KLOEs for the Trust
Area of focus
KLOE
Key detailed questions
Approach
Governance
and leadership
1. Can the Trust clearly
articulate its governance
processes for assuring the
quality of treatment and
patient care? Can staff at all
levels of the organisation
describe the key elements of
the quality governance
processes, i.e. policies and
procedures, escalation
processes, incident reporting,
risk management?

What are the Trust’s main quality priorities?

How does the trust identify, assess and mitigate risk, and how does it
disseminate learning from incidents and never events?

Can staff at all levels of the organisation describe the key elements of the
quality governance processes?

What changes are being made to the governance structure and processes?
(CQSPE in particular)
Interviews with
Board and
governors
Focus groups
with staff
Interviews with
staff

How does governance work at a Directorate and service level?

How is the board using performance information to drive improvements?

Does the trust have responses / action plans for external reviews?
1
Area of focus
KLOE
Key detailed questions
Approach
Clinical and
operational
effectiveness
2. What actions is the Trust
taking to improve mortality
performance, particularly in
general medicine, elderly care
and stroke wards? How does
the Trust manage
deteriorating patients?
3. How is the Trust addressing
its infection control standards,
particularly C-Diff?

How is mortality monitored and action plans developed within the governance
structure?

What actions are the Trust taking for improving mortality performance?

What changes / improvements have been made in 2012/2013 in relation to
general medicine, elderly care and stroke?

How does the trust collaborate with other organisations to reduce avoidable
mortality?

Interviews with
Board
Focus groups
with staff
Observations on
wards
Interviews with
ward leads
How does the Trust manage deteriorating patients?

Have CQC alerts and reviews impacted care levels? How?

Has the Trust introduced Service Line Reporting? If so, is this supporting
clinical and operational effectiveness, particularly mortality performance?

How does the Trust ensure that coding is accurate?

How is the Trust managing services and pathways? E.g. renal, emergency
care

How is the Trust managing conditions? E.g. diabetes

How does the Trust manage frail elderly patients on all wards?

How is post op care managed?

How is the Trust addressing its infection control targets, particularly C-Diff?
What impact is this having? Could more be done?

How is the Trust dealing with the impact of delayed discharge?

What different methods does the Trust use to engage patients and seek views
on their experiences?

How does the Trust identify themes from the patient experience intelligence?

What are the key themes that have been identified? What are the main
concerns?

What actions have been taken to address these themes?

Has the Trust seen improvements as a result of these actions?

How are complaints dealt with? Are there any recent examples of complaints
that can be sited, and what was the action taken following on from these?
Patient
experience
4. How does the Trust seek
views from patients about
their experience? What are
the key themes from patients
on their experiences? What
action is the Trust taking to
address the key themes
emerging?
Interviews with
Board and
governors
Focus groups
with staff and
patients
Observations on
wards
2
Area of focus
KLOE
Key detailed questions
Approach
Workforce and
safety
5. How engaged are staff in the
Trust’s quality strategy? What
do staff groups interviewed
(including trainee groups) say
are the main barriers in the
Trust to delivering high quality
treatment and care for
patients?
6. How does the Trust support
its staff with adequate
training, including
safeguarding and other
mandatory training?

How does the Trust seek views from its staff about quality of treatment and
care? Is the gap between Ward and Board being effectively managed?

What do staff groups say are the main barriers in the Trust to delivering high
quality treatment and care for the patients?

What is staff morale like?

What is the culture within the Trust?

Are staff engaged?
Focus groups
with staff
Interviews with
Board and other
key
management
Observations on
wards

How does the Trust support its staff with adequate training?

What training is provided to staff? In particular, what safeguarding training is
provided to staff?

How does the Trust ensure staff attend mandatory training?

How is completion of training monitored?

What actions are taken where training is not completed on time?

What is the Trust doing to in response to the most recent staff survey? Why
do they think the response rate and engagement rate decreased from prior
year?

What actions have been taken in relation to accuracy of coding?

Is there an audit plan for coding? What have the recent audits shown?

What action has been taken to specifically address palliative care coding?

What is the reason behind the much higher rate of palliative care coding
compared to similar trusts?
Trust specific –
palliative care
coding
7. How is the Trust continuing to
take action on its depth and
accuracy of coding,
particularly in palliative care?
Interviews with
executive team
and key
management
Observations on
wards
3
Area of focus
KLOE
Key detailed questions
Approach
Trust specific –
CIPs quality
impact
assessments
8. What is the Trust’s process to
assess the impact of cost
savings plans on quality of
patient care and its
workforce?

What is the current CIP target?

How are CIP plans developed at a service level?

How much clinical involvement is there in CIP development?

Interviews with
executive team
and other key
management
Who is responsible for assessing the quality impact of the CIP plans at
service/divisional level? Who fills in the QIA?

