Quality Report
2010/11
Part 1 Board Statement on Quality
Message from the Chief Executive
Welcome to the first integrated Quality Report for 2010/11, for the new organisation
which is brought to you at a particularly exciting time – for both staff and patients
and for me personally, as I take up my new role as Chief Executive.
you can see how we have improved in delivering care.
The past 12 months have seen major changes
proposed across the entire health service, all of
which continue the focus on giving patients high
We are committed to delivering the highest standards
quality and safe care. This Quality Report is, in
of quality and safety and as a Board are proud of the
part, our response to this complex but worthwhile
progress we have made in the last 12 months. This is
agenda, and outlines some of the challenges we
reflected in the accuracy and our endorsement of the
have faced, the great changes we have made and
information within this report. However, we know that
identifies where we need to do better.
we cannot take our eye off quality for one minute.
Our new organisation, Walsall Healthcare NHS Trust,
We have agreed ambitious targets for quality over
which brought together hospital and community health
the next 12 months and we know that we have
services was officially formed on April 1st 2011 and
challenging times ahead. With the hard work of staff and
this is the first time we have produced an integrated
the support of our patients we know we will get there.
Quality Report. This takes examples from across all of
our services, from community nursing and midwifery
Richard Kirby
Chief Executive
teams through to hospital doctors and nurses so that
Just to put things into perspective, we see:
A&E Attendees
New Outpatients
Follow-up Outpatients
Elective Inpatients
Day Case Inpatients
Emergency Inpatients
Overall Activity
2008/09
2009/10
2010/11
Total
3 year average
78,626
73,000
74,691
226,317
75,439
77,057
82,000
78,967
238,024
79,341
155,834
195,000
170,874
521,708
173,902
4,659
4,000
4,516
13,175
4,392
24,669
25,000
24,435
74,104
24,701
31,732
31,000
28,549
91,281
30,427
372,577
410,000
382,032
1,164,609
388,203
Did you know that Wembley Stadium holds 90 thousand people? This means we see over four times as many
people a year as can fit into Wembley.
2
Part II Quality Matters
❑ We had a number of national award
successes including a ’highly commended’
in the Healthcare People Management
2010/11 has brought about great changes and
Association (HPMA) awards for our staff
challenges in delivering healthcare across Walsall:
engagement programme ‘Our Manor:
❑ The hospital and local community services
better together’, an award from the Royal College
of Nursing for the maternity team’s ‘Reflexology
integrated into one organisation - Walsall
to Induce Labour’ programme and finalists in the
Healthcare NHS Trust
British Journal of Nursing Awards for the work that
❑ Our new £170million state-of-the-art hospital
we have done around Paediatric services
opened on time and on budget and continues to
❑ Regular clinical meetings have helped build
offer patients high quality care
relationships between GPs and hospital doctors
❑ Groundbreaking work has been undertaken on
❑ We launched our new Quality Plan which set
five pathways of care which will have a significant
objectives for the next three years for quality and
impact on patient care
safety
❑ Walsall Healthcare NHS Trust started the journey
❑ Services across the community carried out more
to become a Foundation Trust by officially
than 130 activities including patient forums and
entering into a contract with the Strategic Health
consultation groups, to capture patients’ views
Authority, Walsall Primary Care Trust and the
and raise awareness of services that are available
Department of Health
closer to patient’s homes.
Photo courtesy of Express and Star
3
We use patient feedback, complaints, the Patient
At any given time Walsall Healthcare NHS Trust
Advice and Liaison Service (PALS), partner
works on a number of programmes that focus on
organisations and national sources such as Dr
improving quality, safety and the patient’s experience.
Foster (an organisation which collects and provides
Here are some examples of where these have been
healthcare information) to identify areas where
successful:
our focus on quality matters. These were further
influenced by the Commissioning for Quality and
New pathways of care
Innovation measures (CQUINs) jointly agreed with
the Primary Care Trust and Strategic Health Authority.
Work started in 2010/11 to make improvements to
These priorities formed the backbone of our Quality
how patients are cared for across five high volume
Plan last year and continue to be our focus moving
clinical pathways:
forward into 2011/12.
l Chronic Obstructive Pulmonary Disease (COPD)
This year tested our organisation as the combination
l Musculoskeletal conditions
of a bad winter and an increased number of very ill
(for example back pain and hip replacements)
patients stretched resources for prolonged periods
l Diabetes
of time. We did however make sure that patient’s
l Cardiovascular Disease
experience and the quality of care they received was
l Frail elderly people
not compromised.
Staff from across the newly formed organisation have
been working together to design these so they are as
patient friendly as possible. This combined approach
to helping patients has lead to:
❑
The musculoskeletal pathway team developing
a triage service (this acts as a single point of
entry for care), so that patients can access the
most appropriate treatment easily and quickly
❑
The cardiovascular team further developing the
role of health trainers to improve the lifestyle and
long term health of Walsall residents. Working
with local people, the health trainers offer
practical support to improve patient’s and carer’s
knowledge, skills and confidence in developing a
healthier lifestyle.
In a town where varying levels of deprivation exist
and industrial pollution is responsible for a large
proportion of chronic ill health, improvements in
lifestyle services will enable many people to enjoy
better health in the long term.
4
Learning Disability Service
Establishment of the Befriending
Service
Empowering individuals to live the life they want is
at the heart of Walsall’s Learning Disability Service.
We care for a large number of frail elderly patients
Work has been undertaken to gain patient’s views on
– some of whom have little or no family. Therefore
the services provided, the outcomes of which have
we established a befriending service to offer patients
helped us make learning disability services more
the opportunity to spend time with our volunteers.
responsive and user friendly.
This could simply be for a chat, to watch television
together, to read a book or to play board games.
Following feedback from our service users, we have
made a number of positive changes:
❑
Reflecting on 2010/11,
Moving Forward in
2011/12
a ‘meet & eat’ service has been set up so that
patients and carers can discuss issues that
affect them and talk to similar, like minded people
❑
increased attendance at self advocacy groups
In 2010/11 we began our journey toward becoming
such as ‘Healthy Lives’
❑
better engagement with the public at events
one new organisation. Bringing hospital and
such as ‘Health Fairs’, ‘Diabetes & Me’ and
community together opens up exciting opportunities
the Pacesetters Programme. These aimed to
to make services more efficient, effective and
help patients better understand, manage and
accessible for our patients. We did this by agreeing
deal with their conditions.
five principles that the Board signed up to.
These are outlined below:
Five working principles to support an integrated health economy for Walsall
1. Enhance our ability to meet the health and social care needs of the Walsall population.
2. Working in partnership to enable our services to be better co-ordinated and integrated.
Existing barriers that hamper service users moving from one part of the service to another
must be removed.
3. Development of a common information set covering patient needs, quality outcomes and
costs. Strong integrated care pathways should deliver greater quality benefits and initiatives
such as increasing care closer to home.
