The North West Transparency Pilot

Policy Context Transparency and the Outcome

Framework

• A culture characterised by openness, transparency and comparability

• Service Delivery – informs patient choice and holds public servants to account.

• Give patients access to the data they need to make meaningful choices about their care.

• Focus on outcomes - enables professionals to drive improvement.

Challenges for Nursing

• Build public trust and confidence in the nursing profession

• Zero tolerance for poor care and patient experience

• Improve Quality Innovation Productivity & Prevention in nursing practice, healthcare and patient outcomes

• Identify critical metrics for nursing practice which linked with patient and staff experience - opportunity to lead the process.

Get Staffing Right

Deliver Care Measure Impact

Patient Experience

Staff Experience

• A Call to Action• A Framework for Quality Improvement • Tools, Metrics and Programmes • Transparency and Accountability

The bold and pioneering participants

Thank you

Aintree University Hospital

Blackpool, Fylde & Wyre Hospitals

Royal Bolton Hospital

East Lancashire Hospital

Liverpool Heart & Chest

St Helens and Knowsley Hospitals

Salford Royal

Wrightington Wigan and Leigh

Publish the incidence of

harms

Improve outcomes for

patients

Capture the staff

experience when the harm

occurred

Capture patient

experience when the harm

occurred

Participating sites take responsibility for

publishing the number of harms that they

identify

Review care provided

Improve quality and safety

Build public trust and confidence in the nursing profession

Identify the areas where the nursing

profession needs to improve the

experience of patients

Identify the areas where the nursing profession needs to improve the experience of staff

What did the Transparency Pilot set out to do?

Transparency Pilot

Increase public confidence in

nursing

Voluntary

Openness&

Honesty

The journey……………

Project Measures

Care Experience Patient questionnaire

Staff questionnaire

Safety Nursing Care Indicators

Number of falls and level of harm

Number of pressure ulcers and level of harm

Effectiveness Nursing Care Indicators Getting the Staffing right

Challenges…………..

Definitions

Barriers to Implementation

Practicalities of Implementing

Barriers to Implementation

Board Challenges…………..

• The current media climate • Risk Management Systems• Organizational Cultures• Data capture• Leadership challenge• Allowing local autonomy• Interpreting the definitions

without Specialist Nurse support• Responding to the increasing

acuity & dependency of patients • Quality improvement journey

‘learning the lessons, measuring for improvement’

Challenges…………..

Our patient is the most important visitor on our premises.

He is not dependent on us. We are dependent on him.

He is not an interruption in our work. He is the purpose of it.

He is not an outsider in our business. He is part of it.

We are not doing him a favour by serving him.

He is doing us a favour by giving us an opportunity to do so.Mahatma Gandhi

(Amended)

Operational Challenges…………..

Practicalities of Implementing

Operational Challenges…………..

• When is a pressure ulcer not a pressure ulcer

• Are all pressure sores reported...how do we really know?

• Are there unavoidable pressure sores?

• Device related sores, especially in Critical Care

• Some patients will fall as part of their rehabilitation package

• Will require continually testing and refinement

Clarification…

Definitions…………..To continue to work to develop a SOP

• What to report / what to exclude• Assurance of data capture• Clarity of how to sample for patient and staff

experience data• Real time identification of harm• How to maintain competence as numbers

reduce…PU can be difficult to diagnose• Falls – recognising the seriousness of the

impact

Quotes…..

Learning lessons…………..

‘It is perhaps not surprising that staff morale is adversely affected when untoward incidents such as Falls and PressureUlcers are experienced by patients in our care’.

‘The implementation of intentional rounding has arisen from the Trust’s focus on reducing harm’

‘We acknowledge the importance of ensuring we are accurate with our risk assessments’.

‘The impact of introducing a Falls Specialist is evident by the significant reduction in falls and also in the level of harm caused as a result of a fall

‘A patient commented that by the time the drinks were Served to them the drink was cold. Staff bought a number of thermal flasks for the hot water so drinks could be served still fresh and hot’

What we did & found………..

Pressure Ulcer 100% of grade 2,3,& 4

Falls 100% of moderate, severe & death

Feb58,141

March64,890

Patients cared for - inpatient admissions

North West Nursing Care Indicators forming part of Case note and RCA reviews

12 57 69

16 49 65

Trust Narrative: Local Results Local Circumstances Quality Improvements

The agreed publication narrative.…

The 8 patient experience questions1. Were you involved as much as you wanted to be in

decisions about your care and treatment?2. When you had important questions you ask a nurse did

you get answers that you could understand?3. Were you given enough privacy when being examined or

treated?4. Did you have confidence and trust in the nurses treating

you?5. If you were ever in pain, do you think the hospital staff

did everything they could to help control your pain?6. Did you get help from staff to eat your meals?7. On reflection, did you get the care that mattered to you?8. If a family or friend needed treatment, would you be

happy with the standard of care on the ward?

