Improving Together - September 2019

Improving Together

Improving Together Issue #6 - September 2019

VIP AWARDS 2019 A night to celebrate our staff and volunteers

AS A RESULT OF YOUR FEEDBACK DBS check charges scrapped

£7m INVESTMENT IN RADIOGRAPHY including a new CT scanner at PRH

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

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CQC inspection this month Improvements Patient Information Boards Sky murals to improve patient experience Five stunning sky murals are to feature on two wards at PRH to patient experience. The LED lit ceiling tiles will feature natural sky scenes and will be fitted in five side rooms on Ward 15 (Acute Stroke Unit) and Ward 16 (Rehabilitation), with one already completed.

The aim of the murals is to provide a distraction, and reduce feelings of anxiety, for patients receiving treatment giving them a more positive experience of being in hospital.

Standardised patient information boards have been created and are in the process of being rolled out across PRH and RSH. The introduction of standardised boards will improve safety and communication at SaTH by providing clear and easy to understand patient information a glance.

The symbols used on the boards are consistent with those already used across the Trust to provide uniformity for staff who move between wards and departments.

Key information includes clinical alerts for diabetes, dementia, allergies and if the patient is a risk of falling.

Ruth Smith, Lead for Patient Experience at SaTH, said: “Information boards have been used in clinical areas for a while, but to support patient safety a standardised approach has been developed through engagement with senior nurses at the Nursing and Midwifery Forum (NMF).

“We trialled the information boards within a number of clinical areas before agreeing on the final concept, which we are in the process of rolling out across all adult wards and

departments, while further trials are taking place in maternity and paediatrics, with the help of patients, carers and staff.

“The use of symbols to code information allows staff to be sensitive and discreet. No detailed patient information is ever displayed on the boards, but what is provided is important and can be easily digested at glance to improve the delivery of safe and kind care.”

The plan for the near future is for there to be a patient information board installed above every clinical area at SaTH. Ruth said: “We are delighted that the project is being rolled out Trust-wide because in a short period of time the information boards have already been proved to improve patient satisfaction.”

The boards also include sections called ‘What Matters to Me’ and ‘Expected Date of Discharge’, following feedback in the most recent National Inpatient Survey.

Ruth added: “Learning from what our patients are telling us is vital if we are going to improve as an organisation.”

Ruth Smith, Lead for Patient Experience at SaTH, said:

“These beautiful sky murals will replace the plain tiled ceilings that patients look up at whilst they are in bed.

We hope that they will provide a distraction for our patients whilst they are receiving treatment, as well as reduce anxiety through promoting relaxation.”

Ann Allsop, Ward Manager for Wards 15 and 16, added: “The tiles have only been in for a few weeks, but our patients and their families have all said what a difference they have made.”

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As a result of your feedback The practice of charging staff for criminal background checks has been scrapped following feedback from our Staff Engagement Champions.

The Trust started absorbing the costs from 23 August following conversations between members of the Senior Leadership Team and the Engagement Champions.

A DBS check can cost up to £60, with many of you needing it renewed every three years. Many other NHS organisations still charge for the service.

Caroline McIntyre, Head of Workforce Resourcing and Assurance at SaTH, said:

“Our Engagement Champions raised concerns about staff having to pay for their own checks, and having listened to their feedback the Trust will now pay the fees.

“We hope that by removing these costs it will encourage more people to come and work at SaTH and build a long and successful career, which in turn will hopefully help our recruitment and retention rates.”

Julia Clarke, Director of Corporate Governance, heads up the Engagement Champion role at SaTH, which was introduced in June as a result of disappointing NHS Staff Survey feedback.

More than 2,000 people are enjoying My SaTH as our staff app continues to grow.

The 35% of staff to have downloaded the app to date have enjoyed a number of exclusive deals, including 20% off at Carluccio’s Italian Restaurant.

Recent updates to the app include information on the forthcoming NHS Staff Survey (in the Your Views section) and a list of exercises for back, neck, hip and shoulder pain (in the Health and Wellbeing section of Help for Staff section).

