UCLH NMAHPP Strategy 2- Stronger together Nursing... · are ‘stronger together’. Now is the...

UCLH Nursing, Midwifery, AHP and Pharmacy Strategy

2016-2021

Stronger together

UCLH Nursing, Midwifery, AHP and Pharmacy Strategy 2016-2021

“Our mission is to deliver top quality patient care, excellent education and world-class research.”

2

Contents

Foreword from the Chief Executive 4 Foreword from the Chief Nurse

6

Introduction and background

10

The journey

14

The context

15

Stronger together - bringing the strategy to life

22

The five strategic aims are that NMAHPPs will:

24

1. Provide the highest quality care within our resources

24

2. Listen and respond to our patients and improve their pathways

26

3. Be valued and developed to deliver their potential

28

4. Practice in ways which manage resources and achieve

financial sustainability

32

5. Inspire, innovate and generate world class research

34

Enablers

38

In conclusion

43

3


Foreword

Sir Robert Naylor, Chief Executive, UCLH

from the Chief Executive

Our reputation as one of the leading NHS Trusts is a testament to the hard work and high calibre of our workforce who go the extra mile, every day, to provide high quality services to patients. Our nurses, midwives, allied health professionals and pharmacists, taken together, are a huge part of that workforce. This strategy, the first ‘joint’ strategy, aligns these staff and ensures they support and complement each other.

There is no doubt that there are challenging times ahead. We will have to provide the same high quality services on ever more limited resources. To do this we will need to draw on the knowledge and expertise of our

staff and I have every confidence that our workforce has the skills and expertise to do this.

As we go into 2016/17 and beyond it is not just about how we sustain, but how we improve our patients’ experience and care. As well as the specialist care we provide to patients from around the UK and beyond, we are working closely with partners from North Central London through our local Sustainability and Transformation Plan to focus on improving the care we provide our local population. This strategy sets out how nurses, midwives, allied health professionals and pharmacists can contribute to this challenge and how we can continue to set the standard for excellent care. Maintaining our reputation as a centre of

4

excellence is crucial to continue to attract and retain more high calibre staff.

This strategy is a central part of our future and sets out how you, whatever your role, can make a difference to patient care. Sometimes it’s the small things that make a big difference – when I receive feedback from patients about how a kind word has made them feel reassured and safe, I feel honoured to be part of UCLH. That is the care we would want for ourselves and for our loved ones.

From the thousands of patients and the executive board, I would like to say a huge thank you.

5


Foreword

Flo Panel-Coates, Chief Nurse, UCLH

from the Chief Nurse

As Chief Nurse at UCLH I am proud to introduce our first joint Nursing, Midwifery, Allied Health Professionals and Pharmacy strategy. This strategy recognises the unity of our professions (registered/ unregistered) to deliver within an environment where we are exposed to the same challenges and drivers. This was recognised through the design of our strategy with an early recognition that we are ‘stronger together’. Now is the time to step up as a group of dedicated and experienced professionals to meet the demands of an ever changing landscape and population.

Our mission to deliver top quality care, excellent education and

world-class research remains our key focus. The unique contribution that our professions will make to deliver this mission is set out in our new five year strategy.

Building upon our previous achievements and ambitions from the 2012-16 Nursing and Midwifery Strategy ‘We will be the best nursing and midwifery workforce in the NHS,’ this new joint strategy identifies high level strategic priorities for our professions which supports our overarching strategic aims and relies heavily on our excellent working relationships between the medical directors as leaders of our clinical boards and services. This has seen us become a more desirable employer of choice for our staff, which will help us sustain the many areas of

6

excellence, improve on those areas where we have work to do and keep a balance of stability and freshness in our thinking and approach.

To be successful, we have recognised we must also pay attention to a number of enablers. These are seen as opportunities to accelerate the pace of change and help deliver a more resilient and flexible workforce. Strong leadership and professionalism is required at all levels to be able to innovate and inspire the changes and alternative approaches which will transform services and make patient pathways fit for the future.

In order to do this, we will need to work differently and what I have witnessed so far is a group of staff with the desire and tenacity to rise

to the challenge, even when the landscape is unclear.

The intention for this strategy therefore is to unlock the huge potential we have in our staff whilst ensuring we meet the local, system and national asks as defined by the evolving Sustainability and Transformation Plan (STP), our strategic aims and those mapped out in the national nursing, midwifery and care staff strategy, ‘Leading Change, Adding Value’ launched in May 2016.

7


Dr Fiona Yung

Dr Robert Urquhart

Annabel Kanabus

“I’m pleased that Allied Health Professionals (AHPs) have been included in this strategy. I see this as a fantastic opportunity for us to not only work collectively and collaboratively with our nursing, midwifery and pharmacy colleagues, but to start to demonstrate our value and strengthen our voice within the organisation. We will need to focus on different ways of working that will enhance and improve the care to our patient. I look forward to working with you all on shaping our future together.”

Dr Fiona Yung, Divisional Manager, Pathology and Clinical Support, Medicine Clinical Board

Allied health professionals and pharmacy staff, like nursing and midwifery staff, are essential to the delivery of safe, effective and evidence based healthcare for all our patients. The strategy is an important step in recognising this and identifying how we can work together to further develop our

staff’s valuable contribution to provide the best outcomes for our patients.”

