Trust develops a patient first improvement system, helping staff to solve problems and improve performance, achieving 99% harm free care

Western Sussex Patient First Programme : We recognise that the strength of our hospitals lies in our staff, and have built an organisational culture that empowers teams and individuals to make lasting changes that benefit our patients and community through our Patient First Programme - our bespoke approach to sustaining a culture of continuous improvement. We have developed a Patient First Improvement System - our Lean management system, developing staff to solve problems and improve performance. Our staff focus on key improvement initiatives aimed at delivering 100% harm free care.

Challenges

• Average levels of staff engagement
• Unfocused centrally led improvement initiatives with outcomes that were hard to sustain
• No clear route for all staff to raise areas for improvement and contribute to improvement – disempowering staff
• Low levels of improvement methodology knowledge at ward/unit level – disempowering staff

Actions

• Learn from others – visits to Virginia Mason, Toyota, well performing NHS Trusts
• Developed Patient First Programme with Board to ward engagement
• Developed a Quality Strategy through patient, public and staff engagement
• Developed continuous improvement capacity by rolling out our Patient First Improvement System supported by a Kaizen team and developed staff as teams, all staff involved
• Leant as we went - PDSA

Significant results

• Staff engagement – a primary outcome of our Patient First Improvement Programme has been a significant increase in staff engagement as measured by the NHS Staff Survey. During 2016/17, the Trust’s engagement score improved from 3.78 to 3.88, above the national average of 3.81.
• We have achieved 99% harm free care as measured by the Safety Thermometer in January 2017.
• We have achieved over 17% reduction in falls over the last three years. This equates to 400 less patient falls, a number of wards seeing 50% reduction in inpatient falls this year.

Value achieved

The greatest value of the Patient First Programme is the engagement of staff in improving care. This impacts the quality of services we provide and experience of patients at our trust. This is demonstrated in our recent CQC rating as an Outstanding Trust. Chief Inspector of Hospitals, Professor Sir Mike Richards: “Western Sussex Hospitals NHS Foundation Trust aspires to be one of the best patient-centred services in the National Health Service, with a trust-wide mantra of patients first. We found that this ambition was understood and embedded in the practice of staff across all professions and at all levels.’’

”’The Trust focuses first on improving quality and safety. Staff and patients who we met during this inspection spoke positively about the patient journey and the striving for continual improvement. We found a clear focus on quality improvement, innovation and safety, starting even before patients are admitted. Services are clearly designed to meet the needs of individuals, with services providing continuity of care from the hospital into the community.’’ All improvement initiatives have the value to the customer / patient at the heart of any improvement. We are just starting to measure financial vale of improvement programme outputs.

In detail

Ambition

Western Sussex Patient First Programme

We recognise that the strength of our hospitals lies in our staff, and have built an organisational culture that empowers teams and individuals to make lasting changes that benefit our patients and community. To do this, we have developed Patient First – the Trust’s approach to sustaining a culture of continuous improvement. Patient First is a programme based on Lean thinking, standardisation, system redesign and ongoing development of care pathways, built on a philosophy of incremental and continuous improvement by front-line staff empowered to initiate and lead positive change.

Western Sussex Patient First Improvement System

The Patient First Improvement System (PFIS) is our Lean management system, developing staff to solve problems and improve performance. PFIS is rolled out in a series of waves. As well as formal training and team-days, each team is coached in the use of tools at the frontline to ensure they become embedded in practice. Key elements include status sheet exchanges (structured daily discussions to learn about the business of the unit, proactively plan and provide coaching opportunities); establishment of Unit Leadership Teams who have ownership for the performance of their unit; daily improvement huddles where staff identify improvements in their own area that they are able to make themselves; and implementation of process and leader standard work to ensure improvements are sustained. Building an ‘army of problem solvers’ We are building continuous improvement capacity throughout our workforce with our Patient First Improvement Programme.

The programme develops and empowers teams to solve problems, improve processes and pathways using Lean tools. The programme enables staff to progress in their awareness, understanding and knowledge of the Patient First Improvement Programme and of Lean systems and practices in healthcare and their application in the Trust.

