Quality

1. Quality

2. Objectives • Understand the importance of quality • Discuss the framework for setting, monitoring quality • Identify and discuss clinical governance • Using examples from clinical practice discuss examples of good practice

3. First class service.DOH 1998 • “The new NHS will have quality at its heart. Without it there is unfairness. Every patient who is treated in the NHS wants to know that they can rely on receiving high quality care when they need it. Every part of the NHS, and everyone who works in it, should take responsibility for working to improve quality”

4. Self assessment questions • What do you understand by the term quality? • What does CHI stand for? • What does NICE mean? • Name five national service frameworks? • What is clinical governance?

5. Policy Drivers • First class service .Quality in the NHS DOH 1998 • The NHS plan 2000 and update 2003 • The New NHS Modern and dependable 1997 • A health service of all the talents 2000 • Essence of Care 2000,2003

6. Setting Quality Standards • National Institute for Clinical Excellence • National Service Frameworks • Professional Self regulation • Clinical Governance • Lifelong learning • Commission for Health improvement (CHI) • National Patient /User survey

7. Patient & Public Involvement Patient & Public Involvement Patient & Public Involvement Quality Framework Clear Standards of Service NICE NSF BENCHMARKS BENCHMARKING Dependable Local Delivery Prof self regulation Clinical Governance Lifelong Learning Performance Framework Patient Surveys CHI Monitored Standards

8. National Institute for Clinical Excellence • Promote clinical and cost effectiveness through guidance and audit to support frontline staff • Advise on best practice in using existing treatment options • Appraise new health interventions • Advise the NHS as to how to implement

9. National Service Frameworks • In “A first class service” NSF s are described as a way of setting standards that will achieve greater consistency in the availability and quality of services for a range of major care areas and disease groups. The aim is to reduce unacceptable variations in care and standards of treatment, using best evidence and ensuring cost effectiveness

10. Purpose • Set standards for a defined service or care group • Put in place strategies to support implementation of these standards • Establish milestones against which progress will be measured • CHI with Audit commission has statutory responsibility to review progress of implementation of NSFs.

11. National service frameworks • Cancer (Calman-Hine) • Coronary heart disease • Older people • Mental health • Diabetes • Renal services • Children s services • Long term neurological care

12. Commission for Health Improvement • Provides national leadership to develop and disseminate clinical governance principles • Independently scrutinise local clinical governance arrangements to support, promote and deliver high quality services • Undertakes reviews to monitor NSFs • Help to identify and tackle serious clinical problems • Oversees and assists with external incident inquiries

13. Clinical Governance • “Every NHS Trust to embrace the concept of clinical governance so that quality is at the core, both of their responsibilities as organisations and each of their staff as individual professionals” The New NHS Modern and Dependable 1997

14. It is a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish” DOH 1998

15. It is about quality healthcare which is patient centred, systematic, accountable and sustainable…Halligan2001 • April 2004 CHAI Commission for Healthcare Audit and Inspection

16. What is happening in Leeds to improve quality? • Leeds Teaching Hospital Trust Clinical Governance Annual Report 2002-3 identifies the following key areas; • The patient experience • Use of information • Process for quality improvement • Staff focus • Leadership, strategy and planning

17. Patient Experience • Improving services for patients . • Patient satisfaction surveys in Clarendon wing identified that patients find difficulty locating the X Ray department. New maps now sent out with patient appointment letters • Privacy and dignity issue at Cookridge and Seacroft hospitals in relation to gowns. Now new gown produced with wrap around ties

18. Planning and organising care • Improving methods of organising care. Clinical management teams empower teams to make decisions at a local level • Developed care pathways for diabetes, stroke, dysphagia, respiratory services • Cardiac surgery pre admission clinics • Rapid access chest pain clinic • Clinical decision units

19. Environment of care • Changes to improve environment of care • Catering schedules • Refurbishment of lifts • Infection control nurses audit of wards • Microbiological air sampling in OT • Minor injuries unit St Georges Middleton

20. Use of information • About patient experience eg PALS Patient advice and liaison services, feedback for surveys • Information about resources, investment in IT, mortality and morbidity. • Outcome of patient care, rates of readmission

21. Processes for quality improvement • Medical Director responsible at Board level, Chief Nurse responsible for patient satisfaction, including patient forums, complaints and organ retention • Newsletter “Quality Matters” • Risk Management processes Clinical Negligence scheme for trusts (CNST) • Clinical Audit programmes eg central venous pressure

22. Evidence based practice programmes eg nurse led dysphasia project, Percutaneous Endoscopic Gastrostomy (peg) • ENT and Oro maxillofacial pre assessment clinic • Learning from incident reporting eg medicines • Learning from complaints eg learning points bulletin

23. Staff focus • Engage staff in decisions • Advanced practitioners in radiology • Internet café at SJUH • Improving working Lives • Appraisal and personal development plans • Education and training • Multi disciplinary team working eg pain team

24. Leadership, strategy and planning • Consultation and patient involvement • Organisation and clinical leadership eg modern matrons, leadership development programmes • Performance monitoring • health community partnership eg interpreting services, equal access

25. Conclusion • “We want to create a culture in the NHS which celebrates and encourages success and innovation” • “the NHS must be more open and truly accountable to the public” • “a clear aim must be the involvement of patients and the public in the decision making process DOH 1998

26. References • www.modern.nhs.uk • www.doh.gov.uk • www.nhs.uk • www.leedshealth.org.uk • www.healthcarecommission.org.uk • www.nhs.uk/national • DOH 1998 A First Class Service ;quality in the new NHS • DOH 1997THE new NHS Modern and Dependable • DOH 2000 The NHS Plan

27. Group Activity • “Clinical Governance is about quality healthcare which is patient centred, systematic, accountable and sustainable” Halligan(2001) • Analyse this statement and draw on examples from clinical practice