4. Key players in a formal alliance must incentivise and share risk around service developments,
governance, and organisational structure.
5. Increase efficiency by reducing non elective activity, unwarranted variation and length of stay.
5
Together staff are committed to making these
to them and included these on our afternoon snack
principles become a reality. Integration of these
trolley.
services heralds a new era in healthcare delivery
Looking back – How we did
for patients, carers and residents of Walsall. An
example of this is ensuring that staff from across both
original organisations are represented in committees,
In the first Quality Report we outlined a number of
bringing together their expertise for the benefit of
areas where changes were needed:
patients.
❑
2010/11 saw the launch of our second Quality Plan,
Improving patient feedback. We implemented a
number of systems that capture patient opinions
“Perfect Care Every Time”. This plan focuses on five
across our wards. This patient’s view of care is
areas where change will have the biggest overall
used by staff to improve their service. We also
impact. These are:
set up systems to highlight to staff what patients
are saying about their ward, based on questions
Priority 1
To further improve the patient experience
from local surveys. This information helps us to
identify where improvements are being made.
Priority 2
To further reduce healthcare acquired infections
An example is highlighted on the next page:
Priority 3
To keep our hospital mortality rates below the
national average of 100
Priority 4
Keeping you safe (reducing harm)
Priority 5
Improving End of Life Care
These priorities have been identified as important to
our patients across our organisation.
Priority 1 –
To Further Improve the Patient
Experience
Walsall Healthcare NHS Trust has worked hard to
improve the experience that people have when they
come to the hospital for an appointment, operation,
to visit relatives or to be seen closer to home by a
community nurse or midwife. Feedback from local
and national patient surveys helps us identify areas
where we are doing well and where we need to make
improvements. For example, patients told us that
they would like a wider variety of snacks available to
them. In response we improved the range available
6
Q28 Rating of food
100
90
80
Walsall Average
70
NHS Average
60
NHS Top 20%
50
NHS Best
40
NHS Bottom 20%
30
20
10
0
AMU HDU Lin
1
2
3
4
7
9
10
11
12
14
15
16
17
23
This graph shows how patients rate (out of 100) the
food on a number of our wards. This is compared to
all NHS hospitals and shows that we are performing
very well.
❑
Setting up a number of staff training programmes
such as ‘Excellence through People’ and ‘First
Impressions’ which focus on helping staff deliver
a better patient experience.
We also:
We also used patient feedback from the National
Inpatient and Outpatient surveys via the Care Quality
Commission, to see how we were doing.
Hospital Ward
❑
❑
Continued to build on the work already
undertaken to educate staff about the impact
that their actions and attitudes have on patients
and relatives. In response to this the hospital
continues to run its ‘Our Manor: better together’
staff engagement programme
Reduced waiting times in Outpatients by
making improvements to our appointment
systems. We responded by simplifiying the
process for sending appointment letters to
patients.
In addition to the examples outlined above, we
undertook new initiatives in 2010/11 to improve the
patient experience. These included:
❑
❑
‘Mealtime Mate’ – volunteers sit with patients at
mealtimes to provide motivation, companionship
and, when appropriate, assist with feeding
‘Create’ – a new project developed in conjunction
with our Arts Coordinator where volunteers
encourage and assist patients in arts and craft
activities
7
Results for
Inpatient
Areas 2009/10
Results for
Inpatient
Areas 2010/11
Results for
Outpatient
Areas 2009/10
Patient’s rating
of their overall
views and
6.4 out of 10
8.6 out of 10
8.1 out of 10
experiences
of the Trust
Results for
Outpatient
Areas 2010/11
Survey not
undertaken
The table above shows how patients scored us
This feedback does lead to prompt improvements.
out of 10, for our Inpatient and Outpatient areas,
For example, Q68 resulted in a review of all the
with 10 being excellent and 1 being poor. As the
information patients are given on discharge to make
numbers show there has been a great improvement
sure it is readable, clear and addressed what to do if
in how patients view the experience they have in our
they ran into trouble at home.
Inpatient areas (improving from 6.4 to 8.6).
The above results are broken down further to show
us which areas did well or badly. This information (an
example shown in the table below) is shared with
Trust Score
staff so they can see where patients want them to
improve.
Year
Year
2009
2010
Overall
Q69
Were you told who to
contact if worried
Q68
Were you and/or your family
given information about your
discharge
Q35
67%
69%
47%
50%
Did you get the answers to your
question from nurses
77%
77%
Q22
Did you consider your room or
ward to be clean
84%
84%
Q76
Were you provided with leaflets
on how to complain
37%
33%
Q65
Were you told how to take your
medication
75%
73%
8
2009
compared to
2010
How we can improve
The hospital is just one piece of the jigsaw. Staff from
community services have also undertaken a lot of
work with the users of their services to understand
A large amount of work goes on across all Walsall
how to improve their experience. Examples include:
Healthcare services to improve the patient
experience, however patient’s comments have
❑
The use of Patient Experience Trackers for
shown us that our communication is not always as
collecting real time data. These help community
informative as they would like. This is an area we will
services to understand what patients really think
focus on over the next 12 months.
so that any problems can be resolved and
Looking forward – what will we do?
suggestions acted on.
❑
Coffee mornings where patients can discuss their
care. These act as a support group so they can
We are embarking on a number of programmes over
share stories about their experience.
the year:
❑
Expert Patient Programme
Launching a programme of culture change for all
staff within the new, integrated organisation.
This will focus on empowering staff to make
The Expert Patient Programme ‘Reunions’ is
simple changes quickly by reducing the red tape
proving to be an ongoing success in the
that often slows down good ideas
community. It teaches patients how to effectively
❑
manage their long term conditions to get the
Continuing to improve the decor on the wards in
the older parts of the hospital so that they are as
most out of life. Patients look at issues such
nice as the new parts of the hospital.
as diet and exercise and what to do if their
condition suddenly worsens. The patients, with
support from volunteers developed and lead this
programme themselves and invite experts to speak
and offer advice and guidance on topics of interest.
This event, held twice a year, regularly attracts
over 200 people. Recent initiatives have included
the ‘dental bus’ where residents can get check ups
and advice.
This programme concludes with an event to
celebrate what they have achieved and an
opportunity to network with other “Reunion”
patients. Staff from a range of organisations, such
as Social Care, the Police and Fire Service have
the opportunity to discuss issues and advise across
a wide variety of topics.
