Improving Together
Improving Together Issue #3 - June, 2019
ENGAGEMENT AWARD SaTH has scooped a national award for the work it does with the communities we serve.
DYING MATTERS Our End of Life Care Service celebrating Dying Matters Awareness Week
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 Getting patients home sooner We have exceeded our Delayed Transfer of Care (DTOC) target in ensuring that people don’t stay in hospital longer than they need to. Current figures for 2018/19 show the number of delayed discharges of care across Shropshire Council Adult Social Care services and ourselves have reduced from 21.2 per day to 10.4 per day - a 60% drop since 2017/18.
Speakers at the conference included Chris Pointon, wife of Kate Granger and co-founder of the #HelloMyNameIs campaign. The campaign was launched to encourage and remind healthcare staff about the importance of introductions in healthcare. During the week, the team also launched ‘Taste for Pleasure’ - a ground-breaking initiative that gives Nil By Mouth patients tastes of their favourite flavours as they receive end of life care.
Life-changing clinical research More than 2,000 patients at SaTH took part in over 110 research studies in 2017/18, it’s been revealed. Helen Moore, Clinical Trials Manager and Trust Lead Research Nurse for SaTH, said: “Research is the only way we can continue to improve treatment of diseases and patient care. “Trials aren’t only open to people who have a medical need, those who are fit and healthy can also take part. If you would like more information, contact the clinical research department on sath.research@nhs.net”
Nigel Lee, Chief Operating Officer at SaTH, said: “Together with the community teams, CCGs and local authorities, we have halved the numbers of patients that are medically fit and awaiting transfer compared to last year. We now routinely transfer most patients within 48 hours of being fit, which is the national standard. “No one wants to be in hospital longer than they need to be and we will continue to work together with our partners to look at ways of improving further.”
Engagement Award Progress and leadership praised
SaTH has scooped a national award for the work it does with the communities we serve. The Trust has been crowned the 2019 Engagement Champion by engagement specialists MES. The award recognised our People’s Academy and Young People’s Academy, which were set up last year to help people gain an insight into the NHS and how it works locally.
Dying Matters Our End of Life Care Service celebrating Dying Matters Awareness Week in May with the launch of a ground-breaking new initiative and a conference that included multiple key note speakers. Jules Lewis, End of Life Care Facilitator at SaTH, said: “Death and dying is very difficult to deal with, even for staff who work in hospitals, but we only have one chance to get it right for our patients.”
The Chief Executive of the organisation which represents hundreds of NHS Trusts has praised our hospitals for their leadership, progress and ‘desire to learn and improve’. Chris Hopson, Chief Executive of NHS Providers, made his comments after a visit wards and departments, including Maternity, Postnatal, Estates, Cardiology and Respiratory, at PRH. He said: “It was great to see the passion and enthusiasm of the next generation of leaders for continuous improvement and improvement methodology.
Improving Together
Improvements this month Unscheduled Care • Following concerns about how quickly sick children are seen in our Emergency Departments, we have recruited additional nurses and now stream children within 15 minutes of arrival to the appropriate area. • Four new paediatric nurses joined the Trust recently and a further two will be joining in September. • A Value Stream has been undertaken to improve patient flow in the minor injury pathway.
•There has been a meeting to agree the ‘5 Steps to Safer Surgery’. The final document has been agreed and will be soon be shared. A training plan will be done to support the roll-out of the new documentation which will further support improvements in safety.
Women and Children’s • Wrekin midwives were delighted to receive a lovely letter of appreciation and a Project Sunshine basket on the International Day of the Midwife on 5 May. The letter said “…you should all be appreciated every day.” • A video demonstrating how the maternity team holds an 8am handover every day, between the teams working on the night shift and the day shift, was presented to the Strategic Overview and Assurance Group (SOAG). It was well received by them and by the CQC and NHS Improvement.
