francis inquiry recommendations what are the implications for all of us in our everyday work?
TRANSCRIPT
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Francis Inquiry Recommendations
What are the implications for all of us in our everyday work?
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Some figures…
• >1 million pages of documentary material
• 250 witnesses • 139 days of oral hearings • Terms of reference
announced 9 June 2010 • Report handed to Sec of
State 5 February 2013 • Costs £13 million to
November 2013 • 1781 pages • 290 recommendations
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A negative culture?PRESSURE
Targets Finance
FT status Jobs
REACTION Fear
Low morale Isolation
Disengagement No openness
BEHAVIOUR Uncaring
Unwelcoming Bullying
Keeping head down
HABITUATION Tolerance
Denial External reassurance
Someone else’s problem
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Recommendations
• Common values • Fundamental standards • Openness, transparency and candour • Compassionate, caring, committed nursing • Strong patient centred healthcare
leadership • Accurate, useful and relevant information • Culture change not dependent on
Government
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Values – Clarity and Commitment
• Do We Put Patients’ first in all we do?• Do we protect patients from avoidable harm?• Are we open & honest with ourselves when
things have not gone to plan?• Are we open & honest with patients when things
have not gone to plan or we have not provided a good experience?
• Do we know how to raise our concerns about patient safety?
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Fundamental standards
• What patients and the public see & experience are the fundamental standards (care, compassion, communication, commitment to effective and well co-ordinated care)
• Is everyone aware of & understand the fundamental standards that the CQC hold us to account as part of regulation?
• If you are not aware – would you know where to go for support in getting a better understanding?
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Fundamental standards - Examples
• Prescribed medication given • Food and water to sustain life &
assistance when needed• Patients environment and equipment kept
clean • Assistance where required provided to go
to the toilet• Consent for treatment obtained
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Openness, Transparency and Candour
• Openness: enabling concerns and complaints to be raised freely and fearlessly, and questions to be answered fully and truthfully
• Transparency: making accurate and useful information about performance and outcomes available to staff, patients, public and regulators
• Candour: informing patients where they have or may have been avoidably harmed by healthcare service whether or not asked
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Compassionate, caring and committed nursing
• Aptitude assessment on entry to training including ability to demonstrate compassion
• Hands on experience a requirement prior to training
• Named nurse (and doctor) responsible for each patient
• Code of conduct and common training standards for HCSWs
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Strong, patient-centred leadership
• Effective clinical & managerial leadership of teams – evidence demonstrates it is linked with better outcomes for patients
• Leadership development & Aston team effectiveness programmes – do we know about them? Are we getting involved?
• How do we use patient feedback to improve our practice and the way we do things?
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Accurate, useful and relevant information
• Individual and collective responsibility to develop performance measures
• Do we use data & information to improve our practice and our services?
• Do you know what measures your department and division use so that you know how well you are doing as a team?
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What is the Trust doing already?
• “We care” programme – are you involved in the values into action events in your division?
• Shared purpose framework of competencies around person-centred, safe & effective care
• Executive Patient Safety Visit programme (Culture)
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What is the Trust doing now?• Leadership programme based on
competencies within Shared Purpose Framework (Nursing and other clinical leaders)
• Ward staffing establishment in process of annual re-review (Nursing)
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What is the Trust doing already?
• Revalidation of doctors to include 360o
feedback from their team, clinical outcomes and patients (Comments and complaints)
• Preparation for the launch of “friends and family test” for in-patients and those attending A&E – going live in April
• Triangulation of data from complaints, concerns, serious incidents and claims
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What does our Board consider to be the priorities?
• listening & responding to feedback from patients and the public
• Listening & responding to staff and encouraging them to raise concerns about any aspect of clinical care
• Ensuring that we are listening and responding to feedback from staff who are in training both pre-registration and post registration
• Ensuring teams have the opportunity of undertaking the Aston Team working approach to clarify roles, responsibilities, accountabilities, approaches to improving communication amongst the team
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What does our Board consider to be the priorities?
• Reviewing our approach to the publication of performance information on the public web-site – strengthen accountability to public
• Exploring the meaning of the “duty of candour” and outlining our approach to openness and disclosure of information
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Notes on Hospitals, Nightingale F, 3rd ed 1863, Longman Green Roberts & Green
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Florence Nightingale, Notes on Nursing (1860) pages 92-93