Western Sussex Hospitals NHSFoundation Trust

Developing our Quality Strategy for 2015-18

Patient First programme

The Trust has recently launched its ‘Patient First’ programme, a long term programme which has as its aim a transformation in the way we deliver services to patients – major transformation programmes such as outpatient services.

Patient First programme

The philosophy behind the programme is centred on:

oThe patient being at the heart of every element of changeoThe need for cultural change across the organisationoContinuous improvement of our services through incremental changeoConstant re-testing of the patient pathwayoRedesign processes led by frontline staffoEqual voices for all

Patient First programme

Quality Strategy for 2015-18

o Every three years we produce a strategy for improving the quality of care patients receive from our hospitals, we call this the Quality Strategy.

o It sets out what we want to focus on to improve hospitals services for patients, visitors, staff and partners.

Shaping Our Quality Priorities for 2015-18

o Our staff already provide high quality care. The Care Quality Commission has judged the Trust to be among the best performing NHS Trusts in the country and offers the “best and safest care for patients”, but we want to improve further.

o We have asked staff, patients and the public to help us shape our quality priorities

Our ambition

Four key goals:Saving more lives and improving

outcomesSafe careReliable careImproved patient and staff

experience

Saving more lives and

improving outcomes

GOAL: To be in the 20% of NHS organisations with lowest risk adjusted mortality

We aim to reduce avoidable mortality and improve the clinical outcomes of patients receiving care at our hospitals.

We will benchmark ourselves against other NHS organisations with a goal to be one of the NHS organisations with the lowest risk adjusted mortality rates.

Saving more lives and

improving outcomes

Saving more lives and

improving outcomes

We aim to be in the 20% of NHS organisations with lowest risk adjusted mortality.

Saving more lives and

improving outcomes

Priorities to help us reduce mortality and improve outcomes:

The implementation of a set of consistent standards, known as care bundles, to improve the recognition and care of physiologically deteriorating patients including sepsis, acute kidney injury and preventing cardiac arrest.

The ‘Better Births’ programme focusing on normalising births and reducing stillbirths.

A programme of structured review of every death occurring in

the hospital to ensure learning.

Safe care

GOAL: 100% of patients receiving safe, harm-free care as measured by the following six harms:•Pressure ulcers•Catheter associated urinary tract infection•Venous thromboembolism•Harm from falls•Hospital acquired infection•Prescription errors We aim to provide safe, harm-free care for all patients, we recognise that this is a challenging goal to achieve this we commit to reviewing all harms to ensure that we learn and continuously improve care. 

Safe care

Each month between 4% and 6% of patients suffer a harm event (a fall, pressure ulcer, VTE event or UTI with catheter), of these 2% occur after admission to WSHFT.

Where are we now?

Safe care

We have made significant progress in relation to infection control in recent years. Numbers of MRSA infections are now down to minimal levels, with four cases reported in 2013/14, but only one of which was considered avoidable. Similarly the level of C. difficile infections has also fallen from well over 100 per year prior to 2011/12 to 57 in 2013/14.

Safe care

Priorities to help us ensure we are providing safe care:

Strategy to reduce the incidence of hospital acquired infection

Strategy to reducing the number of within hospitals falls

Medicines Optimisation Strategy, including the roll out of electronic prescribing

Developing the safety culture of the organisation Safety huddles Ward accreditation

Reliable care

GOAL: Achieve 95% reliability in the following:

oStroke or high risk TIA care bundleoSepsis care bundleoAcute Kidney Injury care bundle

Seven Day Services - Ensuring consistency of care for all inpatients, regardless of when they are admitted to hospital. 

GOAL: All new patients have a consultant review within 14 hours of hospital admission.