Going forward we plan to introduce a Clinical Information section, while Flu campaign details will be updated very soon (Help for Staff) and an equality and diversity survey is to be added to the Your Views section.

She said: “This is another example of us improving what it feels like to work at SaTH. Having an engaged workforce is critical to us becoming a better organisation, and the news that we are going to stop charging people for DBS checks as a result of staff feedback is evidence of exactly that.

“We have just over 100 Engagement Champions across all areas of our organisation and in a short period of time they have helped make a really positive difference.

“Since their introduction we have created a staff retention group to look at ways of introducing flexible working shifts for nurses, we have improved our health and wellbeing offer with the introduction of stress awareness sessions for managers and resilience workshops, while they also played an instrumental part in the launch of our successful staff app.

“Our Engagement Champions have also worked closely with other teams in the organisation to help strengthen our Freedom to Speak Up team and introduce a new dementia-friendly names badges for staff.”

If you haven’t yet downloaded the app, please do so today by visiting http://tiny.cc/mysath - full download instructions for Apple and Android users can be found on the intranet.

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CQC maternity inspection New handheld records

Maternity Improvement Steering Group The Maternity Improvement Steering Group (ISG ) has now commenced Quality Walks within its department.

The purpose of the Quality Walk is to: • support and embed the improvements we have made through our Quality Improvement Plan.

• provide an opportunity to identify the improvements and discuss obstacles which

Unborn babies don’t stop moving that is the message promoted on the new front cover of maternity handheld records given to expectant mums at SaTH. Nationally and locally women say they want more information about their babies’ movements and the importance of any changes to these movements. There are currently around 665,000 babies born in England each year, but sadly there are over 3,000 stillbirths.

In order to help spread the message, SaTH redesigned the front cover of the maternity handheld records, a folder which is given to all pregnant women at their first antenatal appointment.

Jill Whitaker, Matron for Consultant Unit Maternity Services at SaTH, said: “It is extremely important to us that women and their families recognise the importance of their babies’ movements during pregnancy.

“Well babies keep moving through out a pregnancy but nationally it is recognised that women do not always approach health professionals for reassurance that their baby is well if the baby’s movements change.

Sometimes women come into maternity units too late and, sadly, some babies die as a result

“Our aim is to raise the profile of being aware of babies’ The new design was developed following a movements and to encourage competition opened up to youngsters across women to seek advice whenever Shropshire, Telford & Wrekin and mid Wales they notice a change in how their in order to encourage people to have baby is moving.” conversations about this important matter.

Start of Change Weeks The Stroke Improvement Team is undertaking ‘Start of Change’ weeks to improve the way it cares for patients accessing stroke care pathways across Shropshire and Telford & Wrekin. Working with the Emergency Care Improvement Support Team (ECIST), the team is gathering feedback from patients and carers, examining patient outcomes and testing new ways of working to improve care.

The team is also including approaches recommended by NHS England and NHS Improvement as part of the national “Where best next?” campaign, which aims to help deliver a 40% reduction in long-stay patients (people who have been in hospital three weeks

may hinder progress.

• celebrate success and identify next steps.

Feedback from staff suggested they wanted a more simplified incident reporting process. As such the Neonatal Unit is implementing a Trigger List on its Datix system to prompt users when an incident occurs which needs reporting.

This will more accurately identify incidents and reduce future risk through learning from incidents. Learning from incidents is crucial to improve the quality and safety of the care we deliver.

or more) by March 2020. Nigel Lee, Chief Operating Officer at SaTH, said: “This is a great joint initiative involving clinical experts from the Community Trust and SaTH as well as professionals across Primary Care, Social Care and the Voluntary sector and supported by the CCGs. This work is focused on the best location for care for patients after their acute episode of care, and follows a great deal of work looking at national best practice in England. Thank you to everyone involved, and I look forward to developments in the services for patients.”

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News in Brief Rated ‘very good’ for cancer treatment Patients with cancer have rated their treatment at SaTH as ‘very good’, highlighting the dignity and respect they received.

In the 2018 National Cancer Patient Experience Survey, patients gave their treatment an average rating of almost nine out of 10.

