Impact Magazine - June 2022

June 2022

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Making Progress with Getting to Good Developing Our Teams From HCA to RN Improving Our Workplace Inside the new Modular Ward

high standards of care to which we all aspire to achieve our overarching vision to provide excellent care for the communities we serve.

To help us to clearly identify the improvements that we are making together to get to a CQC rating of good – we have created a new logo.

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Message from Louise Barnett, Chief Executive Welcome to Impact - your monthly magazine - which will bring you information about the changes and improvements we are making with your support as part of our Getting to Good improvement programme, with a focus on the value they bring to patients and colleagues.

In this issue, we look at a number of developments and projects that, when fully implemented, will improve the quality of care we offer our patients and the quality of the working environment for you as colleagues.

The recent high levels of demand for our services – and the demands, in turn, this puts on you – have highlighted the importance of the improvements and initiatives that make up our programmes of work.

And through Impact - we will share how hospital services will change and the benefit it will bring as result of Getting to Good.

We also want to highlight the key components of Getting to Good which cover all aspects of what is needed to consistently achieve and sustain the 2

You will also soon see new posters and banners throughout our hospitals and external sites which will enable you to share the valuable work that you are doing to make a difference to our colleagues and our patients, so that we can celebrate and recognise your achievements.

Impact is a forum to showcase all your fantastic work, so if you have any feedback, please do let us know.

Equally, if you have something you think Impact should focus on, get in touch with the Communications Team – sath.commsteam@nhs.net.

Finally, if you would like support for your improvement idea, please contact Matt Mellors in the Programme Management Office or James Owen, Deputy Director of Education and Improvement, who will be able to help you.

Louise Barnett Chief Executive

Impact Magazine June 2022

ital rmation

Culture

Corporate Governance

Our G2G Workstreams

Leadership

Quality & Safety

s& es

Workforce

Maternity

You may have heard the word journey used a lot and there is a reason for that. Our Getting to Good programme of work is a journey to achieve our overarching vision to provide excellent care for the communities we serve.

The three-year programme will help us on the road to get there and our aim is to ensure that when we are inspected by the CQC, we improve our ratings and ultimately receive a good rating for care across all our services.

The approach of the programme is to focus on ensuring that the changes and improvements put in place fully address root causes, are sustainable and lay the foundations for future success.

It has now been in progress for 18 months driving Impact Magazine June 2022

Our Journey to Good, Mary Aubrey Getting to Good Programme Director short to medium term transformational projects including culture, quality improvement, regulatory compliance, urgent and emergency care, clinical standards, restoration and recovery and governance – and we are already starting to deliver positive outcomes for our patients.

There are nine workstreams (pictured) and 26 transformational projects in progress. We are currently in phase two of the programme; this is an exciting stage as all colleagues can play their part – and engage in driving and seeking out best practice, learn from each other and other organisations, and help to embed improvements to make them become business as usual.

To signpost you on our improvement journey and our progress, we are introducing a new logo and visual aids which you can use. These will help us all identify the hard work being done by everyone across the organisation, and include ways for you to get involved.

You will be able to share your improvement work through our new Getting to Good webform via a QR code on our posters and banners which will soon be in place around our sites, and by viewing our new Getting to Good intranet page launching shortly.

If you would like further information, or would like to get involved in the Getting to Good programme, please contact Matt Mellors, Head of Programmes here.

It is really important that you are able to play your part on the journey. Please share your improvements and your ideas with us – together we can get to where we all want to be.

Thank you.

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Improving Quality of Care Strong progress is being made on actions identified from two incidents which led to our organisation being prosecuted by the Care Quality Commission (CQC) - and we continue to make improvements to the quality of care we provide patients.

The Trust accepted responsibility for three charges which related to failures of care of renal service users, including a named patient, and failures in respect of the safe care and treatment of a further named patient, being cared for in a bariatric bed on one of our medical wards between October 2019 and May 2020.

involved in these tragic cases.