Scheduled Care • An induction plan for staff who work in theatres has been created to make sure they are aware of how theatres work and what is involved in the delivery of a safe service for our patients. • The new and updated pre-operative checklist has been taken through the Theatre Safety meeting and agreed. The plan is to now roll this out across all wards and departments on both sites.
Workforce
• Maternity Services have started issuing Friday Focus – a weekly one-sided newsletter for our maternity team as a way of keeping them updated in a fun way. This was presented at the Strategic Overview and Assurance Group (SOAG) and was well received by staff, CQC and NHS Improvement.
• We are partnering with Health Education England and will be interviewing 50 nurses in June. • We have appointed 13 Registered Nurses in our Emergency Departments since March and an additional 13 newly qualified nurses we be joining the departments in September. • Plans to recruit an additional four consultants to support acute medicine have been approved, as have plans for two GPs to support Ambulatory Emergency Care (AEC).
Improving Together
Learning from Excellence To nominate a colleague for a Learning from Excellence Award please visit http://www.shropshirecriticalcare.net /excellence-reporting.html (password sathgaspasser). The Awards were introduced on our ITU Departments as an alternative to learning when things go wrong. 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. Recent winners are pictured on this page. You can also nominate a colleague by completing a form from ITU, on both sites, and posting it through their Golden Letter Box. Alternatively, complete a form on the intranet via Clinical Services and Scheduled Care Safety. For more information, please follow @sath_excellence
Pictured Learning from Excellence Winners: Top right: Alex | Top left: Fiona and Kelly | Middle: Jessey | Bottom left: Ash | Bottom right: Alex
Engagement We have launching our exciting new Staff Engagement Champions role, and Engagement Champions PRH
so far have more than 80 people signed up. Having an engaged workforce is critical to us becoming a better organisation, and in your Staff Survey you told us we weren’t always putting anywhere near enough emphasis on this. The Engagement Champion role was suggested by staff, not managers. It is an exciting and rewarding role that is open to every member of staff. If you would like more information about the role, or to become a Champion please email Julia Clarke, Director of Corporate Governance, at Julia.clarke7@nhs.net
Engagement Champions RSH
Improving Together
Small things make a big difference fund The Small Things Make a Big Difference Fund panel met in May to the most recent bids made.Money in the Fund can be bid on by all members of staff to improve your working environment. The panel awarded money for the following: • Microwave for the staffroom in A&E at RSH • Fridge freezer for the staffroom on Ward 25G • CD payers for AMU and CDU at RSH • Outdoor seating for the area behind the staffroom in the Radiology Department at PRH • Foldable workbench for the therapy department to cut walking sticks to size • Fans for staff in our PALS department. • Items to improve the cloakroom in the Neonatal Department at PRH.
The panel, which is always chaired by an Executive, has four core members who will be joined to a couple of Staff Engagement Champions. To bid for funding from the Small Things Makes a Big Difference Fund, please visit http://intranet/Charity/lottery.asp All bids need to demonstrate how the funding will improve the working conditions of staff.
The Small Things Makes a Big Difference Fund last met on 14 June and the outcomes will be published in this newsletter next month. The panel dates for the remained of the year are: 12 July, 12 August, 3 September, 10 October, 15 November and 10 December.
Did you know? We have undertaken a range of actions following concerns that patient flow on minor injury was not meeting the four hour target. These include: •Improved Emergency Care Practitioner (ECP) competencies and increased cross-site working. Shift patterns are monitored and altered to meet demand over the weekend. •A Value Stream has been undertaken to improve patient flow in the minor injury pathway. •Following a Rapid Process Improvement Workshop (RPIW), Minor Injury has been separated from the main Emergency Department at both sites. •A whiteboard has been installed in our Emergency Departments
Meanwhile, to enter the Staff Lottery, which supplements the Small Things Makes a Big Difference Fund, please visit http://intranet.sath.nhs.uk/hr/small_thing s_big_difference.asp
Radiotherapy Team take a group selfie to say thanks for the new microwave that will allow them to have hot dinners
The first draw takes place in July and the winners will be published in Chatterbox.
to improve visibility and communication
As a result we have consistently performed above the 95% target for minor injury patients since 19 January.
