GRAMPIAN NHS BOARD

Patient Safety in NHS Grampian – Update Report

Actions recommended

The Board is asked to note this report which:

  • Provides an update on work that has been underway since the previous report entitled "Ambition for Excellence - person-centred care in Grampian: lessons from Francis, Keogh & Berwick reports".
  • Highlights lessons from the review of services in NHS Lanarkshire and suggested areas for improvement for NHS Grampian
  • Highlights information on the quality of NHS Grampian services.

Strategic Context

The Strategic context is the national Quality Strategy and its three ambitions of providing person-centred, safe and effective care, NHS Grampian’s Healthfit 2020, and the Institute for Healthcare Improvement (IHI) “Triple Aim” which is a framework describing an approach to optimising health system performance. It comprises the following three dimensions:

  • Improving the patient experience of care (including quality and satisfaction)
  • Improving the health of populations
  • Reducing the per capita cost of health care

Key matters relevant to recommendation

The paper submitted to the Board meeting in September 2013 highlighted work being undertaken under the headings of Caring, Listening, Improving and the underpinning Quality Plan that was approved by the Grampian NHS Board in 2013. The Quality Plan is built around the themes of Executive engagement/vision, clinical engagement, education, measures, networks and internal support.

From August 2013, NHS Lanarkshire services were reviewed by Healthcare Improvement Scotland (HIS) following concerns about the performance in relation to Hospital Standardised Mortality Ratio (HSMR).

The 21 recommendations following that review were themed under

  • Understanding HSMR
  • Patient & Carer Experience
  • Safety of Patient Care
  • Workforce – medical staffing
  • Workforce – nurse staffing
  • Operational Effectiveness
  • Leadership and Governance

The Head of Quality, Governance and Risk has considered the report with key stakeholders and made suggestions as to where NHS Grampian could improve by learning from Lanarkshire.

The main areas of this improvement work are covered below:

Action / Lead person/Group
Quality Vision Statement / Board supported by Quality Governance and Risk Unit (QGRU)
Update Quality Plan and transform to Quality Strategy / Director of Nursing and Quality and Director of Modernisation
Nursing Workforce / Director of Workforce supported by Director of Nursing and Quality
Organisational Development Plan to include quality & safety. / Director of Modernisation
Incident Improvement Plan – monitor progress / Director of Nursing and Quality
Patient Safety
– confirm prioritised plan
– confirm permanent roles
– consider patient safety officer development / Patient Safety Executive Group supported by QGRU
Update assurance framework and review governance committees. / Executive Team
Agree strategic direction for Patient Advice and Liaison Service (PALS) regarding staff experience and patient experience module / Executive Team
All wards & clinical areas to have an annual plan for quality and safety linked to the ward dashboard i.e. build on achievements of exemplar programme. / Executive Team
Person-centred Programme / Director of Nursing & Quality and Director of Corporate Communication
Modernisation Workplan
- Flow work
- Unscheduled Care Work

Our Quality Dashboard indicates that NHS Grampian is a high performing organisation. Following the opening of the Emergency Care Centre our HSMR data at Aberdeen Royal Infirmary (ARI) indicated a small deterioration over three quarters, although this always remained well within the expected parameters. However, this has now stabilised. Work is taking place to understand the difference that the new case mix is making since older people services moved to ARI from Woodend. The infection data shows continuing progress. We have an implementation plan following the HIS review of adverse incidents and have been commended nationally on our approach to incidents and complaints. We continue to work on the prevention of harm from falls. Our person-centred work has been reviewed by the Clinical Governance Committee. As an example of this, 40 wards have taken part in real time feedback from patients and 95% of the 695 patients surveyed rated the service as good or better (4, 5 or 6) on a six point scale where 6 was excellent and 1 was very poor. Our staff experience has been assessed by 227 members of staff with 3% excellent, 18% very good, 41% good, 26% fair, 8% poor and 4% very poor.

NHS Grampian receives a quarterly Hospital Scorecard that shows progress against key indicators such as readmissions, length of stay, A& E waiting times and infections, as well as HEAT targets. The most recent report shows that NHSG is performing well across all areas, with no significant outliers.

Risk Mitigation

By implementing the actions indentified, the following key strategic risks will be mitigated:

  • 853 - Patient Safety
  • 1134- Sustainable Workforce

Responsible Executive Director and contact for further information

If you require any further information in advance of the Board meeting please contact:

Responsible Executive Director
Elinor Smith
Director of Nursing and Quality
/ Contact for Further information
Helen Robbins
Head of Quality, Governance and Risk

May 2014

Additional supporting information

Ambition for Excellence -NHS Grampian Board paper September 2013

Quality Plan 2013 – 2015

Hospital Scorecard Scottish Government May 2014

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