Great Western Hospitals. NHS Foundation Trust. Quality Improvement Strategy

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1 Great Western Hospitas NHS Foundation Trust Quaity Improvement Strategy

2 2

3 Wecome from Nerissa Vaughan, Chief Executive Quaity is at the heart of everything we do. When I first joined the NHS in the eary 1990 s, I wanted to be part of an organisation that changed peope s ives. Since then I ve been proud to work in many organisations supporting cinica teams to do what they do best deiver high quaity care. However, it s cear that in some parts of the NHS at times in recent years the focus on quaity has taken second pace to other things. The NHS has gone through a period whereby in some instances success has been measured not by the quaity of the care provided but whether a target s been achieved. In effect the NHS has hit the target but missed the point. It s equay true that the standard of care provided and the pace at which things are changing around us has never been greater. We shoud be proud of what we aready achieve together. If we are to keep up with the growing expectations paced on us, the increasing demand and the pressures we are a facing, we need to think carefuy about how we wi maintain and improve the quaity of the care we provide. It is the quaity of the care, treatments and services we provide, which determine the experience of our patients. As we as cinica effectiveness and safety, we know that patients care about ots of other things. The way they are greeted at reception, the ceaniness of the ward, the quaity of the food, how easy it is to park, how the doctor takes time to expain These a sound ike simpe and straightforward things but we know from our own experience how compex providing high quaity care can be. This strategy has been deveoped to give a cear direction and a cear set of simpe ambitions we can a work towards so that any member of staff, in any roe, can understand the part you can pay in heping to deiver high quaity care. It supports our overa Trust five year pan and four strategic ambitions as we as inking cosey with our Peope Strategy. After reading this strategy I d ike each of you to consider the quaity of the service you provide, whether to patients, visitors or coeagues, and what a good service ooks ike from you and your team. I want you a to have the courage to speak up, make tough decisions and do what is right for our patients and users. In return I am committed to ensuring that a staff have the support they need to deiver a quaity of care to be proud of. Whether this is extra staff, new technoogy, or training and deveopment opportunities so we can make improvements together. Whatever our roe, we a have the power to infuence the quaity of care and this desire and commitment on behaf of everybody is what wi set us apart in the years ahead. 3

4 Introduction This Quaity Improvement Strategy sets out how we wi define, improve and assure the quaity of our services. Our empoyees are continuay striving to improve quaity in every aspect of the services they provide. We aspire to create a cuture of quaity, where every member of staff sees themseves as paying a key roe in the patient experience, is passionate about providing the highest quaity care and improving patient outcomes. How this Quaity improvement strategy has been deveoped We have deveoped this strategy through taking and istening to staff, members, stakehoders and especiay patients and users of our services. This wide engagement was in an effort to gain an understanding of what quaity is considered to be and how we can work together to make and sustain improvements. Our utimate aim is to deiver the best outcomes and experiences for our patients and their famiies. Quaity is centra to everything we do, we appreciate the contribution that a of our staff make towards high quaity care and commend the ongoing commitment for exceence. What is Quaity? Providing quaity care and service to the 750,000 peope across our area is the foundation of everything we do as heathcare provider. The term quaity can mean different things to different peope working in the Trust depending on the type of job they do for exampe a nurse working on a ward or in a person s home wi have a different view of quaity than one of our staff who works behind the scenes to support the cinica teams. It is therefore important that when we tak about quaity there is a shared meaning which everyone of the 5,500 peope who work in the Trust can reate to in their day to day jobs supporting patients or supporting the teams who provide the care The accepted definition of quaity in the NHS was put forward in 2008 by Lord Darzi a eading surgeon in the NHS. Quaity is the provision of safe, effective care eading to positive patient experiences Quaity is: The provision of safe, effective care eading to positive patient experiences This definition sets out the three key aspects to quaity, a three of which must be present in order to provide a high quaity service. Safety: The first dimension of quaity is to do no harm. This comprises a safe, cean environment, accessibe and safe equipment and competent staff to deiver safe care and avoid harm. Effectiveness: Effective care is based on the knowedge and understanding of the most appropriate and beneficia care to deiver and improve the best outcomes for service users. This care is often driven by externa expert agencies such as the Nationa Institute for Cinica Exceence (NICE) and through Nationa Reviews and is aso highy infuenced by nationa performance priorities and reguatory requirements such as the Care Quaity Commission s 16 Essentia Standards of Care. It is what is considered to be the best evidence based and effective care we can provide. Experience: The experiences of our service users are fundamenta toward the deivery of 4

