Nottingham NHS Treatment Centre
Q
uality
Account
2011/2012
We are unrelenting in the pursuit of excellence.....
Contents
About The Nottingham NHS Treatment Centre
Page 3
About this report
Page 5
Part 1
Statement by the Chief Executive Officer
Page 7
Statement by the Board
Page 8
Circle Credo
Page 9
Part 2
Achievement of Objectives for 2011/2012
Page 11
Review of Quality Performance in 2011/2012
Page 18
Objectives for Quality Improvement in 2012/2013
Page 40
Part 3
Mandatory Statements
Page 52
Stakeholder Statements
Page 64
Part 4
Appendices:
Clinical Unit Quality Account Executive Summaries
Page 66
Jargon Buster
Page 88
We are unrelenting in the pursuit of excellence.....
2
About The Nottingham NHS
Treatment Centre
The Nottingham NHS Treatment Centre
Clinical leaders are backed up by a
belongs to a group of companies owned
management structure that exists to
by Circle, and is the largest Independent
support them. Our success does not lie
Sector Treatment Centre (ISTC) in
with a small group of expert managers at
Europe. Circle is an employee co-owned
the top of the company but in a large
partnership with a social mission to make
community of innovators at grass-roots.
healthcare simpler, better and smarter
This means that those who know the
value for patients. Circle is co-founded,
patients best are free to make decisions
co-run, and co-owned by approximately
in the patients’ best interest.
2,000 Consultants and healthcare
professionals who are empowered to put
patients first in everything that they do.
Circle’s ethos is based on the premise
that clinicians are best placed to decide
how to deliver the best care for patients
and our credo commits us to being
‘above all the agents of our patients’.
Services delivered at The Nottingham
NHS Treatment Centre along with other
The Nottingham NHS Treatment Centre
Circle Hospitals are configured into
aims to deliver patient experience with an
separate clinical units, each having a
emphasis on comfort and respect for the
lead doctor, nurse and administrator.
patients’ individual needs and views with
Each clinical unit has the freedom and
speedy access to out-patient, day case
autonomy to take decisions that impact
surgery treatments and diagnostic
upon the services and patient care they
services in a first-class facility.
deliver, and their own balance sheet. In
Outpatient community clinics including
this way, power is delivered to the
new and follow up appointments have
frontline and decisions are taken as close
been established to provide care closer
to the patient as possible.
to home for our patients.
We are unrelenting in the pursuit of excellence.....
3
About The Nottingham NHS
Treatment Centre
Services provided at the Treatment Centre are:
Dermatology
Orthopaedics
Endoscopy
Cardiology (non invasive)
Diagnostic Services
Gynaecology
Respiratory
Rheumatology
Vascular
Digestive Diseases & Urology
Endocrinology
Day Case
The Treatment Centre comprises of:
71 Consultation rooms
3 Colposcopy/Hysteroscopy rooms
4 Endoscopy suites
3 Dermatology skin surgery theatres
5 Day Case surgery theatres
Light Therapy
Computerised Tomography (CT)
Magnetic Resonance Imaging (MRI)
Ultrasound (US)
X-Ray digital imaging
Over the last year the Treatment Centre has broadened the delivery of outpatient care to four
community-based settings, providing patients with access to high quality consultant-led care in
convenient locations close to their home. Sites include:
Community Clinics comprise of:
Location:
Operational:
Services provided:
Stoneleigh House,
March 2011
Dermatology, Digestive Diseases, Gynaecology,
Borrowash
Nottingham Road
Orthopaedics, Respiratory Medicine, Urology, Vascular
August 2011
Clinic, Mansfield
Digestive Diseases, Gynaecology, Orthopaedic,
Respiratory, Urology, Vascular
Southwell Medical
December
Dermatology, Gynaecology, Orthopaedic, Respiratory
Centre
2011
Medicine, Urology, Vascular
Lister House
December
Gynaecology, Orthopaedic
Surgery, Derby
2011
We are unrelenting in the pursuit of excellence.....
4
About this report
The Health Act 2009 requires all providers
A Quality Account must include:
of healthcare services to NHS patients to

publish an annual report about the quality
the organisation’s priorites for quality for
the forthcoming financial year;
of their services; this report is called a