The Trust scored significantly higher than the national average in patients being told they could bring a family member or friend with them when they were first told they had cancer (84% compared with a national average of 78%).

Passing the SCE exam is essential for trainees to become Consultants in Respiratory Medicine.

The most recent course, which took place this month, was organised by Dr Nawaid Ahmad (Consultant Respiratory Physician), and we would like to thank Dr K Srinivasan (Training Programme Director), Dr Vijay Pakala (Consultant Radiologist) and Dr Anirban Chatterjee (Consultant Clinical Oncologist) for their support.

Freedom to Speak Up Training

Frank Lauriello, a Cleanliness Shift leader at RSH, has introduced a system where ‘health labels’ are placed on the hospital’s cleaning machines so any maintenance issues are flagged up and resolved at the earliest opportunity.

SaTH also scored highly on patients being told who they could contact if they had any concerns after they had been discharged. The Trust scored 96%, a significant increase on last year’s result (93%) and above the national average (94%).

Other areas where the Trust scored highly were patients receiving all the information they needed about tests (94%); patients given the name of a Cancer Nurse Specialist (CNS) who would support them through their treatment (91%); patients having all the information they needed before any operation (95%); doctors having the right notes and other documentation with them (96%) and GPs being given enough information about a patient’s condition and treatment (95%).

Training course for respiratory registrars

Two labels have been produced – one that reads ‘I am sick’ and another that says ‘I am healthy’ – and during an ongoing trial period the amount of broken machines left unattended has decreased.

Helene Donnelly OBE, Ambassador for Cultural Change at Staffordshire and Stoke on Trent Partnership NHS Trust, visited SaTH this month to give a training session for Freedom to Speak Up Guardians and Advocates from SaTH and across the region.

Safety Conversations Almost 50 members of staff have undergone training on how to have safety conversations.

The funding for the external training programme came from an anonymous benefactor who, after personal experience of medical error, wants to help SaTH become safer.

Following the programme, any issues raised regarding safety concerns are fed back to the governance and safety teams so that they can help with improving safety.

The Specialty Certificate Examination (SCE) training programme has been held at PRH for the past three years and remains the only course of its kind in the West Midlands.

initiative to improve the maintenance of the hospital’s cleaning equipment.

Simple idea to keep our hospital’s cleaning equipment healthy The cleanliness team at RSH is driving an

Frank said: “We take great pride in our work and therefore any machine that does not meet the necessary cleanliness standards, or is broken, is given a ‘sick’ label with a list symptoms that needs attention.

“Once cleanliness standards and/or repairs are dealt with they are then given a ‘healthy’ label to say they are ready for use.”

Julie O’Donoghue, Cleanliness Manager, said: “Keeping our machines in excellent condition is a priority to us so that we can work as efficiently as possible while preventing the spread of infections.

“I am very proud of Frank and the team for what they have done.”

Frank and his team, including Annie Spigoloni, who has helped with the labels, will continue to trial the work for a further six weeks, and if successful the teams will start to roll out the initiative at PRH

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Stars shine at Annual Aw A hospital porter who helped save the life of a baby and teams which have improved care for patients with dementia, sepsis and heart conditions were among those honoured at our annual Values in Practice (VIP) Awards.

The awards are held annually to celebrate the outstanding achievements and contributions of its staff to deliver high quality care to patients, and this year a record number of nearly 800 submissions were received for dedicated teams and individuals.Paula Clark, Chief Executive of SaTH, said: “All of the nominations were outstanding and thoroughly deserving of recognition. Our teams go above and beyond to make a difference each and every day – and for that we should thank them.”