Do the Medical Director and/or Director of Nursing sign off all CIP plans?

What oversight does the Board have of the quality impact of CIP plans?

How does the Trust also monitor the post-implementation impact of CIP plans
once they’ve been approved?

Are there any current concerns relating to the quality impact of cost savings?

How can staff escalate concerns regarding the impact on patient care and
staffing levels?

Is there an action plan in place to reduce avoidable pressure ulcers?

Who is accountable for the delivery of this action plan?

How is this monitored through the governance structure?

How are lessons shared as a result of root cause analyses?
Trust specific –
Pressure ulcers
9. What actions is the Trust
taking to reduce avoidable
pressure ulcers?
Interviews with
ward leads
Focus groups
with staff
4
Area of focus
KLOE
Key detailed questions
Approach
Trust specific –
Nurse staffing
10. How does the Trust approach
workforce planning to ensure
that patient care and safety is
managed effectively including
nurse staffing levels? How is
clinical cover managed out of
hours particularly on the
emergency pathway?

How does the Trust approach workforce planning to ensure that patient safety
is managed?

Are there enough staff on wards all day, every day, including weekends, with
a particular focus on nurse staffing levels?

What oversight does the Board have of nursing staffing levels?

Is there the right staff mix on the wards?

How is clinical cover managed out of hours? In particular, how is it managed
at weekends? How is it managed for patients on the emergency pathway?
Focus groups
with staff
Interviews with
Board and other
key
management
Observations on
wards

The risk register identified that nurse staffing levels are sub optimal in certain
areas – which areas are these and what is being done about it?

Are incidents as a result of staffing levels monitored? What action is taken as
a result of these?

Are there any other workforce issues i.e. middle grade doctors?

How is the Trust covering vacancies and sickness levels?
5
Agenda for the Trust visit for discussion
Dates of announced visit
Tuesday 7 May 2013 10 am start - Wednesday 8 May 2013 4pm close
Location
Trust Head Quarters, Russells Hall Hospital, Pensnett Road, Dudley, West Midlands, DY1 2HQ (Trust contact: Helen Forrester, EA to the Chief Executive)
Time
Agenda and Trust attendees
Content
Panel members
[TBC following panel briefing]
Venue/
Room
[TBC]
Day 1
9.3010.00
Panel arrival at Russells Hall Hospital (Dudley)
10.0010.30
Pre-meet for review panel (panel
only)
10.3011.00
Executive team briefing
 Chief Executive Paula Clark
11.0012.30
11.0012.00
BREAKOUT SESSIONS
Interviews with the executive team:
Session 1:
 Chief Executive Paula Clark

Reminder of key messages and plan for the visit
including leads and recorders for each session

Any updates from Chair and moderator on
processes/guidance/issues

Plan for the next two days and set the scene

Clarify any issues and concerns with the Trust
Session 1:
 All KLOEs but prioritising governance and leadership,
patient experience and staff engagement
All
Attendees – All
Panel chair – RM
Recorder - AB
Panel chair – RM
Moderator – KN
Recorder - AB
Panel chair – RM
Attendees – AG, TBC
Recorder - KN
6
Time
Agenda and Trust attendees
Content
Panel members
[TBC following panel briefing]
11.0012.30
Observation Group 1
Observation Group 2
[Specific wards TBC. All observations
to include at least 1 lay rep.
Suggested times for observations
shown as suggestions, though they
can be held at other times should
panellists have availability.]

Undertake observation of clinical areas to observe quality
aspects
Informal discussions with patients and staff in clinical
areas
Areas to cover during visit:
o A&E
o General medicine ward
o Elderly care ward
o Trauma and Orthopaedic ward
o Renal ward
o Paediatrics ward
o Other emergency and speciality wards
Observation Group 1:
Chair – RF
Attendees – AK, SD, BK
Recorder – JM
Focus Group 1:
 Trainee nurses

Chair – MM
Attendees – AG, ChJ, DC
Recorder – AB

Explore the groups understanding of key processes for
ensuring quality of care and treatment in the Trust
Identify any concerns and collate feedback from the
group
Investigate staffing, culture and training issues
Panel chair – RM
Attendees – LP, SD, RF
Recorder - KN
11.4512.45



12.00 –
13.00
Interviews with the executive team:
Session 2:
 Medical Director Paul Harrison
 Director of Nursing Denise
McMahon

All KLOEs
12.3014.00
Lunch and triangulation (panel
only)



Review of evidence identified in the sessions held to date
Discussion of emerging themes and issues
Identification of areas of focus for the remaining sessions
13.0014.00
Focus Group 2:
 Senior doctors

Explore the groups understanding of key processes for
ensuring quality of care and treatment in the Trust
Identify any concerns and collate feedback from the
group
Investigate staffing, culture and training issues