The programme encompasses a basic introduction through Trust induction/annual training updates to help all staff gain an overview of the importance of a culture of continuous improvement, and formal ‘Yellow Belt’ / ‘Green Belt’ training for staff leading larger improvements. Staff engagement in improving care Last year our breakthrough objective was to increase the number of staff who feel they can make improvements in their area of work. During 2016/17, the Trust’s NHS Staff Survey engagement score improved from 3.78 to 3.88, above the national average of 3.81.

For the sixth year, the Trust rolled out the NHS staff survey to all permanent staff and achieved its highest response rate of 59%, an increase of 5% on last year. Safe - Harm free care As our True North objectives for Quality and Safety our staff focus on key improvement initiatives aimed at reducing avoidable mortality and delivering harm free care. Staff lead improvement initiatives contributing to the Trust overall goal of providing 100% harm free care. This year we have focused on falls reduction as our breakthrough objective.

The programme has involved over ten wards where most falls take place using a structured approach to review their own ward level data, and understand the root cause for their falls themes (e.g. time of day of falls, where the falls take place, activity at the time of the fall) then working through PDSA (improvement) cycles to try to address the underlying reasons for patient falls. The project has been supported by the Kaizen team with close executive involvement, supported by weekly review meetings to ensure that issues are addressed as quickly as possible.

The Trust has embedded two core interventions that have been shown to have a positive impact: SWARM, an immediate multidisciplinary review of the patient and ‘Baywatch’, a requirement to keep bays where patients are known to be at risk of falling manned at all times. The Baywatch team can include any member of the ward team including volunteers and ward clerks. Other key interventions involved with this success include reviewing our ward environments to promote safety e.g. accessible call bells, non-shiny, non-slip flooring and ensuring we have the correct staffing levels in place. The results from this project have been very positive with a number of wards seeing 50% reduction in falls this year. Other safety programmes include:

• The implementation of a medicines optimisation strategy
• The implementation of a skin damage reduction programme
• The roll out of ward accreditation

Outcome

• A primary outcome of our Patient First Improvement Programme has been a significant increase in staff engagement as measured by the NHS Staff Survey. During 2016/17, the Trust’s engagement score improved from 3.78 to 3.88, above the national average of 3.81.
• We have achieved 99% harm free care as measured by the Safety Thermometer.
• We have achieved over 17% reduction in falls over the last three years. This equates to 400 less patient falls, a number of wards seeing 50% reduction in inpatient falls this year.

Spread

The Patient First Improvement Programme is currently being rolled out across clinical areas of the Trust. We share our approach with interested NHS colleagues through a series of events showing Patient First in action on our wards. Improvement programmes such as our skin damage programme involve colleagues from our local health economy in trying to improve the assessment and prevention of pressure damage across the patient pathway. We work with KSS AHSN Patient Safety Collaborative to share and promote innovative approaches improving patient safety regionally.

Value

The greatest value of the Patient First Programme is the engagement of our staff in improving care. This has had a huge impact on the quality of services we provide and the experience of patients at our trust. This is demonstrated in our recent CQC rating as an Outstanding Trust. The Chief Inspector of Hospitals, Professor Sir Mike Richards, said: “Western Sussex Hospitals NHS Foundation Trust aspires to be one of the best patient-centred services in the National Health Service, with a trust-wide mantra of patients first. We found that this ambition was understood and embedded in the practice of staff across all professions and at all levels.’’

‘’The Trust focuses first on improving quality and safety. Staff and patients who we met during this inspection spoke positively about the patient journey and the striving for continual improvement. We found a clear focus on quality improvement, innovation and safety, starting even before patients are admitted. Services are clearly designed to meet the needs of individuals, with services providing continuity of care from the hospital into the community.’’ All our improvement initiatives have the value to the customer / patient at the heart of any improvement. We are just starting to measure financial vale of improvement programme outputs such as falls reduction.

Involvement

Patient Safety is a key Patient First focus with harm free care objectives cascaded from Board to ward through our strategy deployment processes. Problem solving to address our areas of improvement focus happens at all levels of the organisation in a structured way through the use of A3 thinking and ward improvement huddles.