5 a first cass service. Our services can ony be improved by anaysing and understanding the experiences of the peope who use our services. The key to providing high quaity care is that quaity does not fa to a singe team or department, it is not soey the responsibiity of the nursing teams or medica staff, it is in fact everyone s business. It requires coaboration and working across heath and socia care organisations in partnership, to deiver a positive patient journey throughout the whoe pathway of care not soey ooking at the individua eements of their care but their entire journey right up to and beyond discharge. Providing consistent and reiabe services Why is Quaity important to us? It is essentia for patients to recognise the care and services they receive as being high quaity. Over the past 12 months the NHS has come under criticism as a resut of some of the nationa care scandas such as Mid Staffs that have taken pace. This has impacted on the confidence some peope have in the NHS and the pubic and our patients righty expect to be given the best care when they need us. We want patients and oca peope to know and experience the highest possibe standards so they are 100% confident of the quaity of care we provide. Our staff come to work to do the best they can and to maintain engagement and motivation at work, it is aso essentia for staff to see quaity in a that they do and to be empowered to continuay improve for the benefit of patient care. Job satisfaction and commitment wi be improved when staff are abe to deiver top quaity care and this strategy aims to support them in that task. There are both nationa and oca drivers for quaity improvement which are important in underpinning the priorities for embracing innovative ways to deiver safe, effective care. The oca and nationa drivers together with ongoing staff, patient and user engagement provide the framework within which the Quaity Improvement Strategy wi move forward. The drivers for quaity are described in appendix 1 Quaity is pivota to our five year vision which is: Working together with our partners in heath and socia care, we wi deiver accessibe, personaised and integrated services for oca peope. We wi provide high quaity care whether at home, in the community or in hospita empowering peope to ead independent and heathier ives The Trust is passionate about getting things right and meeting the expectations of our patients and their famiies, for patients to have the right care at the right time in the right pace provided by appropriatey trained individuas. The Trust Board takes fu responsibiity for the quaity of care and services provided to patients and fosters a cuture that encourages peope to take pride in their work. There are cear inks to improved patient outcomes when there is consistent quaity care provided by a competent and caring workforce. Quaity is important to us as it improves the experience and outcomes for our patients and staff and utimatey good quaity costs ess, reeasing more money to reinvest in patient care. 5

6 What s our approach to Quaity We aready demonstrate quaity in many aspects of the organisation with exceent achievements in both cinica and non cinica settings. We want to buid on these achievements and support staff to go further ensuring: Aspiration to no avoidabe harm to patients Top cass, reiabe and consistent evidenced based treatments Continuay striving to improve the patient experience Compassionate caring staff who are abe to recognise quaity outcomes in the work they do We are committed to ensuring quaity is at the centre of a services provided. This commitment is not just about maintaining the status quo but about continua and sustained earning and improvement. How is Quaity monitored? There are two committees within the organisation set up to continuay monitor and review quaity. These committees are sub-committees of the Trust Governance Committee which reports into Trust Board. There are a range of sub groups which focus on safety and quaity which report into the Patient Safety Committee or the Patient Experience Committee and then onto Governance committee and Trust Board. Patient Safety Committee The main functions of this committee are: To oversee the operationa management of safe and effective patient care. It is responsibe for ensuring cinica risks are identified and acted upon. The Committee seeks to ensure that the principes and standards of cinica governance are appied to monitor and improve patient safety and cinica quaity. Patient Experience Committee The main functions of this committee are: Oversee the deivery and management of care quaity and patient experience Ensure the structures, processes and contros in pace across the organisation are operating effectivey and efficienty to deiver and maintain high quaity patient care To focus on care quaity and quaity improvements, assurance frameworks for care deivery and improvement of the experience for patients, their famiies, carers and a users of our services. Quaity champions and inspired by roe modes These two committees ensure there is continua oversight and chaenge as to how we can further improve what we do and the care we deiver. The earning and experiences from these committees are shared within the organisations directorate structures with the agendas mirrored within the Directorate Governance Meetings and with team and department themed working groups and meetings to ensure earning and review across the whoe organisation. 6

