Improving Together
Improving Together Issue #2 - 15th May, 2019
RECRUITMENT SUCCESS 12 doctors now confirmed as joining the Trust following an overseas recruitment trip
RADIOTHERAPY TEAM CREATES NEWSPAPER to help cancer patients understand more about their treatment.
Caring | Well-Led | Responsive | Effective | Safer This regular newsletter demonstrates the steps we are taking to improve against the five CQC domains
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Improving Together
News in Brief
New Doctors’ Mess at PRH Telford
End of Life Care
The new facility will provide a welcoming and caring environment for staff, and also help recruitment to SaTH.
End of Life Care specific-categories have now been added to Datix, allowing the team to review all incidents related to End of Life Care. This will result in increased knowledge of the core areas of focus to improve patient care for the service.
Sepsis Nurse Practitioner appointed
A new Doctors’ Mess has opened at PRH.
The new mess has been developed within the hospital and will replace the current outdated facility based in a bungalow outside the main hospital. It has created a welcoming space for doctors to rest and network 24-hours-a-day – the official opening took place on 9 May
We have appointed a Sepsis Nurse Practitioner. They will lead the education, training and monitoring of Sepsis at the Trust.
SaTH shortlisted for national award One of our teams has been shortlisted for a national award after making financial savings of nearly £2million.
Safety boards and care group safety events Safety boards and care group safety events are helping us to improve our safety culture by enabling people to raise concerns. There is also a pilot taking place for the Trust to empower staff to talk about safety with 40 safety conversation champions trained to date.
Executive team strengthened We have strengthened our Executive team with the appointment of a new Medical Director, a new interim Director of Nursing and a new interim Deputy Chief Executive. Dr Arne Rose will become SaTH’s new Medical Director in June and our current Medical Director, Dr Edwin Borman, will start his new role as Director of Clinical Governance on 3 June. Barbara Beal joins us as our new interim Director of Nursing in May. She has held an extensive number of board-level roles with the acute health sector, including Midwifery, Executive Director of Nursing, Turnaround Director, Human Resources Director and Acting Chief Executive. Bev Tabernacle joins us as interim Deputy Chief Executive for seven months starting on 1 June. Bev will be on secondment from her role as Director of Nursing and Deputy Chief Executive at RJAH. She will take over the reins from the current Deputy Chief Executive and Finance Director, Neil Nisbet, who is currently on secondment to NHSI.
The Procurement team, based at the Shrewsbury Business Park, has made the final nine in the Health Service Journal’s Financial or Procurement Initiative of the Year. They have been nominated for their ‘Lean Methodology Journey’ – which saw them making savings of £1.8million in the 2017/18 financial year. The overall winner will be announced soon. The savings were achieved by using ‘lean methodology’ from the Trust’s Transforming Care Production System – created as part of the partnership with the Virginia Mason Institute in Seattle, the USA’s Hospital of the Decade.
Improving Together
Improvements this month Scheduled Care • We are setting up a Critical Care Clinical Operational Group to review data trends and performance. • The Radiotherapy Team at RSH has developed its own newspaper to help cancer patients understand more about their treatment. • A Never Event Feedback session for Theatres at RSH and PRH took place on Thursday 2 May. Find our more on page 8.
• Medicine have developed a register of all clinical policies and procedures and established a process for review. This will ensure they are up-to-date and reflect the most recent national guidance. This has also provided an opportunity to rationalise and consolidate our current clinical guidelines.
Women and Children’s • We have created a clear and defined pathway for midwives and sonographers to follow for women with reduced foetal movements. • A team on the Neonatal Unit is developing a range of ways to tackle the four main reasons why full-term babies may be admitted unexpectedly onto the unit.
Unscheduled Care
• We have introduced the Baby Buddy App. It offers improved information to patients and safer care for mum, dad and baby.
Workforce
• 12 doctors now confirmed as joining the Trust following an overseas recruitment trip. • One-stop therapy events have been successful for Radiography, Biomedical Science, Physiotherapists, and most recently a joint event for Physiotherapists and Occupational Therapists. This has made a considerable impact on vacancies in these areas. • The fourth cohort of trainee Nursing Associates is being advertised now. This is a fully-funded two-year foundation degree apprenticeship and is only available to our existing staff.
• We have reviewed and updated the Trust-wide Deteriorating Patients policy to provide clearer lines of accountability. This will be presented to the Trust’s Safety and Quality Committee later this month. • We have created a Standard Operating Procedure within our two Emergency Departments to monitor stock levels, re-ordering supplies and forms to ensure they are delivered to the correct site in time.
Midwives Claire Beaman and Heather Cox with the red hats, given to babies at risk of being admitted to the Neonatal Unit.
Improving Together
Learning from Excellence Within SaTH we have systems to learn from when things go wrong. Learning from Excellence is about learning from all the times that it went well.