a series of statements from the Board;
Quality Account. The primary purpose of a

a review of the quality of services
Quality Account is to enhance
provided.
organisational accountability to the public,
to engage Boards and leaders of
In developing a Quality Account and setting
organisations in fully understanding the
priorities for the future there is an
importance of quality across all of the
expectation that providers of NHS
healthcare services they provide and make
healthcare will engage with their staff,
continuous improvements on behalf of their
patients, commissioners and governors.
patients.
We are unrelenting in the pursuit of excellence.....
5
“We are above
all the agents of
our patients”
76-year-old Mrs Butler, from Mapperley, Nottingham sought advice from her
doctor after experiencing worsening symptoms of an existing health condition.
She was referred to the Nottingham NHS Treatment Centre for an exploratory
procedure and visited the Endoscopy Department (Gateway H) twice over the last
year; initially for a colonoscopy and later for a flexible sigmoidoscopy.
Mrs Butler said: "I was absolutely dreading the procedure, but I needn't have
worried as the staff were so kind and helpful. Everything was explained to me, my
questions were answered patiently and I felt that everyone I met seemed to want
to make my time as stressless and comfortable as possible”.
“In your department you have a very good combination of old style caring nursing
combined with modern efficiency and I’d like to thank you all for it”.
Mrs Gill Butler, Mapperley, Nottingham
Part 1
We are unrelenting in the pursuit of excellence.....
6
Statement from the
Chief Executive Officer
Circle was created around
The result was a partnership structure, where
a set of beliefs that we
everyone from the consultant to the cleaner
call our Credo. Most
becomes a co-owner in Circle. As owners,
important is our
our partners are responsible for the quality of
belief that we are,
care delivered to our patients. They have the
above all else, the agent
control to design services that they judge will
of our patients. We aim to exceed their
deliver the best possible outcomes and
expectations every time so that we can earn
hospital experience. The result has been
their trust and loyalty. We have set in our
exemplary, with on average over 99% of our
DNA a culture of always striving to exceed
patients saying they would recommend our
their expectations, and continuously
services over the past year.
improving the quality and the value of the care
we give to them. We believe that patients,
like consumers of any other service, need the
best value possible.
Our partners and seconded staff here in
Nottingham have been trailblazers for this
model, and we believe that the quality
indicators listed in this document prove how
We define value in healthcare as quality over
much can be achieved by giving healthcare
price, and quality as clinical outcomes plus
professionals the power to push the
patient experience. From the beginning, our
boundaries of excellence for their patients.
task in Circle was to create an organisation
We are so proud of their tireless efforts to
that provides the highest quality healthcare at
deliver the highest quality care for patients in
the lowest possible prices, in order to re-
the Nottingham and wider Midlands region,
engineer value for our patients.
and hope that they will be able to continue to
serve patients here for years to come.
To realise our plan, we had to design a model
that incentivised entrepreneurial drive,
employee passion and financial resources in
fair measure. We did so not out of ideology,
but because we knew we would need
Ali Parsadout, Chief Executive
considerable contributions from all of the
above to achieve our goal.
We are unrelenting in the pursuit of excellence.....
7
Statement from the Board
2011-12 was a great year for
the Nottingham NHS
This year for the first time in
developing our priorities
Treatment Centre and this
we have invited all of the
year’s Quality Account
clinical unit teams to
demonstrates the progress
create their own Quality
we have made in delivering
quality care whilst aiming for
Account. The Executive
Summary for each service is
efficient and effective outcomes. Our
appended to this document. In addition we
patients report extremely high levels of
have outlined in the main body of the Quality
satisfaction and our staff survey
Account those priorities that we are
demonstrated that our workforce feel
proposing to deliver across the whole of the
supported.
Treatment Centre.
Our staff have brought to life our credo by
In developing our approach for both local and
being empowered to make decisions
strategic priorities we have consulted with the
alongside their patients to ensure their
Executive Board, our staff and our Patient &
interests are always at the heart of what we
Public Engagement Group. The Executive
do. We have supported and invested in our
Board have reviewed the content of the
staff so that they are very clear about what
Quality Account and we can confirm on their
quality looks like and provided them with
behalf that the content is a balanced view of
tools to deliver excellent services (Quality
the quality of services we provide and that to
dashboards and Quality Quartet). These
the best of our knowledge, the information in
tools have been designed to provide teams
this document is accurate.
with a balanced view of their service,
reflecting what they consider will provide their
patients with the best patient experience,
Rachael Magnani
General Manager
best clinical outcome, by the most engaged
staff at the best value possible. In this way we
have encouraged innovation and maintained
Roddy Nash
Clinical Chair
the highest quality of care.
WWe
e are
areunrelenting
unrelentingininthe
thepursuit
pursuitofof
excellence.....
excellence.....
88
Circle Credo
Our Purpose
To build a great company dedicated to our patients.
Our Parameters
We focus our efforts exclusively on:

What we are passionate about

What we can become best at

What drives our economic sustainability
Our Principles

We are above all the agents of our patients. We aim to exceed their expectations every
time so that we earn their trust and loyalty. We strive to continuously improve the quality
and the value of the care we give our patients.

