Ashford and St Peter’s Hospitals NHS Foundation Trust has set out to meet the aspirations of the Darzi report in 2008, which focused on achieving a high quality of care to ensure patients have a positive experience.
Heather Caudle, now chief nurse, joined the trust in 2011 as associate director of quality and her first task was to undertake an overview of the organisation and devise a five-year strategy to ensure high-quality care. The strategy is based around four themes: leadership, structure, culture and measurement.
An analysis of the trust’s data showed improvements were needed in two areas: discharge of patients to their usual place of residence, and mortality rates. The management team visited neighbouring trusts to see what best practice looked like and subsequently decided to set up a group of senior clinicians to carry out a detailed review of the data. The group’s objective was to use data to drive a change in behaviour and encourage improvement.
Led by the medical director and chief nurse of patient safety (deputy medical director), the data were reviewed by specialty to see whether clinical processes could be improved. This specialty-level review led by senior clinicians was critical to changing the culture within the trust. The medical director and deputy medical director were able to work alongside other clinical directors and clinicians, creating true clinical leadership.
It was important to get all staff on board to ensure the data were accurate and to get them to understand its importance. Caudle says: “When we first started out, many staff just said the data were wrong, but we pointed out that it was their data and asked them to suggest how it could be improved. Through a lead clinical divisional director we signposted them to lead clinicians who explain what their data said, how they could improve it and how what they were doing had an impact.”
It is not just senior management who have responsibility for improving and creating high-quality care. Caudle and her team have ensured it is a trust-wide responsibility. Patient feedback is crucial to improving care. Nurses use the NHS Friends and Family Test at ward level to find out where the focus needs to be. Caudle says: “Triangulating this with data, such as serious incidents, helps to focus on areas for improvement.”
Also crucial to the strategy is a firmly held belief that leadership is not just for senior staff. Caudle says “Leadership is not a role, it’s a function. We expect leadership to come from all members of staff. We set out leadership expectations at every level. Even at a very junior level, medical students give a presentation and each year one of their projects is chosen for rollout across the trust.”
The trust is also taking part in the national “Be the change” initiative to empower all staff to identify opportunities for quality improvement. An example of this is the “15 Steps Challenge”, to discover what patients think and feel about their experience when they visit an outpatient clinic.
The trust has also signed up to the “One Small Thing” campaign, whereby staff at all levels ask patients what one small change would make a difference to them. A striking example of this was the case of a young patient with learning difficulties who was nearing the end of her life. At her bedside her mother mentioned to her nurse that her daughter loved Christmas. And so in the middle of August, when Caudle visited the patient’s room she found it decorated with tinsel and decorations, with Christmas music playing. She says: “This family had previously had a poor experience of care and felt they hadn’t been listened too. During the time they were with us this got better and culminated in this response.”
As a result of the trust’s focus on high-quality care, the number of patient complaints is decreasing. When a complaint is made, it is now often followed by a letter of thanks for how it was resolved in a speedy and compassionate way.
The trust also set up a programme of work with dedicated clinical leadership to focus on sepsis. Again, this is in line with national initiatives, but was borne out of an issue discovered in the emergency department and other areas when it came to managing deteriorating patients.
The trust’s CQC rating has now improved to ‘good’ and Caudle puts this down to the focus on quality of care. She says: “It’s a demonstration of the long, hard journey we have been on and are still on, ensuring the leadership and culture is right.”