Dr Robert Urquhart, Head of Pharmacy and Divisional Clinical Director, Clinical Support Services Division

“The nurses and allied health professionals made all the difference to me when, following my cancer diagnosis, my world appeared to be falling apart.”

Annabel Kanabus, Governor and member of the Nursing & Midwifery Board

“I am delighted to have been part of the strategy development and to have worked with all the other professional groups in which the value and contribution of midwifery and midwives were recognised.

Birth is the start of the journey of life for us all and UCLH is the first choice for place of birth for many women locally and nationally, leading to a delivery rate of 6,541

8

babies been born at UCLH in 2015. This strategy will support us in focusing on the things that matter most to women and our midwives. The maternity landscape, e.g. demographics, women’s health status in pregnancy, women’s choice and midwifery education and workforce changes mean that we must continue to be flexible, innovative and responsive in order to ensure women receive the very best care that is safe and meet their individual needs and that we provide a progressive and rewarding place where midwives want to work and fulfil their personal and professional ambitions.

The Maternity Review ‘Better Births’ comes with its challenges but mostly opportunities for midwifery to organise and position itself differently to meet our strategic aim of delivering high quality care, where midwives are the lead professional for women with no complications and the key co- ordinator of care for all women. We are focussed on ensuring

women giving birth at UCLH have an excellent experience and that we listen and are responsive when things do not go well. In doing so we will ensure women remain at the heart of care and how we plan our services. I am excited about the energising and positive benefits of the strategy on our workforce in the coming months and years.”

Natilla Henry, Head of Midwifery

“I fully support and warmly welcome the Nursing, Midwifery, AHP and Pharmacy strategy as I firmly believe that patients should be treated and cared for as holistically as possible. Nursing, midwives, AHP and Pharmacy staff working together is a great step forward in providing higher quality, safer and joined up care for patients. I was delighted and impressed to feel the energy in the room for this approach on the away day.”

Dee Carter, Patient Representative

Natilla Henry

Dee Carter,

9


Introduction and background

This is the first joint strategy we have developed to support our ambition to be the organisation of choice for our staff.

This document outlines our five year strategy for nursing, midwifery, AHP and pharmacy at UCLH. This is the first joint strategy, developed to support our ambition to be the organisation of choice for our Nursing, Midwifery, AHP and pharmacy care staff and professionals.

Building upon the previous achievements from the 2012-16 Nursing and Midwifery strategy to ‘be the best nursing and midwifery workforce in the NHS’ this new joint strategy identifies high level strategic priorities for our professions which supports UCLH’s vision and goals.

This strategy has been co-created and developed following a series of discussions, events and road shows over a number of months, across all staff groups and sites. It has been led by Flo Panel-Coates, chief nurse, with senior clinical leaders in nursing, midwifery, AHP and pharmacy and with engagement from a broad representation of nurses, midwives, AHPs and Pharmacists, patient governors and representation from medical and management colleagues. It places nurses, midwives, AHPs and Pharmacists in a strong position to inform and influence the transformation of services, service improvement and patient outcomes.

10

At UCLH in totality as a group; nurses, midwives, allied health professionals, pharmacists and assistants to these professions make up 59% of the total workforce. Throughout this process we recognised our challenges are similar, aspirations the same and together we are stronger. This helped to identify the title of our strategy ‘Stronger Together’, as if we are to meet the growing demands we must work together and stay focused on achieving the best outcomes within our resources.

Nursing and midwifery make up a significant proportion of the NHS workforce and make a huge contribution to ensuring our patients receive safe, efficient and effective care 24/7, 365 days of the year. Whilst many have their own view of what nurses do, we have examples at UCLH of a variety of roles that nurses and midwives undertake such as;

direct care, managing their own patient caseload, providing clinics face to face and via telephone, leading and supporting clinical research, managing patient flow, delivering training and education, supporting clinical governance as well as advanced clinical roles such as emergency nurse practitioners, advanced nurse practitioners, clinical nurse specialists and consultant nurses and midwives.

Allied health professionals and pharmacists make up 6% of the NHS workforce and are the third largest professional group. Within the AHP group there are a range of professions including; occupational therapists, physiotherapists, podiatrists / chiropodists, speech and language therapists, dietitians, diagnostic and therapeutic radiographers, biomedical scientists, orthoptists, orthotists, paramedics, prosthetists, art therapists, and audiologists.

Agnes Niemet, Senior Clinical Pharmacist, Emergency Services

Ashley Wilson, Physiotherapist

Katherine OConnor, Occupational Therapist

11


Our staff identified pride in their professions as being important and this is not lost in having a joint strategy. Working together collaboratively and across our professional boundaries does not mean, and should not mean, losing our professional identity. Strong leadership and professionalism is required at all levels to be able to innovate and inspire the changes needed to transform services and patient pathways to make them fit for the future. In order to do this, leaders will need to work differently. We will need to demonstrate value, address advanced practice and work across health and social care.

This strategy is closely aligned to our UCLH vision and strategic aims. It also addresses the national issues in the national nursing, midwifery and care staff strategy, launched in May 2016 entitled ‘Leading Change, Adding Value’.

