Chief Executive’s Message – Friday 30 March
March 30, 2018
When we developed our 2020 vision in 2015 we decided to distinguish between safety and quality. I have described this since in all sorts of ways. But looking to the year ahead, 2018/19, which starts next week, I wanted again to draw out that distinction, explain why I think it matters, and to mention some important projects and ideas that you or your colleagues are doing that reinforce a sense that as a Trust we are focused on patients first. Money will follow good quality. New buildings and IT are hygiene factors, albeit very important ones. It is a safety culture and improving outcomes that best sums up what we are and should be working to deliver together. Safety is about core standards, quality comes from a team drive to be better tomorrow than we were yesterday.
It is fantastic that we have been shortlisted for a national award for the work teams have done on our Safety Plan. Every single day we are seeing focused effort to make sure that checks are done for patients. Unity will help us with that when we install it, finally, this summer, because it will lock in certain key checks such as VTE assessments as a so-called “hard stop”. Given the safety implications of a missed check that must be right. Our Medicine & Emergency Care Group are now reporting weekly, as part of the Consistency of Care programme, their audits of 35 patients per ward against key additional care standards, including care rounds, MUST and falls assessments. Our A&E teams’ quality scorecard tells us all about how frequently we are reviewing and tackling pain during someone’s stay in the department, as well as the frequency of our Sepsis screening – just to name check two metrics. In each case the message the 6000 or so of us not directly involved in that work ought to know is that this Trust is focused relentlessly on the basics of care. Thank you to the 1000 or so of our colleagues who are making changes to achieve consistent success. I know that within D26 we have seen changes made by Joy Walker and her team to discharge practices, and within paediatric A&E on both acute sites we have a huge focus on improvements over the next fortnight on key clinical indicators.
When we look at the data from Medicine & Emergency Care, and this point would apply elsewhere, we need to be crystal clear on the exam question. We should be suspicious if every audit shows 100% compliance every time. Yet we should not expect for basics of care that 85% is good enough, busy as we are. Instead the point of the matrons’ shift by shift handover focus must be on peers challenging each other, spotting omissions, and fixing them there and then. Put differently, errors will happen. The mark of a safe culture is whether we act on that rapidly. And rapidly means on that shift, or the next one. We do not need action plans or trajectories or summits to do that. This is about feedback, conversations, development and accountability. It. is exactly that ethos which meant that last week, for the first time since teams began collating data at the beginning of February, we had no red-rated discharges from our hospital wards into our community beds. Congratulations to Tammy Davies and her teams for their feedback work, and to nursing colleagues, and our doctors and therapists, in medicine for the improvement. This work has shone a light on issues of concern to many, but we have begun to tackle it.
And that work is an example of the type of issue covered by our Quality Plan. Over the next three months we will use Heartbeat to remind us all of the ambitious aims we co-created across the Trust in 2016/17, and which we intend to try and hit by 2020. High quality discharges and reduced readmissions were one of the key projects teams came up with, and it feels as if some progress is being made. But our Quality Plan overall is about experimentation and innovation. When we are looking to cut sight loss, or keep kids in school, to improve end of life care or reduce MI deaths, we will need to try some things which might not work. Or might not work first time. The NHS managerial culture finds that difficult. Sometimes, within our own organisation, we too expect perfection, and prediction of such, and externally Board colleagues and I are constantly asked to guarantee future results. Quality improvement is about trial and error, incremental change and engagement. Now our Quality Improvement Half Days are embedded, with the high quality data that Unity will give us, with recruitment meaning many teams are closer to fully staffed, now is the right time to press ahead with that movement for change. If it feels like you cannot change things where you work, or that trying things might mean criticism, we need to fix that and ensure we have a culture capable of going for Good, or even outstanding, in which we aim high and find out what works by implementation and adaptation, not over-planning or disappointed berating.
Next week is the first week of our new Oracle finance system. If you are reading this and are someone who orders things in our Trust, or takes responsibility for a budget, I hope that is no surprise. It is an IT change that we hope will go without a hitch. We should get great data from the new system, as we look to drive up quality and make it easier to get things done around here.
Thank you to everyone working over the Easter period. I wrote in my heartbeat column, published earlier this week, but written a fortnight ago, that I thought we had seen the last of the snow. Those of you on our 4×4 mailing list know that there remains some doubt about this weekend’s weather!
And finally, welcome to Paula Gardner, who starts her induction on Tuesday, as our incoming Chief Nurse, when Elaine Newell steps down at the end of April. I know Paula will bring huge enthusiasm and commitment to the role, which spans both safety standards and quality improvement – as you would expect.
#hellomynameis…Toby