quality account 2018-19 account 20… · values locally accessed services and excelling in ......
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Quality Account 2018-19
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Contents
Section 1 – Introduction
Chairmans Statement 3
Our Vision and Values 4
Our approach to quality 5
Section 2 – Quality and Effectiveness
Care Quality Commission (CQC) 6
CQUINS 6
Staff Survey 7
Clinical and Service Audits 9
Incident Reporting 9
Outcomes 10
Section 3 – Service User Experience
Complaints 11
Friends and Family Test 11
Quality of Care 11
Section 4 – Quality Priorities for the next year 2019/20 12
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Section 1 – Introduction
Chairman’s Statement
When, in 2006, a group of 10 GPs and practice managers met and decided to found what soon became Novus Health, our aim was to provide services that were of high quality and more readily available than those which were offered from secondary care at that time. We were committed to ensuring that the clinical and managerial personnel we worked with and the systems we introduced were of high quality.
Over the last 12 years I am pleased to say that we have maintained these aims and, from a very small beginning, have built a provider organisation which has the principles of safety, effectiveness and a positive patient experience at its forefront.
We are committed to a programme of monitoring outcomes, both in terms of compliance with processes which we have introduced to ensure safety, and also in terms of patient satisfaction.
The results of such monitoring are regularly reviewed by our management team and the board. We actively consider all comments made by patients and staff, aiming for constant improvement in our services and to eliminate, where possible, any issues which may adversely affect patients’ experience or outcomes.
We are fortunate to have a dedicated team of staff who go to great lengths to deliver on our program of quality and effectiveness. In return we take steps to support them in their personal training in development and have systems in place to monitor staff views and respond to any concerns.
Having chaired Novus Health since 2006, I firmly believe that our governance objectives and overall strategy have enabled us to provide services which are valued by referrers, commissioners and patients. This is a long-term commitment which, I hope, will allow us to maintain these high standards in the future.
Martin Shutkever Chairman Novus Health
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Our Vision and Values
The statements below identify the Vison, Values, Aims and Priorities for the organisation for the next two years. These statements are underpinned by detailed operational plans that will support the transformation of the organisation and development of the range of services provided locally. Our Vision – identifies our future ambition and how we desire to be recognised Our values – should be embedded in everything we do and every patient contact Our Aims – outline the our purpose and intentions Our Priorities – identify the elements of our organisation that are the most important
Vision and Values
Our Vision Our Values
“To be recognised for our commitment to improving health care services for the local community, developing our range of locally accessed services and excelling in quality, safety and patient experience”
Woking together for patients
Respect and dignity
Commitment to quality of care
Compassion
Improving lives
Everyone counts
Strategic Aims
Improving the safety and clinical quality of our services
Improving the experience for the patients, carers and families that we treat.
Developing the range of services we provide and developing the integration of services between primary and secondary care.
Delivering services closer to people’s homes, with continually improved access to treatment times.
Developing our organisation and workforce.
Improving the financial stability of the organisation.
Key Priorities
Quality
Delivering safe, harm free care focusing on evidence based pathways, supervision and board level clinical leadership.
Developing, maintaining and deploying clinical staff, who are competent, empowered and promote the core values of the organisation.
Delivering personalised, responsive and compassionate care in partnership with patients and families, commissioners and other healthcare providers in appropriate environments safeguarding the most vulnerable.
Operational
Developing a robust organisational infrastructure that supports continuous improvement, can respond to new challenges and become a leading enabler within the local health economy.
Exceeding all key NHS Constitution and commissioned standards and deliverables, including access and quality outcomes.
Developing our range of community services that are available to the local population, delivered by local clinicians, closer to people’s homes, which are integrated with primary and secondary care provision.
Financial Improving our financial stability and generating funds to re-invest in our services.
Equality
Develop a more diverse workforce and promote an inclusive culture, equality of opportunity for all staff and the behaviours and capabilities required to regulate proportionately, fairly and free from bias
Ensure that the way we operate, our rules and the decisions we make are proportionate, fair and free from bias.
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We will Excel by:
Delivering on our promises.
Making it personal.
Putting in the extra effort to succeed.
Taking your healthcare seriously.
Making it timely. The Excel principles underpin the organisations drive to build confidence and satisfaction. They are fundamental to ensuring that staff know the performance that they are expected to deliver and that they deliver a quality service.
Our approach to Quality
Quality is the foundation for all decision making and actions undertaken by Novus Health Ltd. We
have clear objectives to ensure the delivery of safe and effective care. This is evidenced by the
‘golden’ thread of quality woven throughout the delivery plan. The provision of high quality care is
measured against the Care Quality Commission (CQC) domains:
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Section 2 – Quality and Effectiveness
Care Quality Commission (CQC)
Our last inspection was on the 8th February 2014, it was a routine inspection and the following
standards were published:
CQUINs
The Commissioning for Quality and Innovation (CQUINs) was introduced in 2009 to make a
proportion of healthcare providers’ income conditional on demonstrating improvements in quality
and innovation in specified areas of patient care. The key aim of the CQUIN framework is to secure
improvements in the quality of services and better outcomes for patients. Following approval from
NHS Wakefield CCG the Novus Health Ltd initiated 7 improvement projects, the table below
identifies the planned activity and achievement.