OUR FULL GALLERY IS AVAILABLE AT AWARDS.SATH.NHS.UK You can request high resolution photos by emailing

sath.webdevelopmentteam@nhs.net

The winners were: Team of the Year Award: Winner: Dementia Team | Highly Commended: Ward 10 and Emergency Dept (PRH) Improvement of the Year: Winner: Heart Assessment Team | Highly Commended: Carmel Whiting (ITU/HDU) and Enhanced Recovery Team MSK

Patient Experien Winner: Nick Eva Alex Keene (EPAS)

Behind the Scen Winner: Mary Bea Causier (PALS and (Microbiology)

VIP Award: Winner: Critical Care Outreach Team

Inspirational Lea Winner: Hannah Warren (Ward 23)

Rising Star of the Year Award: Winner: Emma Kay (Radiotherapy). | Highly Commended: Andrea Jones (ENT PD) and Gill Jervis (Emergency Centre)

Learner of the Y Winner: Charlotte Francis Novick (Es

Volunteer of the Winner: Roger Tu Jones and Rachel

wards

nce Award: ans (Chargehand Porter) | Highly Commended: ) and Sheena Bamber (Theatres)

nes Award: ales (Education) | Highly Commended: Michelle d Bereavement Services) and Karen Gibson

ader of the Year Award: O’Mahoney (IT/HDU) | Highly Commended: Peter and Jacqui Bolton (Maternity Guidelines

Year Award: e Deakin (Orthoptist) | Highly Commended: states) and Clare Fenn (Paediatrics)

e Year Award: urner | Highly Commended: Ann-Marie and Jan Quartermaine

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Supporting our newly qualified nurses Thirty six newly qualified nurses have completed a transition programme that helps them on their journey to becoming registered nurses. The nurses completed the preceptorship programme on 4 September, which is defined by the Nursing and Midwifery Council (NMC) as ‘a period to guide and support all newly qualified practitioners to make the transition from student to develop their practice further’.

Gill Johns, Clinical Practice Educator at SaTH, said: “The beginning of a newly qualified nurse’s career can be a challenging time, and initial experiences can shape how they develop in their career. The preceptorship programme ensures newly qualified nurses, midwives and allied health professionals receive the best possible start to their career.”

During the preceptorship programme, the nurses were supported by an experienced practitioner to develop their confidence and to refine their skills, values and behaviours. Gill added: “Having expert support, and learning from best practice gives a foundation for life-long learning and allows nurses to provide effective patient-centred care confidently.

“I would like to congratulate everyone who has completed this programme and wish them all the very best in their future careers.”

Simple solution to improving patient care Our new Hospital at Night Team has come up with a simple solution to improve the care of patients who need medical treatment during the night.

The team has developed highly-visual alert labels which can be placed in a patient’s notes to ensure that those who were poorly overnight are seen first when medical teams do their rounds the following morning.

Clare Walsgrove, Hospital at Night Matron, said: “After a board round, most teams review their sickest patients first, but we recognised that the patients that we had seen overnight would not necessarily have a high score on the National Early Warning Score system, because our intervention had helped them.

“We felt that these patients still warranted an early review in the morning in case teams needed to follow anything up, such as blood results or requests for more investigations.”

The plan is to eventually include the information on the Trust’s electronic patient information screens, but this cannot be done immediately.

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Commended for good practice by national improvement programme Areas of good practice at SaTH have been highlighted by a national NHS clinical improvement programme.The Getting It Right First Time (GIRFT) programme looks to improve NHS care by reducing unwarranted variation in the way services are delivered. As part of SaTH’s improvement journey, GIRFT is working with the trust to identify and share good practice, and agree opportunities for further development. A number of areas of practice have been praised by the programme; for example the care of children admitted through A&E being led by paediatricians, with input from other specialties where required. In orthopaedics, SaTH has reduced its surgical equipment costs, while in renal medicine, the trust is

Sepsis pods We have taken delivery of 60 new blood culture pods to dramatically reduce the time it takes for samples to be transported to our labs.

delivering a high-quality home therapy service.

GIRFT is led by expert clinicians, who visit NHS trusts across England to review a range of surgical, and medical specialties, as well as support services, such as radiology and pathology. During each visit, good practice is identified and a series of recommendations are made to improve services further. SaTH has already welcomed the GIRFT team to 13 of its departments, with three more visits booked for the coming

The new plastic pods are safer than the glass pods they replace, and initial calculations suggest as much as one hour could be saved in the time it takes for a sample to reach the Pathology labs using air tube systems at RSH and PRH.

months. The good practice identified at the trust will enable GIRFT to support other providers to make similar improvements.

Teams across the trust are now working hard to improve services further, in line with the recommendations agreed by GIRFT and the trust.

