Quality Account 2016-17
Quality Account 2016-17
1. Introduction
2. Looking back
3. Other areas of quality
4. Patient and public empowerment
5. Looking forward
6. Quality and effectiveness
7. Appendix
Introduction
Foreword
Who we are
Our approach to quality
What is the quality account?
Foreword
Delivering excellent services and high quality care to people in the communities we serve is the prime motivation for all our clinical and support staff alike. Producing our quality account allows us to reflect on how well we have delivered that during the year. We also consider the extent to which we achieved the improvements we set out to make, and decide on priorities for the next 12 months. Our quality account demonstrates that we take seriously the monitoring of the safety of our care, the quality of patient experience, and effectiveness of our services.
We are pleased that staff feel able to report incidents so that they can be investigated and improvements can be made. This year, our Board and senior management team have taken part in visits across the organisation to provide our staff with opportunities to raise any issues they have, and hear about how our teams are ensuring safe, effective care, and good patient experience.
We are also proud of our progress on the amount of staff compliant with their training, increased amount of patient feedback, and our achievements against our CQUIN and quality priorities. However we are not complacent and recognise that in some areas, while still at relatively low levels, there has been an increase in avoidable harm to patients – particularly medication errors and pressure ulcers. We believe this is in part due to increased activity and to increased complexity of the patients under our care. We will not be satisfied until this trend is reversed and we eliminate avoidable harm altogether. That is why these two areas remain priorities for this year.
Well supported staff who are happy at work provide the best care and supporting staff remains a key priority for us. We are renewing efforts this year to provide staff with easy to use, fit for purpose information technology to provide them with accurate and up to date information and to reduce the burden of administrative tasks and data entry on clinical staff. We recognise staff turnover is too high and we are continuing to look at ways to improve staff experience. Work on safe staffing standards supported by a new e-rostering system will help us ensure safe staffing levels and better match our resources to demand.
In our quality account you can find information on incidents and complaints as well as compliments and compliance levels, and information on how successful each of our quality initiatives were last year. We hope you find it informative, open and reassuring.
Julia Clarke - Chief Executive
Paul Kearney - Chair of the Board
Who we are
Bristol Community Health is a staff-owned community interest company, focusing on providing NHS community and prison health services in Bristol and surrounding areas. Our dedicated and compassionate teams have a reputation for high quality, person centred care.
Our organisation spun out from the NHS in 2011, and has been employee owned ever since. Any surplus we make is invested back into our services and community, and our shareholders who are our staff, do not benefit financially. This helps to keep our focus on maintaining high quality patient care.
Our vision is improved health and wellbeing across the communities we serve.
Our mission is to provide person-centred patient care.
Our values are demonstrated in everything we do, and reflect our four strategic themes:
• Making their day: touching lives and partnership.
• Time to care: one team and innovation
• Managing our money: sustainability and invest wisely
• Being the best: aim high and learning
2015-16 has been an exciting year for us, as we were preparing to launch two services. The first, InspireBetterHealth, is a new partnership providing offender healthcare in five prisons in the South West - HMP Bristol, HMP Eastwood Park, HMP Ashfield, HMP Leyhill and HMP Erlestoke. We were also preparing to provide children’s community health services in Bristol for a year, with Sirona Care and Health CIC (lead provider) and Avon and Wiltshire Mental Health Partnership NHS Trust. As both services launched on 1 April, the statistics within this document do not reflect these new staff members or services. To find out more about our achievements, visit page…
Our approach to quality
The three key strands of our quality model that reflect the Department of Health approach include patient safety, patient experience and clinical effectiveness.. Our clinical governance aims to ensure that we continually improve quality within our services – and we retain the gold standard of NHS governance frameworks. Here, you can see our governance framework (fig. 1) and clinical governance framework (fig. 2).
Operationally, our quality model means that staff:
• Deliver the fundamental elements of good care – compassion, dignity, respect and safety – first time and every time and to everyone whom we serve, making every contact count.
• Aspire to provide the highest quality of care, focused on achieving the best outcomes for our patients, by supporting the adoption of best practice and promoting innovation.
