Dr Foster Intelligence

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In this section:

An intelligent NHS: leadership, delivery and safer hospitals

Meeting the challenge: delivering quality and productivity in practice
David Dalton, Chief Executive, Salford Royal NHS Foundation Trust

Meeting the challenge: commissioning for quality, safety and productivity
Joe Rafferty, Chief Executive, NHS Central Lancashire

The international perspective
Stephanie Peditto, Director of Innovation, Johns Hopkins Hospital, Baltimore

Break out sessions:

Patient Safety

We heard Dr Tanya Huehns (chair) who described the role of the National Patient Safety Agency, supporting patient safety with alerts once a month with recommendations and also a series of case studies and publications on how to treat staff if an error is made and how to talk to the patients. They also have a list of questions that managers should ask their Boards to improve patient safety. Stephen Ramsden, chair of Patient Safety First Campaign, talked about needing a more pro-active and ambitious approach built locally and that it was all about changing behaviours. He talked about incomplete data and the need for complete sets of data at ward level. He also talked about the importance of making patient safety the number 1 priority on all Board agendas and getting total commitment from the Board on this. Then we heard from John Bellerby, responsible for quality improvement at Salford Royal who talked about measuring harm and how adverse events could be reduced by using the global trigger tool but it was important to have complete data and this tool provided a long term view. Finally we heard from Danny Keenan, clinical advisor at the CQC, who talked about safer care and the importance of Registration that will come in next year for all trusts. All services will be registered separately and there will be common standards across health and adult social care.

The Q&A sessions raised issues around the variability of the trigger tool that showed significant movements but we were re-assured by John that you had to take a long term view and this was still work in progress. There were questions raised around the Registration process and the amount of change and significant amount of documentation and more regulation that surrounds the process, Much is still unknown as Danny confirmed that the star system would probably go and be replaced by narrative. There was also further discussion around the league table mentality that had grown and it was felt that there was no problem with benchmarking but it was all about improving your own performance. It is all about what you are doing rather than how you are doing it. Finally there was a discussion around release of information to the public around patient safety and it was felt that it was necessary to be cautious in case the information was misinterpreted although it was accepted that there was a need to move to transparency eventually.

Chair: Dr Tanya Huehns, Patient Safety Strategy Advisor, National Patient Safety Agency
Panel: Stephen Ramsden, Chairman, Patient Safety First Campaign for England
John Bellerby, Project Manager, Quality Improvement, Salford Royal NHS Foundation Trust Danny Keenan, Clinical Advisor, Care Quality Commission

Quality Accounts

Chaired by Jo Webber, NHS Confederation, this session focussed upon the upcoming Quality Accounts to promote discussion around the impact of Quality Accounts to Trusts and help clarify the confusion surrounding this high profile topic. Adrian Pennington, Director for Quality at East of England presented the process and work his SHA have embarked upon to deliver Quality Accounts in their region - ensuring the right data is included and how he has worked with his local quality observatory. Roger Taylor from Dr Foster Intelligence then looked at the importance of benchmarking and the issue of how trusts can manage the increasing amount of available data and indicators. A lively Q&A covered how trusts can get the most from their local quality observatory and a discussion of the processes involved in quality improvement plans.

Chair: Jo Webber, Deputy Director of Policy, NHS Confederation
Panel: Adrian Pennington, Director for Quality, East of England SHA
Roger Taylor, Director of Product Strategy and Design, Dr Foster Intelligence

Patient experience as a quality metric - quantifying the anecdotal feedback

Chaired by Jim Potter, Chair of Salford Royal NHS Foundation Trust, we heard excellent contributions from panel members Joan Saddler, National Director for Patient and Public Affairs at the Department of Health (DH), Fiona Gratrix Corporate Matron at Salford Royal NHS Foundation Trust and Ann Jackson, Quality Improvement Co-ordinator at Lancashire Teaching Hospitals NHS Foundation Trust.

A very impressive patient experience programme using the Nursing Assessment and Accreditation System (NAAS) run at Salford and outcomes shared by Fiona got us thinking how far you can go to improve patient experience. Are Trusts simply trying to tick all the boxes to prove to their SHA and the DH that they take patient experience seriously, or are they really passionate about making service improvements and making staff believe they can help improve quality and patient satisfaction? At Salford there seems to be a real culture to drive patient experience with the ‘safe, clean and personal’ logo in mind at all times.