Hannah O’Mahoney-Magee, Ward Manager on ITU at PRH, with her nomination for her excellent approach to cross-site working
Here we shine a light on some of our staff who have gone the extra mile. • Karen (pictured bottom left) one of our amazing phlebotomists receiving her nomination for going the extra mile for a patient with sepsis to start treatment . • ITU superstar Jane received her nomination for not only skilfully managing an emergency situation but also leading a team debrief straight after. • Our wonderful Band 6 team at PRH ITU were nominated for being so supportive to our student nurses - encouraging and inspiring them to get involved. To nominate someone for a Learning from Excellence award you can either go to ITU (on either site) complete a form to post through their Golden Letter Box or go on the intranet and fill out a form via clinical services, scheduled care safety.
Chris Mowatt receiving his nomination from the PRH ITU nurses for his exemplary care and compassion shown to a particularly frightened patient.
Band 6 team at PRH ITU were nominated for the support they showed to student nurses
ITU Staff Nurse Gill Evans receiving her nomination from Sister Heather Rushworth for being so supportive and going to extra mile for a patient with complex need
Karen, a phlebotomists receiving her nomination for going the extra mile for a patient with Sepsis
Engagement
This newsletter is just one of the ways we are improving the way we engage with you. We also hold a monthly Cascade with Chief Executive Simon Wright, Breakfast with the Boss (pictured) and engagement events with staff survey focus groups. So far more than 50 people have expressed an interest in becoming an Engagement Champion but the forthcoming launch events are open to anyone who is interested in learning more about the role. •13 May: Syndicate Room 1&2, SECC, RSH. 4pm-5pm. •14 May: Room B, Education Centre, PRH. 1pm-2pm. •20 May: Meeting Room 1, Douglas Course 2, Shrewsbury Business Park. 10am-11am.
Improving Together
Small things make a big difference fund
Did you know?
We are introducing a new Staff Lottery in July with all the money raised being put into the Small Things Make a Big Difference Fund. Money in the fund will be used to further improve your working environment. For example, should you wish to buy a new fridge, kettle or toaster for your staff room, or a fan to keep you cool in the summer, there will be money in the Small Things Makes a Big Difference Fund for you to bid on. The Small Things Make a Big Difference Fund has already received a significant boost thanks to the recent decision of our Executive Team to put the £12,000 received from the Shropshire Community Health Trust-organised lottery into it. A prize pool will be created by the monthly contributions to the lottery. The greater the number of players, the bigger the cash prizes and funds raised for staff benefit. The prize pool will be split so approximately 50% will go on prizes and 50% of the money will go into the Fund. To bid for funding from the Small Difference Fund, please visit http://intranet/Charity/lottery.asp
• By the end of April, we had looked into 102 of the Root Causes of the 396 ‘Must Do’ and You can enter the lottery by downloading a lottery entry form by visiting http://intranet.sath.nhs.uk/hr/small_ things_big_difference.asp
‘Should Do’ areas identified by
For further information please contact SaTH Charity Office, Stretton House, RSH on 01743 241446 (Ext 1446) or email sath.charity@nhs.net
•Every ward has a sepsis box or a
In order to make fair decisions on who receives money from the Small Things Make a Big Difference Fund, a panel has been set up to read through the bids.
The panel will meet once a month on 11 June, 9 July, 13 August, 3 September, 8 October, 12 November and 10 December. Read next month’s Improving Together newsletter to find out what money was awarded on 9 May.
the CQC.
sepsis trolley, and there are Sepsis Champions on the majority of our wards. • We now have 20 Freedom to Speak Up Guardians, more than 50 Engagement Champions, 22 ‘Think On’ Master Coaches and 10 Peer-to-Peer listeners.
Learning from complaints Complaint: Medication drawer in patient locker was not locked.
Cause: Number of lockers across the Trust that were broken.
Action taken: All lockers now repaired or replaced.
Complaint: Long wait for appointment and lack of information about delays.
Complaint: Patient sent home with another patient’s information.
Cause: Booking staff not aware of how capacity issues are escalated and addressed.
Cause: Documentation was not checked thoroughly prior to discharge.
Action taken: Team leaders to give feedback to staff after weekly meetings with centre managers.
Action taken: Manager and staff were made aware of the complaint and it was made sure that everyone working in the area was up-to-date with their mandatory Information Governance training.
Improving Together
Our latest Rapid Process Improvement Week (RPIW) focussed on improving the care given to colorectal patients – by removing waste, variations and defects that the majority of patients wouldn’t know about. A Multidisciplinary Team (MDT) meeting – a meeting of a group of professionals from one or more clinical disciplines who together to make decisions - is a key part in ensuring patients receive the best treatment so it is vital they are done well. Unfortunately, due to the amount of preparation needed for an MDT meeting and the amount of people required to give input they are not always done as well as they should be. Therefore, the challenge for the people on the RPIW was to reduce silo working, remove waits and waste so that patients can move onto their next step in their treatment without delays.
What they found was: • Delays due to cancellation of MDT as a result of Bank Holidays • Delays during the MDT, resulting in not all patients discussed • Variation in how the MDT meeting is chaired • Variation in how patients are listed
Introduction Course Open to all members of staff, the Introduction to Transforming Care Methodology training continues apace. The workshop will provide you with the key concepts and tools of the Transforming Care Production System, which will enable you to make small-scale changes in your area. Spaces are available, so please book online using the Intranet Training Diary to start your improvement journey.
