the very best care for every patient, every day
Our Transformation Journey the very best care for every patient, - - PowerPoint PPT Presentation
Our Transformation Journey the very best care for every patient, - - PowerPoint PPT Presentation
the very best care for every patient, every day Our Transformation Journey the very best care for every patient, every day Our vision Our aims are: To deliver the best quality care for our patients To be a great place to work and learn
the very best care for every patient, every day
Our vision
Our aims are:
- To deliver the best quality care for our patients
- To be a great place to work and learn
- To improve our financial sustainability
- To develop a strategy for the future
Our values:
- Commitment, Care, Quality
the very best care for every patient, every day
Watford General Hospital
- Inpatient emergency and intensive care
- Elective care for higher risk patients
- Outpatient and diagnostic services
- C.600 beds and nine theatres
- Women's and Children's services
Hemel Hempstead Hospital
- UCC open 7 days a week 8am – 10pm
- Diagnostic services, incl. MRI and pathology
- Outpatient services
- Simpson ward
- Endoscopy and bowel cancer screening services
- HCT operates intermediate care beds on site
St Albans City Hospital
- Elective care (inpatient low risk and day-case)
- Outpatient and diagnostic services
- Forty beds and six theatres
- Minor Injuries Unit open 9am to 8pm, 7 days a week
the very best care for every patient, every day
About us…
Our local hospitals at Watford, Hemel Hempstead and St Albans treated:
Over 500,000 people
136,200 emergency patients treated 450,000 outpatients attendances 39,000 planned and 52,000 emergency operations
- ver 5,000
babies delivered with 4,500 staff and 350 volunteers
the very best care for every patient, every day
The headlines
- West Hertfordshire Hospitals NHS Trust has moved from ‘inadequate’ to ‘requires improvement’ and
has seen a leap in the number of services graded as ‘good’
- The number of services rated ‘good’ is almost double that in 2015 and the number rated ‘inadequate’
has more than halved
- There are 40 individual quality ratings of ‘good’ from the 2016 inspection, compared to 25 in 2015
- The number of services rated ‘inadequate’ is less than half that of the previous year, was 31, now 15
- The CQC inspection in September 2016 involved around 50 inspectors who visited all three of the
trust’s sites
- They interviewed frontline staff and the leadership team, spoke to patients and relatives and took
soundings from key stakeholders
- Before, during and after the inspection, inspectors considered nearly 1,000 documents; policies;
patient notes; medical records and additional information in relation to specific questions.
- Our staff are doing amazing things!
the very best care for every patient, every day
Our 2015 ratings for Watford Hospital are:
the very best care for every patient, every day
See the difference - 2016 Watford ratings:
Urgent & emergency services
the very best care for every patient, every day
2015 ratings for Hemel Hempstead Hospital:
the very best care for every patient, every day
See the difference - 2016 Hemel ratings:
the very best care for every patient, every day
2015 ratings for St Albans City Hospital are:
the very best care for every patient, every day
See the difference - 2016 St Albans ratings:
the very best care for every patient, every day
2015 overall ratings for the Trust 2016 overall ratings for the Trust
the very best care for every patient, every day
Our transformation journey
- Mortality rates consistently ‘lower than expected’ putting us in top 10% of UK non specialist acute trusts
- Clostridium difficile cases at 18 YTD against trajectory of no more than 23, sustained improvement in
performance over last three years
- No MRSA bacteraemia since October 2015
- Stroke service rated ‘A’, placing the service in the top 19% nationally – repeated success for 6 months
- 31 and 62 day cancer and diagnostics performance remains strong, above national average
- Strong partnerships in place with system stakeholders
- Record CIP delivery 2015/16 of £12m, already above this level for 2016/17
- Cardiology move and first phase of endoscopy expansion complete (opening events to take place soon)
- Strong clinical leadership - divisional directors part of our executive team, Board and sub-committees
- Substantive transformation delivery team in place
- Success in recruitment across the board; band 5 nurses, midwives, doctors
- Recent staff survey score improvements since 2015.
the very best care for every patient, every day
Feedback from our 2016 inspection
Areas of good practice:
- Overall morale, attitude and values
- Progress with complaint management
but more work to be done
- Improved medicine management
- Empowered band 7 staff and team
working
- Good understanding of MCA/DoLs
- Evidence of a good safety culture in
maternity with use of safety thermometer
- Maternity security issues addressed
- Vast improvement in end of life care
Areas for further improvement:
- Governance and lessons learnt
- Medicine management temperature
monitoring, TTAs, patient own CDs
- ED environment, escalation processes, pit
stop, consultant oversight in ED resus
- Simpson ward
- Communication between obstetricians
- Air flow in dermatology minor ops rooms
- Track and review of MCA and DoLs
- Level 3 safeguarding children training in
surgery for staff caring for 16–17 year olds
Feedback during and after the CQC inspection has been included in our QIP
the very best care for every patient, every day
Where did we perform well?
