How a culture of openness and transparency has helped to ensure consistent improvement to quality of care

Guy’s and St Thomas’ NHS Foundation Trust won this year’s Top Hospitals quality of care award. The trust is an integrated hospital and community trust covering a population of 700,000 with over 1,000 beds.
 
Adrian Hopper, deputy medical director for patient safety, believes an ongoing focus on quality and safety are the reasons behind its success. “The board voices the quality agenda and is very supportive of what we need to do, he says.
 
When asked what this looks like in practical terms, he say the trust has a well-established clinical outcomes group which reviews data. “We have a regular review and a more detailed review every month so we have a close handle on the data and any quality of care issues that might arise,” he says.
 
One area of focus is crude mortality. The outcomes group discovered a spike in its crude mortality over the winter of 2015. It carried out a sub-group analysis and then looked at peer hospitals to see whether there were any specific departmental issues. After investigation, the group concluded that winter flu cases accounted for the spike. “We identify clusters of spikes pretty quickly,” says Adrian. “If we find there is a cluster of deaths we carry out a rapid, light touch review to see if we do have a problem. We do this with a number of indicators including readmissions.”
 
Adrian believes the culture of the organisation is important for the success of these light touch reviews. Incident reporting is high because the culture of openness and a willingness to address failings in care. “We generally comes out as one of the highest in terms of medicines incidents reporting,” he says. “Reporting is the first step, how we respond is the next important step. When I go to the head of a service to follow up a significant increase or decrease there is a calm response because we take a considered view.”
 
The trust also ensures all its staff aware of serious incidents and any never events. “We make all our staff aware of what is happening and this means sending trust-wide emails following an incident to encourage front line clinical and other staff to come forward with any ideas they may have about preventing similar incidents in the future,” says Adrian.

We are holding a CHKS Quality of Care Study Day at Guy's and St Thomas' NHS Foundation Trust on 29^th November. Through a mix of informative and interactive sessions, delegates will have the opportunity to listen, learn and share what good looks like and how to get there. We'd be delighted if you or your colleagues could attend. Click here for more information and to register.