9
Priority 2 –
To Further Reduce Healthcare
Associated Infections
❑
Developed new policies on giving patients
antibiotics which have now been implemented
❑
Undertaken regular infection control audits
across the wards and within theatres
❑
Healthcare associated infections have been a
Put an antibiotic pharmacist in post, in line
with best practice
measure of quality for the past decade. Improved
❑
technology, new ways of working and more effective
Continued with the ‘Clean your Hands’ initiative.
frontline drugs have led to a decrease in the numbers
Work included introducing infection control notice
of infections. It is important that we continue to
boards for each Community Hub and Sure Start
eliminate as many infections as possible, thereby
centres to inform staff and the public on issues
improving patient outcomes and reducing costs.
such as hand hygiene and Norovirus
❑
Looking back – how we did
Set up an Infection Prevention and Control Study
Day. This event was held in October 2010 for all
community and nursing home care staff. It
Our last Quality Report identified two areas for
included talks on infection control compliance
attention. These were:
with national standards, how to deal with
outbreaks and what precautions to take in the
❑
Improving the techniques staff use when taking
presence of infection.
blood for culture, to ensure that any
❑
contamination associated with poor technique
One significant improvement was the establishment
is eradicated. In response to this, the Trust
of MRSA screening for all patients coming to the
set up an electronic training package for anyone
hospital for an operation. 97% of elective patients
who takes blood so they undertake a higher level
and 92.7% of non-elective patients were screened (of
of training and education
the 29,000-plus patients a year who need swabbing).
The organisation committed to undertake a
This is important as detecting MRSA in patients
project called ‘Seek and Destroy’. This was a joint
earlier helps us eradicate it sooner.
venture with community services to reduce MRSA
in Walsall’s highest risk population. A team visited
Walsall Healthcare NHS Trust takes all infections
every care and nursing home to educate and
seriously. There are, however, two areas where the
raise awareness of MRSA. Every resident was
organisation pays particular attention: MRSA and
screened and all those found to be MRSA carriers
Clostridium Difficile (C.diff).
given safe treatment to remove the bacteria
before it could put the health of themselves or
others at risk. The team are now embarking on
a regular programme of screening and are
working with homes in the community to identify
more ways in which they can keep the
environment safer for our vulnerable elderly.
We have also:
❑
Improved infection control signage and
purchased hand foam dispensers which are
installed across the hospital
10
MRSA
Walsall Healthcare NHS Trust had a total of 11 MRSA cases, achieving the national target. Of those, the
hospital reported seven cases of hospital acquired MRSA blood infections in 2010/11, an increase of four from
2009/10. Three of these turned out to be contaminated samples. The community had just four cases which is
below their national target of six. The integration of the two organisations will help us to reduce these numbers
even further.
MRSA figures 2010-2011
C.diff
Walsall Healthcare NHS Trust had a combined total of 161 cases of healthcare aquired C. diff (80 for the hospital
and 81 for the communtiy). This was against a combined target of 193. We collectively achieved the national
target but unfortunately the hospital did not meet the locally agreed target of 53 cases.
C. diff figures 2010-2011
11
How we can improve
A huge amount of work goes on across all Walsall
Healthcare services to manage infection. Two areas
where change will lead to improvements are:
❑
Better use of Root Cause Analysis to detect the
reasons why an infection occurred. This helps
us learn from what happened and take action to
reduce future risks of problems occurring again.
❑
Better understanding of data from across all
hospital and community services identify patterns and trends. Focused actions can then
be undertaken to target infections that are
increasing.
Looking forward – what will we do?
As the organisation grows and the hospital and the
community work much closer together we will focus
on:
❑
Improving the resources allocated to manage
infections, with the development and introduction
of an infection control plan for the new
organisation
❑
Ensuring the Infection Control Team continue to
make regular visits across our services to review
how staff are complying with standards and to
monitor improvements
❑
Buying new equipment and updating some of the
older estate
❑
Using new techniques such as Hydrogen
Peroxide misting on wards
❑
Focusing on the techniques associated with
intravenous line insertion and management to
help reduce our MRSA rates.
12
Priority 3 – Reducing our
Hospital Mortality Rates
We can then investigate further to see why this
particular condition appears to be more serious than
others in this town.
The Hospital Standardised Mortality Ratio (HSMR)
is an indicator that measures, through a national
Following a review of hospital information and
system called Dr Foster, whether the death rate at a
national reports, a number of conditions were
hospital is higher or lower than expected. Measuring
identified for further investigation (it is important to
the HSMR is complicated as it is influenced by a
note that the hospital was within appropriate, normal
large number of factors, such as the underlying
tolerance ranges for all these).
health of a person before their final illness. Reviewing
These were:
our HSMR on a monthly basis such as total numbers
of deaths and clinical incidents (along with other
❑
❑
❑
❑
❑
❑
❑
quality and outcome indicators) helps to ensure that
the care we give is of a high standard. Although we
aim to keep our HSMR below 100, if this does rise
above the average, we review our systems and
processes of care and feedback our learning to the
wider organisation.
Looking back – how we did
Decubitus Ulcer (pressure sore)
Stroke
Hip replacement 28 day readmission
Knee replacement 28 day readmission
TURP 28 day readmission (prostate surgery)
Obstetric tears (childbirth)
Postoperative Haemorrhage or Haematoma
A rolling programme of audit was set up to see if
anything could be done to improve care for these
We achieved a HSMR of 107. We also determined,
conditions.
from our last Quality Report that we would identify
those clinical conditions where the HSMR scores
The results of these reviews are being presented to
(relative chances of dying of a specific condition in
the organisation and a system has been set up so that
Walsall) are higher than other conditions in Walsall.
any learning points can be shared with clinical staff.
13
The graphs below show how we use information to manage this complex agenda.
150
140
130
National Average 2010/11
HSMRs
120
99.8% Control Limits
110
Acute Trusts (non-specialist)
Walsall Healthcare NHS Trust
2010/11 (Apr to Mar rebased)
100
90
80
70
60
50
0
500
1000
1500
2000
2500
3000
3500
4000
Expected Deaths
The funnel plot above highlights how hospitals are performing on mortality. Those hospitals that are within
the orange lines (Walsall is the blue dot) are performing well in comparison to other regional and national
hospitals. This is another way we use information to make sure we are constantly monitoring and measuring
our performance.
Mortality (in-hospital) l Diagnosis - All
Relative Risk
200
150
100
50
Mar-11
Feb-11
Jan-11
Dec-10
Nov-10
Oct-10
Sep-10
Aug-10
Jul-10
Jun-10
May-10
Apr-10
0
Trend (Month)
As the above graph shows there were three instances
❑
when the hospital went over the national average of
The number of severely ill patients who attended
hospital was much higher than expected
100. This occurred for a number of reasons:
❑
There was sustained, intense pressure over the
Winter.
14
How we can improve
When this increase happened we took a number of
actions:
❑
❑
A large amount of work goes on across all Walsall
Healthcare services to look at our mortality rates. The
main area where change will lead to improvements is
by making changes to our mortality audit form so that
even more information can be captured and used by
our teams.
