff. We believe staff that are better engaged deliver better care. There is compelling evidence that staff wellbeing, and staff experience, correlate with patient experience and outcome. We therefore strive to develop and make best use of the potential and expertise of all those who work for the Trust to provide the highest standards of care to patients. This is why we have developed our own Culture of Care based on the Chief Nursing Officer of England s 6C s initiative.

5. How the quality strategy was developed In 2010 Lord Darzi released a report commissioned by the Department of Health to look at the way in which healthcare was delivered across the country. His report, High Quality Care For All, the next stage review, identified the three domains of quality essential to provide a high quality service, based on patients needs. These three domains, shown below, have shaped and underpin this strategy and the way we provide high quality care. Safety (Patient and Health and Safety) ensuring service users come to no harm within our services Effectiveness ensuring service users receive the right treatments, delivering the right results Patient Experience we listen to service users and carers and their experience of being in our Trust In addition, subsequent publications including Francis, Keogh, Berwick, and the five year forward view continue to be drivers within the Trust to improve quality, using the findings and recommendations to shape our Trust Objectives and Quality Improvement Plan. The quality strategy is made up of all the elements below; Quality Objectives all quality initiatives are categorised into these objectives. Quality Big Dots Longer term aspirational goals with yearly quality initiatives Quality Account Priorities yearly quality initiatives developed in partnership with our service users, carers and stakeholders Quality Improvement Cycle measurement of quality to inform future quality improvement Sign Up to Safety - National safety campaign Lessons Learned continual learning and improvement from experience CQUIN Commissioning for Quality and Innovation yearly improvement initiatives 5 We have given a brief description of these below and in Part 2 of the Strategy you can see our high level plans to implement them. 5.1 Quality Objectives The Trust has established a set of Quality Objectives, which follow the 3 domains of Safety; they set out the Trust s long term objectives, by which all quality improvement is categorised. Safety our goal is to improve safety and reduce harm to patients Objective 1 To improve safety and reduce harm to patients Objective 2 To promote a patient safety culture, encourage incident reporting and learning from adverse events. Objective 3 To reduce avoidable harm to service users and staff by 20% year on year Objective 4 To aspire to reduce service user suicide to zero in 5 years (2013/14 2017/18) Objective 5 To review and monitor the management of the serious incident process across the Trust Effectiveness Our goal is to demonstrate success in our outcomes Objective 1 To improve care and outcomes for our service users Objective 2 To ensure compliance against appropriate NICE guidelines Objective 3 To ensure compliance and frontline understanding of Care Quality Commission standards Objective 4 To promote quality at an operational level Experience Our aim is to ensure that people using our services have the best possible experience. Objective 1 To fully engage service users and carers where indicated in their care Objective 2 To continue to improve the collaborative participation and engagement of service users Objective 3 To listen and engage with our service users to continue to improve quality of care