- In the area of ‘caring’ the trust has moved from ‘requires
improvement’ to ‘good’
- Medical care is one of six service areas whose overall ratings have
moved from ‘inadequate’ to ‘requires improvement’
- Outpatient and diagnostic services at Hemel and St Albans have
both moved from ‘requires improvement’ to ‘good’
- End of life care at Watford has moved from ‘requires improvement’ to
‘good’
- Maternity & gynaecology and critical care made significant
improvement by moving up two ratings from ‘inadequate’ to ‘good’
the very best care for every patient, every day
What the inspectors saw…
- Inspectors commended the children’s emergency department, the
treatment of patients with hip fractures and the hard work of the estate team to keep sites safe and clean
- Inspectors noted good progress with recruitment and in the
percentage of savings made
- Inspectors commented on delayed transfers of care and patient flow
- Inspectors noted inconsistencies in processes and training related to
the care of patients with limited mental capacity
- Inspectors noted improvements in incidents and complaints but felt
that more time is needed to assess the effectiveness of changes
the very best care for every patient, every day
Where is there room for improvement?
- Urgent and emergency care at Watford was rated ‘inadequate’ for a
second year running
- Despite an ‘outstanding’ rating for the second year running in the
domain of care for children and young people’s services, the overall rating has moved from ‘good’ to ‘requires improvement’
- At Hemel, the overall rating has moved from ‘requires improvement’ to
‘inadequate’
- At St Albans, the overall rating has moved from ‘inadequate’ to ‘requires
improvement’ but for the minor injuries unit, the rating was down from ‘good’ to ‘requires improvement’
the very best care for every patient, every day
What have we done?
- Triage in place at UCC, all patients clinically reviewed on registering.
- RCEM initial recognition decision triage position 2011 implemented to ensure clinical
- versight
- Immediate alterations to mental health room made and new furniture in place
(benchmarked with HPFT)
- All patients screened prior to use of room using MH triage tool. Patients identified red,
- range or yellow supervised until assessed by RAID
- Utilising second assessment bay with senior clinician utilising STARRing policy
- Blue sticker to record notes review and no outstanding treatments
- Implemented senior doctor oversight in resus and a resus bleep holder
- Pain management action plan developed
- Monthly ‘Test Your Care’ questions changed to monitor pain management in ED
- A&E Delivery Board, chaired by our CEO, oversees system-wide performance
- Hydration is included in the new ED safety checklist
- Comprehensive review of educational requirements for UCC and MIU. New training
regime has begun
Emergency Care
- Ensure effective
Streaming in UCC and MIU
- ED mental health
room
- Timely use of
pitstop and clinical decision making
- Consultant
- versight in ED
Resus
- Pain assessment
and hydration in ED
Areas for improvement:
the very best care for every patient, every day
What have we done?
Referral to Treatment:
- Comprehensive governance in place
- Revised trajectory to achieve
compliance by March 2017
Planned Care
- RTT performance
- Cancer two week
wait performance
- Consistent use of
WHO checklist
Areas for improvement:
Cancer Two Week Wait:
- Improving position, majority of breaches are patient choice so working with HVCCG
to improve communication with patients WHO Checklist:
- Consistent application of five step
- WHO checklist in all theatres at Watford and St Albans
the very best care for every patient, every day
What have we done?
Governance
- More work on
lessons learnt from SIs
- Duty of candour
and application of policy
- DoLS
- DNACPR
Areas for improvement:
Lessons Learnt from SIs:
- Review meeting in place to ensure action plans complete and lessons shared at
governance meetings
- Quarterly Trust learning events
- Divisional reports to Quality & Safety Group include sharing learning
- Complaints, litigation, incidents and PALS report (CLIPs)
- Further development of Datix to support evidencing of learning
Duty of Candour:
- Improved identification and recording in place
- Audit to be undertaken as part of our Trust wide programme
DOLS:
- Tracking system in place
- Dip sample and full audits planned
DNACPR:
- Stamp in place on consent form
- Developing a regional standard consent form
- Regular audit in place, reviewed at Resuscitation Panel
the very best care for every patient, every day
What have we done?