Patient’s notes were reviewed by clinical
teams, against an internationally recognised set
of standards, to see if any issues could be
identified. This was to make sure that there were
no major issues identified with the care patients
received
These results were discussed at the Board (and
committee structures below the Board) to see
what occurred, why it occurred and what could
be done to improve outcomes during severe
peaks of illness in the future.
Looking forward – what will we do?
We compile a wealth of data on a monthly basis to
see if any issues are beginning to arise. However,
we will use the information in a much smarter way.
The graph below shows we have already made great
improvements in treating Fractured Neck of Femur
(hip fracture). The chances of dying from this have
steadily reduced (as the line of the graph goes down)
since 2006 and is now much lower than the national
average. Information like this will be cascaded to
all clinical teams so they can see how they are
improving in managing patient outcomes or identify
areas where improvements are needed. We will also
audit the notes of every patient who died through
our hospital mortality group, which is chaired by the
Medical Director.
This demonstrates that, as an organisation, we were
able to quickly identify and respond to any issues
caused by the effects of a peak in demand on the
service. This learning is helping us identify what we
will do differently over the next winter period.
Mortality (in-hospital) l Diagnosis l Fracture of neck and femur
Relative Risk
200
150
100
50
2010/11
2009/10
2008/09
2007/08
2006/07
2005/06
2004/05
2003/04
2002/03
2001/02
2000/01
1999/00
1998/99
1997/98
1996/97
0
Trend (Financial Year)
We will also provide clinicians and senior managers with the results of the Global Trigger Tool, a system
that looks in detail at a random sample of notes each month to assess how good the care was and identify
potential areas to improve. They will also see results from reviews of patients who have died, with the aim of
encouraging continuous review of the care we deliver and quickly identifying where we can do better.
15
Priority 4 –
Keeping you safe
❑ We made reducing harm caused by pressure
ulcers and falls a CQUIN measure
(Commissioning for Quality and Innovation)
We use what we call the ‘Quality Dashboard’ to
across the hospital and community for 2010/11.
measure and monitor how we are performing across
We have carried out a lot of work to reduce these
areas of quality and safety. Looking at our data on a
incidents. For example, in the area of falls we
monthly basis helps us to identify issues so they can
have:
l Established a group that specifically reviews
be dealt with quickly.
incidents of falls
l Standardised use of a best practice Falls
One area where data showed there could be the
start of a potential safety issue was in the use of
medications. Although the numbers were small we
were seeing a rise in these types of incidents. So
we made medication errors and harm one of the
priorities for improvement.
Assessment tool. This gives guidance on
the best ways to deal with patients who
have been identified as being at risk from
falling and has now been implemented
across all clinical areas and;
l The use of technology such as newly-
Looking back – how we did
purchased height adjustable beds for all
patients identified as being at risk.
❑ Implementing new web-based systems to help
Last year, our report identified a number of areas that
us analyse information about harm events as
we needed to focus on. Specifically:
soon as possible so we can spot where
problems are occurring and take corrective action
❑ Increasing staff awareness about the causes of
sooner. We responded by ensuring that each
harm and how they should report these. We
area now has access to the electronic system
responded by running campaigns across all
used to report incidents. This makes the
services were undertaken to continually raise staff
identification and management much easier
awareness on safety
compared to previous years.
16
Reducing events that cause harm is part of our new three year Quality Plan and has proven to be challenging.
As the graph below shows, since April 2009 we have decreased the number of harm events. There was
however, an increase over January to March. This was due to the pressures on the organisation of a bad
winter. We have analysed what happened and are using this to build new plans for next winter.
Harm Events Per 1000 Bed Days
70
Number of cases
60
Actual
50
40
30
20
10
It is not just within the hospital that services are being
made safer. The community is also undertaking many
initiatives to improve standards of care. For example:
❑ Safeguarding Adults: A new approach for referring
to adult safeguarding was introduced to ensure
the process is more efficient and effective
❑ Medical Devices: A rolling programme of
maintenance sessions have been established for
all staff
❑ Risk Assessment and Escalation: A review of
the process for risk assessment and escalation
was undertaken across community services.
This showed that quicker and more effective
ways of doing things could be introduced, such as
simplifying documentation and undertaking higher
levels of training and awareness on how to
escalate any issues.
17
Mar-11
Feb-11
Jan-11
Dec-10
Nov-10
Oct-10
Sep-10
Aug-10
Jul-10
Jun-10
May-10
Apr-10
Mar-10
Feb-10
Jan-10
Dec-09
Nov-09
Oct-09
Sep-09
Aug-09
Jul-09
Jun-09
May-09
Apr-09
0
Medication errors
We aim to be proactive in tackling the issue of
medication errors and the integration of the two
Last year we launched a number of projects to
organisations gives us a golden opportunity to share
decrease medication errors across our services.
learning and best practice.
For example, the hospital Pharmacy department
undertook a new approach to managing these errors:
How we can improve
❑ Established a baseline for current incidence of
A large amount of work goes on across all Walsall
medication errors
Healthcare services to manage patient safety. The
❑ Continued to develop, communicate and
two main areas that will lead to improvements are
demonstrate a culture of medication safety
across integrating our pressure ulcer systems so
❑ Improved error detection, reporting and the use
that we have a common approach to measuring
and sharing of information in order to implement
these and greater learning from the results of safety
best practice
investigations.
❑ Reduced the risk of errors with critical medicines
in line with National Patient Safety Agency
Looking forward – what will we do?
(NPSA) guidance and local initiatives
❑ Ensured that staff from across all service areas
We will continue to improve patient safety and reduce
are involved and represented at management
causes of harm by:
meetings and when developing plans to reduce
these incidents
❑ Focusing on one particular aspect of safety each
❑ Identified where new technology can be used to
month
reduce the risk of medication errors.
❑ Using a standard approach to managing
medicines across the hospital by applying
In addition staff from across the community undertook
nationally recognised programmes of work,
a full review into how they manage medications and
for example, the Productive Ward and
what to do if an error occurs. Following this a number
Productive Community Services programmes
of positive changes have been made:
❑ Changing the electronic system used to record
incidents to one that is more staff friendly. This
❑ Improved and more frequent training and
will reduce the time it takes to log an incident and
education for all staff who administer any form
will therefore make reporting much easier.
of medication
❑ Better record keeping for patients
❑ More involvement of patients for example, those
who are receiving palliative care. Staff from the
community worked with this group of patients to
see how and when they self medicated. This was
to make sure that principles of good pain control
were understood so any potential problems,
such as missing taking vital medicines, could be
highlighted and therefore minimised.
❑ Continue to raise awareness on safety issues.