All quality initiatives undertaken by the Trust fit within the objectives set out above, and these include the Trust s established Quality Big Dots and Quality Priorities as defined below. 5.2 Quality Big Dots 2013/14 2017/18 The Trust has established three Quality Big Dots which cover a five year period. These big dots were established by the Trust Board, Senior Leadership Team and Council of Members, supported by AQuA (Advancing Quality Alliance). The following big dots are supported by programmes of work; We will demonstrate a year on year improvement in the collaborative participation with, and engagement of, service users. This will result in improved collaboration and engagement of service users with a long term condition, thus achieving the Quality Big Dot. We will implement our suicide reduction strategy with the aim to reduce service user suicide to zero in five years. This will be achieved by the implementation of a suicide reduction strategy that will be informed by a suicide audit scheduled which we completed at the end of 2013/14. We will aim to reduce avoidable harm to service users and staff by 20% year on year. To reduce avoidable harm to service users and staff by 20% year on year. This will be achieved by an initial scoping of the harms that the trust will focus on and the development of a five year trajectory. 5.3 Quality Account Priorities To demonstrate the Trust s continual commitment to quality improvement each year we engaged with our five Health watch organisations, five Local Authorities, and five Clinical Commissioning groups, as well as our service users and carers and the Council of Members to establish the Trust s Quality Priorities for the coming year. These Quality Priorities follow the same domains of safety, experience and effectiveness and are monitored throughout the year. Themes for each area have now been identified as; Safety Sign up to Safety - During 2015/16 the Trust will expand on previous Quality Priorities by supporting the national Sign up to Safety Campaign, launched by NHS England in 2014. Effectiveness Care Planning - During 2015/16, we will build on work of the 2014/15 Quality Priority and make care plans/statements of care, simple and formed in partnership with service users and/or their carer s. Experience Using patient and staff feedback to shape improvements in services. During 2015/16 we will bring together feedback from patients, carers and staff into one place to inform the development and continual improvement of services. 5.4 Quality Improvement Cycle The Trust will continue to assess itself monthly against the Fundamental Standards of Care, CQC intelligent Monitoring and internal assessments of compliance; reporting monthly to the Trust Board. Assurances will be provided using the Clinical Quality Assurance cycle that incorporates the following three areas: Team Quality Assessment An internal teamled self-assessment of the services they provide. Measured against specific prompts created to reflect the standards of quality and safety and Trust policy. The prompts are considered by the team from three points of view; staff and observations, documentation and service user and carer feedback. Internal Quality Reviews A programme of unannounced inspections of teams undertaken by staff, service user / carer volunteers and Non-Executive Directors, against the standards of quality and safety and Trust policy. Quality and Safety Walk-abouts A programme of visits by Trust Board Members, designed by the Trust and AQuA, to have a 6

structured conversation about safety with frontline staff and patients. These visits are instrumental in developing our open culture where the safety of patients is seen as an organisational priority. The resulting reports feedback into the quality and safety governance arrangements at the Trust and directly at the Board Meetings. Continuous Clinical Improvement A review of outcomes from the above elements that identify areas for improvement. These are either carried out at a local level within teams, or on a Trust wide basis informing the quality agenda for the Trust. 5.5 Sign up to Safety In June 2014 a national Sign Up to Safety Campaign was launched, with the mission to strengthen patient safety in the NHS and make it the safest healthcare system in the world. The ambition was to reduce avoidable harm by half in the NHS over three years, saving 6000 lives. In November 2014 the Trust adopted the sign up to safety campaign, and we submitted our pledges and Safety Improvement Plan to NHS England in January 2015. Sign up to Safety became a Trust high level objective for 2015/16 under the theme Are we delivering our services safely? It has also been agreed by the Trust Board as a quality priority for safety for 2015/16 and is set out as a trust intention in the Quality Account. 5.6 Lessons Learned A learning organisation has been defined by Senge (1992) as a place where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to see the whole (reality) together." The Trust is driven to becoming an organisation that rigorously and consistently utilises and develops the collective knowledge and experiences of its people, and through this we learn and develop. The Trust is putting in place a number of additional methods to enhance the lessons learned within the Trust, as we believe this learning is powerful in the pursuit of continuous improvement. The Trust is a high reporter of incidents, which we believe demonstrates an open safety culture. By examining and learning from incidents and sharing the things we do well we constantly improve the quality of care we deliver. This helps to deliver a better service user experience. The Lessons Learned programme within the Trust is driving how we do this. 5.7 CQUIN (Commissioning for Quality and Improvement) CQUINS are agreed yearly, with the organisations that commission our services; they are made up of both national and local goals, with the aim to incentivise quality and efficiency. We use CQUIN targets within our quality measures to provide further information on Trust performance. These measures cover in-patient and community mental health and learning disabilities and community health services provided across our boroughs; they fit into the same quality domains of safety, experience and effectiveness. 6. How we monitor and report progress and achievement of quality The measurement, monitoring and reporting of quality within the Trust is an important part of the Quality Strategy and requires the following robust governance arrangements we have in place. 6.1 Governance Arrangements The Quality Committee is a sub-committee of the Trust Board with delegated powers to provide leadership and assurance to the Trust Board on the effectiveness of Trust arrangement s for quality, ensuring there is a consistent approach throughout the Trust, specifically in the domain areas of: 7