This cannot be delivered without the day-to-day support and leadership of our excellent clinical leadership team, especially our medical directors.

Professor Jane Cummings, Chief Nursing Officer for England stated in her foreword for the strategy “This framework encourages us all to reach further both individually and collectively. To do this we need to focus on what is important and connect with each other so we achieve more for patients and people and also for our professions”.

Patients across UCLH receive care which is delivered compassionately and continues to be rated as high quality, safe, efficient and effective. Multi-disciplinary collaborative working is key to delivering this, despite the challenges ahead we recognise that whilst the ‘world has changed, our values haven’t’1.

12

This principle was reinforced on International Nurses Day in 2016 when Ann Redmayne, Retired Nurse and Trustee from UCLH London Nurses Charity, said:

“Nursing has progressed so much and diversified but the values remain the same now as in the days of Flo 1. (Florence Nightingale)”.

Annual objectives

To support our strategy, annual objectives will be identified for each year of the five year strategy and will be monitored by the UCLH Nursing and Midwifery Board, which includes AHP and Pharmacy leaders. A progress report will be reported to the Executive Board regularly.

13


uclh

The journey

Development of our co-created Nursing and Midwifery Allied Health Professionals and Pharmacists Strategy (NMAHPP Strategy).

Benefits of co-created strategy for nurses, midwives, allied health professionals

and pharmacists

Workshops

with over 100, nurses, midwives, AHPs, pharmacists, managers, doctors and others

involved in developing the strategy themes and aims

Nurses Day

Staff invited to roadshows and open events at

UCLH sites

over 100 people input into the draft strategy

document

Over 300 people contributing to the overall

production of the NMAHPP strategy

14

The context

Increasing patient and public

expectations

Changing

Changes in workforce

requirements

Shift from

Six drivers for change identified here provide the focus and drive for the strategic aims of this strategy. Together these are essential in realising our ambition to be the organisation

health needs and increasing demands

on healthcare

NMAHPP Strategy

organisation to system leadership

of choice for our professionals.

Technological advances

iCare

Financial outlook

15


Changing health needs and increasing demands on healthcare

There are many factors which are increasing the demands on our health services such as, lifestyle changes, chronic diseases and an increasing ageing population with associated co-morbidities. At the same time there is greater emphasis being placed on health and well-being in order to impact on future generations of health service users.

To be able to meet these changing demands we have already committed to transforming what we do and how we support our patients and staff via our uclh future programme. The Exemplar Ward Programme is a key part of the uclh future transformation programme and is designed to support clinical teams to

implement standard processes, reduce unwarranted variations for our patients and deliver local quality improvement initiatives in their wards and departments.

Increasing patient and public expectations

Patients and the public want care and treatment organised around them, not the services and staff. There is an expectation of high quality clinical care and a good experience. Individuals want to feel in control, to be fully informed, listened to and given easy access to our services. People want more clinician time, to be treated empathetically and be emotionally supported.

We are privileged to be able to offer some of the most advanced treatments and services available. Delivering care to an equally high

16

...The context

standard is as demanding. When we get it right, the impact on our patients and others reminds us all of why we chose the professions we did and UCLH to practice these in.

Changes in workforce requirements

There are significant workforce challenges in the NHS. This is not surprising as workforce is the largest cost in the NHS (70% of a typical hospital’s costs) with most of this spent on the clinical professional workforce.2 The right workforce is crucial to ensuring quality care is delivered whilst also ensuring the productivity and efficiency gains required to meet our financial challenges, as well as transforming services through new care models. Ensuring we minimise waste and use our resources efficiently is key. Agency caps and controls have

been introduced and these will continue. There are opportunities for both skill and role development within the workforce to meet the changing and increasing demands. We will also work with partners in our health sectors, prioritising the STP’s, to train our staff for these opportunities.

From 1 August 2017, new students in England on nursing, midwifery and most AHP pre- registration courses (which leads to registration with one of the health professional regulators) will have access to the standard student support package of tuition fee loans and support for living costs, rather than getting an NHS grant. It is envisaged that this will have a big impact on the professions affected and we need to work closely with our local Higher Education Institutions (HEIs).

In contrast, there will continue to be a healthy supply of pharmacy

Alison Hill

“We are proud to be the system leader for cancer for North and Central London, delivered as part of the National Cancer Vanguard. Working together in partnership enables initiatives and role development to improve patient care and experience to take place.”

Alison Hill, UCLH Lead Cancer Nurse

17


graduates with the skills and abilities needed to deliver existing and extended clinical medicines optimisation roles. This provides an opportunity to enhance patient outcomes by development of a blended clinical workforce with complementary knowledge and skills.

Financial outlook

The biggest threat to our capacity to deliver high quality care is shortage of resources. There is a way forward, set out by the Five Year Forward View 2014 (FYFV)3. ‘With the right changes, the right partnerships and the right investments we can put our health and caring services on a financially sustainable footing’.1

The challenge of delivering better quality care, safe care and improved health at reduced cost is clear (The Kings Fund, 2014)4. The need to work differently to achieve this is well acknowledged. Lord Carter’s (2016)5 review of efficiency in hospitals shows how large savings can be made by the NHS; in such areas as efficient use of clinical staff, optimisation of medicines (medicines

18

...The context

optimisation is about ensuring that the right patients get the right choice of medicine, at the right time) and hospital pharmacy, diagnostics –pathology and imaging, procurement, back-office functions and estates and facilities. As a pilot site for the review UCLH nursing and midwifery staff are leading the way to optimise the usage of our workforce and pharmacy is focusing initially on medicines optimisation.