Learning from complaints Complaint: Child with autism experienced a long wait in clinic which caused her to become very distressed and so parents had to leave before she could be seen. Cause: Staff were not aware of patients who needed fast-tracking through clinic (e.g. due to autism) Action taken: Clinical outcome form has been updated to allow this information to be recorded, so such patients can be prioritised.
Complaint: Relative could not get through to the ward on the phone for an update
Complaint: Patient was left with an open wound whilst waiting for a doctor to review
Cause: Insufficient staff to man phones
Cause: Due to workload, doctors cannot always come immediately
Action taken: Additional ward clerk appointed
Action taken: In future staff will apply a temporary dressing in cases where there may be a delay
Improving Together
We will host the fourth annual Sharing Event on Wednesday 26 June – with guest speakers from all the Trusts in partnership with the Virginia Mason Institute in Seattle.
Book your place at the free conference, which will be held at the SECC, at RSH, by emailing rachel.hanmer@nhs.net. The conference is expected to fill up quickly so spaces will be offered on a first come, first served basis.
Pictured: Surrey and Sussex Healthcare NHS Trust
• The team from Surrey and Sussex Healthcare NHS Trust (SASH) will be giving a presentation on how they have achieve excellent NHS Staff Survey feedback. They are in the top 20% of hospitals nationally, ranked as a place to work and receive treatment and also as somewhere patients receive quality treatment and care. • The team at University Hospitals Coventry and Warwickshire NHS Trust (UHCW) will be giving a presentation on how they won a 2018 HSJ Patient Safety Award. When the CQC identified a low incident reporting rate, members of their patient safety and risk team set about addressing the issue. Since the changes, the incident reporting rate at the organisation has increased significantly and they are now in the top 25 per cent nationally. • Leeds Teaching Hospitals NHS Trust were named Finance Team of the Year at the National Healthcare Finance Awards after they delivered the largest surplus in its 20-year history in 2017/18. During their presentation, the team will talk about: their waste reduction programme, the importance of believable targets, their new reporting arrangements, the development of patient costing information and finance skills development. • Barking Havering and Redbridge University Hospitals NHS Trust will give a presentation about the work they have done to improve engagement with new Executives and team leaders.
Our Procurement Team will a give a brief overview of how they saved £1.8m. The work was done as part of the Trust’s Lean for Leaders programme and has been nominated for a HSJ Value Award. Our Lung Cancer Pathway improvement work will also be highlighted. This is being led by two Lean for Leader Graduates - Donna Moxon and Dr Emma Crawford - and is focusing on reducing the waste in the current lung cancer pathway to enable implementation of the National Optimal Lung Cancer Pathway by 2020.
Pictured: University Hospitals Coventry and Warwickshire NHS Trust
Diary Dates
• There will also be a number of speakers from SaTH, including presentations on our Respiratory Value Stream which has now transitioned to the Standard Work Value Stream, which includes a two-day reduction in length of stay
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 How could we possibly help you to be a great people leaders and help you to help develop others– One conversation at a time? Come and join us to explore and find out the approach to this question using the ThinkOn® approach and methodology. During the interactive and informative day we will: • Help you notice the effectiveness of your own thinking! • Introduce a simple thinking model people naturally use to make a difference • Introduce you to some effective questioning techniques to improve the quality of conversations • Help you identify how to improve the performance of others • Explain the nature of the change we are embarking on A standardised patient behind the bed
• Play some cards!
board is being developed to the highlight There are three dates to choose from (July 11, August 16 and September 26). Please note that all sessions will be held at an external site and will be held over a full day, 9am – 4pm. You only need to attend one date.
important information we need to know
Please follow the link to book onto the People’s Manager Workshops directly via the Training Diary: http://intranet/sathtrainingdiary/SelectCourse.aspx
needs additional nutritional or hydration
about our patients. Examples include if the patient is diabetic, at risk of falls, support, has a cognitive impairment or dementia.