Our People
- Medical care at
Hemel Hempstead
- Improve our team
working and leadership in NNU and ED
- Consistency of staff
appraisal and mandatory training performance
The CQC said areas for improvement:
Medical Care at Hemel Hempstead:
- Staffing on Simpson ward reviewed, leadership support put in place
- Band 6 staff undertaking development course, band 5 staff have completed
competencies, support workers undertaking care certificate
- Action plans in place to address infection control, improvements seen
- Code of practice checklist audit 97% (February 2017)
Team-working in NNU and ED:
- Explicit lead roles and responsibilities in Obstetrics with clear expectations on
team work and culture
- New Clinical Lead role for Obstetrics
- Team development work planned for early 2017 in NNU
- Team building meetings and away day to foster more open culture in ED
- Developed ANP role to support middle grade rota in ED
Mandatory training and appraisals:
- Self-serve training system being implemented
- Alignment of appraisals with incremental progression
- Focus on improvement through monthly divisional performance reviews
the very best care for every patient, every day
Our ongoing challenges
Emergency Care:
- Challenges to
compliance with 95% standard include: – Increased attendances, higher acuity
- Significant increase in use of surge areas (5860 surge / escalation bed days used since mid-
November (+47% from 13/11/16 to 05/02/17). Additional surge areas utilised include surgical ring-fenced beds, and:
– Ambulatory Care – Frailty Unit – Gynae Ambulatory – Cath Lab – Outpatient Physio
- 100 day trial of GP service within A&E has shown that volume of patients best seen by a
primary care physician falls short of the 5 patients per hour anticipated.
Apr-Jan 2015/16 Apr-Jan 2016/17 YTD % Change (2015/16 vs 2016/17)
Attendances – WGH (type 1) 73250 77787 6.2% Attendances - WHHT 114280 117753 3.0% Ambulance Arrivals 24466 26349 7.7% % Ambulance Patients 33.4% 33.9% 0.5% AE Admissions 25330 27461 8.4% AE Admission Rate 34.6% 35.3% 0.7% Attendances - WGH <16 18531 19077 2.9% Attendances - WGH 16-64 37380 39025 4.4% Attendances - WGH 65+ 17339 19685 13.5%
the very best care for every patient, every day
Our ongoing challenges
Emergency Care:
- Challenges to
compliance with 95% standard include: – Very high levels of delayed transfers of care: Additional actions:
- Comprehensive ED transformation programme
- System-wide actions required to improve resilience
- ED layout changes planned to facilitate new ways of working
DTOCs Apr-Dec 2015/16 Apr-Dec 2016/17 % change DToC bed days used
8465 10580
25.0% DToC Beds Occupied (Avg/month)
31 38
22.6% Total DToC Beds Occupied
277 346
24.9%
the very best care for every patient, every day
Our ongoing challenges
Our people:
- Gaps in middle grade training rotas in ED
- Ongoing work with medical teams in ED, obstetrics and neonatal unit
- Overall recruitment and retention challenges
- Health and wellbeing
- Communication
Our infrastructure:
- Shortfall in capital to address significant legacy estate issues
- Investment in clinical systems required to leverage improvements to ICT infrastructure
and meet paperless challenge
the very best care for every patient, every day
Long term plans
Your Care, Your Future
- Fundamental system wide redesign of care pathways and service models to
improve outcomes and integrate care
- Recognises importance of high quality, sustainable acute hospital services
and need to improve estate and IM&T infrastructure
- Providers to take a key leadership role, commitment to strengthen joint
working and work together to drive system value Our local strategy
- Final draft approved at September Trust Board
- Sets out the Trust’s vision and priorities (aligns with Your Care, Your Future)
- Some specialties have well developed local strategies in place; need to
support and empower all teams to develop Financial stability
- Financial and clinical sustainability go hand in hand
- Need to drive out variation in care to deliver optimum value
- SOC outlining preferred way forward for redevelopment approved at Feb 2017
Trust Board
- Exploring potential benefits of joining the proposed Royal Free Hospital group
Your Care, Your Future Clinical Strategy
the very best care for every patient, every day
What happens next?
- A re-inspection is likely in key areas within the next six months
- A re-inspection will show whether the improvements we’ve made
are sufficiently sustainable for us to move out of special measures
- Staff to continue their amazing work!
the very best care for every patient, every day
In summary
- Patients saying we are improving
- Staff want to come and work here
- Trust Board fully recruited - clear ownership for the delivery and quality of
the improvement journey
- Clear diagnosis of the challenges with plans to address
- Longer term options being developed for infrastructure, service resilience,
financial viability and organisational form
- Evidence of significant cultural change, now needs to be sustained
- Patient safety at the heart of everything we do
A team that has taken responsibility and is full of optimism for the future
the very best care for every patient, every day