Chief Executive’s Statement
I am pleased to welcome you to our Quality Accounts 2015.
Now in their sixth year, Quality Accounts continue to provide a truly
objective metric for us, and others, to gauge the quality of our 59
hospitals and the services they provide against a broad range of
criteria.
The past year has seen another step change in the way healthcare
providers are externally challenged on the quality they provide.
Following a spate of high profile controversies around patient safety,
the Care Quality Commission, the UK’s health regulator, has
introduced a new inspection regime designed to raise standards.
No healthcare provider can afford to be complacent and whilst I
believe BMI’s hospitals provide safe and effective care, we should
always be striving for improvement.
To this end we recently introduced a new Quality Strategy, which
articulates how we will provide the best possible care and strive for continual improvement, and live up to
our brand promise to be “serious about health, passionate about care”. Its four core themes – safety,
clinical effectiveness, patient experience and quality assurance – provide our staff with the platform to
consistently deliver the care patients, their insurers, and commissioners expect and deserve.
BMI hospitals have been enthusiastic participants in the pilot programme of the new CQC inspection
regime for private providers, and to ensure our facilities are prepared we have developed a selfassessment tool to enable hospitals to compare their perceptions of themselves with those of the external
inspectors. The rigorous inspection process itself also underpins the sharing of best practice between
hospitals which further drives improvement and consistency.
BMI Healthcare strives to provide the best care but the ultimate arbiters of whether we succeed are our
patients. We are committed to monitoring every aspect of the care we provide, and the results of the
detailed questionnaires we ask patients to complete inform improvement. We aim to provide a consistent,
high quality patient experience and an environment that empowers our consultants to excel. Providing a
dependably high quality of care requires constant focus on improvement; the most recent independent
research conducted for BMI shows that over 98% of our patients rate their care as excellent or very good.
The information available here has been reviewed by the Clinical Governance Board and I declare that as
far as I am aware the information contained in these reports is accurate. Finally I would like to thank all
the staff whose application, professionalism and ceaseless commitment to improvement is recognized
here and in the positive experiences of the patients we care for. Since I joined BMI late last year, I have
witnessed this firsthand on my many visits to our hospitals and I am committed to ensuring we build on
that success.
Jill Watts, Group Chief Executive
BMI HARBOUR HOSPITAL
BMI The Harbour Hospital in Poole, Dorset is part of BMI Healthcare, Britain's leading
provider of independent healthcare with a nationwide network of hospitals & clinics
performing more complex surgery than any other private healthcare provider in the
country. Our commitment is to quality and value, providing facilities for advanced
surgical procedures together with friendly, professional care.
BMI The Harbour Hospital has 37 beds with all rooms offering the privacy and comfort
of en-suite facilities, broadband, TV and telephone. The hospital has three theatres,
including an endoscopy suite and high dependency rooms and 24 hour inpatient doctor
cover.
These facilities combined with the latest in technology and on-site support services, enable our
consultants to undertake a wide range of procedures from routine investigations to complex
surgery. This specialist expertise is supported by caring and professional medical staff, with
dedicated nursing teams and Resident Medical Officers on duty 24 hours a day, providing care
within a friendly and comfortable environment.