• Variation in how patients are discussed on the MDT • Defect as consultant not available to discuss their patients • Defect as notes are not available as patients not added to MDT until the last minute • Defect as inappropriate patients are on the MDT list • Late additions to MDT list, resulting in rework
The improvements currently going through the Plan-Do-Study-Act (PDSA) cycle include:
Lean for Leaders Nominations are currently being taken for this year’s Lean for Leaders course, which is due to commence in July 2019. The course supports our leaders in the organisation apply the principles of the Transforming Care Production System (TCPS) in their daily work. You will learn to apply lean tools in your own work areas by leading change effectively. Please email sath.kpo@nhs.net
• Trialing a note-free MDT with two Consultants • Introducing a MDT agenda to add structure • Planning for holiday cover to ensure all patients get discussed The improvements made on the RPIW will be tested for the next 30, 60 and 90 days. To find out more about the work being done through our Transforming Care Production System, visit their updated intranet pages at http://intranet/TransformingCare/Transforming_Care.asp
Diary Dates
• A new process for referring patients into MDT
Wednesday 12 June at 1pm at RSH: Kaizen Event Training Thursday 13 June at 1.45pm at PRH: Kaizen Event Training Wednesday 26 June at SECC: Fourth National Sharing Event
Improving Together
Leadership Academy
Exemplar The purpose of our Leadership Academy is to support all of our leaders and managers to successfully fulfil their roles and reach their potential. The Trust runs a number of programmes and development opportunities around leadership and organisational development.
For more information about the Leadership Academy, email sath.leadershipacademy@nhs.net
Our Exemplar Programme is going from strength-to-strength—with three Diamond Wards and three Gold Wards. • Diamond Wards: Postnatal (PRH), ITU (PRH) and ITU (RSH). • Gold Wards: Ward 16 Stroke/Rehab (PRH), Neonatal (PRH) and Ward 4 T&O (PRH).
Observe and Act
Four departments are currently going through the Exemplar Programme: Chemotherapy Day Unit (RSH), Endoscopy (PRH), Paediatrics (PRH) and the Delivery Suite (PRH).
The purpose of Observe and Act is to look at a patient/carer’s experience from their perspective, and then learn from it, share good practice and make improvements.
The Exemplar team is currently completing unannounced Exemplar baseline assessments on all of the Trust’s ward areas to identify
The process is not to be viewed as an inspection, rather to identify supportive issues around a service that may seem small but can make a difference to the experience of patients. •“Observe and Act has good potential as a tool to help improve the way in which the hospitals and clinics are run” - Marcus Watkin – Volunteer. • “I was interested in taking part from a layman’s point of view, to look at how things work in the hospitals and to make a difference to the patient from my experience as a carer, relative and past patient.” - Marian Chitty – non-clinical member of staff
departments that are either Exemplar ready or require additional support. • “The overriding positive from for us is seeing the local community have input into the development of our hospitals. We would very much like to be part of future projects.” - Nick Parkin, Ian Stuart and Joe Warwick—following an Observe and Act visit to the Mytton Restaurant at RSH. If you are interested in becoming an Observe and Act volunteer, please contact a member of the Patient Experience team: sath.patientexperience@nhs.net
To date, the team has completed more than 20 initial baseline assessments and aim to complete all initial assessments by the end of May.
Improving Together
Spotlight on... Plans to make surgery as safe as it can be have been unveiled. They include reducing interruptions in theatre, developing theatre team leaders and ensuring that key theatre procedures are given more priority. It follows an in-depth look by into the way the theatres operate at PRH and RSH. We want to learn from recent Never Events – incidents that are preventable and which should not occur – and what could have caused them, to reduce the risk of them happening in future. A theatres ‘taskforce’ has spent the past few months considering all elements of life in the theatres including surgeons and other staff being interrupted during procedures, how surgical counts are dealt with and a host of ‘human factors’ which inevitably play a role with large teams working together delivering complex treatments. The feedback and learning has been shared with theatre staff across SaTH and includes supporting and developing senior nurses and operating department practitioners in their roles as team leaders; introducing an induction for staff who are new to theatres at SaTH, and devising new ways of reducing interruptions when surgery is under way. Mr Jon Lacy-Colson, Scheduled Care Clinical Director for Patient Safety at SaTH and Consultant Colorectal Surgeon, said: “The work being done by the teams to improve patient safety in our theatres has been fantastic. The light has been shone on every area – with an emphasis on the part that human factors play. “Although serious incidents are very rare, it is incredibly important that we look deeply into what may cause them when they do happen in order to learn what we can do differently in future to prevent them from happening again. “Patient safety is absolutely paramount and we have been looking at different ways of ensuring that we make our theatres as safe as they can possibly be, and we are now looking to embed those changes across both of our hospitals.”
Contact Us: Please send your feedback and story ideas to: sath.communications@nhs.net
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