Topic Activity Status
Ensure eRS entry is updated reflecting current service requirements AchievedProvide TRISH with regular, structured service information on access, delivery, innovation
and operational issues that may affect patient choice.Achieved
Development of an Audiology Referral Support Pilot proposal to reduce unnecessary ENT
referrals and deliver activity through a different resource model reducing the costs of
service deliveryAchieved
Continue Telephone Assessment pilot on East of District Achieved
Develop and implement new model for Trinity Medical Centre which includes clinical triage
of all referrals, model to include GP, Nurse triage, care navigator and self referral processAchieved
Introduction of ‘clinical leads’ within community service, enhanced mentoring and support,
introduction of peer review for onward IPT’sAchieved
Introduction of e-consultation within S1 for referrers to get advice prior to referral Not Achieved
Develop CTS pathway for CCG to consider for the replacement of the current Minor Hand
Surgery serviceAchieved
Development of Templates within S1 consultation process to record compliance with CCG
Commissioning Policy and EVB RecommendationsAchieved
Develop opportunities to redesign the General and Vascular service pathway to re-integrate
with MYHTNot Achieved
Service specific Patient Participation Event AchievedIntroduction of QuickSIV Test – enabling an assessment of an individual ears base ability to
process speechAchieved
Move entire hearing aid range to the GN Resound C-Series – a wifi enabled more modern
device with enhanced functionsAchieved
Implement hearing rehabilitation instructional videos C2Hear on NH website and create
hard copies to send to patients that requestAchieved
System Recovery – Engagement
with Referral Support project
System Recovery - Community
Physiotherapy Service
Transformation – Phase 2
System Recovery – Pathway
redesign
Adult Hearing Loss – Service
Transformation and Patient
Engagement
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Staff Survey
The NHS Staff Survey is an important source of information about what it is like to work in the health
service in England. The NHS Staff Survey results are utilised by organisations to support local
improvements in staff experience and wellbeing and are also examined by external organisations
such as the CQC and NHS Improvement.
This is the first time a full staff Survey was completed at Novus Health, we received 31 responses
from 45 surveys sent our – a very pleasing 69% response rate, this is a mixture of clinical and non-
clinical staff members.
The following key elements have reflect the priorities for Novus Health Ltd:
Do the following statements apply to you and your job?
Topic Activity Status
Identify the criteria/ measures to be used in the outcome framework Achieved
Identify the information/ recording requirements necessary to support criteria at 1 AchievedAlter clinical system template/ coding and recording requirements to capture necessary
informationAchieved
Develop ‘Outcome Framework Report and embed in the Clinical and Operational Review
meetingAchieved
Review current LocSSIP’s Achieved
Development of theatre standards and inclusion in LocSSIP’s Achieved
Identification of clinical risk matrix and development of response protocols Achieved
Re-issue new LocSSIP ‘Manual’ which includes enhanced content requirements Achieved
Develop Consultant clinics in the community service – bring consultants out of MYHT to
improve governance and oversight of GPwSI’s, improve access to expertise for patients and
reduce wait times
Achieved
Conduct a clinical Structure and location review for current service – to develop a
centralised Hub with more limited spoke delivery modelAchieved
Introduce nurse led cryotherapy and minor operations clinics Achieved
Develop governance and clinical model to enable community based roaccutane prescribing Not Achieved
Community Dermatology Service
transformation
Develop and implement ‘Outcomes
Framework’ that sits across all services
Review and development of Local
Safety Standards for Invasive
Procedures for all surgical services
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To what extent do you agree/disagree with the following?
Are you aware of how to raise concerns about unsafe clinical practice?
To what extent do you agree with the following statements about unsafe clinical practice?
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Q25. To what extent do these statements reflect your view of your organisation as a whole?
Clinical and Service Audits
During the year a number of planned and reactive audits have been completed, the outcomes of
these audits inform the cycle of continuous improvement, they are presented and discussed at the
Clinical and Operational Review Committee and summarised at Board.
Examples of areas of improvement:
Title Outcome
Infection Control – Bare below the elbow And Hand Hygiene
100% Compliance
Low Risk BCC excision 90% Diagnostic agreement on histology 97% complete excision margin
Documentation Audit – Care pathways 100% compliance – on re-audit
Local Safety Standard for Invasive Procedures – 7 Sequential Steps
100% Compliance
Incident Reporting
At Novus Health Ltd is committed to the safety of our patients, relatives and staff. Over the year our
staff reported 35 incidents and issues, which allow us to investigate, learn and improve our service
delivery. There were no serious incidents, injuries or never events.
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Outcomes
As part of the 2018/19 Quality Improvement Plan Novus Health Ltd developed and implemented an
outcomes framework that captures operational, clinical, Patient and Clinician reported outcomes
and allows the organisation to assess the effectiveness of the services we provide.
The table below demonstrates some of the indicators we are utilising, this reporting is now
embedded into our governance and clinical review processes and used to continuously improve
quality, outcomes and the patient experience.