Venue/
Room
[TBC]
Observation Group 2:
Chair – CJ
Attendees – LP, HM, AM
Recorder – KT
Chair – DW
Attendees – AK, VL, PW
Recorder – JM
7
Time
Agenda and Trust attendees
14.0016.00
BREAKOUT SESSIONS
14.0015.00
Observation Group 3
Observation Group 4
[Specific wards TBC. All observations
to include at least 1 lay rep.
Suggested times for observations
shown as suggestions, though they
can be held at other times should
panellists have availability.]
Content
Panel members
[TBC following panel briefing]

Observation Group 3:
Chair – RF
Attendees – AG, SD, BK
Recorder – KT


Undertake observation of clinical areas to observe quality
aspects
Informal discussions with patients and staff in clinical
areas
Areas to cover during visit:
o A&E ward
o General medicine ward
o Elderly care ward
o Trauma and Orthopaedic ward
o Renal ward
o Paediatrics ward
o Other emergency and speciality wards
Venue/
Room
[TBC]
Observation Group 4:
Chair – CJ Attendees – LP,
HM, AM
Recorder – AB
8
Time
Agenda and Trust attendees
Content
Panel members
[TBC following panel briefing]
15.0016.00
Interview group 1:
 Clinical directors - Emergency &
speciality medicine and outreach
medical team
Jeff Neilson - Clinical director
emergency
Graeme Stewart - Clinical director
specialty medicine
Darshan Pandit - Consultant in
Critical Care & Respiratory Medicine
(Outreach team)

Interview group 1:
Chair – MM
Attendees – AG, ChJ, DC
Recorder – KN



KLOE 2 – general medicine, stroke and elderly care
mortality data
KLOEs 3 and 9 – pressure ulcers and infection control
KLOEs 5,6 and 10 – workforce and safety
Discuss observation findings
Venue/
Room
[TBC]
Interview group 2 and 3
(30mins each)
Chair – RF
Attendees – AK, SD, BK
Recorder – JM
Interview group 2:
 General Managers - Specialty
medicine
Rachel Benson – GM specialty
medicine
Rob Game - GM acute medicine
Karen Hanson - Emergency
medicine
Interview group 3:
 Medical Service Heads - Older
People/stroke
 Matron – Elderly Care /stroke
Atef Michael – MSH Older people
Ashes Banerjee – MSH stroke
Julie Pain – matron ambulatory
medicine
Sheree Randall – matron older
people
Julie Walklate – deputy matron older
people
9
Time
Agenda and Trust attendees
Content
Panel members
[TBC following panel briefing]
15.0016.00
Focus group 3:
 Health care assistants and other
clinical staff

Chair – DW
Attendees – LP VL, PW,
Recorder – AB
16.0018.00
Triangulation (panel only)
16.0018.00
BREAKOUT SESSIONS
16.0017.00
Focus Group 4:
 Senior nurses

Explore the groups understanding of key processes for
ensuring quality of care and treatment in the Trust
Identify any concerns and collate feedback from the
group
Investigate staffing, culture and training issues



Review of evidence identified in the sessions held to date
Discussion of emerging themes and issues
Identification of areas of focus for the remaining sessions

Chair – RF
Attendees – AK, SD, BK
Recorder – AB

Explore the groups understanding of key processes for
ensuring quality of care and treatment in the Trust
Identify any concerns and collate feedback from the
group
Investigate staffing, culture and training issues
Panel Chair – RM
Attendees – KN
Recorder – AB


17.0018.00
Interview group 4:
Meeting with lead Governor


Governance KLOEs
Patient experience KLOEs
18.0020.00
Triangulation (panel only excluding
those leading the listening
surgery)



Review of evidence identified in the sessions held to date
Discussion of emerging themes and issues
Identification of areas of focus for the remaining sessions
18.0020.00
Patient and public listening
surgery (panel only)

Gather views from patients and members of the public
related to quality of care at the Dudley Group FT
Panel chair – RM
Attendees – MM, AG, ChJ,
DC, KN
Recorder – AB
18.0020.00
Governor listening surgery (panel
only)

Gather views from members of Dudley Group FT
Chair – RF
Attendees – AK, SD, BK
Recorder – JM
Venue/
Room
[TBC]
10
Time
Agenda and Trust attendees
Content
Panel members
[TBC following panel briefing]


Interview group 5:
Chair – MM
Attendees – AG, ChJ, DC
Recorder – KN
Venue/
Room
[TBC]
Day 2
08.0011.00
BREAKOUT SESSIONS
08.0009.00
Interview group 5:
 Deputy Director of Finance and
Information
Richard Price and Micheal
Sullivan
CIPs QIA
Workforce and safety KLOEs
Interview group 6:
Chair – RF
Attendees – AK, SD, BK
Recorder – JM
Interview group 6:
 Director of Operations
Richard Beeken and Richard
Cattell
Interview group 7:
Chair – CJ
Attendees – LP, HM, AM
Recorder – KT
Interview group 7:
 Associate Director for Human
Resources
Annette Reeves
Observation Group 5
[Specific wards TBC. All observations
to include at least 1 lay rep.
Suggested times for observations
shown as suggestions, though they
can be held at other times should
panellists have availability.]