Shift from organisation to system leadership

The Five Year Forward View (FYFV)3 sets out a clear direction for the NHS showing how the service needs to change, supporting more engaged relationships with patients, carers and the public in order to promote wellbeing and prevent ill-health.

How this is achieved is complex and the way care is delivered is an important part of the solution. Another important part of the future is how the health and social care service is led. System leadership has two distinct and interrelated attributes - collaborative and boundary crossing on an organisational, professional and virtual level1

which offers us an approach to take this challenging agenda forward. System leadership extends leaders beyond the usual limits of their responsibilities and authority and so new skills, knowledge and behaviours are required for this approach to be successful. We have already ensured UCLH is well represented clinically by our Medical Directors and Chief Nurse contributing as members of the North Central London Sustainability and Transformation Plan, Clinical Cabinet.

George Gannon, Pharmacy Operations Manager, Procurement and Distribution

Clara Ranera-Dowling, Deputy Lead Pharmacist, RLHIM

19


“Nurses, midwives, AHPs and pharmacists will be the biggest users of new technology at UCLH. They

iCare

Technological advances

Technology is

David Kwo

will be at the forefront of digitising care for the benefit of patients by using new technology routinely to assess patients, document care, manage pathways, operate clinical decision support and measure outcomes. They will also be central to the clinical informatics and research strategy that we are implementing with UCL, BRC and the Farr Institute. I look forward to working with Flo and her colleagues across UCLH to realise patient benefits by joining up clinical care, research and technology.”

David Kwo, Director of EHRS and Informatics, ICT

advancing at a fast pace and can offer many advantages to healthcare, patients and staff. The Nuffield Trust’s paper, Delivering the benefits of digital health care, (2016)7 identifies seven opportunities to drive improvements in productivity and quality care: 1) more systematic, 2) high quality care, 3) more proactive and targeted care, 4) better co- ordinated care, 5) improved access to specialist expertise, 6) greater patient engagement, 7) improved resource management and system improvement and learning. UCLH have made a significant step forward during the last year with the rollout of electronic prescribing and medicines administration (EPMA) across all in-patient wards. This project was led by pharmacy with nursing and medical colleagues.

20

g

Strategy within the context of UCLH

UCLH’s five strategic aims are:

1. Provide the highest quality of care within our

resources

2. Improve patient pathways through collaboration with

partners

3. Support the

development of our staff to deliver

their potential

4. Achieve financial

sustainability

5. Generate world-class

clinical research

Nurses, midwives, AHPs and pharmacists unique contribution to

UCLH strategic themes are shown below

NMAHPPs will be valued and developed to

deliver their potential

NMAHPPs will

inspire, innovate and generate

world class research

Stronger together

NMAHPPs will provide the

highest quality care within our

resources

NMAHPPs will practice in ways which manage resources and achieve financial sustainability

and

21


g

Stronger together - bringing the strategy to life

Nurses, midwives, AHPs and pharmacists unique contribution to UCLH strategic themes.

NMAHPPs will be valued and developed to

deliver their potential

NMAHPPs will inspire, innovate

and generate world class research

Stronger together

NMAHPPs will provide the

highest quality care within our

resources

NMAHPPs will practice in ways which manage resources and achieve financial sustainability

NMAHPPs will listen and respond to our patients & improve

their pathways

22

‘Stronger together’emerged during the co-creating events and has been embraced as the title for this strategy. Organisational culture is key and the UCLH values; safety, kindness, teamwork and improving were identified to be important to staff. Five broad strategic aims have been identified and agreed for the five year strategy. There is overlap and synergy between these.

The five strategic aims are that NMAHPPs will:

1. Provide the highest quality care within our resources

2. Listen and respond to our patients and improve their pathways

3. Be valued and developed to deliver their potential

4. Practice in ways which manage resources and achieve financial sustainability

5. Inspire, innovate and generate world class research

During the process of co-creating the strategic aims it became clear that there were three clear enablers; collaborative working, constructive conversation and utilising technology. They are considered instrumental in ‘enabling’ and taking forward our strategic aims.

23


The five strategic aims

Eamonn Sullivan

“The first requirement in a hospital is that it should ‘do the sick no harm’ this key Florence Nightingale quote is as relevant today as it was when it was written over 150 years ago. Nurses, Midwives, AHPs and Pharmacists are key custodians of quality care and this arm of the strategy supports the delivery of safe, evidence based and cost effective care to our patients across all our Hospitals sites.”

Eamonn Sullivan, Deputy Chief Nurse and Head of Nursing (Medicine Board)

1. NMAHPPs will provide the highest quality care within our resources

Consistently delivering efficient high quality care is paramount and reliant on all staff groups working together. Being clear on the standards of care expected, measuring, monitoring, reporting and acting on the results will help continue the improvement journey and improve quality of care and outcomes for our patients.