18
Priority 5–
End of Life Care
Following a pilot using this on one of our hospital wards,
there were a number of positive results (shown in the
table on the next page). These showed that changes
to the ways in which staff support these patients, such
Walsall Healthcare NHS Trust is committed to
as carrying out daily team discussions to ensure better
ensuring that patients who are nearing the end of
discharging and improved communication with families,
their life receive the best and most appropriate care
have really improved care.
through the improved use of nationally-recognised
best practice approaches. These approaches outline
the care that patients can expect and the way in
which organisations should make sure that this is
undertaken.
We made this important agenda one of our main
priorities and set up an integrated community and
hospital working group. The main areas that the
group focused on over 2010/11 were:
❑
Improving communication between healthcare
professionals across all services by having local
staff, from all aspects of healthcare, meeting
regularly to discuss issues
❑
Continuing to use best practice tools and
techniques such as the Liverpool Care Pathway
and the Gold Standards Framework (GSF). The
GSF does not just apply to patients with cancer
but covers all end of life conditions
❑
Making sure that all staff play a part, from
GPs to hospital nurses, in supporting patient’s
understanding of what will happen, when this will
happen and why this is happening.
Looking back – how we did
A lot of work has been undertaken on end of life
care, with hospital and community services joining
forces to support this very important area. One
example of this joint working was the setting up of a
project to support patients planning for their end of
life. This framework (known as the Gold Standards
Framework) is based on a set of principles that
help patients, for example, to ensure that their
psychological and spiritual needs are managed along
with the more conventional aspects of medicine.
19
Common Themes
Pre GSF
(Dec 2009) %
During GSF Pilot
(May 2010) %
Passport (information sent in
from GPs) received on admission
3%
0%
Rapid discharge pathway used
(patients who had a rapid discharge plan)
7%
53%
Patient died at preferred place of care
NR
55%
Liverpool or other Care Pathway used
10%
41%
Evidence of discussion with relative and
information provided.
63%
82%
As the table above shows, there were a lot of
way, if they are admitted to hospital, there is
successes identified:
information readily available for staff to review so
❑
that they are more likely to be treated in line with
Improvements were made across:
their already identified wishes
a. rapid discharge plans being available
❑ End of Life Care ‘champions’ across each clinical
b. use of best practice approaches such as the
area. Supported by the Palliative Care Team,
nationally endorsed Liverpool Care Pathway
c. facilitating patients who chose to die where
these champions provide training, information and
support on best practice for end of life care.
they wanted, such as at home
d. better end of life care discussion with
How we can improve
relatives.
❑ The main area for improvement was:
a. the use of passports (documentation used
A lot of work is carried out across all Walsall
by patients who are towards the end of their
Healthcare services to manage the wider end of life
life) on admission that identify the care
care agenda. The main area that will lead to a good
that they need.
improvement is by making sure that the electronic
systems that share information, across services, are
This is just one of a number of pieces of work that
used more effectively. This is an area that we will be
have been jointly undertaken to support a good
working on over the next 12 months.
approach to planning End of Life Care. Other
examples have included:
Looking forward – what will we do?
❑ Creating new visual icons that let staff know,
Due to the success of the Gold Standards Framework
at a glance, that patients are on a Gold Standards
in 2010/11, Walsall Healthcare has signed up to
Framework. This helps staff to identify the needs
implement this approach across more wards and to
of patients if they have an end of life plan
integrate this within existing community services. This
❑ Joint working across Walsall Healthcare has also
will be undertaken along with:
seen the use of credit cards that patients, who are
towards their end of life, can carry with them. This
20
❑ Looking at the way that information systems
can help with identifying, registering and providing
proactive supportive care to patients and carers
❑ The use of advanced care planning for the
patient and their family. This is about developing a
personalised care plan (detailing patients wishes
and preferred place of care) that patients can rely
upon when nearing their end of life
❑ Raising public awareness on what good end of
life care management is and is not
❑ Improving the current bereavement services that
we offer
❑ Working closely with the newly opened Walsall
Palliative Care Centre.
Looking forward –
Our plans for 2012/13
Walsall Healthcare NHS Trust is in its second year of delivering its three year Quality Plan, and the priorities
below continue to be the most important areas that we will focus on over the next twelve months:
Further reducing healthcare
acquired infections
Further improving the
patient experience
Further reducing harm with a
End of Life Care Management
focus on medication errors
Ensuring that the Trust’s Hospital
standardised Mortality Ratio (HSMR)
is below the national average
21
1. To Further Improve the
Patient Experience
and reassure patients that we are achieving success
in this area in order to build and maintain their
confidence in us as a healthcare provider. Our focus
As our organisation grows, patients will have access
will not just be on the more commonly recognised
to a more diverse range of services across our
infections, but also on:
organisation. We aim to ensure they will have no
❑ E-Coli bacteraemia
❑ Methicillin-sensitive Staphylococcus aureus and
❑ Blood culture contaminants.
cause for complaint, wherever their care is delivered.
Over the next 12 months we will be striving to
improve patient’s perception of our services by
meeting their individual needs and wishes. Our
Reducing the numbers of infections (including
success in doing this will be measured through
MRSA and C.diff) will be key to measuring Walsall
increased patient feedback about our hospital (as we
Healthcare’s success over the next 12 months. Our
recognise that this is low) and increasing the number
pledge is to hit national, mandatory targets.
of positive responses by 50% (from 10 to 20) on
websites such as NHS Choices and Patient Opinion.
3. To Continue to Reduce Harm
with a Focus on Reducing the
Number of Medication Errors
2. To Further Reduce Healthcare
Acquired Infections
We will focus on improving safety and identifying and
It is not only in our hospital that we must manage
eliminating medication errors. The scope for error
infections but across the whole range of services that
lies across all of the clinical services that we provide
we provide. We will work to decrease infection rates
and therefore this is one of the most challenging
22
Part III Regulatory
Statements
areas within the Quality Plan. However, this is an
area to which we are wholly committed to making
improvements across.
4. To maintain our HSMR rate
below the national average
These regulatory statements relate to the hospital for
As the management of patients improves, so should
During 2010/11 Walsall Hospitals NHS Trust provided
the Hospital Standardised Mortality Ratio (HSMR).
services that are common to a medium sized acute
We aim to ensure this remains below the national
hospital.
the period of 2010/11.
average HSMR score of 100. We will do this by
concentrating on those conditions which affect the
Walsall Hospitals NHS Trust has reviewed all the
most patients:
data available to them on the quality of care in 100%
of these services.
❑ Respiratory conditions such as Pneumonia and
Acute Bronchitis
The income generated by the NHS services reviewed
❑ Cardiac conditions such as Congestive Heart
in 2010/11 represents 100% per cent of total income
Failure and Pulmonary Heart Disease and
generated from the provision of the NHS services by
❑ Cancer.
the Walsall Hospitals NHS Trust for 2010/11.
A reduction in the HSMR is one of a number of
Participation in Clinical Audits
positive indicators of good patient care, which is why
we monitor the figures on a monthly basis.
