compassion in practice, pop up uni, 3pm, 3 september 2015
TRANSCRIPT
Compassion in Practice: Open and Honest Care: Driving Improvement
Siobhan Lendzionowski
Leadership Support Manager
NHS England
Aims of session
• To outline the Open and Honest Care Programme and it’s aims
• To demonstrate the achievements and benefits of the programme
• Encourage Commissioners to Use and More Trusts to Engage
• Next Steps
Background
Action Area 3: Delivering high quality care and measuring impact
• Part of Quality Improvement and responding to issues about Care
• Pride back in Profession (Nursing)
• Reports generated following incidents:
Darzi – focus on quality Francis – Mid Staffordshire Putting Patient First NHS Business Plan Keogh Report Berwick Report
Identify problems early Reveal recurrent themes
Facilitate conversations to fix them Board Engagement
Give the public insight Give staff insight Ward level data is displayed Learning and Leadership
Prevention – Open and Honest Care Getting Underneath Quality
1. Minimise data burden on nurses by using
data already collated
2. Bringing available data on harm together in one place and
presenting it differently to make it meaningful to improve
care locally and reduce avoidable harm
Four Overarching Aims
3. Improvement stories describing what trusts have learnt and what improvements they are making
4. Continuous improvement over time against individual Trust aspirations (not for comparing organisations )
Improvement Science Methodologies
Theories Hunches Best Practice
Breakthrough Knowledge
Metrics Core - one or more NHS Safety Thermometers (or equivalent data)
Classic (Acute and Community Trusts; Mental Health Trusts) • Pressure Ulcers • Falls • Catheter Associated UTI • VTE assessment/prophylaxis/treatment
Maternity (Acute Trusts and One to One Midwives) • Maternal infection • Perineal trauma/abdominal wound • Post-partum haemorrhage • Apgar score <7 at 5 mins • Admission to NNU/SCBU • Woman’s perception of safety
Mental Health (Mental Health Trusts) • Self harm • Psychological safety, • Whether a victim of violence or aggression • Omissions of medication, • Restraint (in-patients only)
Core - Experience data • Friends and Family Test - patients/service user’s and staff
• Patient’s/service user’s experience questions • Staff experience questions • Staff/ Patient’s/Carer’s/Woman’s/Family story
Core - Improvement story • Trust story of how improvements have been made
Acute and Community • C Diff &MRSA, Falls & Pressure Ulcers incidence, safe staffing
Maternity • Harms incidence, Mode and number of births, stillbirths, safe staffing data, supervisors of midwives
Mental Health • Restraint, Care Programme Approach
What goes into the report?
• Data and narrative as set out in the Standing Operating Procedure, and the Open and Honest reporting template
• Trusts are encouraged include any local information that they feel is relevant to being open and honest e.g. if they have developed and use a local experience questionnaire on a regular basis
When do we publish?
• Report published monthly (by last day of the month), on Trust internet and intranet sites
Where to access the report?
• The report should be labelled clearly from the Trust homepage, within 2 clicks from the homepage
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Publication: Open and Honest Report
What the Patient Groups had told us:
• People wanted to see hard and soft data to give a
balanced picture
• A mixture of national and self-declared data
• Meaningful from individual through to Board level
• Demonstrate aspirational levels of improvement
against national/current standards
• Show improvement rates rather than benchmarks
• Show evidence of impact
• Term “transparency” is not understood, change to
“open and honest care”
23 Acute Trusts in North publishing Dec 2013 (n=48)
Community metrics introduced
April 2014
Maternity metrics introduced Sept 2014
Mental Health metrics to be
introduced
Autumn 2015
Key milestones
Independent Evaluation Aug-Dec 2014
29 Acute Trusts in North publishing May 2014
34 Acute Trusts in North Publishing at August 2015
Early Adopter Trusts in Midlands & East and London engaged early 2015
Pilot 2011 NW Transparency programme (8)
Findings
Chart 1. Staff reporting knowledge of Open and Honest Care Programme
85%
15% Yes
No78%
22% Yes
No
Chart 2. Staff reporting data shared with them
Chart 3. The OAHC programme helped the Trust to understand where action could be taken to reduce harm, improve safety and patient experience
82% Yes
No
Chart 4. Does the OAHC programme enable Transparency ?
Agreed oragreedstrongly
Other83-87%
Trust Improvement Story
Open & Honest Care
The Blackpool Journey
Tracy Burrell
Assistant Director of Nursing
& Quality
Publish the incidence of
harms
Improve outcomes for
patients
Capture the staff
experience when the
harm occurred
Capture patient
experience when the
harm occurred
Participating sites take responsibility for
publishing the number of harms that they identify
Review care provided Improve quality and safety Build public trust and confidence in the nursing profession
Identify the areas where the nursing profession needs to improve the
experience of patients
Identify the areas where the nursing profession needs to improve the experience of staff
Why did Blackpool participate?
The Journey
Transparency Pilot
Increase public confidence in
nursing
Voluntary
Openness
&
Honesty
The Pilot Participants February 2011
Thank you
Aintree University Hospital Blackpool
Teaching Hospitals
Royal Bolton
Hospital
East Lancashire
Hospital Liverpool Heart &
Chest
St Helens and Knowsley Hospitals
Salford Royal
Wrightington Wigan and
Leigh
People Centred
Positive
Compassion
Excellence
Using qualitative feedback to drive
organisational improvement
Barriers to Implementation
Practicalities of Implementing
Definitions
Challenges…………..
