Improving Together - January 2020

Issue #10 - January 2020

Improving Together

Louise Barnett joins SaTH as new Chief Executive

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An innovative approach to improving theatre safety

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Doctors produce handbook to improve EOLC experience

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Our Quality Improvement journey to delivering great care Caring | Well-Led | Responsive | Effective | Safer

T AS A RESULRVE Y OF S TAFF SUACK FEEDB

1 | Improving Together

More bed space being created to ease hospital pressures “By providing that level of support on a specialist ward, we hope to be able to shorten the length of stay for the patient.

That is obviously better for the patient, and will also allow us to free up more acute beds as we deal with additional demand.”

The new ward at PRH will be created as a result of Wrekin MLU moving into a purpose-built modular building next to the Consultant Unit. The building which will house a new state-of-the-art MLU at PRH has been lifted into place over recent weeks and will include a birthing pool and en-suite bathrooms. It has been designed with the leadership team from

Two new wards are being developed to create more space at RSH and PRH. A 25-bed therapy-led ward/discharge lounge open will open at RSH over the coming weeks, while a 16-bed ward will open at PRH.

the Women and Children’s Care Group.

Sara Biffen, Deputy Chief Operating Officer, said: “The area freed up by the move will be used to create a ward which will cater for acute medical patients, creating more space at PRH.”

The therapy-led ward/discharge lounge will open in the Copthorne Building at RSH and has been designed to shorten the length of stay for patients, while freeing up acute beds.

Meanwhile, three additional trauma and orthopaedic beds

Kath Preece, Head of Nursing for Scheduled Care, said: “The ward is designed for patients who are coming towards the end of their treatment and therefore need less care, but are not yet ready to be discharged as they still need the input of a therapist.

The new bed space has been created on Ward 22 T&O at RSH

opened on 13 February to help improve the flow of trauma patients from our emergency departments into a ward bed. and will also ensure patients are being cared for on a dedicated ward that has the right skills to meet their specific needs.

Most successful flu campaign ever SaTH achieved its most successful ever staff flu immunisation campaign – smashing the Government’s target.

So far this winter, more than 82% of doctors, nurses and health care staff at SaTH have been vaccinated against flu.

The Government’s target is 80%.

Dr Arne Rose, Medical Director at SaTH, said: “This is a great response from our staff, as we know that by immunising ourselves against the flu we are protecting ourselves and our patients.

“Our flu team has worked incredibly hard to make having the jab as easy as possible for our staff. They have held drop-in and walkabout clinics, staff have received a £3 coffee shop voucher as a thank you, there has been a 24-hour jabathon at both hospitals, and we have even set up a dedicated Flu Hotline.”

The Trust launched its Flu Campaign 2019/2020 in October 2019, and it concludes at the end of March 2020.

Last year’s uptake was just over 75%. To date 82.37% of frontline staff have been vaccinated 2019/2020.

Improving Together | 2

Louise joins SaTH as new Chief Executive Louise Barnett has taken up the role of Chief Executive at SaTH.

Resources and Organisational Development at Peterborough and Stamford Hospitals NHS Foundation Trust and Non-Executive Director at Sherwood

Louise joins SaTH from The Rotherham

Forest Hospitals NHS Foundation Trust.

NHS Foundation Trust, having joined

She added: “We have some great staff at

them as interim Chief Executive in

the Trust, however I know SaTH faces a

October 2013, prior to being appointed

number of challenges and I’ll be working

to the substantive position in April 2014.

to lead improvements for the benefit of patients and our community.

She said: “I am delighted to be joining SaTH and I look forward to working with

“I will also be working closely with our

staff across the organisation to provide

Board, senior leadership team and local

the best possible care for the people we

healthcare partners to build on the

serve across Shropshire, Telford & Wrekin

improvements of the past few months

and Mid Wales.”

and work through how we can tackle some of the longstanding issues.”

Prior to her time at Rotherham NHS

Louise replaces Paula Clark, who has

Foundation Trust, Louise held a number

acted as Interim Chief Executive at SaTH

of NHS board positions, including Interim

since 1 July 2019.