The Trust has committed to continually undertake
clinical audit as one of the ways in which it can
5. End of Life Care
support better quality patient care and improved
patient safety within the Trust.
Walsall Healthcare has embarked on a strategy to
ensure patients who are nearing the end of their life
During 2009/10, 40 national clinical audits and one
are supported in a personalised way throughout the
national confidential enquiry covered NHS services
community and the hospital. This pathway should
that Walsall Hospitals NHS Trust provided.
also serve to support carers and relatives. To this end
we are focussing on our bereavement services to
During that period Walsall Hospitals NHS Trust
ensure they meet the needs of those who use them.
participated in 80% of national clinical audits and 0%
national confidential enquiries of the national clinical
audits and national confidential enquiries which it
was eligible to participate in.
23
The national clinical audits and national confidential enquiries that Walsall Hospitals NHS Trust was eligible to
participate in during 2010/11 are as follows:
Audit
Stroke Care
Neonatal Care (NNAP)
Hip and Knees Replacement (NJAR)
Pulmonary Hypertension
National Diabetes Audit
National Lung Cancer Audit (NNCA)
Severe Trauma (TARN)
Adult Critical Care Unit (ICNARC)
Bowel Cancer (NBOCAP)
NHS Blood and Transplant Potential Donor Audit
National Elective Surgery (Proms)
MINAP
CEMACH Perinatal Mortality
Heart Failure
National Comparative audit of Blood Transfusion
BTS Respiratory Disease – Community Pneumonia
CEM Pain in Children / Fracture
BTS Respiratory Disease – NIV
Parkinson’s Study
BTS – Adult Asthma
BTS – Bronchiectasis
National Mastectomy Audit
National Oesophago Gastric Stomach Cancer
National Continence Care Audit
Heart Rhythm Management
(Pacing and implantable Defibs)
Inflammatory Bowel Disease (IBD)
Carotid Interventions
National Health Promotions Audit
Parenteral Nutrition
National Dementia Audit
National Audit on the management of
familial hypercholesterolaemia
National Falls and Bone Health Audit
CEM Asthma Audit
CEM Feverish Children
CEM Ureteric Colic
National Pain Audit
National Epilepsy Audit – Children
National Hip Fracture Database
Heavy Menstrual Bleeding
CEM NASH Pilot Study
24
Participation
Yes
Yes
Yes
No
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
No
Local study undertaken
in place of national audit
No
No
Yes
Yes
Yes
Yes
% Cases Submitted
100%
100%
75%
100%
100%
100%
100%
100%
100%
95%
100%
95%
100%
100%
-
Yes
Yes
Yes
Local study undertaken
in place of national audit
Yes
Yes
100%
95%
100%
-
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
100%
100%
100%
100%
100%
100%
100%
100%
100%
80%
50%
100%
100%
100%
100%
The national clinical audits and national confidential
The reports of 32 national clinical audits were
enquiries that Walsall Hospitals NHS Trust did not
reviewed by the provider in 2010/11 and Walsall
participate in during 2010/11 are highlighted in the
Healthcare NHS Trust is taking the following actions
table in red. The areas which did not undertake
to improve the quality of services provided across the
audits identified in red, from the above list, will be
main audit:
undertaken over the next twelve months (where
Hip Fracture Audit
applicable).
We are introducing a hip fracture care pathway in
response to the outcomes of the audit and to make
The national clinical audits and national confidential
sure we are using national best practice that supports
enquiries that Walsall Hospitals NHS Trust
the national falls and bone health audit.
participated in, and for which data collection was
completed during 2009/10, are listed in the table,
Dementia Audit
alongside the number of cases submitted to each
We have set up a working group and assigned the
audit or enquiry as a percentage of the number of
leadership of this to one of our senior medics. Their
registered cases required by the terms of that audit
role is to take forward the main actions following this
enquiry.
audit. These include:
As the table demonstrates, 32 of the national audits
❑ Introduction of the Butterfly Project which will
were actively participated in and good compliance
assist in recognition and improved care for
against national standards was seen in most cases.
dementia patients
❑ Development of a multidisciplinary care pathway
to allow patients to be managed better.
Stroke Audit
Our audit scores put us in the mid range of all
hospitals across the country. We have identified a
number of areas where we need to make changes
and we are working closely with clinicians to
undertake these.
National Mastectomy Audit
We understand that local, regular monitoring of this
is vital to our patients. We have therefore agreed,
that we will be monitoring the results from audits
locally. If any peaks in information are seen outside
of the norm we will be able to recognise and respond
quicker.
Heart Failure Audit
We met the majority of targets with the exception of
length of stay (although this is only slightly above the
nationally expected length of stay.) However, work is
underway to see why we have a higher than national
length of stay through a programme of clinical audit.
25
Goals Agreed with
Commissioners
Research
The number of patients receiving NHS services
provided or sub-contracted by Walsall Hospital in
2010/11 that were recruited during that period to
A proportion of Walsall Hospitals NHS Trust income
participate in research approved by a research
in 2010/11 was conditional on achieving quality
ethics committee was 167. This is an increase on the
improvement and innovation goals agreed between
number of patients who entered clinical trials from
Walsall Hospitals NHS Trust and any person or
last year.
body they entered into a contract, agreement
or arrangement with for the provision of NHS
Participation in clinical research demonstrates
services, through the Commissioning for Quality and
Walsall’s commitment to improving the quality of care
Innovation payment framework.
we offer and to making our contribution to wider
health improvement. Our clinical staff stay abreast of
Further details of agreed goals for 2010/11 and
the latest possible treatment possibilities and active
for the following 12 month period are available on
participation in research leads to successful patient
request from:
outcomes.
Walsall Healthcare NHS Trust
Moat Road
Walsall
West Midlands
WS2 9PS
What others say about us
Walsall Hospitals NHS Trust is required to register
with the Care Quality Commission and its current
registration status is unconditional.
The Care Quality Commission has not taken
enforcement action against Walsall Hospitals NHS
Trust during 2010/11.
Walsall Hospitals NHS Trust has not participated
in any special reviews or investigation by the CQC
during the reporting period.
Data Quality and Information
Governance Toolkit
Walsall Hospitals NHS Trust submitted records
during 2010/11 to the Secondary Users Service for
inclusion in the Hospital Episode Statistics which are
26
included in the latest published data. The percentage
Achieving a high score in Information Governance
of records in the published data which included the
is important because it is the tool by which
patient’s valid NHS number was:
organisations assess their compliance with current
legislation, standards and national guidance which
2009/10
Admitted Patient Care 99.7%
Outpatient Care
96.2%
Accident and
98.7%
Emergency Care
benefit patient care.
