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 Hospital Information BMI St Edmunds Hospital has 31 beds with all rooms offering the privacy and comfort of ensuite facilities, satellite TV, wi-fi access and telephone. 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. The fire system upgrade has been completed. The uninterrupted power supply system has been replaced. The physiotherapy service has now been brought totally in-house which has contributed to continued patient service improvement and supported our delivery of the enhanced recovery pathway for hip and knee replacement patients. NHS work currently accounts for 42% of our overall work. We currently offer orthopaedics, hernia repairs, cataract surgery, gynaecology, limited colo-rectal and urology services on Choose and Book. We have continued our AQP contract for West Suffolk Adult Carpel Tunnel service and have a number of spot NHS contracts for footwork, scope surveillance, gynaecology, urology, general surgery and orthopaedic work. BMI Healthcare is registered as a provider with the Care Quality Commission (CQC) under the Health & Social Care Act 2008. BMI St Edmunds Hospital is registered as a location for the following regulated services:• • • Treatment of disease, disorder and injury Surgical procedures Diagnostic and screening We are in the process of registering for Family Planning services. We have commenced the replacement of carpet in patient rooms for hard flooring and have had 3 handwash basins installed in the ward corridors over the last year to improve infection prevention and control compliance. The CQC carried out an unannounced inspection on 17th December 2013 and found one standard not met which was in relation to quality assurance in assessing and monitoring the quality of service provision covering infection prevention and control, equipment and maintenance. 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 Actions were immediately taken to address the areas of concern and BMI St Edmunds were then deemed compliant after subsequent follow-up unannounced inspection in July 2014. BMI St Edmunds 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. 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 Jill Cerny. 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 BMI St Edmunds. We have had: • No MRSA bacteraemia cases/100,000 bed days • No x MSSA bacteraemia cases /100,000 bed days • No x E.coli bacteraemia cases/ 100,000 bed days • No cases 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. We have had no hip or knee replacements infections we are aware of over the last year. o Hips replacements o Knees replacements The site undertakes High impact intervention care bundle audits for peripheral cannulas, surgical site pre and post op, urinary catheters insertion and ongoing care. Actions are taken to improve and maintain compliance and results are fed back at Infection Prevention and Control meetings, Clinical Governance meetings and Medical Advisory Committee meetings. High Impact Interventions 2014-2015 Monthly Surgical site pre op Surgical site post op Urinary catheter insertion Urinary catheter ongoing care Peripheral line insertion Peripheral line ongoing care CVC insertion CVC ongoing care Blood Cultures Hand Hygiene BBE Clinical area responsible for audit Oct Nov Dec Jan Feb Theatre 100% 100% 100% 100% 100% 77% Ward 100% 100% 100% 100% 100% 100% Theatre 100% 100% 100% 100% 100% 100% Ward 100% 100% 88% 100% 100% 100% Theatre 91% 92% 83% 91% 96% 96% Ward 100% 100% 100% 100% 100% 95% Theatre N/A N/A N/A N/A N/A N/A Ward RMO All staff All staff N/A N/A 100% N/A N/A 100% N/A N/A 100% N/A N/A 90% N/A 100% 100% N/A N/A 100% Annually HCAI Self Assessment Clinical Areas Inpatient management OPD management Patient Equipment PPE Sharps safety Mattresses Endoscopy Pharmacy Theatre March IPC IPC 98% IPC 95% IPC IPC IPC IPC IPC Theatre Pharmacy IPC 100% 100% 100% 100% Peripheral line insertion has been a main area for focus as a result of the audits and this has largely been due to medical staff not always wearing gloves for cannulation. This has been raised at MAC. We have launched Asceptic Non-touch Training with the staff this year from September onwards through a theoretical e:learning module and competency assessment. Environmental cleanliness is also an important factor in infection prevention and our patients rate the cleanliness of our facilities highly. Excellent & Very good 100% 80% 60% Excellent & Very good 40% 20% 0% Room cleanliness Bathroom cleanliness 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 March 2014 audit, published by NHS England, August 2014 are shown below. Actions taken as a result of the audit included: • the removal of pallets left outside the waste compound • repairs to the road where it had become eroded • remarking of the pedestrian path alongside the road • signage to mark the drop off point at the Hospital Reception • reception radiator cleaning increased to bi-monthly due to their position by the entrance • replacement flooring to reception toilets • removal of limescale residue around some taps and increased audit checks of these areas. 