Chief Executive, and Director of Human Ben Reid, SaTH Chair, said: “I look forward to working with Louise. She has an impressive track record of leadership and stakeholder engagement, and if you add to that her values and commitment to patients and staff, this makes her a great appointment for SaTH. “Louise joins us at an important time as we work towards building sustainable solutions to the challenges we face, as well as building on our areas of strength.

She will provide inspirational leadership to the Trust and strengthen our partnerships across the healthcare community.

“I would like to take the opportunity to thank Paula Clark for the invaluable contribution she has made in a short period of time.”

Update on the Hospitals Transformation Programme,

by Neil Nisbet, Programme Director Many of you have been involved in the programme to date, through task and finish groups and workshops, and we thank you for your valued time and input.

The project is moving forward and the team have been busy in recent weeks. We’ve met with other hospitals who are delivering similar transformation programmes to share our approaches and learnings. We’re also exploring car park solutions and office requirements across both hospitals.

Some of you may hear from us in the coming weeks as we’ll be carrying out an audit of all non-elective/emergency admissions to gain an in-depth understanding of the bed number requirements across the new planned care site and the new emergency care site. Your support will be gratefully received; the information gathered will provide us with the intelligence required to ensure our future service provision is the best it can be.

As you may have seen, there’s been a lot of attention in the media over recent weeks, mainly around the rising costs of the programme. This came from leaks of our draft Strategic Outline Case (SOC), which unfortunately meant that you all heard this news second-hand.

Because of the delays to the programme, which have been beyond our control, additional costs have surfaced particularly in terms of building cost inflation. Our draft SOC outlines a number of approaches to ensure the clinical model is delivered.

We will keep you up to date on the progress of these as we move forward.

Neil Nisbet, Programme Director

3 | Improving Together

Human Factors training in theatres SaTH is taking an innovative approach to improving patient safety by closing their theatres every couple of months to implement Human Factors training.

The Trust’s management are on-board too, and have agreed to close Theatres for half-a-day every other month so staff from all areas of

Healthcare professionals are always exploring new ways to make

the organisation can undergo simulation training to learn more about

services safer. But it’s complicated, and there is so much more to it

themselves and how best to communicate with others in a range of

than just ensuring that the people with the best skills and knowl-

challenging scenarios. Lorien continues: “This is obviously a brave

edge have access to state-of-the-art equipment and technology.

decision but one we applaud. It has allowed us to carry out simulation training using real-life scenarios. “We are finding out how people

That is why, at SaTH a team of Consultants has introduced Human

communicate, how they manage interruptions, how people lead and

Factors training to the Theatres Department.

how people deal with changes in leadership. Once we see that we can then go back and look at how things can be done differently to result

Dr Lorien Branfield, Consultant Anaesthetist who, along with Mr Joe in better outcomes.”

McCloud, Consultant Surgeon, is running the course, explains: “Having the right people in the room is of course essential, and

The training sessions are all themed and are linked to incidents, or

having access to the best equipment is obviously very beneficial, but

near incidents, reported by the Trust’s Patient Safety team. The

even then there is so much more that needs to be done to ensure

current focus is on raising concerns. Bev Roberts, a Healthcare

our patients are as safe as they can possibly be.

Assistant in the Theatres Department at RSH, has been on one of the training sessions and is now recommending it to all of her colleagues.

“Human Factors training is about improving people’s leadership and communication skills. It removes perceived hierarchy and gives people the confidence to escalate concerns.

“We have had two full training sessions, with two more planned in March and May, and so far it has been incredible. We have had people from across the organisation taking part, including some of our top doctors, nurses, healthcare assistants and porters. But, regardless of their job title or speciality, they all learn the same thing and get treated identically.”

She said: “It’s brilliant and gives people the confidence and skills to speak up if they think something isn’t right.

Mark Cheetham, Medical Director for the Scheduled Care group, has praised the approach.