Safety (Patient and Health and Safety) Effectiveness Patient Experience The Quality Committee agree and oversee the Quality Strategy, with a scheduled work plan in place to ensure that all the elements of the Strategy are regularly reviewed and monitored; reporting monthly to the Trust Board. Each element of the Quality Strategy has an accountable Executive Director and identified Trust Leads with responsibility for the implementation of the Quality Initiatives, supported by groups of experienced staff to drive improvement and change within service delivery. 6.2 Quality Accounts Each year the Trust publishes the Quality Accounts, this is a report on the quality of our services; focusing on patient experience, clinical effectiveness and patient safety. The report provides updates on quality initiatives undertaken throughout the previous year and details of the quality improvement priorities for the year ahead. The quality account process is the opportunity to engage with patients, their families, staff, local commissioners, partner organisations, and Foundation Trust members to determine future priorities. 8

PART TWO QUALITY IMPROVEMENT PLAN 2015-2016 The Quality Improvement Plan 2015-2016 is surrounded by the use of tried and tested Service Improvement Methodology which is underpinned by the Trusts Culture of Care. The third circle of the Quality Strategy Wheel contains the six elements which bring our Quality Definition to life. This part of the Strategy provides the high level plans for implementation of the 2015/16 initiatives for; Sign Up to Safety CQUIN (Commissioning for Quality and Innovation) Quality Priorities Quality Improvement Cycle Quality Big Dots Lessons Learned 9

Our Culture of Care Our Culture of Care underpins the Quality Strategy. It brings learning and improvement from external reports (notably, Francis, Berwick and Cavendish) that identified a need for quality improvement in healthcare. Our Culture of Care recognises and translates the Chief Nursing Officer s call to action to embed the 6Cs into everyday practice across all health care organisations. Care Compassion Competence Communication Courage Commitment Culture of Care, has a three year plan. 2013-2014 Branding 2014-2015 Publicity and Promotion 2015-2016 Embedding in Practice 2013/14 When the 6 Cs were launched by the Chief Nursing Officer it was very much aimed at nursing staff. At the Trust we believe that the ethos and principles of the 6 Cs applied to everyone so we developed our own Culture of Care Initiative. We encouraged all staff to sign up to be Care Makers, and were the first trust to include Doctors, Allied Health Professionals, Communication Professionals and Estates Professionals in this initiative. In doing so, this assisted us to realise the 6 Cs and put these into action. embraced the 6 Cs for all. Staff were invited to speak at prestigious events and we received positive feedback about what the Trust has undertaken to promote the 6 Cs. During 2015-2016 This year we want to find out if the Culture of Care Campaign has been successful and has truly become the way we do things here. To do this we are; Developing a set of questions to test the culture of the organisation, this together with the Friends and Family Test will provide a measure against the implementation of the 6 Cs Looking at how we further embed these values by developing further communications to set expectations In 2014/15 Culture of Care became a Trust Quality Priority, with a number of events held to publicise and promote the Culture of Care within the Trust. This included a launch event attended by the Chief Nursing Officer for England, who was delighted with the way the Trust had 10