1. Were patients involved in their care

79%

77%

96%

75%

86%

94%

47%

70%

20%

21%

4%

15%

10%

6%

35%

30%

1%

2%

10%

4%

18%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Trust H

Trust G

Trust F

Trust E

Trust D

Trust C

Trust B

Trust A

Q1 - Were you involved as much as you wanted to be in decisions about your care and treatment?

Always

Sometimes

No

March

Feb

2. Did nursing staff provide easy to understand responses to patient questions?

March

Feb

85%

86%

83%

80%

92%

65%

76%

70%

13%

11%

20%

4%

9%

24%

8%

3%

2%

3%

17%

1%

26%

22%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Trust H

Trust G

Trust F

Trust E

Trust D

Trust C

Trust B

Trust A

Q2 - When you had important questions to ask a nurse, did you get answers that you could understand?

Always

Sometimes

No

No Need to Ask

3. Privacy when being treated?

March

Feb

98%

95%

100%

75%

97%

100%

94%

89%

2%

5%

25%

6%

11%

3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Trust H

Trust G

Trust F

Trust E

Trust D

Trust C

Trust B

Trust A

Q3 - Were you given enough privacy when being examined or treated?

Always

Sometimes

No

4. Were Patients confident in nursing staff providing the care?

March

Feb

92%

93%

100%

75%

91%

99%

82%

89%

7%

7%

25%

6%

1%

18%

11%

1%

3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Trust H

Trust G

Trust F

Trust E

Trust D

Trust C

Trust B

Trust A

Q4 - Did you have confidence and trust in the nurses treating you?

Always

Sometimes

No

5. Did Patients have their pain controlled well?

March

Feb

86%

99%

96%

75%

97%

100%

76%

81%

13%

1%

4%

25%

24%

19%

1%

3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Trust H

Trust G

Trust F

Trust E

Trust D

Trust C

Trust B

Trust A

Q5 -If you were ever in pain, do you think the hospital staff did everything they could to help control your pain?

Definitely

To Some Extent

No

6. Did patients get the help they needed to eat their meals?

March

Feb

62%

89%

78%

95%

73%

28%

47%

37%

7%

5%

5%

1%

6%

2%

3%

6%

31%

6%

22%

24%

71%

41%

61%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Trust H

Trust G

Trust F

Trust E

Trust D

Trust C

Trust B

Trust A

Q6 - Did you get enough help from staff to eat your meals?

Always

Sometimes

No

Did Not Need Help

7. Receiving the Care that Mattered?

8. Recommending Ward?

The 3 Staff Experience Statements

1. I would recommend the ward as a place to work.

2. If a friend or relative needed treatment, I would be happy with the standard of care provided by the ward.

3. I am satisfied with the quality of care I give to Patients/Service Users.

2. Happy for a friend or relative to receive care in the ward where they work

March

Feb

65%

77%

83%

95%

83%

83%

30%

74%

31%

23%

17%

5%

17%

17%

50%

26%

4%

20%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Trust H

Trust G

Trust F

Trust E

Trust D

Trust C

Trust B

Trust A

Statement 2 - If a friend or relative needed treatment, I would be happy with the standard of care provided by the ward

Definitely

To Some Extent

No

1. Recommending their place of work to other staff

March

Feb

64%

76%

84%

95%

70%

16%

80%

33%

20%

13%

5%

13%

28%

74%

20%

3%

4%

3%

7%

2%

11%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Trust H

Trust G

Trust F

Trust E

Trust D

Trust C

Trust B

Trust A

Statement 1 - I would recommend the ward as a place to work

Definitely

To Some Extent

No

3. Staff satisfaction with the care that they provide

March

Feb

63%

76%

93%

90%

92%

81%

50%

83%

32%

23%

7%

10%

6%

19%

45%

17%

5%

1%

2%

5%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Trust H

Trust G

Trust F

Trust E

Trust D

Trust C

Trust B

Trust A

Statement 3 - I am satisfied with the quality of care I give to Patients/Service Users

Always

Sometimes

No

Next Steps…………..

E4E- inform the strategy

Clarify definitions

Spread and expand

Improved Patient Experience of receiving Nursing Care

Improved Staff Experience of delivering the care

Objectivesof the pilot

Standard operating

procedures

Group discussion

Please post your comments on flip charts provided