matters... · Web viewSince 2011, the Trust has been an integrated healthcare provider, providing services in both acute and community settings, supplemented by health improvement

QUALITY MATTERS 2015/17

Appendix 1 – Behaviours Framework

Clinical Quality & Safety Improvement Strategy

‘Quality Matters’ is the clinical quality and safety improvement strategy for County Durham and Darlington NHS Foundation Trust. The purpose of this strategy is to support the delivery of the organisation’s vision, which is as follows:

‘Right First Time, Every Time’

The Trust’s ambition

Since 2011, the Trust has been an integrated healthcare provider, providing services in both acute and community settings, supplemented by health improvement services. Through consultation with our staff, we developed our mission statement ‘with you all the way’. This reflects our commitment to provide the best possible care to our patients at all stages along their care pathway and the best possible experience to our patients and staff, using resources wisely. Reflecting these different elements, we also articulated four ‘best’ touchstones to supplement our mission statement.

Recently the Trust has reviewed its future direction, with its staff and external stakeholders and has affirmed both: a

A vision for the future of ‘Right First Time, Every Time’: we want to ensure that our patients are treated in the right place, by the right clinician, first time and every time, 24/7; and

A set of strategic principles setting out standards that our services should meet in order to realise our vision.

‘Quality Matters’ is one of the Trust’s two core strategies for realising our vision, together with our Organisation Development Strategy, ‘Staff Matter’. They will be supported with strategic developments in enabling areas such IT, Estates and Workforce.

This strategy therefore complements the Trust’s Organisation Development Strategy, ‘Staff Matter’. Together these two strategies set out the organisation’s principles and objectives in order to:

Improve the quality of patient care (Safety, Effectiveness and Experience) Improve the experiences of staff in terms of career development and

behaviours.

The whole framework is encapsulated in the diagram overleaf:

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Values and behavioursAlongside the development of the above framework, we have decided to adopt the NHS Constitution values as our Trust values. We used the values to engage with staff to develop our behavior framework. These will underpin the delivery and success of this strategy. We will recruit and nurture our staff so that we see these values and behaviours at all times from all staff. The values are as follows:

The behaviour framework can be found at Appendix 1.

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How we developed the StrategyWe have used a discussion document for over 12 months to enable stakeholder engagement to influence our evolving clinical and quality strategy. These were originally two separate documents ‘Right, first time, 24/7’ and the Quality Strategy 2013-2015. However, these have now been merged into one overarching strategy; this document. The decision to have one document for both the provision of clinical services and the ongoing improvement of quality and safety was suggested by our lead clinicians and one that stakeholders agreed with. As such, this document encompasses and replaces the Quality Strategy approved by the Board in October 2013. The Clinical Strategy Steering Group will continue to drive the ‘Effectiveness’ priorities of this strategy, building on all the work which has taken place to date in evaluating options for service configuration and service improvement areas under the three ‘Breakthrough’ headings of:

Transforming Unscheduled Care Centres of Excellence; and Integration and Care Closer to Home

In addition, this strategy incorporates the Trust’s obligations and priorities in its Quality Accounts and other safety initiatives including the ‘Sign up to Safety’ pledges (Appendix 2). The priorities were agreed via stakeholder events, Quality Account engagement and more recently focus groups with a variety of staffing groups. The aim of this is to bring all of our priorities into one overarching strategy and plan.

Areas that are still important but that the Trust has already made significant improvements on, such as health care acquired infections, will still be monitored internally and outcomes shared with our stakeholders. However, this strategy focuses on the organisation’s most significant quality improvement priorities.

Priorities for 2015-2017The NHS, since the publication of High Quality Care for All1 in 2008, has used a three-part definition of quality. NHS England describes this on its website as:

‘The single common definition of quality which encompasses three equally important parts:

• Care that is clinically effective- not just in the eyes of cliniciansbut in the eyes of patients themselves;

• Care that is safe; and,• Care that provides as positive an experience for patients as

possible

High quality care is only being achieved when all three dimensions are present- not just one or two of them. And when we strive for high quality care, we must do so for everyone, including those who are vulnerable, who live in poverty and who are isolated. By seeking to deliver high quality care for all, we are striving to reduce inequalities in access to health services and in the outcomes from care.’1High Quality Healthcare for All, Darzi, 2008

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As such, the priority areas for clinical quality improvement and safety for CDDFT are aligned to these three essential dimensions.