Sign up to Safety In June 2014 a national Sign Up to Safety Campaign was launched, with the mission to strengthen patient safety in the NHS and make it the safest healthcare system in the world. The ambition was to halve avoidable harm in the NHS over three years, saving 6000 lives. In November 2014, the Trust adopted the sign to safety campaign, and we submitted our pledges and Safety Improvement Plan to NHS England in January 2015. Sign up to Safety became a Trust high level objective for 2015/16 under the theme Are we delivering our services safely? We will establish targets for the reduction in avoidable harm for the following areas Self-harm Suicide Falls Violence and Aggression Physical Health By collaborating with other Trusts, we will develop learning networks in order to determine harm reduction priorities and develop and implement these solutions locally. By monitoring these projects appropriately we will measure their overall effectiveness in reducing harm during 2015-2016. Quarter 1 Develop and agree the Trust s Safety Improvement Strategy which will include a year one work plan and communication plan. Establish how we will define and identify avoidable harm, to ensure accurate reporting of progress. Utilise existing strategic groups to implement the Safety Improvement Strategy. 11 Develop bespoke training for Matrons and Quality Leads. Develop indicators for the reduction of avoidable harm including % target reduction in years 1, 2 and 3. Develop and design the role of the Safety Ambassador. Quarter 2 Deliver bespoke training to Matrons and Quality Leads. Develop a cohort of Safety Ambassadors, along with roles and responsibilities and training required to fulfil role Quarter 3 Safety Ambassadors in place to identify safety initiatives within their own areas of work and produce Safety Improvement Plans. Quarter 4 Safety Ambassadors present the outcomes of safety improvement plans to the Quality Committee. Evaluate the Trust s Safety Culture using a questionnaire that will be used to shape work plan for year 2.

CQUIN (Commissioning for Quality and Innovation) The CQUIN framework is a national framework for locally-agreed schemes, set by Clinical Commissioning Groups (CCGs) to improve quality and efficiency. The aim of the framework is to help the NHS to improve patient experiences and outcomes. The 2015/16 Trust CQUINs are in the following quality and clinical areas: Child and Adolescent Mental Health Services (CAMHS) Improving care pathway journeys Assuring the appropriateness of unplanned CAMHS admissions Single Point of Access (St Helens) Eating Disorders Children and Young People (Wigan) Mental Health and Learning Disabilities: Physical Health of Mental Health Patients Urgent Emergency Care Employment and Mental Health Mental Health First Aid Smoking Cessation Single Point of Access (Warrington) Care Home Support (Warrington) MH Safety Thermometer (Warrington) Secure Services Physical Health of Mental Health Patients Risk Assessment Carer Involvement Community Health Services: Urgent Emergency Care and Integrating care for patients with LTC Frail Elderly Health Inequalities Each CQUIN target has an allocated Assistant Clinical Director lead, and progress is monitored via monthly CQUIN Update Meetings with leads which is chaired by the Deputy Director of Nursing and Quality. 12

Measurable, Achievable, Realistic and Timed (SMART) The Trust will develop mechanisms to monitor care plans/statements of care for effectiveness. Quarter 4 Re-audits will take place to ensure improvements have been made and are embedded in practice. To demonstrate the Trust s continual commitment to quality improvement each year we engaged with our five Health watch organisations, five Local Authorities, and five Clinical Commissioning groups, as well as our service users and carers and the Council of Members to establish the Trust s Quality Priorities for the coming year. These Quality Priorities follow the same domains of safety, experience and effectiveness, and are monitored throughout the year. Themes for each area have now been identified as; We will continue to use those people already trained from the Involvement Scheme to conduct on-going audits which were developed as part of the care planning priority from last year. Quarter 1 The care planning module in RiO will use the SMART for care planning/statements of care. We will develop an audit tool to reflect this format. Quarter 2 We will audit 50 care plans using the new audit tool. We will report the findings of the audits to the Quality Committee. 2. Using patient and staff feedback to shape improvements in services PATIENT LIAISON SERVICE (PALS) We will improve our systems to ensure that all PALS activity is recorded sufficiently. This will allow us to analyse concerns raised and incorporate PALS into existing mechanisms currently used for complaints that we use to shape improvements in our services. We want to ensure that the service PALS provides is appropriate and effective. We will introduce a method to evaluate the service provided and use the feedback as an opportunity to shape and develop the service to ensure that it meets the needs of those who use it. 1. Care Planning We will ensure that the care planning module in RiO (new electronic records system) is aligned to ensure that care plans are Specific, Quarter 3 Action plans will be developed and implemented for any improvement areas from the audits results. 13 Quarter 1 PALS activity will be recorded using the Trust s Risk Management System, Datix; it will identify both the borough, and themes