7 What staff and patients have tod us We engaged with staff across the whoe organisation to understand what quaity means in reation to the services they offer, where they see exampes of quaity, what the priorities shoud be, how we can encourage a staff to deiver high quaity services and then how wi we know if we have successfuy impemented quaity. Our staff ceary tod us they want to be part of working together to improve quaity across the Trust; there is a huge amount of enthusiasm, commitment and passion for improvement. Staff and patient feedback has informed the deveopment of this Quaity Improvement Strategy and heped us to form the content contained within. The strategy is set out under seven main headings or domains. Each domain has an ambition with priorities for action which wi hep us to achieve our ambitions. Each Domain sets out our commitment and focus to improving quaity, the work streams that wi ie behind each domain wi be described within a Quaity Strategy Deivery Pan, with cear objectives, actions and timescaes for competion. In order to accompish our ambitions we need to buid on the achievements and enthusiasm of our staff. having time to care - putting care back into heathcare 7

8 1 Deivering Safe, Effective Care, Deivering Exceence Ambition: A patients wi receive harm free care By having staff with the right skis in the right pace at the right time By ensuring essentias of care are right first time every time By having cear care standards across the organisation which are known understood and practiced By adopting nationa best practice and evidenced pathways of care to support reductions in harm By effectivey managing risks and earning from incidents By aiming to be within the 10% of NHS organisations with the owest risk adjusted mortaity By achieving 95% reiabiity with harm free care for pressure ucers, catheter associated urinary tract infection, venous thromboemboism and harm from fas. Performing my roe to the highest standard 8

9 2 Leading the Best Patient Experience Ambition: A service users wi rate their experience as good or exceent By having Quaity Champions throughout the Trust By having a consistent, ow toerance for staff with poor behaviours and attitudes that are not in keeping with basic courtesies and Trust STAR Vaues Deivering best practice, evidence based and outcomes focused services with a positive patient experience and safety By engaging with service users, their carers and reatives and using their feedback to hep us deiver quaity By ensuring carity and understanding for patients, carers and reatives, reguary checking out they know what is happening By providing high quaity patient information ensuring communication is cear, concise and appropriate By deivering reiabe, quaity care seven days a week meaning that whatever time of day or night a person needs our care we wi provide the same high standard of care and treatment. By providing high quaity patient environments for the care and treatment individuas may need and surroundings that promote webeing for both staff and patients. 9

10 3 Reeasing Time to Care Ambition: Patients and frontine staff wi fee they have time for the things that matter most By ensuring patient pathways and patient fows are cear and effective and buit around the needs of the patient not the organisation. By improving Information Technoogy and use of other technoogies to enhance and coordinate care By making processes simper and reducing unnecessary dupication By sharing best practice and earning across departments and areas ensuring the whoe organisation is benefiting from service improvements. By dismanting any barriers to quaity improvements and getting things done in a timey way. Review of processess; reeasing time to care 10

11 4 Visibe Inspirationa Leadership Ambition: For eaders to be highy visibe and demonstrabe roe modes championing quaity improvements. By focussing on high quaity eadership deveopment at a eves, succession panning and robust workforce panning. Catch peope doing things right and ceebrate By supporting eaders to demonstrate and deveop quaity services, to ead by exampe. By demonstrating integrity and ensuring consistency in actions Praise, ceebrate and appreciate give reguar positive feedback to our teams to recognise the difference they make. By empowering staff to deiver high quaity care and continuousy improve services By ensuring a staff fee abe to speak out for quaity and fee confident their concerns wi be istened to and acted upon By creating a cuture of continuous improvement and earning. 11

12 5 Cuture of Innovation and Embracing of Continuous Quaity Improvement Ambition: To empower staff to demonstrate continuous and sustained improvement in safety and quaity of care. By ensuring new ideas to improve quaity are encouraged from staff and acted upon By continuing to be a earning organisation, focusing on earning essons when required and improving quaity By having quaity improvement projects that staff can innovate themseves or readiy engage in others projects as part of their daiy work. By ensuring quaity is the bedrock of a panning and performance management processes and considered in a decision making. By extending our quaity approaches across partner organisations By supporting staff to respond we to change and embrace initiatives By staff being open to new ideas and to encourage forward thinking By staff taking ownership for continuous earning and sef deveopment By the deveopment of quaity improvement courses to buid improvement skis for staff, such as Lean methodoogy and Pan, Do, Study, Act (PDSA) cyces. By supporting earning and deveopment on quaity improvement. Ceebrate quaity achievement, acknowedge where we see quaity 12

