Version Control - Review and Amendment Log

Version Control

Document Number / To be assigned by Corporate Governance Team
Version / V1.0 Consultation Draft
Ratified By
Date of Approval
Job Title of Document Author / Associate Director of Quality
Name of Responsible Committee / Quality Governance Committee
Executive Director / Siobhan Heafield
Date Issued
Expiry Date (Maximum Two Years)
Target Audience / All staff across the Partnership Trust

Version Control - Review and Amendment Log

Version / Type of Change / Date / Description of Change
V.1 / Draft
V0.5 / Draft / Discussed at Effectiveness Group
V0.9 / Draft
V1.0 / Consultation draft / 19 September 2013

We are seeking your views on how we improve the quality of health and social care services within Staffordshire.

Last year, we developed our quality framework. It sets out our overall direction for delivering high quality care. We want all our service users to receive the highest quality of care, and we will empower our Front Line teams to provide this.

Now, we want to look at the detailed ways that we will use to improve quality. We have developed three draft strategies that describe the detail:

Safety Strategy
Effectiveness Strategy (this document)
Experience Strategy

We have developed these strategies with key staff from our Quality Directorate, and we would like your comments on them:

Is the document easy to understand?
Does it make sense?
What is missing?
What can be left out?
Will the measures we have outlined tell us
what we need to know?
Should we use any other measures?
What barriers could stop us from
achieving these strategies?

Please respond to these consultation documents! The closing date for comments is 23 October 2013.

You can email your comments

Contents

1.Executive Summary

2.Introduction

3.Purpose

4.Vision

5.Duties and Responsibilities

5.1.Governance Structures

6.Aims, Objectives and Measures

6.1.Practice Audit

6.2.NICE and national guidance

6.3.Evidence-based Practice (EBP) and Evidence-informed practice (EIP)

6.4.Mortality reviews

6.5.Research and service evaluation

6.6.Education and training

6.7.Quality Circles

6.8.Policies, procedures, and standards of quality

6.9.Monitoring and improving outcomes

7.Implementation

8.Monitoring

9.Review

10.Appendix: drivers for Effectiveness

10.1.Clinical Effectiveness

10.2.NICE and National Confidential Enquiries

10.3.External Recommendations

10.4.Research and development

10.5.Transparency in Outcomes: a Framework for Quality in Adult Social Care.

10.6.The Vision for Social care (2010) and Think local act personal (2010)

10.7.Partnership Trust Model of care

10.8.Outcomes frameworks for NHS and Adult Social Care

10.9.Mid Staffordshire Foundation Trust Public Inquiry

10.10.The NHS Change Model and the 6 Cs

11.Equality Assessment

1.Executive Summary

Effectiveness is about doing the right thing at the right time for the right person[1] and is concerned with demonstrating improvements in quality and performance.

Our model of Effectiveness centres on three principles of Inform / Change / Monitor and is closely tied to Evidence-based Practice and Evidence-informed Practice.

The strategy for effectiveness is an integral part of the Trusts vision: to deliver personalised care of the highest quality, with the best possible outcomes for users and carers, empowering them to remain independent.

Effectiveness is necessary for the achievement of all six of the quality goals in the Quality Framework, and is especially required to achieve the quality goal Effective Outcomes. We want to provide effective services with good outcomes for our service users.

The Effectiveness strategy is part of a suite of strategies that support the quality framework. Of the underpinning strategies[2] for the Trusts Quality Framework, the Effectiveness strategy has a direct influence on the practice audit programme.

Key work streams that will be used to achieve the aims of the strategy are:

Practice Audit
NICE and national Guidance
Evidence-based Practice (EBP) and Evidence-informed practice (EIP)
Mortality reviews
Research and service evaluation
Education and training
Quality Circles
Policies, procedures, and standards of quality
Monitoring and improving outcomes

Implementation of the strategy will be monitored by the Effectiveness Group, and the strategy will be refreshed annually during the period of the Quality Framework 2013-18.

2.Introduction

Effectiveness of care means understanding success rates from different treatments for different conditions. Assessing this will include measures such as mortality or survival rates, complication rates and measures of clinical improvement. Just as important is the effectiveness of care from the service user perspective. Examples include improvement in pain-free movement after a joint replacement, or returning to work after treatment for depression. Effectiveness encompasses how well people achieve personalised care services through the assessment and support planning process, and may also extend to people’s well-being and ability to live independent lives.[3]

Effectiveness is about doing the right thing at the right time for the right person[4] and is concerned with demonstrating improvements in quality and performance:

the right thing (e.g. evidence-based practice requires that decisions about care are based on the best available, current, valid and reliable evidence)
in the right way (e.g. developing a workforce that is skilled and competent to deliver the care required)
at the right time (e.g. accessible services providing treatment when the service user needs them)
in the right place (e.g. location of treatment/services)
with the right outcome (e.g. health gain, choice and personalisation)[5]

Being effective also involves thinking critically about what you do, questioning whether it is having the desired result, and making a change to practice. These changes will then be based on evidence of what is effective in order to improve care. This mindset is applicable at Board, directorate, department or team, or individual level.[6][7]

3.Purpose

Our model of effectiveness[8] covers three main work streams:

Inform: finding and appraising the latest & relevant “best knowledge” of health and social care.