We will: • be prepared professionally for

any planned or unplanned review of our services

• consistently provide safe and

avoidable harm free care for all patients

24

...The five strategic aims

“Nationally and internationally standardisation is proven to improve patient safety and reduce avoidable harm. The Exemplar Accreditation Scheme and associated improvement programmes aim to define, embed and monitor best practice standards to ensure patients consistently receive safe care.”

Natasha Phillips, Assistant Chief Nurse and Exemplar Programme Lead

Natasha Phillips

• deliver year on year improvements in our key performance indicators

• embed quality improvement

into everyday work culture

• learn from ourselves and others, share and celebrate local improvements in care

• work together to ensure patient

care is timely and effective

• be nationally recognised for delivering the highest quality affordable patient and maternity care

• recognise personal accountability in driving up quality whilst reducing cost

The top three priorities identified are:

• Recognising and responding to

deteriorating patients

• Reducing avoidable harm to patients

• Reducing unwarranted

variation through ‘Exemplar’ standardisation

25


Lisa Anderton

2. NMAHPPs will listen and respond to our patients and improve their pathways

Making Person Centred care a reality is our aim. Person Centred Care occurs when the person and his/her family/friends if appropriate, is at the centre of their own health care. The patient is actively engaged as a member of the team when making health care decisions, to the level of engagement they wish for. The patient is at the centre of all that we do and we need to ensure that there are consistently good outcomes and a positive experience of care. Peoples’ expectations are increasing and we need to be able to communicate consistent

voice, where services are designed in partnership with patients to promote and enable wellbeing, independence, health and alternatives to hospital – including admission avoidance.

We will work with patients and the public to provide a positive experience of care; compassionate care, living our values, listening and responding to feedback and working in partnership with patients, friends and family. We will work together to ensure our patients, relatives and carers consistently rate their care and experience as excellent.

We will:

• ensure that no decisions about patients and families are made without their direct involvement – ‘no decision about me,

7

and honest messages of what we can deliver and what they can expect to meet their expectations. There needs to be a strong patient

without me’

• enable patients to feel confident in their care 24 hours a day; 7 days a week

26


• listen and respond to the feedback and concerns raised by our public

• facilitate the increased

involvement of individuals and carers in co-designing and providing care services locally and across our systems

• empower people to remain

healthy, independent and active partners in their care

• work with colleagues and

services aligned to our

• professions to improve the overall customer experience

• we will excel at advocacy


• Maintain our patient experience

• Improve involvement and engagement of our patients and public

• Greater focus on the experience

of our patients as customers supporting our transformation programme

Sue Beatson

Despite its singular reference, patient experience is not a singular ‘thing’. Our patients’ experiences are all of the memories we create for our patients. It is the sum of all interactions, shaped by our organisation’s culture, that influence patient perceptions, across the continuum of care. Our strategic aim for 2016/17 is:

‘Ensuring our patients, relatives and carers consistently rate the care and experience as excellent’.

Lisa Anderton, Patient Experience Lead and Sue Beatson, Deputy Chief Nurse & Head of Nursing, Specialist Hospital Board

27


Lorraine Szeremeta, Deputy Chief Nurse & Head of Nursing, Surgery & Cancer Board

3. NMAHPPs will be valued and developed to deliver their potential

Ensuring safe staffing 24/7 is imperative and plays a crucial role in ensuring high quality care with excellent outcomes for patients. NICE published the ‘Safe Staffing Guideline for Nursing in Adult Inpatient Wards in Acute Hospitals’ in July 20148 to be considered in conjunction with the NQB guidance published in 2013. These safe staffing guidelines ask all Trusts to use an NICE endorsed tool to develop their adult inpatient nurse establishments. UCLH has used the NICE endorsed Safer Nursing Care Tool (Shelford, 2013) to review nursing establishments since 2012 and remain ready to respond to any changes, if required.

All these guidance recommend the inclusion of professional judgment into all establishment setting decisions to plan the delivery of the right staff, in the right place at the right time. Applying the same rigour to our workforce reviews for AHPs across the range of disciplines and care pathways will help to ensure the appropriate staff can meet the needs of complex case mixes.

We want and aim for our staff to feel valued and motivated as we believe staff health and wellbeing is fundamental and helps to underpin good quality care for our patients. We employ talented and excellent staff and want them to feel valued and able to perform to the best of their abilities. The workforce needs to be adaptable and flexible as well as highly skilled, competent and developed. The challenges ahead are to have a responsive workforce developing staff with extended roles,

28


“It is essential we strive to continually improve the care we provide, in order to achieve this, we must have a workforce that has the skills to meet the ever changing needs of our patients. We aim to continue educating our staff to the highest level, to prepare them for the future of healthcare and the introduction of new exciting roles and career pathways.”

Ann Casey, Assistant Chief Nurse, Workforce and Lorraine Szeremeta, Deputy Chief Nurse, Surgery and Cancer Board, Corporate Nursing / Patient Support Services. Ann Casey

transferable skill sets, extension of the 7/7 model of working, in-reach and outreach models, and who are able to adapt to changing needs and reflect the diversity of our population, in whatever setting.

