Measuring quality in healthcare: A Foundation Trust approach

Chris Fokke

Director of Clinical practice/Nursing

Bath United Kingdom

The RNHRD

• Specialist Rehabilitation NHS Foundation Trust

– Rheumatology

The RNHRD

• Specialist Rehabilitation NHS Foundation Trust

– Neurological Rehabilitation

The RNHRD

• Specialist Rehabilitation NHS Foundation Trust

– Pain Management

Being an NHS Foundation Trust

• Autonomy

• Entrepreneurial

• De-centralised

• Collective ownership across the teams

• Set own standards and benchmarks

Key components in measuring quality of healthcare

• Committed executive board

• Systemisation of clinical practice

• Solid infrastructure– IT/IS

– Effective communication channels

– Dedicated and skilled middle managers

• Operational staff owning the processes associated with measuring

Vital Aspects of Clinical safety (VACS)

A systems approach to measuring quality

Background/Context

• Unrelated clinical incidents

• Chasing audits and initiatives

• Difficult to quantify quality

• Service manager’s perspective on nursing function

• 5 year development of creating a useful system

What is VACS

• It’s a system, an illustration of how well vital components within a service are working

– Clinical benchmark

– Shows vital knowledge, skills and experience

– Provides information regarding the environment and the tools used within specific areas

What is VACS

• It’s a methodology that:

– Shows quality in quantifiable measurements

– Promotes/ embeds ongoing auditing bottom-up

– Aggregates quality measurements

– Transcribes data into useful information

VACS components

• Domains: Specific to individual areas

• Audit questions: Yes/No specific

• Processes associated with responsibilities/ authorities: Who collects what and feeds back where

• Action plans: Who manages/monitors

• Regular monthly assurances: (board, service, unit, ward, patient specific)

Full process/Nursing pilot

• The data is collected into a spreadsheet which has formulas and findings are represented as figures, percentages and Graphs (Radar Chart)

Audit questions

• Questions are derived from local clinical guidelines, national initiatives, vital knowledge, skills and experience

• Yes/No questions are formulated by expert champions who know the specific unit

• Questions are categorised into domains

– Wound care, Infection Control, Respiration etc.

Questionnaire Example(Domain: Respiration)

Radar Chart: All Scores

0%

20%

40%

60%

80%

100%

Management

Questions, HIU

Respiration for

tracheostomy patients

Difficult behaviour

Environmental hazards

Skin health

Continuity of CareAt risk from treatment

Nourishment & hydration

Homeostasis.

Elimination

Mobility

Data collection

• Junior staff set up structure to assess/ score against domains, (on-line or hard-copy)

• In RNHRD night staff do this (2 hrs per ward per month)

• Data doesn’t need to be collected at once, but it needs to be consistently done

75%Target Performance

76%Overall Performance

SeptMonth

Board Report

73%Vital aspects of care for Rheumatology

72%Management Questions, VP

73%Violet Prince

79%Vital aspects of care for HIU

83%Management Questions, HIU

74%Average patient Questions for HIU

82%CQ

67%Cambridge

74%HDU

Ward Averages.

Benchmarking

• Benchmark standards are agreed

– By the executive directors for Board

– By Lead nurses/Matrons for Unit/ Services

– By Ward managers for ward/area

Action Plans

• Action plans are formulated following benchmarking according to standards i.e. RNHRD VACS standard is 75%

• Agreed flags are in place deviating from the above:– Green: Monitor pressure points

informally

– Amber: Local action plan

– Red: Board report

Roles and responsibilities

Outcomes

• Pro-active- rather than reactive interventions to risks

• Meaningful information regarding complex functions

• Early warning system to ensure patient safety

• Provides operational, tactical and executive decision making platform

The future

• Apply throughout interdisciplinary function

• VACS can be used in any setting that wishes to capture quality

• Package system and systemisation approach as a product

Contact details

Chris Fokke

Director of Clinical Practice/ Nursing

Royal National Hospital for Rheumatic Diseases NHS Foundation Trust

Upper Borough Walls

Bath United Kingdom

Tel: +44 1225 465941

Email: Chris.Fokke@rnhrd.nhs.uk

Web: http://www.rnhrd.nhs.uk