Clinical governance is delivered through a structure of focused working groups that monitor the outcomes from our work-streams for;
• Patient and public empowerment, which includes complaints and compliments
• Patient safety and risk management, – which includes quality and harm free care meetings and complex case reviews
• Information governance
• Prisons governance groups
• Clinical audit, effectiveness, research and innovation
• Safeguarding adults and children
• Medicines management and our non-medical prescribing groups
• Supervision and competency of clinical staff
• Infection prevention and control
Each of the key areas are monitored under the clinical governance structure through reviews of data including audits and incidents and comparing our performance against national and local standards. This is overseen by the Quality Assurance and Governance Committee which reports directly to the Board, who also receive a monthly report on all areas of quality. We aim to group clinical outcomes to provide evidence that assures our services are:
▪ Safe
▪ Effective
▪ Caring
▪ Responsive
▪ Well-led
As an independent sector provider of NHS funded services our main mechanisms for accountability for quality and assurance include;
• Corporate and individual accountability
• Contractual relationships with Clinical Commissioning Groups and NHS England
• Regulatory relationships with the Care Quality Commission, the Health and Safety Executive and the Community Interest Companies Regulator
• Scrutiny by local Healthwatch supported by the publication of Quality Account.
What is the Quality Account?
Our dedicated and compassionate staff are committed to providing the highest quality healthcare, and our fifth Quality Account demonstrates this.
A Quality Account is an annual document which reports on the quality of care under three key elements as outlined by the Department of Health; these are patient safety, patient experience and clinical effectiveness. Each year, providers of healthcare are expected to outline their areas of quality improvement for the year ahead, and reflect on the areas from the past year. All activity is drawn together and is subject to considerable internal consultation shared with a variety of external stakeholders prior to incorporating their feedback in the published version. This will help you, as a patient, carer, family member, or other key stakeholder, to understand the key areas we have improved on as well as those areas that we have identified where quality or safety can be further improved and why.
Within this document, you will find an update on last year’s quality priorities, as well as the priority areas for 2016-17. Sometimes our priorities are driven by national healthcare priorities, like the ‘Sepsis 6’ tool. Other times they are shaped around what our patients think, such as our pledge to collaborate more closely with voluntary sector organisations . You will find that the bulk of this document ‘looks back’ at our achievements over the last financial year (April 2015 – March 2016).We have also outlined our future priorities which we will deliver in the next financial year of April 2016 to March 2017.
The members of staff who lead on delivering our quality priorities, set up work plans to achieve the aims of the priority, and progress is reported to the clinical cabinet and to our Quality Assurance and Governance Committee which reports to our Board.
A Quality Account is not only aimed at patients and carers, but also our commissioners (Bristol and South Gloucestershire CCGs and NHS England) and other healthcare providers and Trusts. We understand that some of the terms within this document may not be easily understood by those who do not work in healthcare. To make this information as accessible as possible, you will find explanations within these boxes.
Thank you
We would like to thank the patients, carers and voluntary sector organisations who have helped us shape this Quality Account. Your views are important to us, and by attending our events or getting in contact in other ways, we have chosen our future Quality Account priorities with you at the centre. Look out throughout this document to see exactly where your thoughts and views have made an impact in this format.
Every improvement we have made that is demonstrated in this document is for the patients of Bristol and other areas we serve, so in the context of this document, 'you' refers to the patient first and foremost.
The following have also helped us shape our 2015/16 Quality Account
This is a public document and is therefore available in a variety of media, formats and on our website. To access the document in another format, call 0117 900 2198 or email .
2. Looking back
Our QA priorities over the past 12 months
In this section, you will find information relating to our quality priorities of 2015-16. The numbering of these priorities is for ease of navigation in this section, rather than an indication of priority. In section xx, you will find our quality priorities for the year ahead.
Clinical effectiveness:
Priority 1: implementation of a Sepsis tool to identify patients with sepsis earlier
Priority 2: Implementation of accessible care plans to ensure shared decision making for all.
Patient experience:
Priority 3: Develop a framework for the production of patient stories using patient, carer and family feedback in a meaningful way.
Priority 4: Improve our equalities monitoring data to ensure all patients who use our services experience equality.
Patient safety:
Priority 5: Improve medicines management to ensure clinical, cost effectiveness and safe use of medicines.
Priority 6: Development of a methodology for safe staffing to deliver effective, safe and compassionate care.
Priority 7: Continuing pressure ulcer prevention by taking further proactive steps through continued learning.
Priority 1: Implementation of the sepsis screening tool to identify patients with sepsis earlier.