We empower our people to do their best. Our people are our greatest asset. We should
select them attentively and invest in them passionately. As everyone matters, everyone
who contributes should be a Partner in all that we do. In return, we expect them to give
their patients all that they can.

We are unrelenting in the pursuit of excellence. We embrace innovation and learn from
our mistakes. We measure everything we do and we share the data with all to judge.
Pursuing our ambition to be the best healthcare provider is a never-ending process.
'Good enough' never is.
We are unrelenting in the pursuit of excellence.....
9
“We empower
our people to do
their best”
Julia started working for Circle in August 2009 as a 'Theatre Support Worker' working in theatres. She
has worked in many different healthcare environments, private and public sector, and has achieved a
senior role through dedication, hard work and taking every opportunity to embrace the Credo and see
the benefits of being empowered.
Julia says “I have been given every opportunity to grow within the company but it has always been my
intention to give my very best to the department I work in. The greatest reward is the feedback from the
patients which is why I work tirelessly to ensure audits and patient feedback are completed to their full
potential. I feel that in this way all the members of the team get to know and understand their
successes and areas for improvement and learning; it suppresses complacency always having the
Credo to look back at.
I have volunteered for many improvement projects and been presented with many challenges; I have
had support and praise along the way, and my opinions and ideas are both valued and rewarded. This
has been an amazing journey on both a personal and professional level and I would have never thought
I could achieve so much or would now have the confidence to strive for more.
I have never worked anywhere like the Treatment Centre that supports and empowers its staff in such a
way as to enable them to provide the best possible care for every single one of our patients from the
very first minute they arrive.
It is very important to be happy and fulfilled in work and with an amazing team and fantastic support it
can only be a positive attribute for the people we care for. But we must always remember 'good enough
never is.”
Julia Overton, Senior Theatre Support Worker (Gateway G)
Part 2
We are unrelenting in the pursuit of excellence.....
10
Achievement of
Objectives for 2011/2012
Quality Domain
Patient Safety
Our Quality Priority
for 2011/12
Embed continuous
quality improvement
at local level
Increase the
opportunity to learn
from our mistakes
Patient Experience
Listen and act on
what our patients are
telling us
1. Reduce wait
times
2. Improve
communication
about
appointments
3. Improve access
to services for
patients
Clinical Effectiveness
Undertake the
Department of Health
questionnaire in order
to benchmark
ourselves against
other NHS providers
Increase participation
in National and Local
Clinical Audits
Increase the
collection of data to
further understand
complications post
surgery and improve
clinical outcomes.
Success Measures for 2011/12
Status
Access to monthly quality data in the form of an
electronic dashboard.
1. Evidence of review and validation of the data.
2. Local development and routine monitoring of
quality matrix.
3. Demonstrable improvements shared with
patients, staff and organisational committees.
1. 90% of all our staff enrolled on a 2 year
refresher programme where they will be trained
in the reporting of incidents.
2. 90% of those identified in our training needs
analysis as requiring investigation skills will be
trained and competency assessed.
3. Develop and monitor an incident reporting
matrix for each Clinical Unit.
1. Clinical units to better understand their wait
times and develop effective plans to reduce
them.
2a. Provide information to patients about their
choices when booking appointments.
2b. Where possible reduce cancellations and
rescheduling of appointments but when
essential ensure the details are communicated
effectively to patients
3a. Ensure that actions from the Markers of Best
Practice 2011 for Vulnerable Adults are
implemented and re-audited in March 2012.
3b. Roll out community services to bring care
closer to home.
To undertake the questionnaire and for our
results to compare favorably with other NHS
Providers. Where this is not the case develop
recommendations to improve services.
Target Met
To deliver all relevant national audits.
Target Met
For each Clinical Unit to deliver a minimum of 5
clinical audits during 2011-12, which must take
into consideration national and local priorities
such as NICE, NSF.
Increase contact rate to 80% for 24 hour and 28
day calls.
Target Partially
Met
Target Met
Target Met
Ineligible to
participate; target
not applicable
Data to be shared via the Clinical Unit
dashboards for validation and action.
Quarterly review of findings to identify trends
and address required service changes.
We are unrelenting in the pursuit of excellence.....
11
Achievement of
Objectives for 2011/2012
Embed Continuous Quality Improvement at Local Level
We have found through experience that the
important to their patients and use this
best way to deliver continuous quality
evidence to make rounded judgments
improvement is to have strong clinical
considering efficiencies and finance alongside
leadership (Clinical Unit Model) with quick