Some immediate actions were taken at the time of the renal dialysis incident and subsequently we have strengthened training, practice and our assurances. Actions included: • New renal dialysis documentation guidance • Two new Standard Operating Procedures developed • All patients connected on dialysis are now checked by two staff and documentation is signed and countersigned on the dialysis record

In relation to the bariatric bed incident, actions The Trust offered sincere included: apologies and heartfelt • Training provided as part condolences to the families of the induction for relevant

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clinical staff • Immediate training programme on the use of the Arjo Baros Bed and Sapphire Mattress for inpatient ward-based staff • A Bariatric Bed folder for each ward Hayley Flavell, Director of Nursing, said: “It is crucial that lessons are learned and that we continue to make improvements to the quality of care we provide patients as part of our Getting to Good programme. We must ensure that the changes and improvements made are fully embedded and maintained right across the organisation.”

Your support is greatly valued and if you have any queries or concerns please contact your line manager.

Impact Magazine June 2022

Positive improvement work across the Trust has been acknowledged by the CQC following our last inspection in February 2022. The CQC has lifted a significant number of the conditions it imposed on our registration.

It follows a review of all the Section 31 conditions imposed on the Trust by the CQC earlier this year. The CQC said it was “assured that there have been significant improvements made”.

There were a total of 60 conditions in place across the two hospital sites including conditions in relation to the effective identification, escalation and management of patients who present with possible sepsis or a deteriorating condition.

Through the CQC Improvement Plan – part

of our Getting to Good programme of work good progress has been made in a number of areas, including safeguarding and the deteriorating patient with no conditions now in these two areas.

However, there are five conditions remaining which we are striving to address.

Hayley Flavell, Director of Nursing, said: “This demonstrates increased confidence in our Trust by our external regulators, which is very pleasing.

“There is still more to do to ensure all improvements are built upon and sustained but we are making progress through our CQC improvement plan as part of Getting to Good.

“Thank you to all the teams involved whose hard work has helped us to reach this stage.

“It continues to be extremely important that we remain focused on driving improvements in the remaining areas in order to ensure that we provide great care for every patient every day.”

Your support to ensure the ongoing focus in these key areas is vital and really appreciated.

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Maternity Transformation Programme Our aim is to have the best maternity care for the communities we serve and everyone is committed to achieving this together.

In order to ensure that we continue to improve our services and embrace all the actions in the Independent Review of Maternity Services, we have a Maternity Transformation Programme in place to drive this.

Women and Children’s, said: “The last few weeks and months have seen huge As part of the work for progress in our Maternity delivering the actions set out in services. We now have a fully the report, a new workstream resourced senior leadership has been added to the six team in midwifery and a existing workstreams which are: powerful multi-disciplinary • Workstream One: Quality and approach to delivering the Choice actions set out in the final • Workstream Two: People and Ockenden Report as well as Culture other improvement initiatives • Workstream Three: we are progressing. Maternity Governance and Risk services are in a good position The first Ockenden Report, • Workstream Four: Partnering to harness the creative released in December 2020 set Research and Learning insight and experience of our out 27 Immediate and Essential • Workstream Five: workforce across all specialities Actions and 25 Local Actions Communications and through initiatives including for Learning. Of the Local Engagement the ImproveWell platform Actions that SaTH is the lead for, • Workstream Six: Maternity and regular, scheduled drop100% have now been delivered Improvement Plan in sessions with our senior (89% of the total 52 actions).

• Workstream Seven: leadership team.

The actions that have not yet Anaesthetics been delivered are dependent “In addition we encourage on other organisations, such as Further developments continue and embrace a very positive NHSE/I and the CQC. to take place within Maternity relationship with our MVP including the redevelopment colleagues, which helps The final Ockenden Report of the maternity section of us ensure our services are released in April 2022 set our website, the fourth cycle responsive to the needs of out a further 15 Immediate of the User Experience (UX) our service users. There is and Essential Actions, with system focusing on ‘Managing much work ahead, but a real 92 sub actions, and 66 Local Expectations’, an induction determination to achieve.”