of concerns together with outcomes and actions. PALS feedback and evaluation methods will be developed and agreed. These will comprise of methods for both people contacting the service and staff. Quarter 2 Develop and agree robust reporting mechanisms for PALS activity, to align fully with existing processes used for the evaluation of themes and feedback for complaints. Roll out the agreed evaluation methods to gain patient and staff feedback of the service provided by PALS. Quarter 3 Implement the agreed reporting methods to aggregate the PALS activity from the Datix system, and communicate these within our services and teams to establish actions for improvements. Review and report on the feedback received from the evaluation of the PALS service; and agree improvements and actions to achieve this. Quarter 4 Receive and report on actions taken within services to address PALS concerns within our services, to ensure that further learning is disseminated throughout the Trust. Implement actions and report against progress and changes made as a result of the evaluation exercises. Family and Friends Test (FFT) FFT was introduced to all areas of the Trust from January 2015. Outcomes from the FFT will be published nationally on a quarterly basis from April 2015. The Trust will establish a working group that will develop a process for measuring the impact of and sharing the intelligence and learning from FFT. Quarter 1 Membership of the Friends and Family Working Group will be established. The Group will meet and agree their Terms of Reference. Quarter 2 The Group will identify and agree methods of data collection for the whole Trust, and decide on a system to measure improvements from actions implemented as a result of FFT. 14 Quarter 3 Collect and collate information on improvements. Identify opportunities to utilise other patient experience intelligence to form an overall picture of patient satisfaction. Quarter 4 Provide a report to the Trust s Quality and Safety Meeting that incorporates collated PALS information with other patient experience sources identifying where improvements are needed and been made within services. Incorporate PALS information to Patient Experience Reports for each borough. Values Based Recruitment The Trust is committed to ensuring we have the right staff, with the right values in our services. By recruiting the right people who are caring, compassionate and committed, we will in turn increase the quality of care we provide. To support this commitment, we have introduced a series of Values Based Interview tools aligned to both the Trust Values and the

Nursing Six C s. Each value contains a series of interview questions, enabling managers to select from a range of options. In addition, the tool requires managers to create their own technical competency-based questions, resulting in candidates having a two-part interview consisting of five values questions and a number of technical ones. The Trust has also introduced other values based recruitment selection tools which we would like to develop further as below. Quarter 1 Continue to actively promote the values based interviewing tools across Nursing and seek on going feedback from managers. Trial the Admin and Clerical values based interviewing tools across the Trust, proactively involving managers in the development of questions. Implement Values Based Application questions on NHS Jobs for all posts that are advertised. Train a further 25-30 recruiting managers and service users and carers in Values and Behavioural Based Interview Training, evaluating feedback regularly. Continue to develop the pool of service user and carer values based interview questions. Further extend the service user and carer interview involvement scheme to band 6 posts and above. Quarter 2 Involve Domestic Managers in the introduction of values based interview questions for both substantive and bank posts. This will include on-going evaluation from recruiting managers. Create a values based interviews assessment centre / recruitment event tool kit incorporating role play materials and scenario based exercises for volume posts. Train a further 25-30 recruiting managers and service users and carers in Values and Behavioural Based Interview Training, evaluating feedback regularly. Start work on the values based interview tool for Psychological Therapies, engaging recruiting managers in the design of the questions and subsequent piloting. Further extend the service user and carer interview involvement scheme to band 5 posts and above. Quarter 3: Commence working on values based interview questions for Medical and Consultant recruitment, engaging senior medical leaders in the design of questions. Start work on the design of AHP values based interview questions involving recruiting managers throughout. Train a further 25-30 recruiting managers and service users and carers in Values and Behavioural Based Interview Training, evaluating feedback regularly. Further extend the service user and carer interview involvement scheme to band 4 posts and above. 15

