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Trust launches various initiatives to focus on patient safety and staff wellbeing, reducing care discrepancies and achieving outstanding CQC rating

Challenge

    • In the past few years, Trust faced financial, external relationships and workforce challenges, along with increased demand
    • Difficulty in recruiting and attracting specialists with a UK-wide workforce shortage
    • Deliver a 5-star patient-centric solution, focussing on trust-wide safety, care, communication, system, and pathways

Action

    • Introduced various interventions to embed continual quality and safety improvements
    • Introduced well-being champions to disseminate information to their peers
    • Launched a vague symptoms pathway, incorporating direct CT scanning
    • Re-designated surgery beds to become medicine beds and recruited additional medical staff
    • Engaged with GIRFT(Getting It Right First Time) to reduce variation and improve efficiency

Result

    • Led to recruitment and retention of staff, supporting their wellbeing
    • Reduced patients’ length of stay by 50% (25 to 11 days)
    • Improved efficiency within the in-patient journey and reduced variation in care
    • Saved £1m in orthopaedics alone, enabling a better quality of care for patients
    • Achieved an overall outstanding rating from the Care Quality Commission and other caring domains

Synopsis:

Patient experience is at the heart of our vision to deliver 5-star patient care, ensuring the best possible patient care.

We achieved an overall OUTSTANDING rating from the CQC. We achieved the top acute, trust staff survey results for the third consecutive year with exceptional staff engagement, the best PLACE survey results for the second consecutive year, and the highest influenza vaccination rate for frontline workers at 95.4%.

We maintain a cumulative surplus of £2.6m and are amongst the most efficient Trusts in the country financially with Model Hospital reference costs at 91. We have successfully addressed both finance and workforce challenges, achieving annual CIPs of 3.8% and increasing our nursing and medical workforce despite national shortages.

Our philosophy of continuous quality and safety improvement continues to reduce incidents resulting in harm and supports innovation. We achieved all national targets except the 2-week wait (92.2%) and A&E four-hour target (87.1%). The Trust developed a vague symptoms pathway that is rolling out regionally and has engaged with GIRFT to reduce variation and improve efficiency. We are Lead Provider for St Helens Cares and together won the 2018 Municipal Journal Care and Health Integration Award.

Ambitions:

Finance, external relationships and workforce have been the biggest challenges facing the Trust in the past few years, along with capacity and demand. The Trust is fairly unusual in being in cumulative surplus to date and plans to deliver a further £3.8M surplus for 2019/20.

We delivered a 3.8% annual CIP over the past 3 years and have one of the lowest Model Hospital Reference costs in the country at 91. Staffing challenges mean attracting specialists with a UK-wide shortage, operating successful retention strategies, and managing sickness at a low level.

We support staff wellbeing, have a successful overseas recruitment campaign and seek to be an ‘employer of choice’ for staff. We have committed to developing a broadly representative workforce and strive to increase diversity and inclusion through EDS2 and share best practice widely.

Our vision is 5-star patient care: focused on Safety; Care; Communication; Systems; Pathways. It is underpinned by values and linked to the annual Trust objectives and has been embedded since 2005. It is ‘owned’ by our staff. We have a philosophy of continuous quality and safety improvement, reducing incidents resulting in harm and supporting innovation. Relationship building is supporting the integration of services locally.

Outcome:

Our vision is being achieved by placing patients, their families and our staff at the centre of everything we do. We gained an overall OUTSTANDING CQC rating and in the well-led and caring domains. We achieved the top acute Trust staff survey results for the third consecutive year with exceptional staff engagement, the best PLACE survey results for the second consecutive year, and the highest frontline worker influenza vaccination rate (95.4%).

Our Use of Resources inspection was GOOD, and we met all national targets except the 2-week wait (92.2%) and the A&E four hour target (87.1%), which was hindered by estate capacity. The Trust has introduced well-being champions to disseminate information to their peers, with the second lowest rate of stress in the staff survey. We are successful at recruitment and retention, supporting wellbeing.

We have a strong focus on patient safety and introduced a hierarchy challenge tool ‘HALT’ in theatres to reduce never events. We have a robust learning from deaths policy that is assessed through multiple modalities. We have strong collaborations and partnerships locally in developing integrated care partnerships and are the lead provider for St Helens with integrated primary and community care services Supporting care excellence.

Spread:

The Trust is represented on a number of local and national organisations and participated in a visiting programme with The Emergency Medicine Committee Chinese branch. We are collaborating with our local CCG in provision of primary care and primary/community pharmacists rotating through secondary care. The Trust provides the only 24/7 routine microbiology service locally; we have shared our learning or the planning, implementation and successful management of this service with numerous Trusts who would like to replicate our model.

We encourage clinicians to present their work and publish papers. We have set up an innovative system of clinical placements for Army Combat-Medical-Technicians to prepare them for their operational role. We launched our innovative vague symptoms pathway in 2014, incorporating access to CT scanning and acute oncology MDT review, alongside direct access to CT. This is now being rolled out across the

Eastern Mersey Footprint, reducing LOS by 50% (25 to 11 days). Direct CT scanning is now available in two additional major teaching hospitals in Liverpool. This is additionally augmented by a successful virtual multidisciplinary diagnostic pathway for non-cancers and an initiative to develop ambulatory care for cancer patients. The latter has been shared and local Trusts are seeking to emulate it.

Value:

Patient experience is at the heart of the Trust’s vision to deliver 5-star patient care. Patient stories are shared in numerous forums and have contributed to multiple service improvements. A recent trial collected person-centred information, reminding staff of the person behind the patient and better supporting their care. 

This has been shared internally and externally. The Patient Experience Manager engages with at least 5 patients or carers every day, providing valuable information ‘as it happens.’ We have enabled animal assisted therapy, which has been positively received, and are developing a Carers’ passport with local Trusts.

Formal complaints are managed at Executive level and informal complaints through PALS and locally, all driving improvements in the Trust. We have engaged with GIRFT, saving over £1M in the first year in orthopaedics alone through addressing opportunity shown in the Model Hospital, reducing variation and enabling a better quality of care for patients.

We undertook an initiative to reduce medical outliers, a source of significant variation and suboptimal medical care. We re-designated surgery beds to become medicine beds and recruited additional medical staff. This improved efficiency within the in-patient journey and reduced variation in care within a specialty as well as reducing overall LOS.

Involvement:

The Trust has exceptional levels of staff engagement, supported by team-brief, News-n-Views, cultural surveys, speaking-out-safely campaign, team talks, Pizza-Wednesdays, annual staff awards, annual learning and development awards and many others.

This supports staff to achieve our vision of 5-star patient care. The well-being team engages the whole Trust, with well-being champions, supporting mental health, highlighting different health initiatives during the year and encouraging staff to keep active with walking, yoga and tai-chi. Recruitment and retention supports well-being, including overseas recruitment.

The Trust undertakes values-based recruitment to ensure all staff are committed to 5-star patient care. We celebrate success and listen to our staff. We retain an excellent and inclusive relationship with our PFI partners, supporting 5-star patient care. 

Our workforce EDI strategy ensures equitable opportunity everywhere. The Trust runs the Health Informatics Partnership, improving cyber-security and improving digital maturity. We provide a successful pathology service to a local Trust, with very high customer satisfaction.

We are Lead Provider for St Helens and are integrating pathways to better meet the needs of the patient, increase quality and reduce waste thereby increasing efficiency. The Trust engages with patients through multiple forums, enabling sharing of Trust developments with patients, carers and the community.