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PREPARING FOR CNST LEVEL TWO CHALLENGES SOLUTIONS

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PREPARING FOR CNST LEVEL TWO CHALLENGES SOLUTIONS

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    1. How was it for us? – Level 2 Rabia Imtiaz – Consultant Obstetrician Karen Kokoska – Maternity Services Risk Manager / Midwife Thursday 27th May 2010

    2. FROM PREPARATION TO ACHIEVEMENT OUR JOURNEY to CNST LEVEL 2

    3. Our Maternity Services 3 sites - 2 Consultant Units Worcestershire Royal Hospital – 4000 births Alexandra Hospital – 1800 births Kidderminster Treatment Centre

    4. Which level / Whose decision ? Trust Board informed us we would go for level 2 Pre-assessment visit: Level 2 achievable but may be challenging Pros and Cons Benefits of pilot criterion Quality Service Financial Reduced Senior Midwifery Structure (10.6 wte 3.6 wte ) Trust Divisional restructure Resource (Time, money people) constraints Involve everyone in decision making so they feel part of it – BE REALISTIC & HONEST Traditionally only risk management team , so important to have paeds, anaesthetists staff on board. PROS & CONS Pilot Criterion Severe reduction in senior midwifery team Demonstrates to our mothers a quality service. ( trust see the financial benefits) Trust divisional restructure women & Childrens directorate was split. Neonates moved to anaesthetics / Paeds – Need excellent working relationship. Further reduction on the Matron structure to represent Neonates.Involve everyone in decision making so they feel part of it – BE REALISTIC & HONEST Traditionally only risk management team , so important to have paeds, anaesthetists staff on board. PROS & CONS Pilot Criterion Severe reduction in senior midwifery team Demonstrates to our mothers a quality service. ( trust see the financial benefits) Trust divisional restructure women & Childrens directorate was split. Neonates moved to anaesthetics / Paeds – Need excellent working relationship. Further reduction on the Matron structure to represent Neonates.

    5. Previous senior structure 10.6 down due to lost posts & vacancies. Following Divisional restructure senior team 3.6 Previous senior structure 10.6 down due to lost posts & vacancies. Following Divisional restructure senior team 3.6

    7. REALISTIC Keep all team informed Executive team / reg report/RAG status/ try to secure funds Individual manuals – cant make ppl read them though (if individuals DON’T engage – move on) SHOW MANUAL colour coded Inform staff regularly of what NHSLA is Action plans – as problems identified action them i.e. poor documentation. feedback ongoingREALISTIC Keep all team informed Executive team / reg report/RAG status/ try to secure funds Individual manuals – cant make ppl read them though (if individuals DON’T engage – move on) SHOW MANUAL colour coded Inform staff regularly of what NHSLA is Action plans – as problems identified action them i.e. poor documentation. feedback ongoing

    9. The A TEAM Standard leads Risk Manager / Consultant Labour Ward Lead Matron Community & Inpatient services Over all responsibility to coordinate Criterion leads Choose interested staff – specialist midwives- ANC midwives- enthusiastic consultants TEAM Together Everyone Achieves More - What size team ? Doers NOT talkers Ideally want 5 standard leads If staff do not engage move on. Need a good cop / bad cop. Not all staff have the enthusiasm – don’t waste your on them. Beware defensive staff.TEAM Together Everyone Achieves More - What size team ? Doers NOT talkers Ideally want 5 standard leads If staff do not engage move on. Need a good cop / bad cop. Not all staff have the enthusiasm – don’t waste your on them. Beware defensive staff.

    10. NHSLA ASSESSORS / VISITS Pre assessment visits – Oct & Dec 2009 Listen to and take assessors advice Mock Assessment - January 2010 STANDARD 1 passed 9/10 Evidence Template Extremely time consuming When to complete? Back up copies

    11. PREPARING THE EVIDENCE Getting Ready Know your criterion well: How many cases?, clinical care, time period etc. Pilot/ Pilot sub - criterion Do you require supporting evidences? Pathways, record/ admission books May use one set for many criterion If in doubt clarify sooner than later CNST meetings (fortnightly), Standard (Weekly) WEEKLY DROP IN SESSIONS

    12. COLLECTING THE POTENTIAL EVIDENCE Identifying Cases for Evidence Retrospective: Coding, Database, Registers, Datix, Memory Prospective: Folders in ANC, Delivery suite, DAU Multisite – proportional to deliveries Obtaining Cases Electronic request (7-10 working days) Notes not tracked properly Request more than required May not receive all/ may not be good / correct evidence Storing Case Notes - crucial Clear instructions on where to send these notes All criterion leads may be looking for same notes so work together as a team

    13. PREPARING THE EVIDENCE Systematic approach Highlight the guidelines Colour code Standards ORANGE YELLOW PINK GREEN PURPLE

    14. PREPARING THE EVIDENCE Deadlines/ Targets Gentle reminders may not work Use good guy / bad guy approach Final Check /Spot Check Only Use best evidence

    15. How to pass? How not to fail? Focus on criteria you are confident of If 1 /2 criteria are difficult to achieve – Do Not Panic Safety Zone

    16. PREPARING THE EVIDENCE Last week Stay calm – Keep count of the days If in doubt - Get Help Phone a friend Refer to FAQ on NHSLA website

    17. PRESENTING EVIDENCE ON THE FINAL DAY How best to: Display/ store notes – Serial number / system / Trolleys/ Boxes Present evidence to assessors Store it back for next criterion Who will do what: Who will find notes, who will present Timetable / Back up Who will Run around to collect last minute stuff/ further evidence Who will do counselling – if thing are not going right! What else – Water, food, fan, camera ?

    18. Keep Work Life balance One day to go Do not Panic!

    19. PART III

    20. Assessment Must Dos Organised Honesty Adaptable & Ready for Criticism If its not going well move on Additional evidence Clients lists / clip boards Criterion leads present evidence Support each other & the team Refreshments Honesty – If you have concerns about a criterion SAY SO Assessors are strict / harsh but have the experience, accept the constructive advice. Have a runner / change the program / Clinical care take priority Don’t under estimate staff emotions if their criterion is non compliant Honesty – If you have concerns about a criterion SAY SO Assessors are strict / harsh but have the experience, accept the constructive advice. Have a runner / change the program / Clinical care take priority Don’t under estimate staff emotions if their criterion is non compliant

    21. THE RESULT

    22. Next steps Action plan Update Resources Trust Board Report Embed Maintain and improve Task Force 2013

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