He said: “I am delighted that Joe and Lorien have agreed to lead the work on Human actors in the Care Group. This will improve team, working and communication in order to create the conditions for safety and staff experience to thrive.”

Improving Together | 4

Mums feel cared for during labour and birth, CQC survey finds New mums in Shropshire feel cared for during labour and birth and have their concerns taken seriously, a new survey from the Care Quality Commission (CQC) has found.

SaTH’s results were better than most other trusts in four questions: • Was your discharge delayed?

• Did you get active support and encouragement about feeding baby?

The 2019 CQC Maternity Survey—which was published on 28 January 2020—found women cared for by SaTH had confidence and trust in the staff caring for them during their labour and

• Were you given a choice over where postnatal care would be?

• Could you get feeding advice during the evening or at weekends?.

the birth of their baby.

There were no areas where SaTH performed worse than other trusts.

Women who responded to the survey said they were treated

Findings of the survey include:

with dignity and respect during labour and birth, and were able to get help when they needed it.

• Women having confidence and trust in the staff caring for them during labour and birth.

The CQC survey highlights women’s views on all aspects of their

• Women being treated with dignity and respect.

maternity care from the first time they see a clinician or

• Concerns being taken seriously.

midwife, through to the care provided at home in the weeks

• Women getting the help they needed.

following the arrival of their baby.

SaTH scored 8/10 or higher in 73% of the questions asked. Of the 35 questions in which SaTH achieved this scored, 21 (60%)

• Midwives listening to women during their antenatal check-ups.

• Women getting the help they needed when they needed it.

• Women being spoken to in a way they could understand.

scored 9/10 or higher.

Golden Children’s Ward The Children’s Ward at PRH has scooped gold in an innovative scheme which aims to ensure patients have the best experience possible.

Patient experience is at the heart of Exemplar – which awards Silver, Gold and Diamond to participating wards at SaTH. Wards must show strong leadership to inspire their entire team to make changes in areas including care and compassion, infection control, documentation and communication in order to improve a patient’s journey through their ward.

Jennie Probert, Children’s Ward Manager, said: “I am really, really proud of everyone for achieving Gold status. This really was a big team effort.”

Jennie, who took up the role of Ward Manager in August, when the Exemplar process was already under way, added: “For me, it has highlighted what a great team we have and how we all pull together. “Our standards are really high, so to get this recognition is fantastic.”

Sister Beckie Nock, who oversaw much of the work undertaken by the ward, said: “The Exemplar programme has been really useful. It helped us look at things through fresh eyes and from a different perspective, which has definitely helped us drive up standards even further.”

Paula Clark, outgoing Chief Executive, who presented the ward with their award, said: “This is a fantastic achievement by the whole team. They are an excellent example of a caring and compassionate team, who work hard for the benefit of their patients.”

5 | Improving Together 2 | Improving Together

Cancer service at Hamar Centre set to expand SaTH and Macmillan Cancer Support are working in partnership with other local charities to build a new Macmillan Cancer Support Service and extend existing services within the Hamar Centre at RSH. SaTH provides counselling and well-being services at the Hamar Centre for individuals with cancer and other life-threatening conditions.

The new extension and refurbishment of the centre will see the existing Macmillan Cancer Support Service, which provides information and advice to people living with cancer and their loved ones, being relocated to a larger space within the Hamar Centre, and will include a new quiet room for patients and carers.

The project also includes the construction of an extension to the building, providing more facilities for counselling and well-being services provided by the Trust. By relocating the Macmillan Cancer Support Service and expanding the facilities on offer, staff and volunteers will be able to support more people affected by cancer and other life-threatening conditions in Shropshire, Telford & Wrekin and mid Wales.

Julia Clarke, Director of Corporate Services, said: “I’m delighted that we can expand the physical building and the patient services at the Hamar Centre, where we provide counselling and well-being services for people with cancer and other life-threatening conditions.

“The financial assistance from Macmillan Cancer Support, Lingen Davies Cancer Fund, The League of Friends of the Royal Shrewsbury Hospital and SaTH Charity has enabled us to make these improvements, for which we are very grateful.”

