Our Transformation Journey the very best care for every patient, - - PowerPoint PPT Presentation

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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


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the very best care for every patient, every day

Our Transformation Journey

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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
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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
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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

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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!
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Our 2015 ratings for Watford Hospital are:

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See the difference - 2016 Watford ratings:

Urgent & emergency services

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2015 ratings for Hemel Hempstead Hospital:

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See the difference - 2016 Hemel ratings:

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2015 ratings for St Albans City Hospital are:

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See the difference - 2016 St Albans ratings:

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2015 overall ratings for the Trust 2016 overall ratings for the Trust

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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.
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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

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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’

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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

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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’

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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:

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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
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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
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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
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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%

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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%

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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

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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

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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!
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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

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Thank you