The Trust will continue to assess itself monthly, against the Fundamental Standards of Care, CQC intelligent Monitoring and internal assessments of compliance; reporting monthly to the Trust Board. Assurances will be provided by via the Clinical Quality Assurance cycle that incorporates the following three areas: 1. Team Quality Assessment A team led review of the services they provide, against specific prompts created to reflect the standards of quality and safety and Trust policy, against the domains of; staff and observations, documentation and service user and carer feedback. We will update the team quality assessment tool to reflect the framework of the CQC Fundamental Standard. We will collate and report and report against progress of Caring, Responsive, Effective, Well-led and Safe to identify hot spots for further trust-wide and local learning and improvement. 2. Internal Quality Reviews A programme of inspections of teams undertaken by staff, service user / carer volunteers and Non-Executive Directors; against the standards of quality and safety and Trust policy. We will provide support our clinical teams in the completion of the Team Quality Assessment and review the evidence gathered for their self-declarations. We will review action plans for the team quality assessment and Quality and safety walk-rounds and support teams to achieve improvements. We will gather information from the internal quality reviews to identify Trust wide improvements that will shape future quality initiatives. 16 3. Quality and safety Walk-rounds These walk-rounds are instrumental in developing our open culture where the safety of patients is seen as an organisational priority. We will continue with the programme of weekly walk-rounds by Trust Board Members and Senior Managers, designed to have a structured conversation around safety with frontline staff and patients. We will produce comprehensive reports to feedback into the quality and safety governance arrangements at the Trust and directly at the Board Meetings. 4. Continuous Clinical Improvement We will review the outcomes from the above elements to identify areas for improvement, either at a local level or on a Trust wide basis that informs the quality agenda for the Trust.

Quality Big Dots The Trust has established three Quality Big Dots which cover a five year period 2013-2014 to 2017-2018. As the Quality Big Dots have longer term goals than the in-year Quality Priorities, the measurement of achievement differs to reflect both goals. Big Dot One We will demonstrate a year on year improvement in the collaborative participation with, and engagement of, service users. This will result in improved collaboration and engagement of service users with a long term condition, thus achieving the Quality Big Dot. Big Dot Two This quality big dot aligns to the 2015-2016 high level objective under the theme of Are we delivering our services safely? Big Dot Three We will aim to reduce avoidable harm to service users and staff by 20% year on year. To reduce avoidable harm to service users and staff by 20% year on year. - This will be achieved by an initial scoping of the harms that the trust will focus on and the development of a five year trajectory. This quality big dot aligns to the 2015-2016 high level objective under the theme of Are we delivering our services safely? These big dots were established by the Trust Board, Senior Leadership Team and Council of Governors, supported by AQuA. We will implement our suicide reduction strategy with the aim to reduce service user suicide to zero in five years. Each quality big dot is shown here; they mirror the three Quality Priorities for 2014-2015 and have joint work plans and monitoring arrangements with the Trust s Quality Committee. This will be achieved by the implementation of a suicide reduction strategy that will be informed by a suicide audit scheduled for completion by the end of 2013/14. 17

To support the Trust as a learning organisation we have established a Lessons Learned Forum chaired by the Medical Director. The aims of the forum are; 1. To provide assurance to the Trust that lessons are learned from Serious Incidents. As part of the Trusts Transformation agenda we are developing a standard approach to learning lessons which can be applied to broader areas of learning such as organisational change projects and improvement initiatives in addition to individual areas such as serious incidents. Lessons Learned The Trust is driven to becoming an organisation that rigorously and consistently utilises and develops the collective knowledge and experiences of its people. Through each experience we learn and develop as individuals, so learning often feels quite natural. Yet learning is much like an art and a skill in that it can be developed and perfected. When considered carefully, learning can be very powerful for individuals and organisations in the pursuit of continuous improvement. 2. To prevent reoccurrence of Serious Incidents, by holding to account, strategic and operational groups to deliver on actions from Serious Incidents linked to rapid improvement. 3. To monitor and test improvements made are sustained and embedded. The group identify themes from serious incidents and commission work to address these issues. This is then presented back to the Organisation in a variety of ways through the Trusts internal communications and by holding events to share the outcomes of incidents, promote best practice and improve patient safety. 18