Trust launches various initiatives to imbibe quality improvements in every service area, developing safety campaigns to educate patients and achieving 95 per cent 4-hour ED wait target

Outline:

Northumbria Healthcare NHSFT provides a wide range of health and care services to support more than 500,000 people living in Northumberland and North Tyneside. Our integrated approach to patient safety has the potential to reach a great number of people: we had more than two million patient contacts in 2017/18. We are also one of the North East’s largest employers with 9,500 dedicated members of staff.

Northumbria offers true integration of hospital, community and social care services, managing adult social care on behalf of Northumberland Council - ensuring better transfer of information and support when leaving hospital - all under one leadership team. The Board recognises their responsibilities for patient safety and quality are threefold:

-Ensure that the essential standards of quality and safety are at a minimum being met by every single service that the organisation delivers

-Ensure that the organisation is striving for continuous quality improvement and excellence in every service; and

-Ensure that every member of staff is motivated and enabled to deliver our quality aims. The Trust listens to the views of more than 50,000 individuals each year through one of the most comprehensive patient experience improvement programmes in the NHS

Challenges:

Our organisation encourages a culture where services are improved by learning from mistakes, and staff and patients are encouraged to raise concerns about the quality of care at an early stage e.g. External reviews are welcomed to validate internal findings if the Board deem that there may be a quality or safety risk within a particular service. Safety and quality priorities generated by frontline staff, specific to their ward area to drive rapid and sustainable change. High reporting of safety incidents – Northumbria consistently amongst the leading organisations in national staff surveys and named as best in the NHS in NHSE’s Learning from Mistakes league table.

Critical campaigners engaged in the development of highly visible safety campaigns ensuring patients know how to raise concerns. Safety films relating to SUIs produced to ensure learning is as wide as possible. Individual patient feedback fed through consultant appraisals. Peer results transparently shared within specialities. The inextricable link between staff experience and patient safety recognised with Northumbria developing the first real time comprehensive staff experience measurement programme in the NHS. Real time patient experience results shared with patients, families, and members of the public and updated fortnightly.

Outcomes:

Tangible improvements in patient safety that we are currently able to report include :- Northumbria one of very few organisations in 2018 to achieve 95% for 4 hour ED waits 119 additional lives saved in 2016-2018 through our HIP QIP patient safety collaborative. 25% reduction in patient falls in hospital in 2018 using AFLOAT (avoiding falls: level of observation assessment tool).

Anaemia detection and treatment before surgery : Tested in three hospitals within Northumbria in a trial involving 3000 patients, demonstrated reduced transfusion rate (5.9 to 3.9%), readmission rate (4.47 to 2.9%), and length of stay (3.9 to 3.64 days), as well as reduced critical care admission (1.3 to 0.55%).

Northumbria named by CHKS as Trust of the Year for patient experience for the third year in a row, based on performance in national benchmarked data e.g. PROMS, ED waits, national surveys. 96% of inpatients, 99% of outpatients and 99% of day-case patients rating services a or excellent. 94% of staff feeling their work makes a real difference to patients. Northumbria achieving highest NHS staff survey response rate for three years in a row.

Spread:

RUBIS.Qi, is the external facing quality improvement delivery arm of the Trust, aiming to work in partnership with other providers to help the NHS improve from within. Since 2016, RUBISQi has provided coaching and QI support to more than 40 teams across the NHS to spread innovation and improvement.

With The King’s Fund, Northumbria is also delivering a ‘Leadership for Improvement’ QI development programme for 20 NHS boards. In 2016-2018: reducing mortality across 5 partner organisations in a breakthrough series collaborative on hip fracture care.

In 2018 launching a large £1.3m scaling up improvement programme involving 30 NHS organisations to improve patient safety after surgery and save Sharing ideas across the NHSI Falls Collaborative cohort where Northumbria won the award for the idea most likely to be taken away and used. AFLOAT resulting in 904 fewer falls in 2018. Partnering with 10 NHS organisations and the Patient experience network to share resources and effective spread of Northumbria’s real time patient experience programme.

Value:

Evidence of improved value in current Northumbria QI programmes include:- Adapting our surgical care bundle specifically to meet the needs of patients with joint replacement. Before and after data on 9000 patients is encouraging, showing a statistically significant reduction in overall infection rates and this is dominated by the reduction in MSSA - annual savings for Northumbria of £1,230,450.

Proactive anaemia screening: Annual savings of £412,000, based on 3000 patients within orthopaedics but interventions may be scalable to all surgery 904 fewer falls in 2018 equating to savings of £2.3 million based on estimated costs of a no harm fall. LOS following hip fracture has fallen by nearly 10 days since 2008.

In the last 12 months alone, following radical service redsign, length of stay has fallen by 4 days resulting in annual savings of £800k with mortality performance recorded at its best. HIP QIP Collaborative: Placing a value on lives saved is complex. The standard unit for Quality of Life analysis is a QALY. As part of our acute care collaboration, external evaluators have independently assessed HIP QIP data and concluded a total social value of £1m based on 39.7 QALYs saved in 2017.

Involvement:

‘There was a ‘can do’ culture that is evident across the organisation with staff encouraged at all levels to make changes to services that would improve the safety and quality of care to patients’ CQC A robust process is undertaken every year to engage staff, public, governors and stakeholders in strategic planning for the year ahead. Our quality strategy balances compliance with national guidelines with prioritising local quality issues which are important to patients and staff. It also seeks to ensure that any plans align directly with the trust’s strategic vision, lead to measurable quality improvements and encourage continuous improvement. Our commitment to person centred care lies at the heart of all of this.

The involvement of well trained and supported patient leaders, together with extensive real time patient experience feedback, has brought a unique and valuable perspective to inform, influence and contribute to our improvement work Staff experience results in 2018 place Northumbria as the leading acute organisation for staff morale and equality, diversity & inclusion – both domains have proven links to patient outcomes and safety. The trust scores 7.1 for its safety culture which falls narrowly short of being the best score in the NHS by only 0.1