BMI The Harbour Hospital also benefits from:
Three operating theatres (two with laminar flow ultra clean air systems)
On-site pharmacy
Imaging suite
Endoscopy facilities
Phlebotomy service
Eight consulting rooms
Dedicated MRI and CT scanning unit
Two minor treatment rooms
Radiology
Physiotherapy centre with Alter G treadmill and Watt bike
Phlebotomy
Health screening
Clinical specialties
Bariatric surgery
Breast services
Cardiology
Chest medicine
Colorectal surgery
Cosmetic surgery
Dental surgery
Dermatology
Endocrinology
ENT surgery
EVLT (Endovenous Laser Therapy for varicose veins)
Gastroenterology
General medicine
General surgery
Gynaecology
Haematology
Histopathology
Immunology
Microbiology
Neurology
Oncology
Ophthalmology
Oral/maxillofacial surgery
Orthopaedic surgery
Plastic and reconstructive surgery
Spinal surgery
Vascular surgery
Services
Allergy testing
Audiology
Breast screening
Chemotherapy
CT scanning
Diabetology
Diagnostic imaging
Emergency admissions
Endoscopy
Fertility consulting and scanning
Health screening
Mammography
MRI scanning
Pain management
Palliative care
Pharmacy
Physiotherapy
Pre-admission clinic
Prostate screening
Respiratory medicine
Rheumatology
Sports injuries clinic
Ultrasound
X-ray
Approximately 32 % of the hospital net caseload is from NHS Choose and Book work. . The
Harbour Hospital offers the following services on the Choose and Book network:•
•
•
•
•
•
•
•
Ophthalmology
ENT
General Surgery
Gastroenterology
Pain Management
Carpal Tunnel Surgery
Knee replacement surgery
Imaging & Diagnostics
BMI Healthcare are registered as a provider with the Care Quality Commission (CQC) under the
Health & Social Care Act 2008. BMI Harbour Hospital is registered as a location for the following
regulated services:•
•
•
•
Treatment of disease, disorder and injury
Surgical procedures
Diagnostic and screening
Family Planning
The CQC carried out an unannounced inspection on7th January 2014 and found full compliance
Standards of treating people with respect and involving them in their care
Standards of providing care, treatment & support which meets people's needs
Standards of caring for people safely & protecting them from harm
Standards of staffing
Standards of management
The Harbour Hospital has a local framework through which clinical effectiveness, clinical incidents
and clinical quality is monitored and analysed. Where appropriate, action is taken to
continuously improve the quality of care. This is through the work of a multidisciplinary group
and the Medical Advisory Committee.
Regional Clinical Quality Assurance Groups monitor and analyse trends and ensure that the
quality improvements are operationalised. There has been development of
At corporate level the Clinical Governance Board has an overview and provides the strategic
leadership for corporate learning and quality improvement.
There has been ongoing focus on robust reporting of all incidents, near misses and outcomes.
Data quality has been improved by ongoing training and database improvements. New reporting
modules have increased the speed at which reports are available and the range of fields for
analysis. This ensures the availability of information for effective clinical governance with
implementation of appropriate actions to prevent recurrences in order to improve quality and
safety for patients, visitors and staff.
At present we provide full, standardised information to the NHS, including coding of procedures,
diagnoses and co-morbidities and PROMs for NHS patients.There are additional external
reporting requirements for CQC, Public Health England (Previously HPA) CCGs and Insurers
BMI is a founding member of the Private Healthcare Information Network (PHIN) UK – where
we produce a data set of all patient episodes approaching HES-equivalency and submit this to
PHIN for publication. The data is made available to common standards for inclusion in
comparative metrics, and is published on the PHIN website http://www.phin.org.uk. This website
gives patients information to help them choose or find out more about an independent hospital
including the ability to search by location and procedure.
1. Safety
1.1 Infection prevention and control
The focus on infection prevention and control continues under
the leadership of the Group Head of Infection Prevention and
Control, in liaison with the link nurse in the Harbour Hospital.
The focus on infection prevention and control continues under
the leadership of the Group Director of Infection Prevention and
Control and Group Head of Infection Prevention and Control, in
liaison with the Infection Prevention and Control Lead Harbour
Hospital.
We have had: -
•
0 MRSA bacteraemia cases/100,000 bed days
Quality Improvement Tools (QIT) are completed in all clinical areas annually.
The QIT are completed by a link person in that area, and in the absence of a link person the
Head of that Department.
The results are readily available in all clinical areas.
Action plans are produced where results are inadequate and repeat audits conducted using RIT
monthly until adequate results
•
42.735 MSSA bacteraemia cases /100,000 bed days
•
Zero E.coli bacteraemia cases/ 100,000 bed days
1
of hospital apportioned Clostridium difficile in the last 12 months.