13 6 Measurement of Essentia Quaity Standards, Providing Assurance of Patient Safety and Cinica Effectiveness Ambition: There wi be assurance of improvement at a eves. Treat everone as though they were a member of your own famiy By ensuring a robust, reiabe and timey Quaity and Safety Dashboard and a Nursing Performance Dashboard, identifying standards of care and patient safety, is received and understood at a eves through from ward/department and Directorate right up to Trust Board. By embedding the use of the NHS Safety Thermometer to monitor the frequency of four specific harms (VTE, Fas, Pressure Ucers and Catheter Associated Urinary Tract Infection) By deveoping the Infection, Prevention and Contro programme to further reduce risks to patients and staff of hospita acquired infections By having cear governance reporting ines from ward to board via the Patient Safety and Patient Experience committees. By reviewing and strengthening our interna reguatory compiance monitoring and reporting processes. Ambition: For improvements and deveopments to show a positive impact on outcomes for patients and staff. By achieving positive feedback from staff and service users By supporting teams to deveop their use of measurement pans for projects they are invoved with By reducing the number of concerns raised through a forma process and a reduction in compaint handing times By improving patient outcomes, achieving and sustaining harm free care By seeing an increase in staff motivation and patient satisfaction By becoming a roe mode Trust for other organisations, pursuing quaity improvements to improve safety. 13

14 7 Staff Wi Understand their Contribution to the Whoe Organisation Ambition: Staff wi fee invoved and proud to be part of the care and treatment deivered across the Great Western Hospitas Foundation Trust By supporting staff to achieve their own ambitions of quaity care By ceebrating quaity achievements and acknowedging where and when we see quaity By reviewing best practice and evidence of quaity improvements throughout the organisation and sharing the good news. By supporting oca ownership of quaity improvements By providing staff with a cear understanding of the need for change whist recognising that everyone in the organisation is doing their best. By ensuring cear organisationa structure with cear reporting and accountabiity ines for teams and individuas. there wi be improved patient and staff satisfaction and motivation 14

15 Appendix 1 We have set ourseves these cear ambitions to raise standards and improve quaity because they are the right thing to do for patients and service users and because our staff come to work everyday to do the best they can. There are aso nationa and oca drivers for quaity improvement which, by deivering on the ambitions we have set out in this document wi aso be achieved. The key drivers are: Loca drivers To deiver the five year vision the Trust wi be embracing innovative ways to continue to deiver safe, high quaity care coser to home. The Trust s business pan and the Directorate business pans set cear deiverabes to achieve this. Our vaues and strategic priorities ensure that high quaity care and safety is at the heart of everything we do for our service users and their famiies. This is underpinned by our four strategic ambitions: Review best practice of quaity and evidence throughout the trust, and share evidence, and best practice We wi make our patients the centre of everything we do We wi work smarter not harder making the best use of imited resources We wi innovate and identify new ways of working We wi buid capacity and capabiity by investing in our staff, infrastructure and partnerships. 15

16 Loca Quaity Contracts with Commissioning CCGs: These contracts are driven by oca and nationa priorities and as such wi infuence the Quaity Improvement Strategy s supporting work streams. Corporate and Directorate Business Pans: Initiatives, co-design of service deveopments and quaity improvement pans wi be inked to and inform the quaity strategy. Loca Quaity Accounts: Annua quaity improvement accounts are mandated by Monitor and are ocay driven. Monitor advises that these accounts are inked to and informed by oca contracts agreed with CCGs. These accounts are outcomes focused and shoud be informed by the quaity strategy and invovement from the pubic and our patients on an annua basis but consistent to demonstrate year on year improvements where appropriate. Trust Strategies and Work streams There are a number of strategies, frameworks and programmes of work within the Trust which need to inform and support impementation of the Quaity Strategy. These incude: Nursing Strategy Fas Strategy Boundary Strategies ie Safegaurding Chidren and Aduts Business pans Directorate and Corporate Risk Management Strategy Information Governance Strategy Workforce Deveopment strategy Maternity Strategy Engagement Strategies Finance Strategy Nationa/externa drivers Equaity and Exceence; Liberating the NHS (2011) and the subsequent Heath and Socia Care Act - These pubications affirmed the desire to ensure that heath services achieve quaity and desired outcomes and identify a number of reforms that drive quaity improvements, in particuar: Putting service users at the centre of care, no decision without me Creation of an NHS Outcomes framework which wi span three areas of safety, effectiveness and experience Estabishment of oca and nationa Heathwatch and We Being Boards, Cinica Commissioning Groups and a Nationa Commissioning Board Strengthening the roes of the Care Quaity Commission, the Nationa Institute for Heath and Cinica Exceence and Monitor Best practice is shared easiy The NHS Outcomes Framework: The NHS Outcomes Framework, pubished by the NHS Commissioning Board sets out the nationa outcomes that a providers of NHS-funded care shoud be contributing towards. The framework buids on the definition of quaity by Darzi through setting out five overarching outcomes or domains, which capture the breadth of what the NHS shoud be striving to achieve for patients as foows: 16