In addition, our patient feedback process captures the patient reported symptom improvement as a
results of the treatment they have received at Novus Health Ltd.
Minor Hand
Surgery
Cataract Surgery
General Surgery
Vascular Surgery
Dermatology Audiology Wakefield
Audiology North
Kirklees Physiotherapy
96% 97% 91% 100% 93% 93% 96% 65%
Service Pathway point YTD
2
42
97.17%
84.32%
88.55%
Followup 58
1:0.7
Minor Procedure - Surgical phase 0
2
5
SOS apointments Number of patients self referring for urgent review
0
2
Excision margins within tolerance 99%
Diagnostic agreement (predicted against histology) 86%
0
10
43
0
0
0
1:0.9
0
0
0
1
3
Routine post surgical followup/ review 32
01:0.7
FA:FUP Ratio 1:2.8
DNA Rate 8.0%
Clinic Utilisation 87.0%
100 % ; Fully resolved 18.2%
75-99%; Good improvement reported 50.1%
75-30% ; Moderate improvement reported / able to better self manage 15.0%
30- 0 %; Minimal improvement / change in symptoms 15.4%
Ceased to Attend / Did Not Attend 20.9%
Referred to Other Speciality. 4.5%
Routinely wearing hearing aid Yes 89.52%
Aids comfortable Yes 86.68%
Confident fitting hering aid Yes 91.15%
Able to change hearing aid batery Yes 95.49%
Able to clean hearing aid Yes 87.03%
Because of the hearing aid, hearing has improved Yes 84.21%
Can now hear satisfactorily more of the time Yes 80.63%
General Surgery 4/7 day review
Post Operative Wound Infections
Post operative complications
Low Risk BCC
Followup
No interopertive complications
Cancelled Operations - On day of surgery by surgeon - transferred to MYHT
4/7 day review
No interopeartive complications
Post operative complications 4/7 day review
12 week reviewMHS
Outpatient pathway
General Dermatology
FA:FUP Ratio
Consultant Followup appointment - as a result of post surgical contra-indication
Surgical site healing (fully)
Night symptoms improved
Post operative wound Infections
8-10 Week Review
Consultant Followup appointment - as a result of post surgical contra-indication
Surgical Phase
FA:FUP RatioFollowup
Routine post surgical followup/ review
Post Operative Wound Infections
Post operative complications
4/7 day reviewPost Operative Wound Infections
Symptom improvement
Post operative complications
Outcome FrameworkElement
Consultant Followup appointment - as a result of post surgical contra-indicationFA:FUP Ratio
Vascular Surgery
Surgical Phase
Interopertive complications
Cancelled Operations - On day of surgery - health related
Cancelled Operations - On day of surgery by surgeon - transferred to MYHT/ other
4/7 day reviewPost Operative Wound Infections
Post operative complications
Followup
Physiotherapy
Audiology
Clinician Assessed Improvement
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Section 3 - Service User Experience
Complaints
As a learning organisation, complaints are a vital source of information shared across our services to
inform and improve what we do, we actively encourage all types of feedback and have introduced a
new category to our complaints management system of ‘concerns’ which are in essence informal
negative feedback which helps to give a measure of lower level issues and what can be done to
improve the patient experience.
During the year we received:
Formal Complaints 2
Informal Complaints/ Concerns 76
Friends and Family Test
We actively promote a culture of continuous improvement and encourage service users to feed back
there experience. It is therefore pleasing that the average response was 94% of respondents stated
they would be likely to recommend Novus Health. The table below identifies the responses by
individual Service.
Percentage of patients likely to recommend our service’s to friend and family
Minor Hand
Surgery
Cataract Surgery
General Surgery
Vascular Surgery
Dermatology Hearing
Loss Wakefield
Hearing Loss
North Kirklees
Community Physiotherapy
99% 100% 100% 100% 99% 97% 99% 85%
Quality of Care
The Patient Feedback questionnaires also enable reporting of our patient’s assessment of the quality
of care they receive, whether they were involved in the decision making and were they treated with
Dignity and respect.
Overall - Quality of Care (Excellent, Very Good and Good)
96%
Individual Service - Quality of Care (Excellent, Very Good and Good)
Minor Hand Surgery
Cataract Surgery
General Surgery
Vascular Surgery
Dermatology Hearing Loss
Wakefield
Hearing Loss North
Kirklees
Community Physiotherapy
99% 99% 100% 100% 99% 99% 99% 91%
Yes No
Were you treated with dignity and respect? 99% 1%
Were you involved in decisions about your care? 98% 2%
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Section 4 - Quality Priorities for the next year (2019/20)
Quality is the foundation for all decision making and actions undertaken. Novus Health has a clear
objective to ensure the delivery of safe and effective care. This is evidenced by the ‘golden’ thread of
quality woven throughout the delivery plan.
Priority 1 – Increase staffs knowledge of incident reporting processes and why they should be
encouraged to be used.
Priority 2 – Improve the Adult hearing loss patient’s functional outcomes
Priority 3 – Improve Physiotherapy patient’s symptom improvement scores.
Priority 4 – improve the clinical and operational audit program across services.