Undertake observation of clinical areas to observe quality
aspects
Informal discussions with patients and staff in clinical
areas
Areas to cover during visit:
o A&E ward
o General medicine ward
o Elderly care ward
o Trauma and Orthopaedic ward
o Renal ward
o Paediatrics ward
o Other emergency and speciality wards
Observation Group 5:
Chair – DW
Attendees – VL, PW
Recorder – AB
11
Time
Agenda and Trust attendees
Content
Panel members
[TBC following panel briefing]
09.0010.00
Interview group 8:
 Chair of CQSPE (clinical, quality,
safety and patient experience)
committee
David Bland chair and David
Badger deputy


Patient experience
Governance
Chair – MM
Attendees – AG, ChJ, DC
Recorder – AB
Interview group 9:
 Director of Community Services
and Integrated Care
Tessa Norris
Jo Bowen - consultant


KLOE 7- Palliative coding issues
Follow up on observation
Chair – CJ
Attendees – LP, HM, AM
Recorder – JM
Focus Group 5:
 Non-clinical staff

Chair – CJ
Attendees – LP, HM, AM
Recorder – KN

Explore the groups understanding of key processes for
ensuring quality of care and treatment in the Trust
Identify any concerns and collate feedback from the
group
Investigate staffing, culture and training issues
Interview group 10:
 Matron for T&O
 Clinical services head for T&O


Trauma & Orthopaedics mortality data
Follow up on observation
Chair – DW
Attendees –VL, PW, AG
Recorder – KT
11.3012.30
Interview group 11:
 Clinical Director for Trauma &
Orthopaedics (to start after
surgery)
Interview group 7 and 8:
 Trauma & Orthopaedics mortality data
 Follow up on observation
Chair – RF
Attendees – AK, SD, BK
Recorder – AB
11.0012.30
Lunch and triangulation (panel
only)



10.0011.00

Venue/
Room
[TBC]
Review of evidence identified in the sessions held to date
Discussion of emerging themes and issues
Identification of areas of focus for the remaining sessions
12
Time
Agenda and Trust attendees
12.3013.30
BREAKOUT SESSIONS
12.3013.30
Focus Group 6:
 Diabetes team
Content
Panel members
[TBC following panel briefing]

Explore the groups understanding of key processes for
ensuring quality of care and treatment in the Trust
Identify any concerns and collate feedback from the
group
Investigate staffing, culture and training issues
Chair – MM
Attendees – AG, ChJ, DC
Recorder – JM
Explore the groups understanding of key processes for
ensuring quality of care and treatment in the Trust
Identify any concerns and collate feedback from the
group
Investigate staffing, culture and training issues
Chair – DW
Attendees –VL, PW, LP
Recorder – KN
Undertake observation of clinical areas to observe quality
aspects
Informal discussions with patients and staff in clinical
areas
Areas to cover during visit:
o A&E ward
o General medicine ward
o Elderly care ward
o Trauma and Orthopaedic ward
o Renal ward
o Paediatrics ward
o Other emergency and speciality wards
Observation Group 6:
Chair – MM
Attendees – AG, ChJ, DC
Recorder – JM

13.0014.00
Focus Group 7:
 Junior Doctors



13.3014.30
Venue/
Room
[TBC]
BREAKOUT SESSIONS
Observation Group 6
Observation Group 7
[Specific wards TBC. All observations
to include at least 1 lay rep.
Suggested times for observations
shown as suggestions, though they
can be held at other times should
panellists have availability.]

Follow-up session 1, 2 and 3:
 Focus to be agreed on site as
required



Observation Group 7:
Chair – RF
Attendees – AK, SD, BK
Recorder – AB
Hold for outstanding areas for investigation
13
Time
Agenda and Trust attendees
Content
Panel members
[TBC following panel briefing]
14.3015.30
Final triangulation (panel only)


End of visit feedback / initial findings
Discuss emerging themes and any issues already
escalated during the day
Triangulation and agree issues for further investigation
Capture recommendations
Agree approach to unannounced visits
Finalise recording templates and draft report
Panel chair – RM
Attendees – All
Recorder – AB
Discuss themes from the visits and recommendations
Agree urgent actions for any key issues identified on the
visit
Discuss next steps including principles for the
unannounced visit(s) and formal reports
Panel chair – RM
Attendees – KN
Recorder – AB




15.3016.00
End of visit wrap up with Trust
Chief Executive and Chair



Venue/
Room
[TBC]
CLOSE
14