Safety

Patient FallsSepsis Learning from incidents

Effectiveness

Right patient, right place, right timeCare bundlesHealth ImprovementUnscheduled Care

Experience

Dementia Care End of Life

Nutrition & Hydration

Monitoring & ReportingThe Quality & Healthcare Governance Committee is responsible for providing assurance to the Board of Directors that the Trust is managing the quality of patient care, the effectiveness of clinical interventions, patient experience and patient safety. The Committee will review the quality goals at its meetings to ensure that progress is being made in relation to the key areas for improvement.

Operational Committees within the Trust will also provide specialist advice and monitoring for their dimension (see table below).

In order to track progress there will be one singe quality improvement plan that is cross referenced to other relevant quality initiatives, e.g. CQUIN, Quality Accounts, Sign up to Safety etc. Progress will also be reported in the

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Trust’s annual Quality Accounts, which will be made available on the Trust’s website, NHS Choices and included in the Trust’s annual report.

Measurement tools and outcome measures will be identified, developed and agreed by Quarter 1 2015 to enable quantitative monitoring in addition to work-stream updates.

Priority Operational Lead (s)

Accountable Director

Operational Committee

Patient Falls Joanne Todd Director of Nursing

Safety Committee

Sepsis Lisa Ward Medical Director Safety Committee

Learning from Incidents

Joanne Todd Director of Nursing

Safety Committee

Right Patient, Right Place, Right Time

Diane Murphy Medical Director Clinical Strategy Steering Group

Care Bundles Jeremy Cundall Medical Director Clinical Strategy Steering Group

Health Improvement

Lee Mack Medical Director Clinical Strategy Steering Group

Unscheduled Care

Stuart Dabner Medical Director Clinical Strategy Steering Group

Dementia Care Jayne McClelland/David Bruce

Director of Nursing

Patient Experience Forum

End of Life Julie Clennell Director of Nursing



Jennie Winnard Director of Nursing


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Patient Falls

What do we want to achieve?We will ensure that all appropriate measures are taken to reduce the chance of patients falling & suffering harm.

Why is this important?Patient falls continue to be one of the highest adverse events reported. This often results in harm to patients and occasionally death. Successful prevention strategies include identifying patients who have the highest risk for sustaining a serious injury from a fall and taking preventive action to modify and compensate for these risk factors. Reporting all falls or near misses as incidents helps us identify additional risk factors, take action where appropriate and share learning.

How will we achieve this?

Falls Group to investigate the causes of preventable falls, using incident and near miss information

Work-stream plan to be developed and monitored by the Falls Group Falls Care Bundle to be monitored as a process measure Root cause analysis (RCA) investigations to be undertaken rapidly

following any serious harm caused following a fall Aggregated RCA to be undertaken of falls resulting in serious harm over

the last 12 months.

How will we know we have been successful?

No preventable deaths from falls

Year on year reduction in incidents reported for preventable falls causing harm to patients

Increase in compliance with the Falls Care Bundle

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Sepsis

What do we want to achieve?We will identify & treat sepsis at the earliest opportunity.

Why is this important?

Sepsis is a life threatening condition that arises when the body’s response to an infection injures its own tissues and organs. Sepsis leads to shock, multiple organ failure and death, especially if not recognised early and treated promptly.

Sepsis claims 37,000 lives annually in the UK. Early intervention can save lives, reduce length of hospital stay and the need for critical care admission.


Implement the sepsis care bundle in all areas of the Trust Develop a post-1hour pathway to start when the bundle elements have

been completed Develop an audit tool and identify outcome measures Raise professional awareness internal and external to the Trust through

partnership working, study days and ward based education Raise public awareness of sepsis through the World Sepsis Day &

Medicine for Members events


Zero ‘failures to rescue’ (people whose clinical condition deteriorates but where this could have been better managed or prevented) as a result of sepsis

No deaths from sepsis where the sepsis has not been identified & treated appropriately.