Joan Saddler followed by giving an insight into the DH beliefs of high quality care and patient experience. "The main responsibility for the failures... rest with (the) Trust." - a quote from Sir Ian Kennedy, Chair of the former Healthcare Commission reminded us of the Mid Staffordshire story and lessons learned. Patient experience is a key performance measure and part of the quality framework with real-time patient feedback a very important aspect in this. The DH will now publish a performance framework listing underperforming and under review Trusts every quarter. Joan concluded that it really comes down to what matters to patients.

Using real-time patient feedback is key to understanding what matters to patients. Ann Jackson took us through her Trusts’ Patient Experience Tracker (PET) project and the importance of local ownership and effective use of real-time data as well as staff involvement to make tangible improvements. Receiving more patient responses than ever received through the national patient survey, the Trust has been able to use the more meaningful feedback to strengthen team work and drive quality by improving patient satisfaction.

Chair: Jim Potter, Chair, Salford Royal NHS Foundation Trust
Panel: Fiona Gratrix, Corporate Matron, Salford Royal NHS Foundation Trust
Joan Saddler, Director of Patient and Public Affairs, Department of Health
Ann Jackson, Quality Improvement Coordinator, Lancashire Teaching Hospitals NHS Foundation Trust

Clinical leadership

The session attracted an audience comprising of mainly Medical Directors and Clinical Directors. Gordon Ramsden (Chair) stressed the importance of good clinical leadership and engaging clinicians for effective implementation of the quality agenda in NHS. The audience had the opportunity to hear some practical examples from three great clinical leaders, Martin Farrier, Stephen Waldek and Ben Bridgewater, Martin Farrier, clinical leader, engaged clinicians, wards managers and front line staff to improve quality at his hospital by, amongst other things, prioritising FNoF mortality reduction. He stressed the importance of communicating his initiatives by involving every clinician in the trust through pushing out clinical outcomes reports on a regular basis and following them up by asking them the right questions. His view’s were shared by Stephen Waldek, Medical Director, Salford Royal NHS Foundation Trust who talked about motivating clinicians by recognising good work through incentives such as rewards, awards and "thank you" gestures from Chief Executives or Medical Directors.

Stephen followed up by pointing out the importance of providing clinicians with data and analysis tools such as Dr Foster and Internal dashboards. Ben Bridgewater touched on how medical recertification and appraisals would improve clinician engagement for effective implementation of the quality agenda. The Q&A sessions raised issues around lack of clarity on clinician appraisals and tools to support this.

Chair: Gordon Ramsden, Medical Director, Warrington and Holton NHS Foundation Trust
Panel: Martin Farrier, Consultant Paediatrician, Wrightington, Wigan & Leigh NHS Trust
Stephen Waldek, Medical Director, Salford Royal NHS Foundation Trust
Ben Bridgewater, Cardiac Surgeon, University Hospital South Manchester NHS

The Intelligent Board

This session Chaired by Sir William Wells drew delegates attention to best practice in terms of board reporting and the best information which board should have to hand to effectively lead and deliver safe hospitals. Mark Britnell highlighted Mid staffs and Bradford as two high profile examples of what went wrong and made suggestions of how these cases could be prevented in the future. David Dalton then demonstrated the effective systems and processes which have been implemented at Salford Royal NHS Foundation Trust, again, encouraging best practice. Sir William chipped in occasionally with snippets of useful information as a result of his vast experience in this area.

Chair: Sir William Wells, Company Chairman, Ashley House
Panel: Mark Britnell, Partner and Head of Healthcare UK & Europe, KPMG
David Dalton, Chief Executive, Salford Royal NHS Foundation Trust

Handling the media

This was a very practical, hands on session which explained how having a long-term communications strategy can help to negate the need for crisis-management. Hospitals and PCTs won’t be able to stop negative stories but they can be controlled through the power of personal relationships built over time and by providing a consistent message. By creating a narrative around healthcare and painting a bigger picture, potentially negative stories can be put in context. People, inevitably, want to feel good about our National Health Service.

Hiding from news stories is not an option, neither is a bunker mentality. Instead, tell the truth, be open and don’t come across as defensive. If you are pro-active and break the story yourselves by informing the press you can help to control the message and build up credibility within the media. The synergised media is a powerful tool across print, web and broadcast and so PR must be seen as a fundamental tool at the highest levels within the organisation. Think about providing specialist knowledge and briefing the press - they want to understand and they (mostly) want to provide balanced coverage.

Chair: Pam Garside, Judge Business School, University of Cambridge
Panel: Paul Horrocks, Media Consultant, former Editor of the Manchester Evening News
Rebecca Evans, Deputy Editor, Health Service Journal and Nursing Times

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