Macmillan Cancer Support is the main funder for the build and the other local charity partners within the Trust have also put forward a total of £120,000 towards the cost of the development. The new centre is scheduled to open in summer 2020.

Learning from Excellence Learning from Excellence Awards were introduced on our ITU Departments as an alternative to learning when things go wrong.

Alternatively, complete a form on the intranet via Clinical Services and Scheduled Care Safety.

Learning from when things go wrong is of course incredibly important, but so is learning from colleagues in other departments who are perhaps doing something that could allow you to provide better patient care.

Pictured: from left Staff Nurse Lucy Finch received two nominations her policy writing skills and Route Cause Analysis investigations Cardiology Consultant Jayesh Makan was appreciated for the way he manages difficult conversations; Paediatric Sister Jacqueline Hyne was nominated

by Fran from our Critical Care Outreach Team for her excellent management of a patient with IV access issues; the catering team at PRH were nominated by ITU at PRH for going above and beyond for a patient with complex dietary needs.

You can also nominate a colleague from anywhere across the Trust by completing a form from ITU, on both sites, and posting it through their Golden Letter Box.

Improving Together | 6

News in Brief Swan Fund has raised more than £43,000 since launch A fund set up to benefit patients who are end of life, and their families, has raised more than £43,000 since its launch.

The Swan Fund was set up by Jules Lewis, End of Life Care Facilitator SaTH in July 2015 with a £500 donation collected at the funeral of her own father, Harold, who died at the RSH. The fund has now grown to £43,627.

The generous donations have helped to fund many improvements – including 23 Swan Rooms across both hospital sites which provide privacy and dignity for patients who at the end of their life, and their families. Other additions funded by the Swan Fund include ceiling skylights (see below), vouchers for relatives, Coping with Grief leaflets and Swan Bags for unexpected deaths. The latest will be a chair bed to allow relatives to stay overnight with their loved ones, Pet Passports and Children’s Bereavement Bags.

care and outcomes, ensuring that everyone is treated with dignity and respect.”

In March, Kal Parkash will join SaTH to take up a brand new role - Equality, Diversity & Inclusion Lead. Kal joins the Trust from West Mercia Police where she was shortlisted for the National Excellence in Diversity Awards, in recognition of increasing BME representation.

Ron delivered a fascinating lecture on the changing face of Sepsis and held a Q&A session at both sites, providing staff with the opportunity to make suggestions, raise concerns and have open and robust discussions about the condition.

5S workshops

The 5S workshops are run over two days.

On day one you will receive a half-day interactive teaching session on elements of waste, 5S and mistake proofing. Once completed, you then go back to your genba (place of work) to start making improvements using the 5S principles.

Improving Equality, Diversity and Inclusivity

Ruth Smith, SaTH’s Lead for Patient Experience, said: “The information gathered will be used to develop improvement plans and support the Trust in identifying priorities to address inequalities of access,

“Insightful” Sepsis event SaTH welcomed Dr Ron Daniels, CEO of the UK Sepsis Trust, to both PRH and RSH recently.

Over the past two and a half years more than 300 members of staff have undertaken their 5S training.

SaTH held its second EDI Stakeholder event this month to improve its services to all members of the community with the aim that everyone who attends our hospitals feels valued and treated with compassion and respect.

to be a great success, so much so that one of our VMI partnership Trusts, (Barking, Havering & Redbridge) ‘have pinched with pride’ our 5S workshop teaching model!

Why not book onto a 5S workshop today?

This can be done via the Training Diary on the intranet.

On day two you will continue with your improvement work on your genba; at all times knowing that a member of the KPO Team is available to support you. At the end of day two the workshop attendees will be brought back together to report out and update on the improvements they have made during the workshop.

The format of our 5S workshops has proven

Speaking after the event, Ron said: “It was fascinating to spend a day at SaTH. What was palpable was the appetite for progress.

People in Shropshire take sepsis extremely seriously, and are motivated to work hand-in-hand to drive progress.”