In order to meet the growing demand for registered staff, all avenues need to be explored and developed including the introduction at a national level of new roles, such as the Band 4 nursing role which is currently

“As a Student Nurse at UCLH, I have the opportunity to work alongside highly qualified Allied Healthcare professionals and Pharmacists. The Strategy is an exciting development for the future to continue to build strong partnerships between disciplines. Maintaining and developing a culture of learning and sharing expertise ensures that patients continue to be cared for holistically, and are supported by a cohesive team to make informed decisions about their care.”

Marianne McFadden, LSBU Student Nurse.

29


Cedrick Ruiz

“I was attracted to the name, the reputation, the facilities, the specialist service and the career opportunities at UCLH.”

Cedrick Ruiz, Nursing Assistant

under consultation, which we aim to be a pilot site for phase one.

The further development of multi professional roles, with inter- professional training, to meet the needs of the patients is required. Embracing new roles and adapting roles to meet the future needs of our patients will ensure the workforce is fit for the future.

Defined career pathways from band 2-8 in clinical practice, management, education and research (including generalist to specialist roles, Sister, Clinical Specialists, Advanced Practitioners,

consultants, Extended Scope Practitioners, Superintendents and pharmacists) as well as career pathways which cross organisational boundaries can not only develop and support staff but also play an important part in the recruitment and retention of staff. The pathways need to be clear and visible and include education and rotations, not only at newly qualified band 5.

Understanding why staff choose to stay working at UCLH and why staff leave is important to inform us and work to avoiding unnecessary loss building on the success of initiatives to date such as our ‘career clinic and transfer register’.

We will:

• have the right staff, in the right place at the right time

• ensure that decisions about

staffing are based on available evidence, take account of

30


the wider multi-professional team, and there is a proactive approach to delivering improved outcomes and productivity1

• recruit, appraise and develop

staff using our values based recruitment model and test the case for strength based recruitment model

• develop and recognise

excellence across our NMAHP care assistants

• consolidate and build into

a framework the current components of the clinical and / or academic post graduate pathway and NMAHPs will know the options available to them

• be properly educated for the

level of accountability and skill they need to be effective practitioners

• have an accredited portfolio of education which recognises the importance of work-related learning, theoretical knowledge and research

• reduce waste by eradicating

agency usage and minimising bank


• Consolidate and build on

the components of career pathways, including new roles and existing opportunities

• Maintain a low vacancy rate

and continue to reduce and stabilise the turnover rate

• Reduce lost hours from clinical

duties through sickness and absence and achieve a better utilisation of the workforce

Ravijyot Saggu, Senior Clinical Pharmacist, Medical Specialties

Lochlainn Mahon, Occupational Therapist

31


4. NMAHPPs will practice in ways which manage resources and achieve financial sustainability

Five Year Forward View 2014 (FYFV)3 states that with the right changes, partnerships and investments, we can reach financial sustainability. The focus needs to be on achieving what the FYFV called the ‘Triple Aim’: better outcomes, better experiences for people and better use of resources. This can be achieved by closing the three gaps- the health and wellbeing gap, the care and quality gap and the funding and efficiency gap.

This requires us to focus on activities that are ’high value’, and investigate and correct unwarranted variations in health care, which will often reveal lower value activity. Unwarranted variations can be a sign of poor

quality care, missed opportunities and waste and can result in poorer outcomes, poorer experience and increased expense.1

This strategy provides NMAHPP staff the opportunity to demonstrate the beneficial outcomes and impact of our work

We will:

• Live within our agreed budget

• Review and compare key

performance indicators and practice to improve care outcomes

• Further develop NMAHPP

led clinics to support patient pathways

• Further develop and provide

telephone clinics where appropriate

• Reduce avoidable harm linked

to increased length stay

• Work with pharmacy to enhance medicine optimisation

32


• Reduce unplanned absences and improve roster efficiency

• Eradicate agency usage in all

but exceptional circumstances


• Ensure that expenditure is

within agreed budgets and contribute to the on-going efficiency and productivity challenge of the trust

• Reduce unwarranted variation

across the our workforce

- through delivery of the exemplar ward workforce efficiency pillar (e-roster)

- implementation of the recommendations made by the Carter review5 of operational efficiency in the NHS

• Improve discharge processes

which result in an increase in discharges before 12 noon

“UCLH is an aspirational organisation which is always trying to improve. The financial challenges of recent years have promoted a focus on efficiency as we have tried to reduce costs and improve productivity across all our services. The new strategy changes the emphasis. It recognises that our staff are our greatest asset and that the future of the organisation depends on our ability engage, support and develop our workforce, helping our staff feel proud of the role they play in delivering great care. It promotes a truly patient centric approach with safe care and excellent patient experience care as its key priorities.”

Dr Viki Mitchell, Divisional Clinical Director, Theatres and Anaesthetics

Dr Viki Mitchell

Shantha Ilandaridewa, Pharmacy Technician

33


Julie Hogg

5. NMAHPPs will inspire, innovate and generate world class research

We aim to be innovative, productive, responsive and collaborative in developing and delivering services for the benefit of patients, relatives and carers. To make the changes to the way we work will require building on our culture of innovation and improvement. It is fundamental to have a culture and workforce that is questioning and inquisitive. UCLH has an excellent reputation for clinical research and we aim to broaden the scope of this and further develop clinical academic career pathways9 to support increasing multi-disciplinary and NMAHPP led research.