• SSI data is also collected and submitted to Public Health England for Orthopaedic
surgical procedures. Our rates of infection are;
o Hips
o Knees
Infection control audits are undertaken on a monthly basis by the Infection Control lead and link
staff from the varying hospital departments. These include
•
•
•
•
•
•
•
•
Sharps audit
Waste audit
Environment assessments of all ward areas and clinical departments
Care bundles have been introduced and are in place for
Urinary catheters
Peripheral cannula insertion
Surgical site
Hand hygiene
In patient areas complete blood cultures, peripheral line & urinary catheter on-going High
Impact Intervention care bundle audits quarterly
Oncology areas complete blood cultures, central line, & peripheral line insertion and on-going
High impact Intervention/ care bundle audits quarterly.
Theatre departments (including minor procedures) complete central line, peripheral line and
urinary catheter insertion plus pre, intra & post-operative High Impact Intervention/ care bundle
audits quarterly.
The results are reported to the HIPCC & to Governance.
ANTT training has been rolled out to Theatre Staff and all relevant Clinical staff.
Environmental cleanliness is also an important factor in infection prevention and our patients
Root Cause Analysis is undertaken for all bacteraemia reports, Clostridium difficile reports and
deep surgical site infection (SSI).
All RCA involves clinical staff associated with that patient pathway.
All RCA results are fed back to clinical staff. All RCA is reported through HIPCC & to
Governance.
The theatre department complies with national guidelines (HBN 26) including the air handling
units (HTM 0301) and appropriate checks are in place and compliance reports sent to the IPC
Committee. Annually
QIT audits are conducted in Operating Rooms. Annually
Staff have received appropriate training and can demonstrate competence in scrub procedures.
Annually
Patients rate the cleanliness of our facilities highly.
Feedback on cleanliness was 100% satisfaction of very good and excellent
100
90
80
70
60
50
40
30
20
10
0
Satisfaction
Room
1.2 Patient Led Assessment of the Care Environment (PLACE)
We believe a patient should be cared for with compassion and dignity in a clean, safe environment.
Where standards fall short, they should be able to draw it to the attention of managers and hold the
service to account. PLACE assessments will provide motivation for improvement by providing a clear
message, directly from patients, about how the environment or services might be enhanced.
In 2013 we introduced PLACE, which is the new system for assessing the quality of the patient
environment, replacing the old Patient Environment Action Team (PEAT) inspections.
The assessments involve patients and staff who assess the hospital and how the environment
supports patient’s privacy and dignity, food, cleanliness and general building maintenance. It focuses
entirely on the care environment and does not cover clinical care provision or how well staff are
doing their job.
The results will show how hospitals are performing nationally and locally. Results of the hospital
were as follows
Cleanliness
92%
Food
95.4
Privacy and dignity
79.31
General condition of facilities 87.5
1.3 Venous Thrombo-embolism (VTE)
BMI Healthcare, holds VTE Exemplar Centre status by the Department of Health across its
whole network of hospitals including, the Harbour Hospital. BMI Healthcare was awarded the
Best VTE Education Initiative Award category by Lifeblood in February 2013 and were the
Runners up in the Best VTE Patient Information category.
We see this as an important initiative to further assure patient safety and care. We audit our
compliance with our requirement to VTE risk assessment every patient who is admitted to our
facility and the results of our audit on this has shown 100%.
The Harbour Hospital reports the incidence of Venous Thromboembolism (VTE) through the
corporate clinical incident system. It is acknowledged that the challenge is receiving information
for patients who may return to their GPs or other hospitals for diagnosis and/or treatment of VTE
post discharge from the Hospital. As such we may not be made aware of them. We continue to
work with our Consultants and referrers in order to ensure that we have as much data as
possible. .
There was one reported incident of VTE which developed and was reported after the patient
was discharged from the hospital.
2. Effectiveness
2.1 Patient reported Outcomes (PROMS)
Patient Reported Outcome Measures (PROMs) are a means of collecting information on the
effectiveness of care delivered to NHS patients as perceived by the patients themselves.
PROMs is a Department of Health led programme.
The Harbour Hospital only commenced NHS activity on PROMS out comes for hip and Knee
surgery in July 1014. There is no data currently available for inclusion in this report.
2.2 Enhanced Recovery Programme (ERP)
The ERP is about improving patient outcomes and speeding up a patient’s recovery after
surgery. ERP focuses on making sure patients are active participants in their own recovery and
always receive evidence based care at the right time. It is often referred to as rapid recovery, is
a new, evidence-based model of care that creates fitter patients who recover faster from major
surgery. It is the modern way for treating patients where day surgery is not appropriate.