The trust has already ring-fenced 14 beds for orthopaedic surgery, with a view to reducing cancellation rates and minimising infection risks, while in obstetrics and gynaecology, SaTH is now offering more laparoscopic Karen Gibson, Senior Specialist Biomedical Scientist, said: “Our target is to load all samples within one hour. The arrival of the pods - which have been kindly funded by SaTH Charity - will allow us to hit our target, but most importantly they will be responsible for saving lives.”

Angela Windsor, Sepsis Nurse Practitioner, said: “Mortality increases by 10% for every hour’s delay in administering antibiotics in cases of Sepsis, and it is also important to ensure the patient is given the correct antibiotics.

procedures, which carry a lower surgical risk and shorter recovery times than open approaches.Professor Tim Briggs, NHS Director of Clinical Improvement and GIRFT Chair, said: “It’s great to see the teams at SaTH so engaged with the GIRFT programme.

“GIRFT aims to improve patient outcomes and ensure value for taxpayers, by reducing unwarranted variation in NHS services. We look forward to continuing to work with the trust to build on the success realised so far.”

GIRFT works with NHS trusts in England across 40 clinical specialties. The programme has already published eight national reports, making a wide

“We have made tremendous strides in improving our performance and the delivery of these Pods should allow us to meet our ambitious target and save more lives.”

range of recommendations into how services can be improved. For more information and to read the reports, visit www.gettingitrightfirsttime.co.uk

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News in Brief The aim is to bring together clinical expertise, to make services more efficient so that they deliver better value, high quality care for patients.

New waiting area for cancer patients A new waiting area for patients being treated for cancer has been officially opened at RSH – and has been named after a former patient who helped create it.

By choosing to partner with UHNM, SaTH aims to build a more effective, efficient pathology service for the future, as well as attract required investments into pathology in Shropshire.

It will also help to address challenges surrounding recruitment, retention, training and access to new technology.

The Bernadette Roberts Waiting Room was opened on the O’Connor Haematology Unit by members of Bernadette’s family.

Bernadette was diagnosed with cancer in 2008 and regularly attended The O’Connor Haematology Unit until her death in December 2015.

The 69-year-old was so grateful for the support and friendship she received during those seven years that she decided to leave more than £235,000 to the unit.

Sally Hodson, Operations Manager for Oncology and Haematology at SaTH, said: “In the six months since the expansion was completed, over 10,794 patients have used this area and we have received so many comments from patients saying how comfortable it is and how the environment has improved.”

Our screening timeline goes national A group of staff have overhauled an NHS screening timeline for their patients, and now the resource has been rolled out nationally by Public Health England.

Managers for six screening programmes at SaTH put their heads together after realising information about screening for patients in Shropshire and Telford & Wrekin needed to improve.

With the help of SaTH’s Graphic Designer, Sam Parker, they devised a timeline that runs from conception up to age of 70 and illustrates the screening services that are available to people throughout their lives – improving awareness and access for the local community.

Public Health England Screening was so impressed with the timeline that it adapted it into a double-sided resource and have made it available nationally so that others can benefit.

Healthcare professionals around the country can now add in details of local screening programmes and give their patients an explanation of population screening, a definition of personal choice and signpost to more resources.

Dr Angus McGregor, Pathology Clinical Director at SaTH, said: ““Choosing a network partner is only the beginning of a long journey towards transforming Pathology Services for the future.

“We are looking forward to working more closely with UHNM who are like-minded in developing high quality pathology service, in order to improve patient outcomes in our region.”

New Swan Room

Andrew James, Diabetic Eye Screening Programme Manager, said: “The common goal we all share in screening is to identify disease and provide access to treatment for our patients. With so many health concerns being publicly promoted, the screening leads at SaTH felt we had to do something to help signpost all More than 20 Swan Rooms, which provide patients to the amazing services we offer, and so the local treatment timeline idea was born!” privacy and dignity for patients at the end of life, have been created at both PRH and RSH.

Pathology SaTH is to form a partnership with University Hospitals North Midlands (UHNM) under national plans to improve pathology services.