High quality care requires highly skilled, knowledgeable and competent staff. Their practice

requires sound evidence and research basis. There is an active research community, however, this requires extending with a demystifying of research and opening the doors for more practice led research and generating a more evidence based approach for our practice and role development, accessing the support and capability already in place, such as staff already leading research and the Centre for Nurse and Midwife-led Research (CNMR).

Career development and clinical academic career pathways for NMAHPPs need to be supported and mentored, including MDT study opportunities, support for staff to complete academic study, apply for externally funded opportunities (e.g. internships, fellowships) as well as opportunities to engage in research while developing their clinical careers.

34


We aspire to leadership that is consistent, fair, caring and assertive. Developing and strengthening both our leadership and managerial capability is important to us. Leadership is key at a personal, team and system level and requires targeted development and support in order to identify emerging leaders and to nurture and grow leaders of today and the future. Leaders are able to inspire and innovate, they take pride in what they do, are

good role models and recognise and praise the good work done by others.

Leaders are resilient, taking risks and hold themselves and others to account. They tackle behaviours which are not in line with the UCLH values or their own.

There are many opportunities for leadership development here at UCLH, provided by the Institute, Organisation Development and existing leadership programmes;

Professor Lesley Baillie

“The ‘Five Year Forward View (FYFV)’ sets out a clear direction for the NHS –illustrating why change is needed and what it will look like. This evolving NHS landscape requires significant changes in the way that we provide care to meet the needs of patients whilst rising to the workforce and financial challenges posed locally and nationally. Building capacity for leadership, research and innovation over the next 5 years is integral to our future success.”

Professor Lesley Baillie, Director, Centre for Nurse and Midwife-led Research and Honorary Professor, University College London and Julie Hogg, Deputy Chief Nurse & Head of Nursing Specialist Hospital Board

35


Dr Emma Taylor

“The workshop to develop the strategy was a wonderful chance for all interested parties to get together and discuss the issues that concern us all. It was a great opportunity to meet colleagues and really get to the bottom of how best we can support patient care. From a personal point of view, I learnt a great deal about how the UCLH Institute can provide support with education and learning.”

Dr Emma Taylor, Director of Education, UCLH

these however, do not meet all the existing needs. We need to ensure that NMAHPP leaders are representative of our diverse population and staff and that there are strong voices at key internal and external forums.

Our staff identified pride in their profession as being important. Working together collaboratively and across our professional boundaries does not mean and should not mean losing our professional identity. Strong leadership and professionalism is required at all levels to be able to innovate and inspire the changes which will transform services and patient pathways fit for the future.

36


We will:

• strengthen our leadership capabilities and professional practice

• create a positive culture that

supports professionally led research, builds capability and capacity in research skills and promotes clinical academic careers

• consistently use the best

evidence to improve the quality of patient outcomes for our patients within our resources

• work collaboratively to develop

the evidence base for NMAHPP practice and contribute to programmes of research that deliver improvements in care

• ensure that theory and practice

are closely aligned

• increase the visibility of our professionals as leaders in pathways, services and research

• use learning from our research to innovate and improve care and define our professional contribution and value1


• Develop leaders at all levels

who will drive evidence based innovations to improve patient experience and outcomes at UCLH, across our system and nationally

• Increase the visibility of

research led by NMAHPPs and strengthen structures for our clinical academic career pathway

• Ensure all staff should take

the opportunity to act as role models, mentors, teachers and coaches; so that this becomes a predominant and consistent style of care, help and support1

Cymbeline Gaynor, Musculoskeletal Therapy Services Manager & Physiotherapy Professional Lead

37


Enablers

During the process of co-creating the strategic aims it became clear that there were three clear enablers; collaborative working, constructive conversation and utilising technology. They are considered instrumental in ‘enabling’ and taking forward our strategic aims.

Constructive conversations

Developing a culture where we are confident, competent and comfortable with ‘constructive conversations’ is essential. Constructive conversations are not focused on negatives. They are about having positive and effective communication and should highlight and celebrate the good so that it is repeated and shared. They can also be effective in acknowledging our difference and similarities enabling us to reach consensus and understanding of each other’s perspectives. Our aim is that these constructive conversations are accepted and become part of the norm. Listening is an essential part of these conversations and being

transparent and open is integral to good effective communication. We need to encourage and role model courageous conversations. Breaking down the boundaries and hierarchical structures will help enable these conversations.

We will:

• develop our communication skills for use; at the bedside, mentoring, coaching, action learning, revalidation, clinical supervision as identified by our appraisal process

• consistently provide real time

and constructive feedback to team members and peers

• listen to our staff using listening

events, formal and informal feedback mediums

38

...The enablers

Top three priorities are:

• enabling staff to ‘speak up’

• ensure all professional leadership development and support courses offer 360 degree feedback and/or mentorship

• Improve the ability to offer

immediate debriefing and conversations following episodes of stress, incident and trauma

Collaborative working

Collaborative working in healthcare occurs when multiple

“We are investing in line managers so they have renewed confidence and skill in conversations that enable better working relationships - which are recognised as being a cornerstone of success in tackling unacceptable behaviours. We also want to give our staff greater confidence to raise concerns and enable more support for them and the teams that they work in, when they do.”