Actions for Learning. A multiof labour video being codisciplinary gap analysis has produced with the Maternity Thank you to everyone involved been conducted to identify Voices Partnership (MVP) and for your ongoing support and which actions are already much more. commitment which is making in place; of the 158 actions, a positive difference for our 17 have been accepted as Carol McInnes, Divisional communities. ‘evidenced and assured’, and 1 Director of Operations for

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accepted as ‘delivered, not yet evidenced’.

Impact Magazine June 2022

ImproveWell One of the key aspects of Getting to Good is ensuring that we engage our colleagues across the organisation to deliver our improvements. We have launched ImproveWell, a digital engagement app, to allow colleagues to share their ideas for how they would improve their area of work.

ImproveWell can be accessed through any mobile device or desktop computer and allows colleagues to share their ideas for improvements which are reviewed and implemented through our ImproveWell champions. Whether the ideas are big or small, every idea is reviewed and, if chosen for implementation, the person who submitted it will be kept up to date with its progress throughout.

So far, 187 colleagues across Maternity have signed up and submitted 86 improvement ideas, with 19 colleagues having recently been awarded certificates following their ideas being successfully implemented in their areas of work.

This feedback is really encouraging and has shown that staff are working together, the use of this app is really helping the Maternity teams to be able to share their ideas more readily and get more rapid feedback. The use of this app has made it much easier for colleagues to engage with others as it brings a structure and transparency to raising ideas and how these get considered and progressed.

Thank you to all colleagues for embracing this way forward. We are keen to review how this goes over the coming months with a view to making it available to other teams in the Trust.

Impact Magazine June 2022

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Improving Our Working Environment Modular Ward As you know we have significant challenges with our estates at both sites which were not designed in a way that meets the requirements of modern healthcare. We have been seeking to secure capital funds to invest in our estates whilst pursuing the Hospitals Transformation Programme. We were delighted to secure funding to create a Modular Ward at RSH which gives us extra capacity and enables us to upgrade our ITU. Sara Biffen, Acting Chief Operating Officer, said: “The new Modular Ward delivers much-needed additional bed capacity and support to our services.

“I would like to thank those that have been involved in this project, which

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should help to alleviate some of the emergency pressures being felt within our organisation and also support us to restore more elective surgery.”

On the Modular Ward is eight single ensuite rooms. ITU and HDU at RSH have temporarily moved into the building – Ward 37 – whilst Estates upgrade works take place. Ward 26 (surgical ward) will then move in.

We secured a £7.1 million grant from the Department of Health and Social Care (DHSC) to build the Modular Ward, which took seven months to complete.

Thank you to everyone involved in this work - we are keen to capture any learning which we can feed into future projects and HTP.

Impact Magazine June 2022

£2 million Ophthalmology Unit Delivering high quality care is at the heart of our Getting to Good programme and in order to ensure that we are able to provide fantastic facilities for our patients, we have invested in our Ophthalmology Unit, which includes a new Cataract Suite.

Almost £200,000 was donated by the League of Friends (LoF) towards the cost of medical equipment and clinical furnishing of the department and the Cataract Suite has been named after Tony Barker in recognition of his 37 years of continuous service as Honorary Treasurer of the LoF. Other improvements made to the Ophthalmology Department include: • New adult and paediatric departments

• Engagement across all clinicians, nurses, allied professionals and community stakeholder groups • Fully staffed with substantive positions • Fully functional clinical areas • Daily safety huddles and robust governance Debbie Allmark, Sister in Opthamology, said: “The Suite has created a lovely environment for patients as well as for staff working in the area. Colleagues have praised the new facilities as they are specific to the needs of the cataract theatre journey, enhancing the patient’s experience. Discharge for patients is more streamlined meaning they can go home sooner which is better for their recovery. This is a great example of how a dedicated theatre suite for cataracts improves patient care and how staff can provide a more efficient service.”