Change: harnessing activities such as practice audit and transformation, to ensure that change happens and results in the desired outcomes. Change is to do with policy making, changing practice, concentrating effort and innovating.

Monitor: ensuring that relevant outcomes are achieved. “Monitor” includes measuring health benefit, examining outcome indicators and audit.

The definition of “effectiveness” is broad, so careful planning and coordination would be needed to avoid duplication or uncoordinated developments.

4.Vision

The effectiveness agenda also contributes to better use of resources – seeking to achieve ‘more for less’ by getting evidence into practice.

The Quality Framework aim is that all service users receive the highest quality of care, by ensuring that front line teams are empowered by the organisation to provide this. In line with our organisational values, we will put quality first. This means that we will apply the best approaches in health and social care for quality, always being service user focussed and responsive.

Staff will benefit from a clear approach to effectiveness:

Staff are supported to focus on the effectiveness of their teams and outcomes for their service users.
Staff are recognised for their contribution to improving quality outcomes, in those that are ‘measured’ and where staff go the extra mile in delivering excellence
Staff appraisal and development will harness their potential for front line continuous quality improvement
Staff make use of research and development to improve the effectiveness of their services, as well as evidence-based practice.

The Effectiveness strategy is part of a suite of strategies that support the quality framework. Of the underpinning strategies[9] for the Trusts Quality Framework, the Effectiveness strategy has a direct influence on the practice audit programme.

Figure 1: strategies that support the quality framework

5.Duties and Responsibilities

5.1.Governance Structures

Governance structures in relation to Effectiveness are illustrated in figure 2.

Assurance on the implementation of the effectiveness strategy will be provided to the Board via the Quality Governance Committee on a bi annual basis. Any risks associated with an inability to implement any component of the effectiveness programme will be noted to the Quality Governance Committee / Board via the risk register.

Figure 2: Key Governance committees / groups in relation to the Effectiveness Strategy

6.Aims, Objectives and Measures

We aim to provide effective services that provide the best possible outcomes for our service users. We want to develop a culture where effectiveness is seen as being integral to the day to day provision of care.

To do this we will apply the Partnership Trust Effectiveness Model to the structures and processes in the organisation, to ensure that these support effectiveness for front line teams.This, in line with our model for quality, will result in high quality support to front line teams.

To achieve this aim we will use systems and processes in the following areas:

6.1.Practice Audit

Previously known as “clinical audit” in healthcare, practice audit described a quality improvement cycle that involves measurement of the effectiveness of care against evidence-based agreed standards so as to improve the quality of health and social care.

Aim

We will ensure that the practice audit programme:

Is a force for quality improvement across all services,
Focusses on achieving the best possible service user outcomes
Is systematically prioritised, aligned with Partnership Trust priorities for quality
Is conducted according to best practice for audit
Is led by Front line teams

Objectives

During 2013/14 we will:

Embed a culture and new terminology of “practice audit”
Integrate health and social care audit processes into practice audit
Continue to develop the practice audit resource
Fully participate in all applicable national clinical audit
Increase the volume of rapid improvement cycle activity as a part of practice audit
Improve the quality of audit projects
Enhance our audit forward planning processes
Increase service user engagement in practice audit
Develop practice audit as a supportive link with other governance work streams

Key Measures

Quality Goal / Effectiveness Strategy / Indicator / 2013/14 target / 2018 target / Reporting
Service User Involvement / Practice audit / Number of practice audits with service user involvement / 10% increase year on year / Year on year increase in number of audit projects with service user involvement. >75% of audit projects on the annual programme have service user involvement / Practice Audit Group, via Audit annual report
Delivering Excellence / Practice audit / Audits – proportion of audits demonstrating improvement following completion of action plans (“re-audit”) / 10% increase / >75% of audits on the programme / Practice Audit Group, via Audit annual report
Assuring Quality / Practice audit / Participation in applicable audits from the National Clinical Audit and Patient Outcomes Programme / 100% / 100% / Practice Audit Group, via Audit annual report

6.2.NICE and national guidance

Aim

We will ensure that NICE and national guidance is:

disseminated to all relevant staff within the organisation
reviewed and implemented in a timely systematic manner
contributed to by our staff during development

Objectives

Develop and implement robust systems to disseminate, implement and monitor NICE and other national guidance, achieving compliance with the highest NHSLA standards
Develop robust systems for ensure that all relevant information is received analysed and key implications shared at all levels of the organisation, including for the most critical / relevant learning at Board level.
Continuously compare our practice to that set out in NICE guidance and, unless there are evidence based exceptions, seek to address any shortfalls.
Work closely with our commissioners to ensure that resources are secured where NICE guidance depends on investment