ERP is based on the following principles:1. All Patients are on a pathway of care
a. Following best practice models of evidenced based care
b. Reduced length of stay
2. Patient Preparation
a. Pre Admission assessment undertaken
b. Patient Education sessions
c. Optimizing the patient prior to admission – i.e HB optimisation, control comorbidities, medication assessment – stopping medication plan.
d. Commencement of discharge planning
3. Proactive patient management
a. Maintaining good pre-operative hydration
b. Minimising the risk of post-operative nausea and vomiting
c. Maintaining normothermia pre and post operatively
d. Early mobilisation
4. Encouraging patients have an active role in their recovery
a. Participate in the decision making process prior to surgery
b. Education of patient and family
c. Setting own goals daily
d. Participate in their discharge planning
There are a number of surgeons working at the site who have a specific interest in ERP. We have hosted
study days locally in association with the local Trust who have shared their working practices and
encouraged collaborative working arrangements.
The transfusion link practitioner for the Hospital works closely with the surgeons to aim for
optimization prior to major surgery.
All incidents of extended length of stay are looked at proactively to see whether ERP practice
could have made a difference to the outcome.
2.3 Unplanned Readmissions within 31 days and unplanned returns to theatre.
Unplanned readmissions and unplanned returns to theatre are normally due to a clinical
complication related to the original surgery.
3.Patient experience
3.1 Patient satisfaction
BMI Healthcare is committed to providing the highest levels of quality of care to all of our
patients. We continually monitor how we are performing by asking patients to complete a patient
satisfaction questionnaire. Patient satisfaction surveys are administered by an independent third
party.
96
95
94
93
92
91
90
Admission
Accommodation
Discharge
100
98
96
94
92
90
88
86
Nursing
Catering
Overall Quality
During the course of the reproting period, the Harbour Hospital was consistently ranked in the
top 20 out of the 58 hospitals in the BMI Group. We are committed to ensuring a positive patient
experience and actively encourage feedback from our clients. We are planning to host patient
focus groups from a cohort of patients who will be invited into the hospital for informal feedback
sessions hosted by our administration team.
3.2 Complaints
In addition to providing all patients with an opportunity to complete a satisfaction survey BMI
Harbour Hospital actively encourages feedback both informally and formally. Patients are
supported through a robust complaints procedure, operated over three stages:
Stage 1: Hospital resolution
Stage 2: Corporate resolution
Stage 3: Patients can refer their complaint to independent adjudication if they are not satisfied
with the outcome at the other 2 stages.
3. CQUINS
Friends and Family Test - Early Implementation Friends and Family Test - Increased or Maintained
Response Rate
Friends and family question -100% would recommend to friends and family. New questionnaires being
st
introduced during September and in operation by October 1 2014.
NHS Safety Thermometer Data sent to IMU. Survey undertaken on a monthly basis.
Dementia
Screening question asked of all relevant patients on Pre assessment or admission to hospital. Monthly
carers survey completed when patient with known dementia admitted for care. Nil return to date
VTE
All clinically eligible patients have assessment for VTE/ need for prophylaxis on pre-assessment or
admission. Quarterly BMI detailed audit also performed in addition to monthly return to IMU.
Care Bundle Audits- Catheters
Where urinary catheter in situ, care bundle is undertaken. Given nature if surgeries undertaken at
Harbour, there has been nil use of urinary catheter to date for the NHS activity undertaken.
Post Surgical Remote Follow- Up Digital First
All patients whether NHS or not are routinely contacted at 48 hours post surgery. Follow up appointments
are on Consultant request only. All cataract patients are reviewed in line with best practice pathway at 2
weeks post procedure
4. National Clinical Audits
The Harbour Hospital was only eligible to participate in National Joint Registry audit and all joint
replacements are submitted to this. BMI hospital data is from page 196 onwards in attached
latest NJS report. Use this if appropriate with your narrative on the data and any improvement
plans.