Renal Dialysis Service to Move Part of our strategy is to deliver high quality patient services closer to home ensuring that only those patients who need to be are in hospital. As part of this strategy, we are progressing a move for the renal dialysis unit to be off site and also a Community Diagnostic Centre (CDC).

Getting services closer to home and investing in community services through the new CDC and renal dialysis service will be fantastic for our local communities who will be able to get their needs met in the community.

Work has started on the building for the renal unit, which will also house the first Community Diagnostic Centre (CDC) in the county. The CDC will see elective diagnostic tests delivered away from acute hospital sites and separately from urgent diagnostic scans.

The move, which is expected to be in March next year, will allow us to meet not only the current level of dialysis demand but also future demand for approximately the next 10 years.

This off-site location will also create more

Impact Magazine June 2022

clinical space for both patients and staff with capacity for renal clinics as well as dialysis over two floors.

Renal dialysis services are currently in Ward 5 at PRH and the move will allow this space to be upgraded and converted back into an inpatient ward providing more acute beds for our community.

Trevor Hubbard, Divisional Programme Manager (Interim), said: “Moving renal dialysis services to such an ideal off-site location means that patients and colleagues will have a purposebuilt and more spacious environment for their dialysis treatment. The move also frees up Ward 5 which will create more space at the PRH for an inpatient ward.”

If you feel there is an opportunity for you to provide elements of your service in the community, please do share this with your manager and divisional team because we are keen to explore further opportunities to improve services for patients, whilst also freeing up much-needed space in our hospitals.

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Restoration of Elective Orthopaedic Surgery You will be aware how challenging it has been during the pandemic to restore elective orthopaedic surgery which is a critical part of our Getting to Good plan.

Following significant challenges we are really pleased to have finally achieved this in June.

Sara Biffen, Acting Chief Operating Officer, said: “It is important to our patients that we resume as many of our services that have been paused as soon as possible, and I am glad to say that elective orthopaedic surgery is now taking place at the PRH. “Thank you to all those that have been involved in the hard work to get elective orthopaedic surgery restarted. This includes not only the department, but includes support from radiology, therapies and other colleagues from across the Trust and our system.”

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Staff training has taken place as a refresher after a break of more than two years and surgery re-started on 20 June.

Elective orthopaedic surgery was first paused due to winter pressures. Our hospitals have since remained under pressure from the demand for urgent care and the ongoing effects of COVID-19.

Although elective orthopaedic surgery has not taken place during this time, it has continued at The Robert Jones and Agnes Hunt Orthopaedic Hospital and the PRH Vanguard Unit. Clinical prioritisation is taking place when determining when patients are being seen.

We appreciate how difficult this has been for patients and for you. Thank you to all involved.

Impact Magazine June 2022

Improving the Way We Work As part of our Getting to Good programme, we are committed to transforming our digital systems to improve our day-to-day working lives and transform services for our patients.

• New systems to change how we work from booking appointments, managing theatre lists and managing patient flow • Enhance the way patient information is shared to help reduce hospital attendances We recognise how challenging • Make it easier to provide it is in this organisation with patients with individual care the use of paper records in So far we have delivered: many areas and duplication • Vitals 4.2. upgrade – of information, so we want to an electronic Vital signs change this to free up your monitoring system time to care and carry out • BadgerNet Maternity - an other aspects of your role. end-to-end maternity system We have a long way to go but • ICNet Infection Control – an remain determined to do this. integrated infection control and management system The Digital Transformation • ViewPoint – ability to view Programme will see: baby scans

We are currently working on The Bluespier Theatre Management System and BadgetNet Neonatal; with our next focus the delivery of the Patient Administration System, CareFlow, which will replace the SemaHelix system.

Nigel Lee, Interim Director of Strategy and Partnerships, said: “All these new systems will have a positive impact on how we work, from booking appointments, managing theatre lists, adding notes to care records, generating reports and managing patient flow.”