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, BMI St Edmunds 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 BMI St Edmunds achieving 100% of patients being risk assessed. The VTE Risk Assessment has been incorporated into the patient medication chart so is reviewed by nursing staff frequently. BMI St Edmunds 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. In 2014-15 we had not reported incidences of DVT at this site. DVT (Rate per 100 admissions) 0.045 0.040 0.0396 0.0346 0.035 0.0343 2009 0.030 2010 0.025 2011 0.020 2012 0.015 2013 0.010 2014 2015 2011 0.0000 0.0000 2015 0.0000 2014 0.0000 2010 0.005 2013 2012 2009 0.000 In 2014-15 we had only one pulmonary embolism which was notified to us post patient discharge. PE (Rate per 100 admissions) 0.0686 2009 2010 0.0396 0.0357 0.0354 2011 2012 2013 2014 2015 2014 0.0000 2013 2012 0.0000 2011 2010 0.0000 2009 0.080 0.070 0.060 0.050 0.040 0.030 0.020 0.010 0.000 2015 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. For the current reporting period, the tables below demonstrate that the health gain between Questionnaire 1 (pre-operative) and Questionnaire 2 (post–operative) for patients undergoing hip replacement and knee replacement at BMI St Edmunds Hospital. Due to the reporting mechanism for PROMS results are only reported where there are more than 30 PROMs questionnaire returns a quarter. We are therefore only able to report hip scores. April 14 – September 14 Oxford Hip Score average Health gain between reporting Q1 Q2 periods BMI St Edmunds Hospital 23.222 39.556 16.333 England 18.16 40.081 21.922 Copyright © 2013, The Health and Social Care Information Centre. All Rights Reserved. April 14 – September 14 BMI St Edmunds Hospital England Oxford Knee Score average Health gain between reporting Q1 Q2 periods <30 unable to score <30 unable to score Unable to score 19.401 36.103 16.702 Copyright © 2013, The Health and Social Care Information Centre. All Rights Reserved. 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. Group 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 We are pre-assessing the majority of patients planned for general anaesthesia and additionally are telephone pre-assessing many patients undergoing procedures under local anaesthesia. We have introduced group education classes for hip and knee joint surgery patients which have proved very popular from patient feedback. We are reviewing our service to see if this workshop approach could work for any of our other specialities. 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. Unplanned readmission with 31 days per 100 discharges, have remained low. Unplanned Readmission within 31 days (Rate per 100 Discharges) 0.4635 0.500 2009 0.400 2010 0.300 0.1981 2011 0.2300 0.1731 0.200 0.1373 2012 0.1429 2013 0.100 0.0000 2015 2014 2013 2012 2011 2010 2009 0.000 2014 2015 Unplanned return to theatre (Rate per 100 Theatre Cases) 0.4545 0.500 0.4197 2009 0.400 2010 0.300 0.200 0.2592 0.2221 0.1533 2011 2012 0.1128 2013 0.100 0.0000 2014 2015 2014 2013 2012 2011 2010 2009 0.000 2015 Unplanned return to theatre cases have remained consistently low. 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. Additionally we participate in data collection questionniare for NHS Friends and Family for both in-patient and outpatient servcies. Do tables with your data and narrative on your improvement plans etc. Suggest doing the scores of % excellent and very good for the grouped sectios i.e. Admisison, Nursing, Accommodation, Catering, Departure, Overall quality of care. Compare last 2 years. 2012-14 2014-15 98 Admission 96 100 Admission 80 Consultant Nursing 94 60 Nursing Accommodation 40 Accomodation Catering 20 Catering 92 90 88 86 0 Departure 84 2012/2013 Discharge St Edmunds Hospital 201415 2013/2014 Quality of Care 3.2 Complaints In addition to providing all patients with an opportunity to complete a satisfaction survey BMI St Edmunds 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. BMI St Edmunds Written Complaints (Rate per 100 admissions) 0.900 0.7961 0.800 0.700 0.7431 0.6786 0.6337 2009 0.5704 0.600 0.5258 2010 0.4804 0.500 2011 0.400 2012 0.300 2013 0.200 2014 2015 0.100 2015 2014 2013 2012 2011 2010 2009 0.000 We have received 1 written complaint regarding patient care and 3 verbal complaints from NHS patients over the last year. No trends were identified. Across the site we received