5. Research
No NHS patients were recruited to take part in research however the hospital has been a trial
site for the GEKO device which recently received NICE approval for use in the prevention of
DVT in June 2014. The Turbo trial is currently underway and will be evaluated in late 2015.
6. Priorities for service development and improvement
Cancer unit Development
The Harbour Hospitals Oncology unit has been approved for a refurbishment programme which
is due to take place later in 2015. This will provide patients with a state of the art facility for day
case and inpatient chemotherapy to be administered. An open plan day case unit is being
designed, together with individual bedrooms with upgraded facilities to provide comfort to
patients and their families being treated for solid tumour and haematological cancers. The unit
will also house consultation and assessment rooms for patients in therapy. There are links with
the Dorset Cancer Network and local Hospice service .
Endoscopy and Theatre
The Harbour Hospital is looking to undertake off site decontamination for endscopy allowing
further opportunity to expand the theatre suite to develop the Theatre 3 for ambulatory care
work . There has been n a shift over the years for more in the way of walk in walk out theatre
cases given the advances in technology and operating techniques . The patient journey has
been modified accordingly
Specialist Physiotherapy Services
Effective, evidence based techniques and equipment to optimise recovery from surgery.
Rehabilitation based on the foundations of enhanced recovery principles.
•Patients involved in thorough pre-operative assessment and intervention so that they
know what to expect when they come in to hospital.
Post- surgery physiotherapy involvement to get patients mobile, improving recovery
and limiting complications.
Patients are involved in plans for their discharge from hospital early in their
admission process so that we can get them home feeling safe and well prepared for
further rehabilitation.
Excellent links with orthopaedic specialist outpatient physiotherapy team who will continue
rehabilitation after discharge to help patients to achieve their goals.
Cryotherapy
Game Ready cryotherapy system is now used following hip and knee replacement. Game
Ready uses technology to regulate cold and compression getting to areas following surgery,
aiming to limit pain, bruising and swelling.
Mechanical intermittent compression Cryocuff is now used after joint replacement. This uses
modern technology to intermittently push ice cold fluid into a cuff around an operated area
aiming to limit swelling, bruising and pain.
AlterG Antigravity Treadmill
The AlterG treadmill uses NASA technology to reduce weight going through the body down to
between 20-100% of body weight. As the machine weighs the patient this is an excellent
objective method of controlling the force going through the body, which can result in a number
of benefits:
• It is possible to progressively load the body over time meaning that rehabilitation can start
earlier and be gradually progressed.
• Rehabilitation is likely to be more effective returning patients to their chosen activities.
• Patients will be able to walk unaided on the Alter G just days after their joint replacement
surgery.
Watt Bike
Patients at The Harbour Hospital are now benefiting from the introduction of The Watt Bike.
Created with British cycling, The Watt Bike measures power developed by the patient. It is able
to compare power from one leg to another and also shows the patient, and physiotherapist,
which muscle is working whilst using the bike. This helps with rehabilitation by giving objective
measurement of strength and enables specific rehabilitation, aiming to improve leg strength and
technique.
Phoenix Muscle Stimulator
The Phoenix muscle stimulator is especially designed to work on improving quadriceps strength.
Using specific settings the stimulator is able to contract the muscle over 20 minutes. As patients
are able to use this at home as part of their treatment they can benefit from a daily workout of
their quadriceps muscles without loading the knee joint excessively.
EXOS Bracing System
The Exos bracing system is used for hand and wrist problems. It is removable, adjustable and
waterproof and is a great alternative to plaster and splinting for suitable fractures and injuries.
7. Mandatory Quality Indicators
8.1 The value of the summary hospital-level mortality indicator (SHMI) for the Harbour Hospital
for the reporting period.
Unit
6
Reporting Periods
(at least last two
reporting periods)
Oct 2012 – Jun 2014
National
Average
Highest National
Score
Lowest National
Score
0.9987
1.1849
0.58345
The Harbour Hospital considers that this data is as described for the following reasons:The unit provides oncology services and has provided end of life care for patients.
