Energise for Excellence in Care

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Energise for Excellence in Care

• Jane Cummings
• Executive Director of Performance, Nursing,
  Quality Commissioning, NHS North West
• Hilary Scholefield
• Chief Nurse
• Sheffield Teaching Hospitals Foundation Trust
• Angela Brown
• Associate Director of Clinical Quality, NHS North
  West

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Energise for Excellence in CARE
Jane Cummings Executive Director of Performance,
Nursing, Quality and Commissioning NHS North West
Katherine Fenton Chief Nurse Director of
Clinical Standards and Workforce NHS South
Central
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Energise for Excellence in CARE

• What do you think that this means and how does
  the title make you feel?

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Aim of Session

• Reconnect and strengthen connections and feelings
  with why we care about what we do as nurses
• Understand and identify how we know when we are
  making a difference when we deliver that care
• Offer a tool kit that might help support a
  movement

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NHS wide shared vision and values

• Respect and dignity
• Commitment to quality of care
• Compassion
• Improving lives
• Working together for patients
• Everyone counts
• Aligning around Quality

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Shared vision and values

• as nurses we
• share a common purpose
• care about our patients, their carers and
  families
• promote health and well being
• care with compassion
• care with dignity and respect
• care about outcomes
• care about what we do and the way we do it
• Care about Quality

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Do we always live them?
MAKE IT PERSONAL
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No of incidents reported Is just the tip
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Ellen 76 yrs Wife of Harry Mother Grandmother
Active fit and well - then.. femur now
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Other motivators and challenges

• Patients and public rightly demand and expect
  high quality care we are failing them. For
  example
• Mid Staffs / BCH / Maidstone / Six Lives and
  others
• Changing health economies financial pressure
• National demographics
• Next Stage Review opportunity
• Must deliver satisfying and rewarding careers
• We know what to do
• Effective leadership

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THE MAGIC BOX
Clinical Development
Drift
Cost
!ENERGY!
reduced hospitalisation standardisation technology
reducing clinical error and harm waste
reduction reduce variation systematic application
of what works measurement
Cuts
Improved quality
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Pursuit of excellence the ultimate challenge

• Freedom from
• needless death or disease
• needless pain
• feelings of helplessness (amongst service users
  and staff)
• unwanted delay
• waste
• inequality in service delivery
• Pursing Perfection IHI

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So what must we do?

• use our collective energy to
• drive and maintain continuous improvement
• revisit and review shared vision and values
• evaluate and measure effectiveness
• reward and celebrate success
• learn from failure and apply knowledge to change
  process
• we know what to do we just have to do it!

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How can we assure ourselves and our patients?
Measurement the vision Where all clinical
care provided anywhere in the NHS is
appropriately measured for its safety,
effectiveness and patient experience, where we
can increasingly measure the ultimate outcomes of
care, and where information on quality is acted
upon rapidly and effectively to ensure continual
improvement.
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Quality The Organising Principle
Staffing Numbers and Skill Mix
Nursing Metrics
Staff and Patient Experience
Subsidiarity
Co-production
Clinical Ownership
Alignment
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Quality the organising principle

Safer Nursing Care (AUKUH) a simple tool that
calculates nurse staffing requirements based on
the acuity and dependency of the patients and
linked to nurse sensitive outcome indicators
Subsidiarity
Co-production
Clinical Ownership
Alignment
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Application across Sheffield TH Directorate level
(Neurosciences)
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Action by Directorate Management Team

• Review root cause analyses (RCAs)
• Baseline position on Nurse Sensitive Indicators
• Review overall Directorate position
• Move staff between wards

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Directorate position after intervention
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Quality the organising principle
Safer Nursing Care (AUKUH) a simple tool that
calculates nurse staffing requirements based on
the acuity and dependency of the patients and
linked to nurse sensitive outcome indicators
North West Metrics
Subsidiarity
Co-production
Clinical Ownership
Alignment
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• best bets

• Failure to rescue
• Infection
• Falls
• Pressure sores
• Compassion

Prof. A M. Rafferty (State of the Art Metrics
NNRU 2008)
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NHS North West Care Indicators

• process indicators linked to outcomes
• provide assurance at ward, directorate and Board
  level
• further metrics being developed in maternity,
  paediatrics and short stay
• Community and mental health is an area for
  further development

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The metrics

• falls assessment
• food and nutrition
• pain management
• pressure ulcers
• medication prescribing and administration
• patient observations
• infection prevention and control

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NCI WARD-LEVEL REPORTING
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Trust Board
Governance Quality performance assessment at
division level
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Benefits realisation outcomes

• significant compliance with the core indicators
  (98)
• reduction in falls incidence 26-55
• improved risk assessments 90-100
• MEWS compliance 96-100
• reduction in prescription sheet/errors 47

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Nurses in Society (October2008)

• The work of the North West SHA Nurse Directors
  was inspiring in terms of their agreement to sign
  up to putting into practice a set of metrics as
  well as an arrangement to share results for
  benchmarking purposes.
• This work should be reviewed and could be built
  upon across the country

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Quality the organising principle
Safer Nursing Care (AUKUH) a simple tool that
calculates nurse staffing requirements based on
the acuity and dependency of the patients and
linked to nurse sensitive outcome indicators
North West Metrics
NHS Patient and Staff Metrics
Subsidiarity
Co-production
Clinical Ownership
Alignment
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Listening to patients the Southampton
experience

• overall satisfaction with care
• recommend to family and friends
• privacy when discussing a condition
• treated with dignity and respect
• information about condition
• staff talk in front of patients

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Quality the organising principle
Food Nutrition Pain Management Patient
Observations

• Patient Surveys
• Staff Experience
• Nutritional Assessment
• Pain Management
• Medication Assessment
• Infection Control

Falls Assessment Pressure Area Care Medication
Prescribing Administration Infection
Prevention Control Staffing Numbers Skill
Mix
Subsidiarity
Co-production
Clinical Ownership
Alignment
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Current position Tools available to measure
outcomes improve experience

• Evidence based process and outcome metrics for
  safety effectiveness and experience
• Links to
• Staffing, patient dependency / acuity
• Care interventions and practice
• Real time feedback and evidence of improvements
• Easy to use tools, tested in practice options
  for further development
• Front line clinical ownership
• Board accountability - the care line

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Aspiration

• To build on tools and approaches that you are
  already using and share nationally and regionally
  to spread and adopt
• To develop excellence in care tool kit
• Pick and mix approach to use that enables local
  and setting specific tailoring
• Approach sustained by collective energy for
  excellence in care and benefit realisation

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• How?
• Energise for Excellence in CARE

• Use the power of shared visions and values to
  galvanise
• unified direction of travel
• energy and commitment to see the journey through
• pursuit of excellence in everything we do

The Power of One, the Power of Many
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• You cannot build a reputation
• on what you are going to do
• Henry Ford

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Angela Brown Associate Director Clinical
Quality NHS NW
Energise for Excellence
Mobilise for Action

• we would really welcome your thoughts and
  feedback
• How could the approach be enhanced and
  strengthened by what you are already doing
  share examples?
• How does this link to the key challenges you
  have?
• What are the hurdles to delivery?
• Would you like to be involved in scoping this
  piece of work for the next phase?

Jane.cummings_at_northwest.nhs.uk Katherine.fenton_at_s
outhcentral.nhs.uk
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CNO SpringBusiness Meeting

• The Met Hotel, Leeds
• Wednesday 29th April 2009