“These huge digital transformation projects will deliver the benefits of efficiency, accuracy and accessibility to colleagues and thereby increase the care that we can provide to our patients. As a consultant in Obstetrics and Gynaecology and Clinical Chief Information Officer (CCIO), I am acutely aware of the current digital systems that work well (and those that work less so). These are times of great change in ‘the ways that things are done around here’ and these digitallyenabled changes will help to maximise improvements within our Trust.”

Dr Ashley May - Consultant Obstetrics and Gynaecology/CCIO

BadgerNet Following the launch of the BadgerNet patient record system in Maternity Services, the system is now being rolled out to include Neonatal.

accessibilty over their pregnancy record and care notes. It is an online portal and the app replaces the traditional, paper-based handheld notes and can be accessed through a PC, a tablet, or a mobile device.

BadgerNet gives birthing women greater

It will give women the chance to add important personal information and birth preferences, ensuring that their choices on what

Impact Magazine June 2022

they want to happen at each stage are clearly captured for all those caring for them to see.

From our work alongside the Maternity Voices Partnership (MVP), we know that these issues of choice, accessibilty, and continuity are extremely important for our service users.

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Supporting the Next Generation As part of Getting to Good, we have a leadership workstream. It is really important that we have education and development programmes and opportunities in place to develop the skills and knowledge we need now and in the future. Supporting you and your colleagues to be the best and most effective you can be is positive for teams and ultimately for the patients we care for.

A key part of the workstream is ensuring we have a wide ranging development programme for Healthcare Assistants (HCAs) to progress through to nursing roles if they aspire to do so.

HCAs now have the opportunity to progress to Nursing Associate before doing the ‘Topup’ Registered Nurse Degree Apprenticeship programme and qualifying to become a Registered Nurse (RN).

Any HCA who joins the Trust is offered a place on an academy for Health Care Support

Workers. The purpose-built academy, which is based at Telford College, has welcomed 128 HCSWs from our Trust and within the system.

Since the academy was introduced there has been a 33% reduction in the number of HCA vacancies and a 40% increase in the number of HCAs on the bank. HCAs can initially have the opportunity to undertake a two-year Trainee Nursing Associate (TNA) Programme to become a Nursing Associate.

Our Trust has been running the TNA programme since 2017 with its 10th cohort starting in September 2022. There are now 55 trainees on the programme.

For Nursing Associates who wish to progress to become an RN there is the chance to apply and undertake the 18-month ‘Topup’ RN Degree Apprenticeship. The first cohort of nine joined the University of Wolverhampton last December and a further 10 Nursing Associates start this July.

Hayley Flavell, Director of Nursing, said: “HCAs are now given the opportunity to develop within the Trust and this is fantastic.”

If you have ideas about how we can further strengthen education and training and further develop career pathways so that we can attract and retain great people and deliver high quality care now and in the future, please share these with Rhia Boyode; and we can explore these as part of our improvement journey.

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Impact Magazine June 2022

Part of our Getting to Good improvement journey is ensuring that we have the right leaders in place with the right skills. Not only does this have a positive impact on patient care, it will help us to harness talent and plan for our future.

Jamie Henry, Professional Development Nurse, has successfully completed the 12-month Developing Aspirant Ethnic Minority Nursing and Midwifery Leaders (DAL) Programme. The programme is a regional pilot to support ethnic minority nursing and midwifery staff to develop leadership skills and progress.

She said: “It helps you to stretch yourself beyond your normal working role and to think about how you can expand your leadership skills.

appreciation of some of the challenges I would never would have considered before speaking with Jamie.

The benefits of the programme are far reaching. For Jamie it was the skills, knowledge, confidence, academia and tangible outcomes and for me it was the experiences, the conversation, watching Jamie grow and helping her by ‘opening door and being supportive, and the insights I gained will help me in my leadership.”

Cohort 2 is due to start recruiting for September. The closing date for applications is 31 July. Find out more details about the programme here.