the quality of services, no one element being
access to credible, clear, and timely
seen as more important than the other. As
information. As well as being an informed
such considerable improvements have been
Board it is our belief that data needs to be
made across the facility, leading to an
closer to the frontline in order to quickly
improved ability to meet the Health and Social
recognise issues and be able to make
Care Act. This was reflected by high
necessary and lasting changes.
satisfaction rates of 99% and low complaints
rate, equating to 0.08% of our total activity.
During 2011-12 quality data was provided to
each clinical unit in a monthly dashboard,
We found that by empowering staff they
which provided clinical leads with detailed
became passionate about their quality
patient safety, patient experience and
improvement projects and wanted to share
effectiveness data. This data although
their results widely. Along with our belief in
presented by the clinical unit leads to the
transparency, we aim to share the successes
Executive Board as part of the quality
of the teams through a variety of methods,
scorecard (Quality Quartet) was also discussed
such as messages on TV screens which are
directly with their clinical team to enable them
located in waiting areas, or the ‘In focus’ notice
to identify areas of practice or environmental
boards that can be found across the Treatment
comfort that could further improved. Clinicians
Centre as well as being published on our
were able to hear and see firsthand what is
website.
We are unrelenting in the pursuit of excellence.....
12
Achievement of
Objectives for 2011/2012
Increase the opportunity to learn from our mistakes
Making services safe for patients is fundamental
reported, a massive 120% increase on the
to the provision of high quality care . I t is crucial
previous year. We have therefore decide d that
that we have good incident reporting systems,
incident training will be an annual update and
staff that are not afraid to report, and clinical
not biannual as previously described in the last
teams that actively review and seek solutions.
Quality Account.
High levels of incident reporting are a mark of a
highly reliable organisation and not, as one might
A Root Cause Analysis (RCA) investigation
think an unsafe one. We therefore encouraged
training session was delivered to the clinical
our staff to report all incidents including near
leads, lead nurses and administration managers
misses and those that caused no harm in order to
at an academy session. In order for staff to
optimise learning.
maintain competency in the methodologies we
agreed that although all senior staff should have
100% of all new starters (including bank staff)
an awareness of RCA, a faculty of 6 people would
received incident training on induction. All existing
be required to undertake any investigations of a
staff (including seconded and contracted staff)
serious nature. Competency would be gained by
received training during 2011 -12 as part of their
training and practically undertaking investigations
mandatory training update which, were delivered
alongside a more experienced colleague. So far
at Partnership sessions. These s essions occur
we consider 5 members of staff as competent
every 6-8 weeks and are used by the clinical units
and 2 requiring further experience.
to provide the team with a common understanding
of issues and provide direction to enable
challenges to be resolved. This presents an
excellent forum for training as all team members
hear one message, tailored to the needs of the
clinical unit. Due to the extensive and detailed
training we have delivered we have seen a
dramatic increase in the number of incidents
We are unrelenting in the pursuit of excellence.....
13
Achievement of
Objectives for 2011/2012
Listen and act on what our Patients are telling us
During 2011-12 we concentrated on monitoring
In order to address patient expectations and
patient wait times in clinic, improving
better inform them of the length of time they
communication of delays and understanding
may be attending the unit for tests, consultation
the causes so that we could anticipate and
and /or treatment, a communication sheet has
alleviate them. We reviewed 6 months of
been developed. The booking arrangements
patient feedback data to establish at what point
are being reviewed to accommodate urgent
patients move from satisfied to dissatisfied with
short notice appointments which were
the wait, this equated to between 20-30
previously slotted in. We have rolled this
minutes. We created an application which
project over to 2012-13 as we want to evaluate
allowed wait times for each doctor’s clinics
the improved communication system and roll
across the Treatment Centre to be seen by
out the audit to other units that also have
patients via the TV monitors in the waiting
experienced similar feedback.
areas. The senior managers were provided
with an application for smart phones and a
We implemented a number of methods for
monitor has been set up in the office so that
patients to access the Treatment Centre. Our
significant delays could be quickly identified
appointments are published on the national
and support provided to assist the clinical
Choose and Book system at Consultant level
teams to resolve delays.
enabling patients to choose the clinician they
wish to see at a date and time that suits them.
Furthermore Gateway F, Gynaecology,
Short term follow up patients are able to walk