Observe and Act The first areas that have been visited as part of the Trust’s Observe and Act programme are: • Ward 22 Respiratory • Ward 21 Frail and Complex • Outpatients Clinics D, E & F (PRH) • Fracture Clinic (RSH) • Fracture Clinic (PRH) • Outpatients Clinic 2 (RSH) • External public pathway and access (RSH) • Mytton Restaurant (RSH) • Ophthalmology (RSH) • Audiology (RSH) • Pre-Op Assessment (PRH) • Pathology – Elizabeth House (RSH) • Radiology (RSH) 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 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.
Laura Carlyon, who works in our Workforce Department, said: “As someone who has received care from our hospital, and whose family receives care from our hospital, helping the patient experience be the best it can be is something I’m absolutely passionate about.
Nursing documentation has been reviewed to identify and remove waste or duplication. The new documentation will be piloted on two wards during June 2019 and if successful will be rolled out Trust wide. We currently have: • 3 x Diamond areas: Postnatal; Critical Care at RSH & PRH • 3 x Gold areas: Ward 16 Stroke/Rehab;
“I work off-site in a non-clinical capacity so being able to participate with Observe and Act helps me feel connected to the care of our patients and provides me with the opportunity to help improve the patient experience by sharing observations of good practice from a non-clinical perspective.” The group meet at alternate sites each month to undertake Observe and Act visits, with the objective being to train enough volunteers to make these monthly visits at each site. For staff who complete the training to support SaTH with its Observe and Act initiative, a commitment of 2.5 hours every two months to assist in conducting observe and act observations is required. For further information please contact sath.patientexperience@nhs.net
Neonatal Unit; Ward 4 Trauma & Orthopaedics Four areas that are currently working through accreditation. These are: Paediatrics, Delivery Suite, Chemotherapy Day Unit and Endoscopy at PRH.
Improving Together
Spotlight on... £32 million is to be invested into improving quality at our hospital under bold and exciting plans unveiled today by SaTH. Almost £15 million will be invested in recruiting 200 new clinical staff, including doctors, nurses and midwives, in what will be the biggest ever investment in the workforce. There is also a £17 million cash injection towards improving ageing estates at PRH and RSH – with £7 million of this in improvements in Radiology, including a new CT scanner at PRH. It is a massive investment in SaTH, made up of: efficiency gains, waste reduction, procurement savings and central tariff uplifts. Simon Wright, Chief Executive at SaTH, said it was fantastic news for patients and staff, and would make a real impact on care. He said the Trust had laid bare the historic issues that it has been facing over the last few years, including staff shortages as well as ageing estates, and it was now in a position to invest significantly in making improvements in advance of NHS Future Fit. Simon said: “This will enable us to take the organisation forward and take a significant step forward for the future and begin to move away from the fragility that we have had over the last decade.
The investment will be split across two areas - People and Estates. People • 200 new Doctors, Nurses and other clinical staff in areas such as A&E, Critical Care, Maternity and End of Life Care • As well as general recruitment, the Trust is also working with partners to develop programmes to train staff including Nursing Associates, Advanced Nurse Practitioners and Consultants in order to boost the workforce over the next 24 months. Last year SaTH appointed 151 more clinical staff than the previous year, including 48 additional doctors and this will build on this significantly
Estates • New CT scanner at PRH and new imaging equipment for Radiology • Protecting current hospital buildings by addressing essential maintenance issues • Developing clinical services across the two hospitals, including Ophthalmology, Endoscopy and new wards • Developing IT
Contact Us: Please send your feedback and story ideas to: sath.communications@nhs.net
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