All pathology services in England are required by NHSI to be part of a national pathology network, of which there will be a total of 29.

The latest Swan Room has opened on Ward 7 (Short Stay Medical) at PRH. It brings the total number of Swan Rooms at both hospitals to 22.The Swan Rooms build on the work being done by the Trust to improve end of life and bereavement care.

The rooms allow relatives to spend valuable time with their loved one, who is at end of life, in a more private, peaceful and calming environment. Plans are in place to create a 23rd Swan Room at RSH in the near future.

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DID YOU KNOW? • The Emergency Department has introduced a weekly newsletter for its staff to keep the teams updated with important information, things that are happening and to share improvements. The first Medicine Centre newsletter was launched last week.

• The renal team on Ward 28 has worked with dietetics to make dietary information more accessible for staff and patients on the ward.

Learning from Excellence Learning from Excellence 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.

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

• The Emergency Department has introduced a People link board to communicate the departmental and organisational goals to colleagues and share the team’s great work • Our Pathology laboratories have maintained their UKAS accreditation following a recent

Pictured: ITU Staff Nurse Andrew Curzon was nominated by two separate families for the

assessment. The inspections take place every

compassionate care he showed; Nurses Emily, Lizzy and Zoe with their nomination for being ‘so

year to ensure they maintain a high level of

supportive’ during challenging shifts; Consultant Intensivist Dr Omu Davies received nominations

quality and have evidence of continual

for his work with the ITU clinics and the compassion and dignity he showed towards and end of

improvement.

life patient and the family; Rob from our Medical Engineering team became the 100th person to receive a Learning from Excellence nomination for ‘going above and beyond’ to help the ITU team with one of their ventilators.

Learning from complaints Complaint: Concerns regarding pain management postnatally.

Complaint: Difficulties in obtaining correct equipment.

Cause: Care was appropriate, but patient was experiencing higher pain than normal.

Cause: Lack of clarity over the role of the community equipment stores.

Action taken: Review of postnatal documentation to see if numerical pain score would help flag up unusual levels of pain sooner.

Action taken: Staff to ensure that patients are given clear contact details, as well as support if they feel they would struggle to contact the service directly themselves.

Complaint: Long wait for a scan.

Cause: Capacity issues.

Action taken: Additional staff appointed.

Improving Together

Spotlight on...

Patients are set to benefit from a multi-million pound investment in state-of-the-art radiography services.

A new CT scanner will be installed at PRH as part of a £7 million investment in Radiology equipment across SaTH, which will also include a full upgrade to digital x-ray equipment, a cardiac catheter laboratory and a vascular and interventional laboratory.

The building work will commence on 23 September and forms a large scale programme of replacement spanning over 12 months, with the new CT scanner expected to go live in December.

The additional scanner will help the Trust ensure the sustainable and reliable delivery of emergency and urgent CT scanning. Its superior technology will also allow for improved image quality and advanced imaging such as cardiac.

Glen Whitehouse, Centre Manager for Radiology at SaTH, said: “This is a significant investment for the hospital. The new scanner will provide excellent quality images at the lowest possible radiation dose to the patient using the latest scanning technology.

“The addition of a new CT 320 Slice Scanner to our expanding imaging service will greatly improve access to patients, improving referral to scan time which in turn improves clinical prognosis.

“The high specification scanner will also meet the demands of current growth in CT demand, and importantly for patients, which means they would not have to be transferred to another hospital site should the existing scanner break down or be unavailable due to scheduled maintenance.”

A CT – computerised tomography – scan uses rotating x-rays and a computer to create detailed images of the inside of the body such as the internal organs, blood vessels and bones.

They can be used to: • Diagnose conditions including damage to bones, injuries to organs, problems with blood flow, strokes and cancer • Guide further tests or treatment for example helping to determine the location, size and shape of a tumour before radiotherapy, or allowing a doctor to take a needle biopsy (where a small tissue sample is removed using a needle) or drain an abscess • Monitor conditions such as checking the size of tumours during and after cancer treatment Paula Clark, Chief Executive at SaTH, said: “This will be a real boost for our patients and our radiology team.”

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