Compliance with the care bundle

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Learning from Incidents

What do we want to achieve?We will inform patients, families and staff when we make mistakes, investigate and share any lessons we learn, and implement change to prevent recurrence, where possible.

Why is this important?It is important that patient safety incidents that could have or did harm a patient receiving care are reported so they can be learnt from and any necessary action can be taken to prevent similar incidents from occurring in the future, where possible.


Understand which areas/staffing groups are good or poor reporters of incidents

Develop an education/awareness programme to increase the reporting of incidents that could have or did cause harm

Train staff to undertake robust Root Cause Analysis investigations to identify causes & contributory factors of incidents

Monitor actions taken to reduce harm – both in response to RCA investigations and following thematic analysis of incidents

Aim for a reduction in the proportion of incidents causing harm to patients, including patient falls, medication issues and avoidable pressure ulcers.


No Never Events

No preventable pressure ulcers

Year on year reduction in medications incidents resulting in harm

Year on year reduction in avoidable falls resulting in harm

Year on year increase in patient safety incident reporting (particularly near misses & no harm incidents). Reported as being in the upper quartile in the National Reporting & Learning System for patient safety incident reporting.

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Right care, right place, right time

What do we want to achieve?We will ensure that patients and service-users are cared for in the most appropriate clinical environment by staff with the right skills, and ensure that all transfers of care to other clinicians and care settings are clinically necessary.

Why is this important?The earlier a patient is seen, diagnosed and treatment plans agreed the better their outcomes of care and experience are. This also improves use of resources by removing, repeated, unnecessary or duplicated assessments and tests. It is also known that many patients have been moved from one ward to another for reasons not related to their specific care or condition. These issues can resulting in a poor patient experience and increase risks to patient safety as a result of fragmented care. If a patient does not receive the right care in the right place at the right time, this can result in delayed discharge or unplanned readmission to hospital.

How will we achieve this?By developing and implementing plans and service improvements, including the work on service configuration and strategies in our three ‘Breakthrough areas: Transforming Unscheduled Care; Centres of Excellence and Integration and Care Closer to Home – led by the Clinical Strategy Steering Group: Understanding patient flow to implement change Planning patient discharges as early as possible in the patient and

enacting plans in a timely manner Monitoring and understanding why patients are transferred between wards

for non-clinical reasons Reviewing and implementing new ways of working that focus on removing

duplication and waste in a patient’s pathway of care Developing workforce plans that focus on “front of house” services being

consultant delivered

How will we know we have been successful? Year on year reduction of patient transfers for non-clinical reasons Year on year decrease in patients with delayed transfer or discharge Year on year reduction of readmissions to hospital Improved clinical outcomes i.e. mortality

Reduction in length of stay

Improved staff experience as measured in the staff survey Positive patient feedback in the FFT, outpatients’ survey, discharge

surveys & national inpatient surveys.

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Care Bundles

What do we want to achieve?We want to achieve the best clinical outcomes in nationally benchmarked pathways, such as fractured neck of femur. We will identify other clinical pathways/best practice bundles that could increase the quality & effectiveness of our care.

Why is this important?A number of ‘best practice care bundles’ have been developed to support clinicians in providing care that is evidence based and known to provide the best results. Research continues to provide innovative solutions and develop new pathways to treat patients. It is important that the best possible care and treatment is provided to achieve the best clinical outcomes.


Improve adherence to the fractured neck of femur pathway through education & support

Develop & implement a clinical pathway/care bundle for Acute Kidney Injury

Adopt further care bundles within all Care Groups that will contribute to improving quality, safety & clinical effectiveness

Continue to review clinical outcome data to identify new pathways/bundles to introduce in response to any new guidance or deficiencies identified


Top 20% in benchmarked data for fractured neck of femur Zero ‘failures to rescue’ as a result of Acute Kidney Injury Remain at or below expected levels of deaths in nationally

benchmarked mortality data

Reduce the number of mortality2 alerts received

2 Alerts indicating excess deaths known as Variable Life Adjusted Display charts (VLADs)12

Health Improvement

What do we want to achieve?We will extend life expectancy, improve quality of life and tackle health inequalities – in short: longer, better, fairer lives.