What we said we would do
Our Advanced Nurse Practitioners (ANPs) in the Rapid Response Teams developed a sepsis screening tool which they planned to introduce. We planned to design a teaching programme for all clinical staff so they could all use the tool effectively, and to disseminate the tool more widely across our clinical teams.
< pull out box> Did you know: 150,000 people develop sepsis per year in the UK, with 44,000 of these people dying from sepsis.
The early recognition of patients with sepsis and the reporting of these findings to GPs or medical teams in the hospital is crucial to reducing the risk of a patient’s condition deteriorating further. The sepsis screening tool helps clinicians to do this. It enables staff to recognise a diagnosis of sepsis early so that patients are given the right treatment to stop their condition from worsening.
What we did
We piloted our sepsis screening tool within the three Rapid Response Teams, the Out Of Hours Team, the In-Reach and REACT Teams (based in the Bristol Royal Infirmary (BRI) and Southmead hospitals) and the Community Respiratory Team. To do this, we designed a sepsis teaching programme for all our clinical staff, which was validated by a geriatric consultant from the BRI.
We completed monthly audits, the findings of which were used to educate and up skill staff within these teams to ensure sepsis was being recognised, treated and documented correctly.
We also rolled the tool out to the prisons, within which we provide healthcare, and we are in the process of rolling it out to all our community staff. We gathered sepsis related case studies to identify how the sepsis screening tool was put into practice during the pilot.
We have also spread the word on sepsis more widely on World Sepsis Day by communicating the signs and symptoms to all staff.
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How we will continue the work
We will continue to audit the Sepsis Tool on a monthly basis, using the findings to update our staff to ensure they are documenting cases of sepsis accurately on our patient record system, EMIS. We will continue to educate all new staff around the importance of recognition and escalation of sepsis. As we changed clinical system this year we were unable to measure if we have increased the numbers of patients identified with sepsis but we are now in a position to monitor this in 2016/17 to see if the improved training and tools will ensure patients receive early treatment for sepsis. New guidelines for the diagnosis of Sepsis will be released in July 2016 and we will ensure we update our processes and our staff.
What this means for patients
Sepsis is a life threatening condition and in order to reduce morbidity our patients will continue to be screened for sepsis. If sepsis is suspected you will be treated in a timely manner by the right person in the right place at the right time.
Priority 2: Implementation of accessible care plans to ensure shared decision making for all.
What we said we would do
Our aim was to ensure that accessible personalised care plans were available ready for use by our staff, and rolled out across our services, to make sure all our patients with communications or language needs were empowered to make decisions about their own healthcare.
We planned to launch the tool to our staff, and other healthcare providers, and support them to use it well.
It was important to us to consider our varied range of patients, and to reflect this we had plans to pilot the care plan in one of our prisons
What we did
The care plan has been printed and it is being held within our Community Learning Difficulties Team (CLDT) as they are the team who have the highest proportion of patients in need of the plan.
We made the accessible care plan available on our staff website, which is used by our whole staff team.
We launched our accessible care plan through training and education for GPs, practice nurses and our own staff and gave advice on how to use it. In the last 14 months, 350 accessible plans have been used within CLDT. The team have rolled out shared decision making using the accessible care plan to therapy teams within the Disabled Children’s Service with the goal of enhancing transition processes.
The tool was introduced to Ashfield Prison where it was adapted to meet the needs of prison patients. So far 40 patients with respiratory conditions across Ashfield and Leyhill prisons have completed accessible personalised care plans with staff adopting the shared decision making approach. They reported that patients engaged better and identified the support they needed to achieve their health goals, especially around smoking cessation.
We have identified care plan champions in teams across the organisation as well as introduced the ‘Care Plan Buddy’ volunteer role as a pilot within community health teams to improve implementation even further. A cohort of ten volunteers were recruited and trained in order to support patients and carers to develop their own care plans. Of this cohort, five buddies remain active and within six months of training, they had supported 22 patients with their care plans.
<include excerpt from Gemma Smith’s case study>
How will we continue the work?
We believe that shared decision making is significant in enhancing the experienced quality of patient care we deliver. In continuing our commitment to this, we aim to roll it out to our wider services with appropriate support. Our aim is that all patients and service users who wish to develop their own care plan are supported and enabled to do this. Our new clinical system now has codes which will enable future measurements of percentages of our patient population who use a personal care plan.