APPENDIX 3 - BOARD WORKSHOP – 27 NOVEMBER 2013

Progress / More to do
A culture focused on doing the system’s business – not that of the patients / Listening events and team meetings have focused on quality of care for patients and have given staff an opportunity to share their issues.
Improvements in quality governance have been implemented at all levels
Increasingly more patient and quality focused Board agenda / More focus is required on “compassionate” aspects of nursing
The NHS is set up in such a way that much still happends at convenience of staff not patients. We are nowhere near doing what other service sectors do to turn this around
A failure of communication between the many agencies to share their knowledge of concerns / Trust is part of a Quality Review Group and Contract Review Groupwith Commissioners.
Trust is part of the two local health and well being boards, and regularly attends local OSCs / Local Area Teams are setting up systems to address this, although more to do.
We need to keep our stakeholder relationships under review, especially as financial pressures build: CCG, Area Teams, Local Authority, Neighbouring Trusts
An institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern / The balanced score card is being developed which has a strong quality focus
Assumptions that monitoring, performance management or intervention was the responsibility of someone else / Progress is being made on improved accountability, including performance review sessions, but more needs to be done
Standards and methods of measuring compliance which did not focus on the effect of a service on patients / Regular Board reports on patient experience including compliments, complaints and friends and family test. / Patient experience reference group is being established to take action, especially around FFT scores
A failure to tackle challenges to the building up of a positive culture, in nursing in particular but also within the medical profession / Revising Nursing Quality Metrics will feature as regular reporting outcome to Trust Board
Great line management programme is still at an early stage, but has a strong focus on culture and behaviour / Emerging issues around: behaviours, leadership, governance
Too great a degree of tolerance of poor standards and of risk to patient / Poor care is not tolerated, but there are examples in SUIs and complaints.
Mortality committee has been established and is reviewing all deaths. / Physical environment at DMH needs addressing because of risks around patient experience
Examples of poor care being tolerated in SUIs and complaints
A failure to appreciate until recently the risk of disruptive loss of corporate memory and focus resulting from repeated, multi-level organisation / More work needs to be done on succession planning to avoid loss of corporate memory.

Points raised from KPMG’s Quality Governance Review

re: Quality / Patient experience Integrated Board Report

Progress / More to do
Board-level ward visits (unannounced, and taking account of intelligence on the service reviewed / Executive directors frequently visit patient areas unannounced. / Board visits take place but not unannounced.
Triangulationwith data required. Community services as well as wards should be visited.
Board-level patient engagement limited to traditional route. Need to increase patient contacts and use more innovative methods / Annual general meeting includes a “market place” where people can meet directors and find out about services. / This will be explored in the patient experience forum
Need for increased use of patient stories at Board level / Incident reports relating to individuals are shared at Board level by nursing and medical directors.
12 patient stories to be written up as part of Quality Strategy / Stories shared at the board only occasionally, more action required.
Positive and negative experiences need to be shared.
Need to continue to work on staff engagement challenges based on national survey / This theme has been taken forward through:
- Great all round events
- Great line management
- Staff survey action via model employer group
- Mixed bag in Estates and Facilities / Prevailing staff perception that morale is low
Further work required on issues identified in Staff survey
Work needs to be done to improve local engagement and Junior doctor / student nurse engagement (Possibly at ECL)