Why is this important?Alongside social and economic factors (poverty, poor housing) our lifestyles can adversely affect our health. Smoking is the largest cause of early excess death via cardio vascular disease, cancer and lung disease. Lack of exercise and the food we choose contribute to obesity and there are now over 3,000 alcohol related admissions to A&Es in England every day. We need to support Public Health England’s strategy in ensuring that children get the best start in life and tackling smoking, obesity and harmful drinking.


Implement workplace health programmes for our employees Continue to make every contact count via brief interventions on major

lifestyle issues such as tobacco, alcohol, food and exercise. Support NHS Health Check and Just Beat It! - a diabetes prevention

programme Develop a new service to support people struggling with obesity Work with partner organization’s to promote health and wellbeing and

ensure parity of esteem in relation to public mental health, for example through workplace health programme.


Reduction in staff sickness absence rates

Publication of a new organisational covenant on our approach to health improvement by 31 December 2015

Positive feedback from patients using the ‘getting sooner better’ programme

Year on year increase in local number of local people engaged in wellbeing for life programme – 2,300 supported to achieve personal health goals in 2015/16.

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Unscheduled Care

What do we want to achieve?We will provide accessible, high quality emergency care.

Why is this important?

Although we achieve the 95% target for A&E 4 hour waits on average, there are days when the target is not achieved. Multiple ambulances can be waiting outside A&E to hand over patients, and patients are waiting for beds to become available for them to be admitted. This pressure is experienced on both acute sites, but is particularly high at University Hospitals North Durham where last year’s ‘winter beds’ have remained open throughout the year.

We recognise the limitations of the existing A&E departments in terms of capacity and infrastructure. Both of these factors lead to an unsatisfactory experience for patients and staff, especially at UHND where the physical space is inadequate.

How will we achieve this?We will implement the initiatives within the Clinical Strategy programme (Transforming Unscheduled Care), including: Continue to implement the ‘towards midnight’ programme Implement systems to ensure no patient admitted via A&E waits longer

than 14 hours to see a consultant Redesigning some services so that we can continue to deliver the majority

of acute specialties on a 24/7 basis across County Durham and Darlington.

Work towards providing 7-day access to diagnostic tests, such as X-rays, ultrasound, MRI scans and pathology

Work towards weekend access to multi-disciplinary teams, which includes expert nurses, physiotherapists & other support staff.

Review and, as appropriate, expand capacity and infrastructure


Positive feedback from patients via the FFT, surveys & compliments.

Continuous achievement of all A&E targets

Sustained reduction in the number of ambulance handovers that take longer than 60 minutes

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Dementia Care

What do we want to achieve?We will have a workforce that is dementia aware and has the skills and knowledge to support patients and their families with dementia. We will contribute to a dementia friendly community.

Why is this important?Dementia is a syndrome that affects memory, thinking, behaviour and ability to perform everyday activities. Dementia is overwhelming not only for the people who have it, but also for their caregivers and families. There is lack of awareness and understanding of dementia that can result in stigmatisation, barriers to diagnosis and care. Dementia was identified as a national priority in 2009 and there is still a long way to go to achieving a dementia-friendly community.


Develop a dementia strategy Increase dementia training Full implementation of the dementia pathway Auditing against the pathway for continuous improvement Awareness raising Creating dementia-friendly environments


Positive feedback from patients, families & carers

Continuous improvement in the audits of the dementia pathway

>90% appropriate staff received dementia training

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End of Life

What do we want to achieve?We want people approaching the end of their life to have confidence that the care we provide will be consistent with their preferences. We want patients and their families to be supported and informed of all options available to them.

Why is this important?Supporting people who are nearing the end of life can ensure that they maintain the best possible quality of life, remain in control and minimise suffering for them and their families.