People Centred
Positive
Compassion
Excellence
Reviewed and validated
pressure ulcer and falls harm as per agreed
definition
Spoke with staff and
patients about their
experience of care
Retrospectively reviewed the nursing care
delivered
What we did ………..
Undertook root cause
analysis where harm
occurred
Published our
data and
improvement
story
Agreed: definitions
Inclusion criteria
Patient & staff experience questions
NCI
Developed SOP’s
What we found………..
Pressure Ulcer 100% of grade 2,3,& 4
Falls 100% of moderate, severe & death
April 2013
Patients cared for – Staff recommend
place of work
72
23 (community)
1
Trust Narrative: Local Results – % HFC, HAI, Staff Experience, Patient Story, Quality Improvements
March 2012
- 57 12
September 2014
75 11 (community) 4
Friends & Family Test Inpatients
How likely are you to recommend our ward to friends and family if they needed similar
care or treatment?
79
79
87
1 13 (11 community)
93.4 91
June 2015
People Centred
Positive
Compassion
Excellence
• Patient stories at Trust Board / Senior Nurses • Rotation of meal distribution • Improved protected mealtimes • Purchase of new hot/cold food trolleys • ‘Chef’ rota for ward visits • Colour coded devices to support nutrition • Pressure ulcer prevention processes • Falls prevention processes • Reduced patient harms • Focussed on preventing PPH • Improved monitoring of the deteriorating patient • Patient experience – listened and heard • Improved patient involvement in developments and meetings • Improved staff experience
Just Some of The Improvements made………..
What has the Open & Honest Care Project Meant to Blackpool?…
• Transparency was not new at Blackpool • Method of publicising information concisely / Tool • Understandable to all - Layman Terms • Focused attention – linked staff & patient experience to outcome • Where we needed to focus attention to improve patient and staff experience • Development of new initiatives / tools • We all do things differently, but, now standardising – allows benchmarking • The power of triangulating data • Highlighted good, bad and ugly!!! • Provide forum for organisational sharing and learning lessons / Feedback to staff • Catalyst to drive Improvement - link to Quality Improvement programmes • Honesty is best policy – not just about what happens but how you deal/manage
/learn from it/ share ideas / support each other • Small changes make the difference! • Recognise good practice and compassionate care • Change Culture • Duty of Candour • Improved relationships with CCG’s (CQUIN)
Discussion and questions
Standard Operating Procedures have been revised
Local ownership of the Programme
Participation in the Programme by NHS organisations throughout England
Our vision for the Open and Honest Care: Driving Improvement Programme
Trusts publishing Maternity and Mental Health metrics
Implementation of the Edge Hill recommendations
To embed the Programme with front-line staff To drive local quality improvement National plan to develop patient friendly open and honest report
Where are we now? • Year 3 - Compassion in Practice: Focus on ‘scale up and spread’
• Legacy of resources/templates from the North and Midlands and East
NHS England Regions
• Engaged boards and stakeholders, North , Midlands and East and London
• Trusts are publishing In North and Midlands and East • Currently in discussion with South Region
• Each region progressing things differently according to local need
• Reports layout determined by local need
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NHS Choices
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The drop down box enables you to find your own trusts /area http://www.nhs.uk/service-search/accountability
CCGs are ideally placed to support the Programme
CCGs are local leaders of whole system change
Access to multiple stakeholders across
local health community
Opportunities for Patient and public engagement via Lay CCG members,
Healthwatch, engagement events
Able to incentivise quality improvement programmes via
contractual mechanisms eg CQUIN
The Safety indicators lend themselves to collaborative
working
Additional benefits to CCGs
• Consistency of reporting across local health community
• Supports triangulation of hard and soft data from different sources
• Supports quality surveillance and early detection of issues
• Supports cultural change • Supports assurance agenda without placing
extra reporting burden on providers
• Guidance and Support - NHS England • Facilitate sharing of good practice for rapid scale
and spread of improvement – National programme support WebEx’s
• Provide information on strategic direction, future developments and events
• Trust buddying • M&E resources & National resources – templates,
documents available on NHSE website http://www.england.nhs.uk/ourwork/pe/ohc/
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What support is available?
Further information
• Open and Honest Toolkit for Trusts • Standard Operating Procedures • Publication templates • Board Compact
• Edge Hill report • CCG resources (to be published shortly)
• Example CQUINS • Example Terms of Reference for health community wide forums • Information on Investing in Behaviours Programme
http://www.england.nhs.uk/ourwork/pe/ohc/
• Honesty is best policy – not just about what happens but how you deal/manage /learn from it/ share ideas / support each other
• Highlighted good, bad and ugly!!! • Use real patient, carer and staff stories – link to improvement and Board if
possible • Triangulate data – don’t use in isolation • Small changes make the difference! • Engage staff and raise awareness – in preparation and use of information • Recognise good practice and compassionate care with staff and celebrate • Provide forum for organisational sharing and learning • Use as catalyst to drive quality Improvement / staff & patient experience
programmes • Don’t publish every improvement at once – keep a list
Authors: Tracy Burrell and June Taft (North Region)
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Open and Honest – Top Tips
Contacts
Enquiries or Guidance
Open and Honest Care Programme
They will then put you in touch with your regional lead :
Rachel White – Midlands and East
Hazel Richards – North
Jan Fowler – South
Debbie Parker – London
Discussion and questions