Kate Price, Head of Workforce

“I am pleased to see that cultural development sits at the heart of this unified strategy document. That there is an emphasis on co- creation and collaboration, with acknowledgment that we need to create an environment to allow our

health providers from different professions provide comprehensive services by working with people, their families, care providers, and communities to deliver the highest quality of care across settings. One of our values is teamwork and collaborative working

staff to be courageous and have those crucial conversations.”

Yogi Amin, Head of Department of Anaesthesia of Critical Care, Queen Square and Senior Organisational Development Lead for Leadership and Engagement

Yogi Amin

39


Heidi Jensen

Millie Johnson, Head of Pharmacy & Medicines Governance, NHNN

“The energy and drive to create this joint strategy has been great and the work planned for the coming years is both exciting and challenging.”

Heidi Jensen, seconded from Guy’s & St Thomas’ Trust

embraces not only teamwork and partnership working but working across systems and professional boundaries. There are many patient pathways and networks and collaborative working already taking place with many more opportunities and trusting each other’s/teams contribution will enable the patient journey through healthcare be consistent and seamless.

We will:

• work across our professional

groups and beyond to improve the experience and outcomes for our patients

• challenge the quality of services we deliver to reduce unwarranted variations

• promote a culture where

increasing the population’s health is a core component of our practice

• work with partners external to

our organisation to improve our services and care

• ensure staff work in partnership

to maximise the quality of care

Top three priorities are:

• use the exemplar programme to bring teams together, to learn, understand, reflect and focus on improving consistency and reducing unwarranted variations

• use alternative approaches to

support areas/teams, such as the ‘wonder ward programme’, guardian service and Schwartz

40

...The enablers

rounds to build resilience and foster better relationships

• explore the options for all our

professions to be involved in shaping of services within our system

Utilising technology

NMAHPPs need to have a voice in this arena in order to be equal partners in the strategy development and roll out of

We will:

• develop the skills needed for a technological literate workforce

• strengthen the voice of

NMAHPPs on the development of technological enablers

• lead as early adopters of

technology

• use technology to manage our professional workforce to avoid waste

Nick Kirby

initiatives. There is much to be gained from embracing IT, digital working and technology in order to drive and facilitate improvement. Technology supports transformation and patients and users of health services are using and wanting more from technology to meet their needs. Using the right systems should also enable staff to reduce the administration burden, and reclaim their reported ‘lost third’ where time is not spent on direct patient care.

“Achieving excellent patient outcomes and improving patient experience across cancer pathways is our main goal. This is dependent on attracting, developing and retaining great staff. AHPs, pharmacists and nurses play a pivotal role, caring for patients when they are often at their most vulnerable as well as across their entire journey as a patient. Innovating in role design and enhancing the roles of our AHPs, pharmacists and nurses within the multi-disciplinary team will be critical factors for success. The NMAHPP strategy provides an important platform from which we can realise this, bringing professionals together.”

Nick Kirby, Divisional Manager, Cancer Services

41


Janvika Shah, RLHIM Dispensary Manager

Orla McCourt, Team Lead Physiotherapist – Haematology

• influence access and opportunities for patients to be involved in their care

• ensure NMAHPPs have access

to the data/information/ intelligence they need to deliver and continuously improve or conduct research


• Support EHRS solutions and

their implementation

• Improve patient safety through use of technological enablers, i.e. vital signs monitoring

• Explore options for increasing

remote working for staff and remote consultations for our patients

42

In conclusion

This Strategy begins to map out our requirements to be the best we can and help shape our professionals across the systems. It cannot at this stage predict every possible change or challenge but will strengthen our ability to respond and lead where needed. This is an exciting and challenging strategy which will be supported by annual objectives identified for each year of the five year strategy which will be monitored by the UCLH Nursing and Midwifery Board, which includes AHP and Pharmacy leaders. A progress report will be reported to the Executive Board regularly.

References

1. Leading Change, adding value – the national framework for Nurses, Midwifery and care staff, 2016. 2. NHS Improvement (2016) Evidence from NHS Improvement on Clinical staff shortages; a workforce analysis. 3. NHS England (2014) Five Year Forward View. 4. The King’s Fund (2014) System Leadership; Lessons and learning from AQuA’s Integrated Care Discovery Communities. 5. Carter (2016) Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. 6. The Nuffield Trust (2016), Delivering the benefits of digital health care. 7. DH (2012) Liberating the NHS: No decision about me, without me – Government response to the consultation. 8. The Shelford Group (2014) Safer Nursing Care Tool for Adult In-Patient wards – Implementation Resource Pack. 9. Department of Health (2014) Delivering high quality, effective, compassionate care: developing the right people with the

right skills and the right values: A mandate from the Government to Health Education England: April 2014 to March 2015.

43


Stronger together

UCLH NMAHPP Strategy 2- Stronger together Nursing... · are ‘stronger together’. Now is the...

Documents

Transcript of UCLH NMAHPP Strategy 2- Stronger together Nursing... · are ‘stronger together’. Now is the...