Angela Windsor, SaTH’s Sepsis Nurse Practitioner, said: “The insightful lecture and Q&A allowed staff at both hospitals to go home with ideas and opportunities to improve the way we detect and communicate our concerns about Sepsis.”

7 | Improving Together

Doctors produce handbook to improve end of life care experience Two doctors with interests in Geriatric Medicine and Palliative Care have produced a Prescribing Handbook to help improve symptom management for patients at End of Life and subsequently improve patients and relatives’ experience of End of Life Care at our hospitals.

Core Medical Trainees, Dr Laura Dewhirst

“Research shows that Frail, older patients

website for anyone who can’t find it. “It's

and Dr Hannah Hudson, created the

undergoing palliative care can often be

great. Use it.”

prescribing aid to help junior doctors and

under-assessed and undertreated so we

other prescribing members of the

also want to raise awareness and increase

Dr Elin Roddy, Clinical Lead for End of Life

Multi-Disciplinary Team in managing

confidence in managing some difficult but

Care, said: “This is a great handbook and

common symptoms patients have at the

not uncommon prescribing scenarios such

covers lots of tricky areas where a bit of

end of life.

as Parkinson’s disease and epilepsy.

extra guidance is useful and can give

Dr Dewhirst said: “We hope this handbook

“We really hope our colleagues will find

doctors. Well done to Laura and Hannah

will be useful for our colleagues

the handbook useful and that patients and

for their enthusiasm and initiative.”

prescribing for those at the end of life. We

their relatives will benefit from it.”

have focused on the management of

Dr John Bowen, Consultant Neurologist at

The Prescribing Handbook can be found by

symptoms arising in patients with common

SaTH, said: “This booklet is an invaluable

searching for ‘prescribing aid’ on the

chronic conditions who may require

practical guide for end of life medicines

Intranet.

medication changes or initiation of new

management. I have, with permission,

medication.

positioned it on the SaTH Neurology

confidence – for senior as well as junior

Supporting and informing safeguarding - conversations to truly hear the person’s voice Foundation Year Two Doctors enhanced their communication skills

to protect and empower vulnerable individuals by finding out

during a well-received training event that was organised as part of

their views and wishes.”The cards have been co-produced with

National Safeguarding Week. The course was delivered by Joint

individuals who have care and support needs, self-advocacy and

Training, Shropshire Council, in partnership with SaTH, and was

peer experts in Shropshire.

commissioned by SaTH Emergency Doctor Adrian Marsh.

To express interest in the training course or to purchase “My The training, which was delivered by Mary Johnson, Learning and

Enquiry and Safety Plan Cards” please contact Joint training,

Development Officer for DoLS and Autism at Joint Training,

Shropshire Council - Tel 01743 254 734

utilised “My Enquiry and Safety Plan Cards” to give staff a

joint.training@shropshire.gov.uk

resource to aid meaningful conversations with vulnerable patients.

Last year’s uptake was just over 75%. To date 82.37% of frontline Mary said: “This is especially important in times of crisis, helping

staff have been vaccinated 2019/2020.

Improving Together | 8

Improvements to the intranet The Trust’s Communications Team and Clinical Audit Team have concluded a mammoth project to cleanse the clinical guidelines and policies section of the SaTH Intranet.

• The Communications Team has removed more than 14,000 out-of-date documents from the File Library • The Clinical Audit Team have reduced the clinical guidelines in the formal document library from 468 to 45.

This has been achieved by providing greater clarity about the requirements, and implementing a more directive review process, using email voting buttons for ease of response.

The Trust’s Communications and IT teams have also made improvements to several elements of the intranet. These include: • An immediately visible search bar for guidelines and policies on the homepage • Streamlined shortcuts on the homepage so that important information is quicker to find • A modern and colourful revamp the homepage and banner to make sections easier to navigate. Improvement to the homepage also allows the Communications Team to gather page view analytics, meaning the team can determine which pages are more popular and therefore the can alter the homepage shortcuts accordingly.