By being part of the Deciding Right regional initiative Training staff in the ‘Deciding Right’ principles & DNACPR Having clear principles and practices to support staff in providing care and

information to patients Supporting patients to make advance care plans Helping patients to be cared for in the location they wish to be cared for

and in meeting their choice of place of death


Positive feedback from patients & families

>90% training for appropriate staff

Year on year increase in patients being cared for in their preferred place of care

Continuous improvements in the National Care of the Dying Audit & local audits of end of life practice (including DNACPR)

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What do we want to achieve?We will promote optimal nutrition for all patients in our care, ensuring that this is tailored to individual patient need.

Why is this important?Clinical malnutrition can lead to poor patient outcomes, hospital acquired conditions and longer lengths of stay. The provision of enjoyable and nutritious food and drink or the prescription of suitable artificial nutritional support is essential to help patients feel better, maintain their strength and energy and to promote a return to health following illness or surgery.


Identify patients at risk of under nutrition by screening with the MUST tool Re-energise protected mealtimes and reduce unnecessary interruptions

whilst patients are eating Encourage the use of dayrooms for meal times & social interaction Offer a choice of beverages and served appropriately dependent on

patient need Increase the use of volunteers for mealtime assistance Provide nutritious snacks between meals for patients at risk of poor

nutrition


Positive feedback from patients & families

>98% of all adult patients being screened for under nutrition within 6 hours of admission using the MUST tool

>98% of patients identified as high risk of under nutrition having an appropriate nutrition care plan implemented.

>95% compliance with the completion of fluid balance chart

Achieving & maintaining the ‘Food for Life Catering Mark’

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Additional Service Improvement The Trust has a number of improvement and transformation projects that will support the delivery of this strategy but are not aligned to just one priority. These include increased use of technology, such as e-observations and e-prescribing and safe staffing levels. All of these projects are intended to improve the quality of patient care overall.

There are also areas that staff, patients and stakeholders are familiar with and that remain important, such as healthcare acquired infections, medication errors and pressure ulcers. We will continue to monitor and report on these areas under the priorities identified in this strategy.

Measuring SuccessEach priority work-stream will have an implementation plan and outcome measures aligned to the ‘How will we know we have been successful?’ sections. There will be one Quality Improvement plan and set of measures to track progress. The overall success of the Strategy will be measured via mechanisms, which include:

Patient experience feedback – this will be via surveys, compliments, complaints, focus groups & patient groups

Quality Accounts – achieving the annual priorities described in the Quality Accounts will contribute to achieving the aims of this strategy

Quality Matters – an audit tool against nursing standards and Trust policies, which identifies any areas requiring additional support or development to achieve best practice standards

Mortality ratios, clinical outcomes & national clinical audits – we will continue to monitor our performance against our peers.

Care Quality Commission – if this strategy is implemented successfully, we will obtain a minimum of a ‘good’ rating, aiming for ‘outstanding’ where possible.

Appendix 3 provides an overview of the quality priorities and the vision for each element of quality.

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Appendix 1 – Behaviours Framework

Our NHS ValuesOur Behaviours

You will see that we You will see that we do not

Working together for

patients

Patients come first in everything we do. We fully involve patients, staff families, carers, communities and professionals inside and outside the NHS. We speak up when things go wrong.

Will think of our patients first Are proud of where we work & our role

in delivering the services we provide Provide clear, open, honest & timely

information Keep people informed – give regular

updates where possible Work as an effective team, pull together

& include everyone Admit when we get things wrong, tell

patients & their families & learn from this

Work within our own teams only, forgetting we are part of a wider organisation for the benefit of patients

Set unrealistic expectations or make false promises

Withhold useful information or forget to pass something on

Put up barriers to communication & team work

Respect & Dignity

We value every person – whether patient, their families or carers, or staff – as an individual, respect their aspirations and commitments in life and seek to understand their priorities, needs and limits.