17 NHS Outcomes Framework Darzi Quaity Framework Domain 1 Domain 2 Domain 3 Preventing peope from dying prematurey Enhancing quaity of ife for peope with ong-term conditions Heping peope to recover from episodes of i heath or foowing injury Effectiveness Effectiveness Effectiveness best practice and evidence is shared and used for service improvement as part of our daiy work Domain 4 Ensuring peope have a positive experience of care Patient experience Domain 5 Treating and caring for peope in a safe environment and protecting them from avoidabe harm Safety Loca quaity contracts with our Cinica Commissioning Groups (CCGs) are now structured utiising the NHS Outcomes Framework, hence, it is our intention to ensure this wider framework is recognised and aso utiised to buid upon and deiver our Quaity Improvement Strategy. The NHS Commissioning Board wi commission the Nationa Institute for Heath and Cinica Exceence (NICE) to deveop Quaity Standards which wi set out evidence-based characteristics of a high quaity service for a particuar pathway or condition. The Nationa Commissioning Board has now taken over the functions of the Nationa Patient Safety Agency (NPSA). The NPSA was set up in response to recognition that the same things go wrong again and again. The agency set up a Nationa Reporting and Learning System and database to identify and tacke important patient safety issues at nationa and oca eve. 17

18 The Care Quaity Commission (CQC): The CQC is the independent reguator of a heath and socia services in Engand. Its 16 Essentia Standards of Care and new fundamenta standards outine the basic minima service quaity which the trust is expected to attain and sustain. Recent changes within the CQC informed, in part by the Francis Review and pubic/ patients demand, have directed the CQC to review and change its inspection processes. Preparedness for and managing these externa inspections inform our quaity strategy to ensure a proactive response supportive of our externa reguators and aso to support our staff through these inspection processes which can be chaenging. Commissioning for Quaity and Innovation (CQUIN): CQUIN is a key driver to ensure Trust Boards maintain a focus on the deivery of a high quaity improvement service. It is intended to be one of the ways to have a shift in focus to a continuous improvement cuture amongst commissioners and providers and represents an investment by commissioners in quaity improvement and innovation Monitors Quaity Governance Framework: There is a requirement for the Boards of both new and existing NHS Foundation trusts to sef certify with regards to quaity governance. The eements of quaity governance which Monitor focus on are: Boards accuratey understand the quaity of care that their organisation provides Boards are abe to assess and abe to demonstrate that they assess and mitigate risks Quaity is seen as a responsibiity of the entire Board and not ony with the Medica and Nursing Directors Trusts are committed to continuous quaity improvement and have in pace the toos to address poor performance. During 2012, the Trust Commissioned an externa assessment against Monitors Quaity Governance framework and arising actions wi be incorporated within this strategy as appropriate (Deoitte report) Nationa, Loca and Peer Reviews: There is much oca earning and improvement from externa reviews which can and shoud be considered within the Trust s Quaity Improvement Strategy. Such reviews incude the Francis Report and Winterbourne Report. The Francis Report provides significant direction for heath care providers regarding the important eement of patient experience and how this is captured, istened to and acted upon, organisationa cuture and eadership and accountabiity for the safety of our patients. We wi ensure that oca pans deveoped as a resut of this report and other externa reviews are integra to and inform our Quaity Strategy and measure quaity aong the fu patient care. Having quaity improvement projects that staff can innovate themseves, or readiy engage in others projects as part of their daiy work 18

19 19

20 Great Western Hospitas NHS Foundation Trust Great Western NHS Foundation Trust, February Designed by NHS Creative CS37222

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