2010/11
99.7%
95.1%
98.9%
Clinical Coding Error Rate
Walsall Hospitals NHS Trust was not subject to the
Payment by Results (PBR) clinical coding audit
As the above demonstrates, the data quality scores
during the reporting period by the Audit Commission.
are exceptionally good as the closer to 100% you get,
However the error rates reported in the latest
the better the quality of data the organisation has.
published audit for that period for diagnosis and
treatment coding (clinical coding) were:
However, we are not complacent and will ensure that
we continue to review our practices so that the data
2009/10
13%
Primary Diagnosis
Incorrect
Secondary Diagnosis 8.4%
Incorrect
Primary Procedures
5.5%
Incorrect
Secondary Procedures 7.7%
Incorrect
is as accurate as it can be.
Walsall Hospitals NHS Trust Information Governance
Assessment Report overall score for 2010/11 was
57% and was graded red (against a set of criteria).
In response to this the hospital has undertaken a
number of actions so that this will be much improved
2010/11
10.5%
9.6%
11.7%
10.0%
next year. These include:
This is reflective of good coding practices within the
1. Additional expert resources have been aligned
Trust. The above results are very good in comparison
to the wider Information Governance agenda.
with organisations in the wider NHS.
This means that there is more resource to provide
guidance, training, education and support.
As the above highlights, there has been an
2. We will be reviewing how we collect the
improvement in one area and a decline in three of
information. Senior staff will be nominated to have
the four areas that are being measured. Having low
ownership of each standard and it will be their
percentage rates are essential as they lead to better
role to ensure that this information is collected to
quality outcomes for patients, they can be used to
time and it is of a high quality.
benchmark where we are as an organisation and in
3. We will use the ‘critical friend’ approach. This
providing care and helps ensure that the income we
is where teams of staff who are independent to
get is appropriate for the patients we treat.
the area visit, make observations on practice and
feed this back to the leads of the area. This will be
on an ongoing process so areas can show that
they are getting better.
27
Response to feedback from Members and
Governors
Response from the Walsall PCT
Members for Walsall have a number of different
Commissioners and comments have been invited.
This Quality Report has been sent to the Walsall
ways to give feedback on issues that concern them
Quality Overview
for the organisation as a whole. However members
of Walsall Parliament have been instrumental in
Performance of Hospital against
selected indicators
developing this report.
Response from the OCS
This Quality Report has been presented to the
There are a multitude of quality measures that we
Walsall Overview and Scrutiny Committee and
can be measured against. The following metrics
comments have been invited.
have been chosen to demonstrate performance
in organisational quality compared to similar type
Response from LINks
hospitals and against a national average. This should
The LINks have been actively working with us to
give our patients a sense of how we are performing
develop this Quality Report. Therefore any comments
on a number of quality measures.
they feel they need to give will be supplied in due
course.
Measures
2009/10
2010/11
Pressure Sores
308 cases
244 cases
Slips, Trips and Falls
911 cases
1004 cases
Medication Errors
162 events
323 events
Harm Events (actual number)
76 events
56 events
Near Miss Reporting
308
362
Clinical Incident Reporting
3829
4649
100
107
- Elective
3.6
2.5
- Non Elective
5.4
5.4
Re-admission rates
6.7%
7.2%
MRSA Rates
3
7
C-Difficile Rates
63
80
Patient Safety
Clinical Effectiveness
HSMR Rates
Length of Stay
Patient Experience
Performance against the 6C model
4.7 out of 5
Switched models for measuring patient experience
As the table above shows, there have been some positive improvements made in areas such as our Length
of Stay and we have increased our reports within areas of patient safety. This is important as good levels of
reporting are indicative of a good safety culture.
28
We have however seen an increase in our MRSA
and C. diff rates (discussed in the earlier sections of
this report). The one area that we are investigating
is within our readmission rates. Audits have been
undertaken to see the reasons why this has
increased.
National targets and regulatory
requirements
The measures below are nationally required and
again demonstrate to our patients how we are
performing.
Measure
2009/10
Core standards compliance
------
Patients seen in A&E within 4 hours
98.26%
Patients admitted within 18 weeks :
93.4%
- admitted
- non admitted across all specialties
2010/11
Target
15/16
measures
achieved
1 partially
achieved
16/16
measures
compliant
95.06%
98%
90.49%
(admitted)
90%
Patients offered an appointment to Genito-Urinary
Medicine (GUM) clinic within 48 hours
100%
100%
100%
Patients seen in GUM clinic –
access within 48 hours
96%
97.69%
95%
Number of cases of Clostridium Difficile,
63 cases
80 cases
pre and post admission
Number of cases of MRSA
(pre and post admission)
6 (only 2 were
attributable to
the Trust)
No more than
110 cases
11 (of which
7 were
attributable
to the Trust)
No more
than
10 cases
Percentage of patients whose
operations were cancelled for non-clinical
reasons on the day of admission
0.72%
0.66%
0.80%
Number of cancer patients receiving first
treatment within 31 days of decision to treat
98.30%
99.11%
96%
Number of cancer patients receiving first
treatment within 62 days of GP referral
82.30%
86.98%
85%
29
Here at Walsall Healthcare NHS Trust we work hard
In addition, by cancelling elective activity for three
to ensure we meet the needs of our patients, while
weeks during the winter, we were able to cope with
also meeting the requirements placed on us by our
the seasonal pressure with no detrimental long-term
regulators and the Government.
effects on the patient experience.
Last year, following the appointment of the new
The measures on the opposite page are nationally
coalition Government, the performance target for
required and again demonstrate to our patients how
patients being seen in A&E within four hours was
we are performing.
changed from 98% to 95% - a target that we met.
As the information in the table on the opposite page
However, an exceptionally bad winter played a part
highlights, there have been some excellent areas
in seeing a reduction against the previous year’s
of performance across areas of quality, safety and
performance, as it did with the 18 weeks referral to
the patient experience with Community Services
treatment. Again, the target was met, although not by
achieving all but one of its targets for 2010/11.
a great margin.
Delivering these targets is fundamental to patient/
client care as each of these impacts on the way our
Another factor here was our status as the designated
patients/clients perceive their experience in any one
regional centre for the provision of bariatric surgery
of the services they access.
to aid weight reduction in very obese patients. During
the year we saw more of these cases being referred
than expected and, to effectively deal with this influx,
negotiated a longer waiting time for some of these
patients, to ease winter pressures in particular.
30
The information in the table below relates to Community Services.
Clinical Quality Review Measure
2010/2011 Annual target
and forecast
MRSA Bacteraemia
4
6
Clostridium Difficile (C. diff)
81
83
Delivery of the 18 week referral to treatment
target for consultant led services
100%
95%
Patient level data information sharing with primary care
100%
75%
Non-consultant letters to be legible contain minimum data set
and sent within 10 days.