Faster diagnosis pathway for lung cancer As part of SaTH’s work around the faster diagnosis pathway for lung cancer, members of the Radiology Team, supported by a Lung Cancer Working Group, have looked at the process of chest x-ray reporting.

Dr Emma Crawford, Consultant Physician in Respiratory and General (Internal) Medicine at SaTH, said:

“Much of this work in the short term has been achieved by the hard work of our radiologists accompanied by a shift in the prioritisation of chest x-ray reporting.

“We are committed to training and mentoring reporting radiographers to consolidate this work in the medium to long term, but would like to thank the radiology team, and in particular Dr Richard Orme, who has led this work, for the impressive results to date which have been achieved without increasing reporting times for other radiology investigations.

The aim is for the majority of chest x-rays to be reported within 24-hours, and therefore identifying any suspicion of lung cancer at the earliest opportunity. This will ensure timely access to a CT scan and the lung cancer pathway, where appropriate, and feeds into other work streams with the ultimate aim of significantly reducing the time to diagnosis and treatment for patients with suspected lung cancer.

“We have received positive feedback, particularly from GPs, that this improvement has made a tangible difference to their work and has facilitated early and important discussions and decision making with patients.”

9 | Improving Together 2 | Improving Together

NHS Careers Live event SaTH and the Shrewsbury Colleges Group (SCG) combined forces this month to host the second joint NHS Careers Live event for young people in education.

The event, which was held at The Shropshire Conference Centre on Wednesday 12 February, showcase a range of exciting careers available at SaTH. The event was an opportunity for SaTH to present the wide range of jobs and career opportunities in the NHS, and there was staff from the Trust on hand to discuss routes into the many job roles, including work experience and apprenticeships

International Nurse Recruitment With nearly 180 new nurses joining SaTH from India, it is expected that 100 of them will be in place by the end of March.

Almost 30 nurses have arrived so far and a plan is in place to accept an additional 30 each month.

Clair Hobbs, Deputy Director of Nursing, said: “So far the overseas nurses that have been have joined us are of a high calibre with very good English and clinical skills.”

The overseas recruitment has been made possible through Health Education England’s (HEE) Global Learners programme.

Weekly meetings are held by the Deputy Director of Nursing and the Workforce Team to ensure pace around the recruitment process and that the plan remains on track to be delivered in line with the original proposal.

Improving Together | 10

Learning from complaints The Complaints team is continuing its efforts to improve the timeliness and quality of responses to concerns and complaints.

This is being done using the Trust’s Transforming Care Production System, which has identified that a significant rate-limiting step is the time taken to get a response from the relevant clinician. Work is under

Complaint: Patient contacted a about cancellation instead of his/her daughter, despite known memory problems Cause: Short-notice cancellation therefore secretary phoned patient – she was not aware of memory problems Action taken: Secretaries to ensure any alerts are checked prior to contacting patient

way to explore supportive ways of working with clinical colleagues.

Other innovative approaches being explored by PALS and the Complaints Team include: • The trial of paperless working, which has already commenced in complaints

Complaint: Lack of Physiotherapy input and information Cause: Advice and information given verbally on the wards was not sufficient Action taken: Physiotherapy teaching material for family and carers is being identified.

• The introduction of ThinkOn methods • Participation in the Equality and Diversity Stakeholder Event to ensure that services are accessible and that the team identifies where any specific groups may be disadvantaged. As part of this, work is ongoing with Signal to ensure that the service is accessible to the hard of hearing community, for whom there are specific constraints to communication.

• Improved links with secretaries to further support consultants in responding to complaints, for example by facilitating more timely

Complaint: Patient not given enough information prior to test Cause: Current information does not include sufficient details of test Action taken: Written information being updated to ensure that patients are fully informed about all aspects of test

access to notes.

Staff Celebrate A group of our staff celebrate the completion of their Foundations of Supervision and Team Leadership course.

The five month programme culminated in each member of the cohort delivering a presentation on improvements made in the workplace using leadership and engagement approaches.

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