a total of 23 complaints April 2014 to March 2015: Type of complaint Total Number Clinical Consultant Admin Financial Other Verbal 14 6 4 4 0 0 Written 9 5 0 1 3 0 Total 23 11 4 5 3 The number of complaints represents a 0.0003% complaint rate across the site for in and outpatient care. There were no trends in the data. Actions taken as a result of feedback: • • • Customer care training rolled out to all staff with patient contact Changes to processes in our admissions team Pain training to be refreshed for clinical team 4. CQUINS CQUINs were agreed and set to cover: • • • • • Number of Friends & Family responses Collection of Outpatient Friends & Family Response impelementation High impact intervention care bundle completion for patients with an indwelling urinary catheter Dementia assessments on inpatients over the age of 65years Smoking cessation health education literature and cessation referrals if required for patients identified as a smoker at pre-assessment Friends & Family questionnaire returns dropped off in the last quarter. On investigation it was discovered that some inpatients were being given the outpatient questionnaire for completion and that this was affecting our data. The questionnaires have now been altered to clearly identify them as ‘in-patient’ or ‘out-patient’ so this should address the problem going forward. BMI St Edmunds has achieved the CQUINs set across all the areas for this year. CQUINs 14-15 BMI Bury St Edmunds Hospital N1a Friends and Family Increased Response Rate Description of Indicator Increase response rate Performance and Target 25% in Q1, 26% in Q2, 27% in Q3 and 28% in Q4 N1b 54.4 25% Yes 40.1 26% Yes na na na na na na Implem ent only no na 100% 70% Yes Implem entatio n only no value na 93% tbc na Implem entatio 100% n only no value 55 27% Yes 32.12 28% Yes Imple ment and Yes na na na 100% 70% yes 100% 96% tbc 100% tbc 100% tbc 100% tbc Friends and Family Early Implementation Extended implementation of FFT to Description of Indicator Outpatients and Daycases by October 2014 Report implementation to commissioner Performance and Target by 31 Oct 2014 N2.1 % % % % Achiev Achiev Targ Achieve Targ Achiev Achieve Target Achiev Target Achieve Achieve ed ed et d et ed ment ement ment ment Safety Thermometer - Improvement Goal Description of Indicator Catheter Care Bundle Audit Percentage of patients with appropriate Performance and Target bundle (implement Q1, 70% Q2 and 100% Q3, Q4 target tbc) L1 Description of Indicator Mental Capacity Assessing inpatients aged 65 or over using the agreed questionnaire Percentage of inpatients aged 65 or over who were asked the agreed Performance and Target questions (Implementation Q1, target to 50% be set thereafter for subsequent quarters achievement) L2 Description of Indicator 70% 100% Smoking Cessation Offering advice on quitting to patients who are identified as smokers at preoperative assessment clinics Percentage of smokers who were Implem provided with self-help and selfentatio Performance and Target referral information (Implementation Q1 100% n only and Q2, targets to be set for Q3 and no Q4. value na 5. National Clinical Audits BMI St Edmunds 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 NJR report. Quality of information submitted by BMI St Edmunds Hospital. . Data for 1 April 2013 - 31 March 2014 This National Hospital Expected Quality Measure Compliance (For the Trust) Consent No Data Available Better Than - - 99.4% 85.0% 93.7% 92.0% 8 Days 30 Days Expected Valid NHS number Time taken to enter data As Expected Better Than Expected 6. Research No NHS patients were recruited to take part in research. 7. Priorities for service development and improvement • • • • • • • Access road badly eroded in places after the winter and unable to be repaired. To be resurfaced to prevent risk of falls to our patients and visitors. High toilet to be put into Reception area toilet to assist patients with arthritic hips. This was as a result of patient focus group feedback. Improved internal signage as identified at PLACE audit to identify toilets in Reception and way out signage from pre-assessment Pre-assessment screening to be undertaken for all local anaesthetic procedures as well as general anaesthetic procedures. Meal courses to be served separately at meal times as identified at PLACE audit. Redecoration of some patient rooms to be undertaken to refreshen. Recovery monitors to be replaced to increase monitoring provision. • Feedback of incidents with actions to the relevant departments for improved shared learning. 