  

Reliability of care

Key Quality Improvement Priorities for 2015-18

Implementation of Stroke or high risk TIA care bundle

Implementation of Sepsis care bundle

Implementation of Acute Kidney Injury care bundle

Improvement in referral and discharge information, working with primary care 

Implementation of seven day services programme

Implementation of care pathway for frail elderly patients – including building on dementia care pathway 

Patient and staff experience

GOAL: Achieve top 20% for patient and staff experience surveys Patient experienceImproving the patient experience is at the heart of the Trust’s vision and values, and is a central aspect of our Patient First programme.  The Trust has invested heavily in its staff to improve the experience of patients through its customer care programme:oInduction and recruitment have been radically redesigned to ensure all staff are fully focused on delivering great care oSuccessful pilot for delivery of Western Sussex Way training programme, aimed at groups of staff to improve customer careoOver 50 staff have become ‘ambassadors’, to act as exemplars of best practice and guides to others.

Patient and staff experience

Where are we now?

Patient and staff experience

Patient experience

Key Quality Improvement Priorities for 2015-18

A programme of work focused on improving patient experience including:

Night time care - reducing noise and night and ward moves that take place at night,

Mealtime support, Information and communication with particular focus

on the involvement of relatives/carers and discharge planning.

Patient and staff experience

Staff experience

Whilst we are above average in the percentage of staff recommending the Trust as a place to work or receive treatment, we seek to be in the top 20% of acute trusts and maintain this position.

Patient and staff experience

Over the next 3 years, we will seek to improve our overall engagement score annually so that we are in the top 20% of acute trusts.

Staff experience

A programme of work focused on improving staff experience including:

A series of staff engagement roadshows and events.

Within the Facilities and Estates Division, a Steering Group, with representation from all levels of staff, is being established to oversee improvements in staff engagement.  

Workshops with medical staff have been established to identify and agree actions required to improve medical engagement, focusing on the findings of the medical engagement survey carried out in 2014.

Extending staff health and wellbeing programmes throughout 2015/16.

Engagement exercise

Who did we hear from?

771survey responses

Q3: Are you male or female?

Answered: 740 Skipped: 31

Q4: Are you currently a carer?

Answered: 739 Skipped: 32

Q5: Do you have a condition that requires long-term care?

Answered: 739 Skipped: 32

How well are your/ your family's needs being met by our current services?

Answered: 537 Skipped: 234

Do our services need to improve to meet your/ your family's needs?

Answered: 739 Skipped: 32

Please rank our four goals in order of importance to you

Answered: 567 Skipped: 204

How well do you think our four goals represent the areas that require improvement in our hospital trust?

Answered: 552 Skipped: 219

What is your (primary) relationship to the Trust?

Answered: 599 Skipped: 172

How much do you think the Trust values the quality of the care provided?

Answered: 250 Skipped: 521

How empowered do you feel to drive improvements in the quality of care?

Answered: 250 Skipped: 521

Themes in feedback

• Support for quality improvement goals• Support for identified programmes of

work – also include programme on quality of end of life care

• Feeling Trust values the quality of the care provided

• Not all staff feeling able to drive improvements in the quality of care

Themes in feedback

• Vacancies in staffing adding to pressure of busy hospital

• Positive patient experiences• Less positive experiences around

waiting for outpatient appointments, cancellations

• the Trust values the quality of the car• the Trust values the quality of the care

provided

Themes from last Stakeholder’s Forum discussions

• Support for quality improvement goals and programmes

• More focus on patient experience, listening to patients

• Expand work on avoiding mortality to ensuring excellent end of life care

• Supportive of care bundles – seen these improve care

• Focus on safety, good care, observations, communication

Next steps…

Share feedback OnlineInternallyKey Stakeholders (eg Healthwatch)Members

Next steps…

We will….Include additional programme of work on End of Life Care in Quality StrategyImplement and communicate transformational programme improve outpatient services

Next steps…

We will….Continue to focus on staff recruitment and retentionTriangulate staff feedback with staff survey results, hold listening events for areas with low staff survey scores to further explore staff experience and review and refresh programmes aimed at improving staff experience as necessaryTrain and support staff to lead quality improvement