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
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