“Hayley Flavell was my executive sponsor for the programme and we went through a reciprocal mentoring relationship – it was a give-and-take relationship where I could teach her about ethnic minorities and there were lots of shadowing opportunities with her to help me learn from her leadership and introduce me to her networks.

“It has given me better leadership skills and knowledge. It helped boost my confidence, talking with people, influencing and engaging with different people.”

Hayley said: “When I was asked to be Jamie’s Executive Sponsor, my initial thought was that it would be honour and privilege – 12 months on I still feel that way. It was a great opportunity for Jamie, but also for me, to really understand the issues, develop new skills and awareness and lead others in our Trust.

“I can’t sing Jamie’s praises highly enough and she was an absolute gift as a candidate.

She made my role easy – her commitment, courage and professional questioning allowed us to develop a really effective relationship quickly.

“The other part of the role was listening to Jamie’s experiences of working within the UK and particularly within rural Shropshire – it really made me think and gain a degree of Impact Magazine June 2022

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Continuing to Improve The Way We Work We want to empower all our teams to have the confidence, capability, passion and knowledge to drive continuous improvement in the care and services we provide for the benefit of patients, and to ensure you feel proud of the work you do.

So we have in place an Improvement Hub, led by our Improvement team, to develop and support a culture of consistent continuous improvement.

Accessible to all, the team offers a consultancy-style service to enable and support colleagues find and develop solutions to issues to make sustainable change happen.

They will provide and develop tailored training and coaching to further embed continuous improvement. A clinical lead for improvement, Dr Ed Rysdale, is also now in place to support our clinical improvements.

including the Model of Improvement, Reasons Why, Stakeholder Engagement and the Five Whys.

• Improvement Sharing Huddles every month (next is 20 July) so you can hear directly about the improvements being made • Genba Walks – where Trust Board members are invited to, and visit, different wards and departments amongst other informal activities • Masterclasses You can talk to our colleagues in the Improvement Team who will be able to provide you with advice, guidance and support along the way.

Visit your Improvement Hub to find out more about the help and support available.

There are already many fantastic examples of improvement being made across the organisation every day and some of these were showcased at our first Improvement Conference. More than 38 case studies were submitted involving 168 colleagues – with four receiving recognition awards.

The support provided by the Improvement Hub includes training courses for all colleagues who are at different stages of their improvement journey: • Improvement Introduction – an introduction to the improvement philosophy • Improvement Fundamentals – improvement tools and concepts provided which can be transferred back the workplace • Improvement Practitioner – advanced understanding of improvement tools and techniques • Lean for Leaders top up There are also: • Improvement bitesize videos on topics 14

Impact Magazine June 2022

Case Study – Switchboard Care Co-ordination Our Switchboard team, led

by Paul Corbett, Telecomms Manager, wanted to improve the time taken to connect our clinical teams with the Care Co-ordination (CCC) teams so there is a faster response to the families they support. This is turn would free up hours of Switchboard time to answer hundreds of calls from other callers, including the public.

Supported by the Improvement team, the trial of a system called netcall was successfully implemented which led to an improvement in the time the team spent on calls to the CCC, freeing them up to deal with other

Impact Magazine June 2022

calls.

Care Co-ordination (CCC) is a service managed by Shropdoc that connects GP services to the medical teams. The CCC is the highest user of the switchboard service and when calls are received by the switchboard operator, they have to be managed while clinical teams are contacted.

It was agreed that the teams would pilot the netcall service with the highest call volume area – our Medical Teams.

showed that 158 calls were successfully connected to the pilot bleeps for the medical teams. This resulted in around 11 hours’ worth of waiting time being saved during the first week of the trial which the switchboard would usually manage.

Positive feedback was received from the switchboard operators with around a 40% reduction in call traffic from the CCC. The next steps are to roll out the netcall software to all CCC users and other departments, with further opportunities for improvement also identified.

The results of the initial pilot

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