100%
75%
Consultant Led outpatient letters to be legible, contain
97%
minimum data set and sent within 10 days
Achieve 95% by the end
of quarter 4
Consultant Discharge Summaries to comply with locally
92%
determined minimum data set and be sent within 10 days
Achieve 90% within a
minimum of 72 hours
Breastfeeding at 6-8 week check coverage - % of infants with
a recorded breastfeeding status at their 6-8 week check
99%
95%
Breastfeeding at 6-8 week check rates - % of infants wholly
or partially breastfed at their 6-8 week check
32.4%
32.3%
Immunisation rate human papilloma virus full course of
vaccine for girls aged 12-13 years (i.e 3 doses of HPV)
55%
≥80%
Immunisation rate for children aged 15-18 who have been
immunised with booster dose of tetanus, dipheria and polio
87.4%
≥80%
Chlamydia Screening - 15-24 year olds tested for Chlamydia
entering the Hatherton Centre and the Hatherton Centre
Outreach Clinics
3614
3500
48 hour access to GUM - % of patients offered appointments
appointment entering the Hatherton Centre and the Hatherton
Centre Outreach Clinics
100%
100% offered
48 hour access to GUM - % patients seen within 48 hours
entering the Hatherton Centre and the Hatherton Centre
Outreach Clinics
95%
95% seen
All chargeable activity to identify GP and patient
98.96%
Achieve 95%
Cancellation/postponements by WCH for any consultant led
service that uses the outpatient booking system
3.17%
Achieve <5%
Cancellation/postponements by WHC of clinical appointments
for services which currently use IPM to record activity
4.46%
Achieve <5%
Measurement of percentage of SUS data altered in period
between 5 operational days after month end and the
relevant inclusion point
0.18%
Achieve <5%
31
Closing words from Medical Director – Mr Amir Khan
It is a pleasure to close the first, integrated, Quality
Report that we have produced as a new organisation.
Making sure that quality is high on everyone’s
agenda, from the front line through to the Board is
one of my main priorities as Medical Director.
Continuously improving services for the benefit of
patients, carers and relatives is what we strive for
and now we have become an integrated organisation,
this can only lead to greater benefits across Walsall.
This report has highlighted just some of the work that
is undertaken on a daily basis by staff and hopefully
shows you just how seriously we look at all aspects
of our systems to make them as safe as we can.
Admittedly we have had a few disappointments in
2010/11 but this has only strengthened our resolve
to make 2011/12 the year where we get everything
right. Ambitious I know but we cannot settle for
second best on quality.
Lastly I would like to echo our Chief Executive’s
words and thank our staff for all their hard work over
a tough winter.
Walsall Healthcare NHS Trust would like to give a
special thanks to the members of the MyNHS Walsall
Parliament and the LINks, whose contributions to this
Quality Report were invaluable.
Mr Amir Khan
Medical Dirctor
32
33
Glossary
Foundation Trust:
An NHS Foundation Trust organisation is part of the
National Health Service in England and has gained
Community Services:
a degree of independence from the Department of
Services that are provided in a number of locations
Health and local Strategic Health Authority.
outside the physical wall of the hospital. An example
is podiatry.
Global Trigger Tool (GTT):
An internationally recognised audit tool which allows
Clinical Audit:
hospitals to identify events that have the potential
Measures the quality of care and services
to cause harm to patients, enabling them to identify
against agreed standards and suggests or makes
possible trends and initiate changes.
improvements where necessary.
Gold Standards Framework (GSF):
Clostridium Difficile (C.diff):
A systematic evidence based approach to optimising
A bacterium that is recognised as the major cause
the care for patients nearing the end of life delivered
of antibiotic associated colitis diarrhoea. It mostly
by generalist providers.
affects elderly patients with other underlying
diseases.
Healthcare People Management Association
(HPMA):
Commissioning for Quality and Innovation
(CQUIN):
The professional voice of Human Resources in
healthcare. Their purpose is to maintain and develop
A payment framework that enables commissioners
the people management contribution to healthcare in
to reward excellence by linking a proportion of
the UK.
provider’s income to the achievement of local quality
improvement goals.
Hospital Standardised Mortality Ratio (HSMR) :
An indicator of healthcare quality that measures
Department of Health:
whether the death rate at a hospital is higher or lower
A department of the UK Government with
than expected.
responsibility for Government Policy for health, social
care and the NHS in England.
Information Governance Tool Kit:
Ensures necessary safeguards for, and the
Dr Foster:
appropriate use of, patient and personal information.
A provider of healthcare information in the United
Kingdom monitoring the performance of the NHS and
Inpatient:
providing information to the public.
A patient who is admitted to a hospital or clinic for
treatment that requires at least one overnight stay.
Elective:
A procedure that is chosen (elected) by the patient or
LINks:
physician that is advantageous to the patient but is
Local Involvement Networks aim to give citizens a
not urgent.
stronger voice in how their health and social care
services are delivered. Run by local individuals and
groups and independently supported – the role of
LINks is to find out what people want, monitor local
services and to use their powers to hold them to
account.
34
Liverpool Care Pathway (LCP):
Quality Dashboard:
An integrated care pathway that is used to drive up
A report that, on a monthly basis outlines the
sustained quality of the dying in the last days and
performance of the organisation on the main quality
hours of life.
measures.
Methicillin-resistant staphylococcus aureus
(MRSA):
Quality Plan:
The new integrated organisation’s plan to delivering
A troublesome bacteria strain that is resistant against
high quality, safe patient care.
broad spectrum penicillin antibiotics. The resistance
makes it difficult to treat, and it can be especially
Research Ethics Committee:
deadly to those who have a compromised immune
Provides independent advice on the extent to which
system.
proposals comply with ethical standards. Their remit
is to protect the dignity, rights, safety and well-being
National Patient Safety Agency (NPSA):
of research participants.
Leads and contributes to improved, safe patient
care by analysing trends in incidents, informing and
Root Cause Analysis:
supporting the health sector.
A method that is used to address a problem or nonconformance, in order to get to the “root cause” of the
Non-Elective:
problem. It is used to correct or eliminate the cause,
An admission or procedure that is urgent and where
and prevent the problem from recurring.
patient is admitted as an emergency, for example
Royal College of Nursing (RCN):
through A&E.
Represents nurses and nursing, promotes excellence
Organisation:
in practice and shapes health policies.
The newly integrated Walsall Healthcare NHS Trust
which is made up of the Hospital and Community
Strategic Health Authority (SHA):
Services.
Part of the structure of the NHS in England. Each
SHA area contains various NHS trusts which take
Outpatient:
responsibility for running or commissioning local
A patient who is admitted to a hospital or clinic for
NHS services. The SHA is responsible for strategic
treatment that does not require an overnight stay.
supervision of these services.
Patient Advice and Liaison Service (PALS):
Provides information, advice and support to help
patients, families and their carers.
Primary Care Trust :
An NHS organisation responsible for improving the
health of local people, developing services provided
by local GPs and their teams and making sure that
other appropriate health services are in place to meet
local people’s need.
35
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