Trust feedback – great all round

Progress / More to do
Seven day and 24 hour services / Being taken forward in Clinical Strategy key to future financial stability
Significant effort already in place, some real and positive improvements / Well developed case required especially where services may need to be reconfigured
“One Trust” model needs to be progressed across sites
More work needs to be done on clinical engagement
Financial challenges are significant for developing new models
Encouraging start (in some areas) lot more to do / to plan
Staff training and development / Great line management is focusing on development needs of middle managers / More needs to be done to develop senior managers and heads of department, and ADs to support EDs
Courageous leadership and visibility needs to be displayed by corporate and clinical leaders
Lack of confidence from staff that things will change
Integrated IT systems / “Slowly but surely making good ground” with IT integration / More clarity required on priorities and what will make the greatest difference / best benefit. Needs aligning to clinical strategy
Some plans (e.g. clinical portal) – lot more to do
More needs to be done to rationalise processes including form filling
Staff recognition and benefits / Annual awards scheme
Increased focus on staff benefits
Celebrating success is a key theme in communications strategy and YT magazine
Free Christmas lunch
Day off for staff who receive flu vaccine / Better recognition is needed for discretionary effort, good practice, excellent performance
More work needed to promote benefits
System wide approach to managing unscheduled care / Focus of considerable attention within care group and in clinical strategy
Balanced scorecard in development / More cohesion required
We need to examine whether we can sustain ED over two sites
We need to examine whether we can fast track ECC development at Durham
Opportunities to listen to patients and act on feedback / A Patient experience forum is being established by the nursing director
Minimum care standards and accreditation / Already developing what this might look like as part of Quality Strategy
Balanced scorecard in development
Improved communication / YT to go to staff homes from next year.
ECL have agreed investment in communications this year, including:
-Media relations
-Intranet
-Internet
Communications and engagement has been a focus for the CEO including
-Monthly senior manager and heads of department meeting
-“breakfast with Sue”
-Personal visits to wards/departments / Effective communication is needed for staff who do not have access to IT. Front line require handheld and other IT access to information / communications
There is absenteeism at key meetings, e.g. SMHOD, ECL, leaders forum.
Pace and clarity is required around Clinical Strategy, including the seriousness of the financial position of the Trust/NHS going forward

Berwick Recommendations

Progress / More to do
Continually reduce patient harm / Work on measures underway, through
- Quality Strategy
- Clinical strategy
- Mortality reduction committee / More to do
NHS must be a learning organisation / Patient safety shares learning points based on incidents. / We need to address this with some urgency
Quality (and safety) as priority areas for investment / - In hand / Pace, priorities in clinical strategy (finance and quality). Some key areas need addressing with some urgency
Environment in DMH wards need addressing
Transparency to be complete, timely and unequivocal / Effective processes for incident reporting and escalation / Problems occur when incidents are not reported
Patients and carers present, powerful and involved / Priority for the Patient experience group
Trusts to seek patient and carer voice to help monitor the quality of care / Priority for the Patient experience group
Sufficient staff must be available / Director of Nursing has carried out an analysis of nursing workforce and identified where staff need to be recruited. / Challenges in a number of areas. Still need to understand what “sufficient” staffing means in terms of services to be delivered in the future
- Need to plan future workforce to meet clinical strategy
- Gaps between staff budgeted for and actual staffing, and availability of staff
Supervisory and regulatory systems should be simple and clear / Recognised and work ongoing around patient documentation etc / Needs real effort post NHSLA
Needs to develop and strengthen supervision in some key clinical areas
Mastery of quality and safety as fundamental building blocks to lifelong learning / Quality strategy
Support responsive regulation of organisations with recourse to criminal sanctions

Keogh 8 ambitions

Progress / More to do
Reducing avoidable deaths / Mortality Reduction Committee established to look at this.
Resuscitation team work on failure to rescue
Professional, academic and managerial isolation will be a thing of the past / Focus on clinical research and innovation. / Work needs to be done to understand what this means for the Trust.
Using data intelligently / Too much focus on the needs of the system rather than care delivery.
We need to model good use of data through accountability, and implementing the new accountability system visibly
We have data but can’t/don’t use it effectively
Nurse staffing and skill mix to reflect caseload / Director of Nursing is leading work on nurse numbers and response to National Quality Board
We need to optimise the development of current staff / More to do in workforce planning to ensure visibility of gaps, links to future direction, vacancies and challenges.
Working with patients and service users – and listening to them more / Patient experience forum being developed
Including patient voice in clinical leader development / More work needs to be done
Harnessing the energy and creativity of junior doctors / 360 / upward payback in Clinical Leadership Development and Progression / We need better processes Where do GMC surveys get discussed? How does TB know about this?
Innovation – we are currently slow to harness and realise
Patients and clinicians to be involved in CQC assessments
Trusts understand the impact that happy and engaged staff have on patient outcomes – making it a key part of its quality strategy / Central to Clinical and Trust Strategy, engagement and OD work / Need to do more on staff benefits agenda