Introduce ourselves, explain our role & listen to you

Be polite, courteous & friendly Respecting others differences Value people’s privacy & dignity Make eye contact & talk to people

directly, using their preferred name Respect the environment we work in

Put our own priorities before those of patients or colleagues

Be rude, abrupt, shout or insult people

Undermine people’s dignity through actions or words

Talk about people as though they are not there or don’t understand

Avoid people who need help Tolerate aggressive behaviour or

bullying of any description – from each other, patients or visitors

Commitment to Quality of

Care

We earn the trust placed in us by insisting on quality and striving to get the basic of quality of care – safety, effectiveness and patient experience – right every time.

Are competent & professional at all times

Are open & honest, learning from experience

Are clear about our roles & responsibilities

Accept responsibility & hold each other to account for our actions

Act on concerns & challenge poor services or behaviours

Seek out best practice and share it Avoid duplication & waste

Let professional registration lapse or fail to keep up with CPD

Absolve responsibility, pass the buck

Wait to be chased Dismiss new ideas, refuse to try Ignore or condone bad behaviour

or poor practice Ignore research or evidence based

practice

Compassion

We ensure that compassion is central to the care we provide and respond with humanity and kindness to each person’s pain, distress, anxiety or need.

Show care & compassion Support & empathise with others Stop to help others, take the time to

help Listen to each other & our patients Be open & honest with patients about

their condition & support them to make difficult decisions

Make excuses for lack of compassion

Hold inappropriate or personal conversations in public areas

Use closed body language, show irritation, be unapproachable

Improving Lives

We strive to improve health and wellbeing and people’s experiences of the NHS.

See people as individuals, see the whole person & their individual needs, respecting their beliefs & ideas

Be innovative & creative, look for solutions

Support people to reach their potential Support each other to have a good

work/life balance & healthy lifestyle

Make it difficult for people to access the right services at the right time

Be judgemental, patronising, making inappropriate generalisations or assumptions

Everyone Counts

We maximise our resources for the benefit of the whole community, and make sure nobody is discriminated against or left behind.

Understand each other’s skills, roles & responsibilities & respect everyone’s contribution

Encourage people to raise their concerns

Promote & reward innovation Say thank you when others help us Value the experience & knowledge of

other team members Include all team members in service

developments – everybody has a valid opinion

Undermine colleagues, be spiteful or talk about people behind their back

Say one thing and do another Be disinterested in other people’s

aims, skills or ideas

Appendix 2

Put safety first - Commit to reduce avoidable harm in the NHS by half and make public our goals and plans developed locally.

We will

Reduce sepsis by:

-using the Trust sepsis care bundle to identify and treat sepsis and do this within the golden hour

-keeping sepsis on the agenda and at the forefront of people's mind

-using appropriate steps in preventing resistance including the targeted and prudent use of antibiotics. Early culture and involvement of microbiology who will support this

-considering that any patient receiving chemotherapy or any patient with a known haematology disorder are at risk of sepsis

-referring to critical care at an early stage and involving senior members of the team

Provide safe staffing levels by:

-reviewing all areas (hospital and community) using validated tools where available

-apply pragmatic professional analysis to determine current requirements

-establish a validation panel, chaired by Director of Nursing (with Finance and Human Resources) to review analysis work

Introduce e-observations:

- Implement an electronic system that allows for patient physiological observations to be recorded, documented and escalated from the patient's bedside

- Ensure that an Early Warning Score is calculated for every observation recording on ward based in-patients

- Introduce the validated National Early Warning Score as part of e-observations

- Ensure that all staff have access to patient observation data at any point within the hospital

Review the serious incident process to:

-consider a new way of delivering messages across the organisation so that we have full assurance that staff are aware of issues that have occurred and learning is shared

Continually learn – make our organisation more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe our services are.

We will

Continuously strive to improve the care delivered to our patients and evidence compliance using our Quality Matters framework to:

County Durham & Darlington NHS FT Sign up to Safety Pledge

October 2014

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-understand at care delivery level how we are doing from a patient's perspective

-engage with and listen to ward staff to understand the issues and challenges they face

-monitor compliance with agreed care standards in real time

-gauge awareness of policies

-observe practice and correlation with related documentation

-review the clinical environment

-inform our improvement journey

-acknowledge and share what is working well

Remain accountable to patients and the public by:

-publishing a set of patient outcomes at ward level so that patients and the public can see how we are performing against safety and experience indicators

Honesty – Be transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.