8. Mandatory Quality Indicators 8.1 The value of the summary hospital-level mortality indicator (SHMI) for the BMI St Edmunds Hospital for the reporting period. Unit Reporting Periods (at least last two reporting periods) Oct 2012 – Jun 2014 0.00 National Average Highest National Score Lowest National Score 0.9987 1.1849 0.58345 BMI St Edmunds Hospital does not have a High dependency unit or intensive care and has only undertaken day case chemotherapy. No patient deaths have been reported. 8.2 The BMI St Edmunds Hospital patient reported outcome measures scores for (i) Groin hernia surgery Unit Not reported due to low numbers. 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 (ii) Varicose vein surgery for NHs patients is not undertaken at this site. (iii) Hip replacement surgery Unit Reporting Periods (at least last two reporting periods) Apr 14 – Sept 14 16.333 National Average Highest National Score Lowest National Score 21.542 28.6 9.714 The BMI St Edmunds Hospital has an active enhanced recovery programme in place and a hip pathway. Joint school classes have been commenced to improve patient preparation and expectation. (iv) Unit 17.04 Knee replacement surgery during the reporting period. Reporting Periods (at least last two reporting periods) April 13 – Mar 14 National Average Highest National Score Lowest National Score 16.641 24.429 5.833 Hospital data unavailable for period as for hip surgery previous quarter data displayed. The Hospital considers that this data is as described due to the active enhanced recovery programme and joint school for knee surgery patients. 8.3 (i) This site does not admit children under the age of 18 years of age. 8.4 The BMI St Edmunds responsiveness to the personal needs of its patients during the reporting period. Unit 98.19% Reporting Periods (at least last two reporting periods) 2014-2015 National Average Highest National Score Lowest National Score 68.7 85 54.4 This result was obtained from the average of all measures combined (Impression of admission/consultant/Nursing/Accommodation/ Catering/Discharge/Quality of Care/How likely to recommend to Friends and Family). Monthly quality meetings are held to feedback patient results and review actions to be taken to improve the patient journey and experience. 8.5 The percentage of patients who were admitted to BMI St Edmunds Hosptial) 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 The BMI St Edmunds considers that this data is as described for the following reasons: consistent adherence to completion of pathway. The VTE scores were embedded into the patient medication charts which ensures consistent completion by the nursing staff. 8.6 The rate per 100,000 bed days of cases of C difficile infection reported within the St Edmunds Hospital amongst patients aged 2 or over during the reporting period. Unit 0.00 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 The Hospital only admits over 18 years of age. 8.7 The number and, where available, rate of patient safety incidents reported within the BMI St Edmunds 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 86 Reporting Periods (at least last two reporting periods) Apr 14 – Mar 15 National Average Highest National Score Lowest National Score 20 139 0 Rate of patient safety incidents reported (Incidents per 100 Bed Days) Unit 6.6755 Reporting Periods (at least last two reporting periods) Apr 14 – Mar 15 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) Apr 14 – Mar 15 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) Apr 14 – Mar 15 National Average Highest National Score Lowest National Score 0.3 2.4 0.0 The number of incidents and rate of incidents per 100 bed days reported appears high but demonstrates the robust reporting culture across site. Comparatively the number of incidents resulting in severe harm was very low. The BMI St Edmunds Hospital considers that this data is as described for the following reasons: • Work has been undertaken to improve the reporting of incidents and near miss events across the departments and the importance of reporting so incidents can be reviewed and actions taken. • Improved clinical training programme for staff • We are in the process of training all clinical leads how to report incidents on the system We will continue to encourage this open reporting culture. 9. Non-Mandatory Quality Indicators 9.1 The percentage of patients who received care as inpatients during the reporting period, who would recommend the BMI St Edmunds Hospital as a provider of care to their family or friends. Unit 82.42% Reporting Periods (at least last two reporting periods) April 13 – Mar 14 National Average Highest National Score Lowest National Score 66.23 94.38 35.63 The following actions have been taken to improve this: • To try and increase the number of responses returned • Minimum 6 weekly quality review meetings to discuss results and comments • Quality Health results to be a mandatory topic for discussion at all departmental meetings