8.2 The Harbour Hospital patient reported outcome measures scores for
(i) Groin hernia surgery
Unit
Reporting Periods
(at least last two
reporting periods)
Apr 14 – Sept 14
National
Average
Highest National
Score
Lowest National
Score
0.0786
0.278
-0.112
The Harbour Hospital considers that this data is as described for the following reasons (insert
reasons).
(ii) Hip replacement surgery
Unit
No data
Reporting Periods
(at least last two
reporting periods)
Apr 14 – Sept 14
National
Average
Highest National
Score
Lowest National
Score
21.542
28.6
9.714
Hip replacement surgery was only performed at the Harbour hospital form July 2014. We do
not have any statistically relevant data available for this reporting period.
(iii) Knee replacement surgery during the reporting period.
Unit
No data
Reporting Periods
(at least last two
reporting periods)
Apr 14 – Sept 14
National
Average
Highest National
Score
Lowest National
Score
16.641
24.429
5.833
Knee replacement surgery was only performed at the Harbour hospital form July 2014. We
do not have any statistically relevant data available for this reporting period.
8.3.(ii)The percentage of patients aged 15 or over readmitted to a hospital which forms part of
the Harbour Hospital within 28 days of being discharged from a hospital which forms part of the
hospital during the reporting period.
Unit
0.324%
Reporting Periods
(at least last two
reporting periods)
Apr 11 – Mar 12
National
Average
Highest National
Score
Lowest National
Score
10.01
14.51
5.54
8.4 The Harbour Hospital’s responsiveness to the personal needs of its patients during the
reporting period.
Unit
98.34%
Reporting Periods
(at least last two
reporting periods)
2013-2014
National
Average
Highest National
Score
Lowest National
Score
68.7
85
54.4
8.5 The percentage of patients who were admitted to the Harbour Hospital and who were risk
assessed for venous thromboembolism during the reporting period.
Unit
100
Reporting Periods
(at least last two
reporting periods)
Apr 14 – Jan 15
National
Average
Highest National
Score
Lowest National
Score
95
100
87
8.6 The rate per 100,000 bed days of cases of C difficile infection reported within the Harbour
Hospital amongst patients aged 2 or over during the reporting period.
Unit
Rate
Reporting Periods
(at least last two
reporting periods)
Apr 13 – Mar 14
National
Average
Highest National
Score
Lowest National
Score
14.7
37.1
0
8.7 The number and, where available, rate of patient safety incidents reported within the
Harbour Hospital during the reporting period, and the number and percentage of such patient
safety incidents that resulted in severe harm or death.
Number of patient safety incidents reported
Unit
122
Reporting Periods
(at least last two
reporting periods)
Oct 13 – Sep 14
National
Average
Highest National
Score
Lowest National
Score
20
139
0
Rate of patient safety incidents reported (Incidents per 100 Bed Days)
Unit
4.747
Reporting Periods
(at least last two
reporting periods)
Oct 13 – Sep 14
National
Average
Highest National
Score
Lowest National
Score
3.589
7.496
0.0245
Number of patient safety incidents that resulted in severe harm or death
Unit
1
Reporting Periods
(at least last two
reporting periods)
Oct 13 – Sept 14
National
Average
Highest National
Score
Lowest National
Score
40.2
97
0
Percentage of patient safety incidents that resulted in severe harm or death (Incidents per 100
Admissions)
Unit
0.08%
Reporting Periods
(at least last two
reporting periods)
Oct 13 – Sept 14
National
Average
Highest National
Score
Lowest National
Score
0.3
2.4
0.0
8.8 The percentage of staff employed by the (name of hospital) during the reporting period, who
would recommend the (name of hospital) as a provider of care to their family or friends.
Unit
Reporting Periods
National
Highest National
Lowest National
85%
(at least last two
reporting periods)
2014
Average
Score
Score
64.58
96.43
33.73
8. Non-Mandatory Quality Indicators
9.1 The percentage of patients who received care as inpatients or discharged from A &E during
the reporting period, who would recommend the Harbour Hospital as a provider of care to their
family or friends.
Unit
85.33%
Reporting Periods
(at least last two
reporting periods)
Jun 13 – Jan 14
National
Average
Highest National
Score
Lowest National
Score
66.23
94.38
35.63