Measures

Quality Goal / Effectiveness Strategy / Indicator / 2013/14 target / 2018 target / Reporting
Assuring Quality / NICE and national guidance / Proportion of applicable NICE guidance that the Trust is compliant with, based on returned self assessments / 100% of guidance published in-year / 100% of all guidance / NICE Guidance Group
Quarterly NICE report
Delivering Excellence / NICE and national guidance / Number of practice audits that demonstrate compliance withNICE or national guidance / 10 audits / Year-on-year increase in number of audits / NICE Guidance Group
Quarterly NICE report
Practice Audit Group, via Audit annual report

6.3.Evidence-based Practice (EBP) and Evidence-informed practice (EIP)

Aim

We will ensure that Evidence Based Practice (EBP) and Evidence-Informed Practice (EIP) techniques areused to ‘get evidence into practice’. It is vital that our staff know how to access evidence and have theappropriate resources to do so.

Objectives

During 2013/14 we will:

Provide training and awareness sessions for staff on EBP and EIP
Ensure that audit criteria are evidence-based
Collaborate with Library Services, Medicines Information, the IT team, Communications, Medicines Management and Education to promote innovative methods for knowledge management

These systems and processes will contribute to the fulfilment of Objective 4 in the Research Strategy, “to improve the pathway to adopt research findings, new technologies and procedures into practice”.

Measures

Quality Goal / Effectiveness Strategy / Indicator / 2013/14 target / 2018 target / Reporting
Quality at the Front Line / EBP and EIP / Number of staff who have received EBP / EIP training / TBC / Year-on-year increase / NICE Guidance Group
Quarterly NICE report
Delivering Excellence / EBP and EIP / Proportion of practice audits with criteria derived from a high quality evidence base (eg RCT, systematic review) / 10% / Year-on-year increase / Practice Audit Group, via Audit annual report

6.4.Mortality reviews

Aim

We will ensure that:

Strategic plans are in place that work to reduce morbidity and mortality
Community hospital mortality, and other relevant morbidity and mortality, is fully reviewed, with lessons learned and disseminated across the organisation to improve quality and safety

Objectives

To do this, we will:

Maintain a regular mortality review group, chaired by the medical director
Investigate unexpected deaths of service users in line with incident management policies and guidelines
Develop strategic plans and methodologies via the mortality review group to reduce morbidity and mortality

Measures

Quality Goal / Effectiveness Strategy / Indicator / 2013/14 target / 2018 target / Reporting
Assuring Quality / Mortality Reviews / Proportion of applicable deaths reviewed via mortality review group / TBC / 100% / Mortality Review Group

6.5.Research and service evaluation

Aim

As outlined in the Partnership Trust’s Research Strategy, we aimto be recognised as a research centre of excellence in community health and social care. This research should be relevant at a local, national and potentially international level. The trust should engage in research, service evaluation and innovative activities that make a real difference to service user benefit.

Objectives

We will ensure that:

staff can easily access information about research and research projects in the Trust
staff are encouraged to conduct research and development as part of their work
staff have access to support and expert and advice to conduct research
research and development is aligned with trust priorities

To do this, we will build capacity for research, manage delivery of research, and implement findings from research as outlined in the research strategy and delivery plan.

Measures

Quality Goal / Effectiveness Strategy / Indicator / 2013/14 target / 2018 target / Reporting
Delivering Excellence / Research and Service Evaluation / Papers published in peer-reviewed journals / Meeting with Hazel Mackey Thurs 4th to agree / >25% of research projects published in a peer review journal / Research and Innovation Group: Annual research report
Delivering Excellence / Research and Service Evaluation / Research projects undertaken / Meeting with Hazel Mackey Thurs 4th to agree / Year on year increase / Research and Innovation Group: Annual research report

6.6.Education and training

Aim

We will ensure thatall staff are made aware of the principles of effectiveness and the structures available to support them to deliver effective practice.

Objectives

To do this, we will:

Ensure that all professional staff should attend updates every year on topics linked to their area of practice
Provide regular updates via the “the word” and team brief on the latest effectiveness developments.
Provide support, training and guidance for individuals, front line teams and other groups to ensure they are equipped with the skills needed to monitor and review the services they provide.
Provide direct advice and support to individuals/groups involved audit projects, performance monitoring and ICP work.
Directly support and assist with specific effectiveness projects
Promote awareness of effectiveness in other appropriate groups and forums, locally and nationally.
Support staff to undertake accredited development, enhancing staff ability to provide evidence-based care
Make use of clinical and professional supervision to promote a learning culture around evidence-based practice

Measures

Quality Goal / Effectiveness Strategy / Indicator / 2013/14 target / 2018 target / Reporting
Quality at the front line / Education and training / Number of staff who have received practice audit training / Practice Audit Group

6.7.Quality Circles

Aim