We will

Continue to move forward with Duty of Candour principles and monitor implementation by:

-producing standardised templates for sending letters of apology to patients if an adverse incident occurs

-utilising the risk management system to identify that staff been open with patients and relatives when incidents occur

-monitoring compliance with the principles via Safety Committee

-continuing the delivery of Duty of Candour educational sessions across the organisation

-ensuring that patients are offered a copy of reviews when serious incidents have occurred

-offer face to face meetings with patients/families when serious incidents and complaints occur

Continue to involve stakeholders in the identification of key issues for the organisation by:

-holding a series of updates on progress against key aims identified within the Trust's Quality Accounts

-ensuring a feedback mechanism through stakeholder events to inform on aims for coming periods and to ensure agreement on priorities

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Collaborate – Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.

We will

Share serious incidents across the wider health economy by:

-collaboration with regional work streams to identify and learn from serious incidents including Never Events

Utilise the "Investing in Behaviours" consortium to improve staff insight and increase knowledge around Human factors to prevent harm within the organisation

Support – Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress

We will

Support innovation by:

-introducing a Dragons Den. similar to the television show, where staff can take their ideas and go face to face with a group of Trust "experts" to seek support in the form of finance and mentorship for implementation

-introducing innovation scouts. We will be looking for innovation scouts to identify and then develop new ideas, working with front line staff

-holding business case master classes. This will help clinicians and business managers to create compelling and persuasive business cases which demonstrate sustainability and high quality for services

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Appendix 3 – Example – to be completed in full following completion of implementation plansFrom….

‘With you all the way’ QUALITY MATTERS….To

‘Right for you First Time, Every Time’

2014/15 2015/16 2016/17Lower quartile in peer group for patient safety incident reporting.

Patients have been caused severe harm or have died as a result of a fall over the last 2 years.

Strong performance in infection prevention & control. Better than peers for pressure ulcer prevention.

Safety

Sepsis care bundle re-launched for adults.

Reasons for poor patient safety incident reporting identified.

New governance structure/practices

Weekly Patient Safety meeting – Exec Lead

NCEPOD report for sepsis expected August 2015

Sepsis care bundle implemented or children & maternity patients

Identify staff groups who are low incident reporters & support improvements

Post-1 hour sepsis pathway to be implemented

Upper quartile in peer group for patient safety incident reporting.

No patients suffering severe harm or death from a preventable fall.

Continued learning & good performance with health care acquired infections, medication errors & pressure ulcers.

No failure to rescues relating to sepsis.

Mortality within expected ranges overall, with some variation across services & sites.

Good clinical outcomes overall with some areas for improvement.

Effectiveness

Clinical Strategy Steering Group identified priorities & data sets

Care bundles identified

Implement NICE workplace health programme for employees

Areas for length of stay reductions identified & plan implemented

Implementation of plans for reduction in delayed discharges

Baseline process & outcome measures for all identified Care Bundles

ED at DMH to have 2 entrances

Mortality consistently below expected range on all sites, for all specialties.

Top 20% for all benchmarked clinical outcomes.

Demonstrable improvements in chosen care bundles with no failure to rescues relating to acute kidney injury.

Variable quality of dementia friendly environments across the Trust.

No dementia strategy.

Recently signed up for the ‘Right to Decide’ initiative for End of Life care. End of Life care variable across the Trust.

Variability in practice for nutrition & hydration

Experience

Develop & implement Dementia Strategy

Include Dementia and End of Life Training in Trust TNA & deliver training

All identified clinical areas to be dementia friendly.

Dementia aware, skilled & knowledgeable staff contributing to a dementia friendly community.

Patients nearing the end of life to be consistently confident in our ability to meet their preferences in relation to care & support provided.

Consistency in achieving nutrition & hydration standards.

Our ValuesWorking together for patients Respect & Dignity Compassion

Commitment to Quality of Care Improving Lives Everybody Counts

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Documents

matters... · Web viewSince 2011, the Trust has been an integrated healthcare provider, providing services in both acute and community settings, supplemented by health improvement