undertook an audit to establish the cause of
away with their appointment, and long term
delays in their clinical area. They identified that
follow up patients (appointments set 6-12
patients on average arrived 35 minutes prior to
months ahead) are contacted 6 weeks before
their appointment time, and that the
their appointment to arrange a mutually
appointment for follow up patients overran on
convenient date and time. The Patient & Public
average by 10 minutes and 7 minutes for new
Engagement Group have reviewed the letter
patients. The audit identified that junior doctors
that goes to patients called the ‘partial booking’
did take a little longer as they often required
letter to ensure that the purpose and process of
advice from a consultant.
partial booking is clearly explained.
We are unrelenting in the pursuit of excellence.....
14
Achievement of
Objectives for 2011/2012
We have also reviewed our Access Policy to
We have outlined the progress made against
reflect the changes we have made to practice
the regional safeguarding self assessment tool
throughout the year.
‘markers of best practice’ as part of our
Mandatory Statement and we are content that
We have undertaken several initiatives to
we have provided adequate assurance to our
reduce the number patients’ affected by
Commissioning PCT.
appointment re-scheduling such as monitoring
those clinics cancelled by doctors within the 6
We have established 4 community clinics
week notification period. The escalation
covering Derbyshire and Nottinghamshire so
process has been clarified to ensure that the
that our patients can be cared for closer to
patients affected have been reviewed by their
home. All community clinics are based within
clinician to ensure the appointment change will
existing healthcare premises and have CQC
not compromise their care and that their
registration. Specially trained nurses support
appointment is made in accordance with the
the clinics that are able to provide patients with
Treatment Centre Access Policy of 28 working
a pre-operative assessment for those patients
days. Patient cancellations are monitored
requiring surgery on the same visit. Patients
locally on a weekly basis by the Gateway
requiring treatment are offered a choice of
Coordinators and over-viewed by the Executive
facilities which include the Treatment Centre
Board monthly. Over the last 6 months the
for diagnostics and day case surgery and local
percentage of patients affected remains low at
Trusts for elective inpatient care. Circle is
1.6% of total activity.
committed to the ongoing development of
services at the existing community sites,
including the addition of further community
locations throughout 2012-13.
We are unrelenting in the pursuit of excellence.....
15
Achievement of
Objectives for 2011/2012
Undertake the Department of Health patient questionnaire
We were not eligible to undertake the national
Out Patient survey based on the national
Out Patient survey. Eligibility was determined
survey asking questions about waiting times,
on the basis of an adult outpatient from acute
hospital facilities, seeing a doctor or other
and specialist NHS Trusts in England who
members of staff, tests and treatments.
attended an outpatients department(s) during
April or May 2011. As an Independent Sector
We were not eligible to undertake the national
Treatment Centre we were not included.
In-Patient survey. Day case patients were
excluded from the survey.
We have however undertaken an in-house
120
105
96
100
99
97
102
100
83
80
70
64
60
45
40
20
0
Did you receive an
appointment w hich
allow ed sufficient time
for you to attend?
Did you receive a
telephone call to
remind you off the
appointment?
Did you receive
Did you receive
Were the car parking
sufficient information sufficient information
arrangements
about the appointment about how to get to the
satisfactory?
in advance?
Treatment Centre for
the appointment?
Yes definitely
Yes to some extent
Not really
Were the Gatew ay E Were the Gatew ay E If there w ere delays in Were you satisfied Were any plans for a
reception staff polite nursing team polite and the clinic w ere you
w ith the Gatew ay E follow -up appointment
and considerate?
considerate?
kept adequately
patient w aiting area? clearly explained and
informed?
scheduled?
Definitely not
Does not apply
We are unrelenting in the pursuit of excellence.....
No Comment
16
Achievement of
Objectives for 2011/2012
Increase participation in National and Local Clinical Audits
We have participated in all the national audits
audits have been registered of which 37 are
relevant to our services (in order to improve the
complete and 30 ongoing. Although
participation rate in clinical audit, each clinical
participation in audit has doubled over the
unit agreed to undertake a minimum of 5 clinical
past year we will continue to encourage and
audits, ensuring that national and best practice
increase participation in audit. The focus for
audits were prioritised). An audit registration
2012-13 will be ensuring that re-audits take
process was implemented so that there was
place to measure the effect of any change put
central oversight and when audits were
in place and improve sharing the learning.
completed the audit findings are shared at the
Clinical Governance and Risk Committee. 67
To increase the collection of clinical outcome data
Clinical outcome data provides an indicator of
such as surgical site wound infection rate and
clinical performance, patient safety and value for
re-admission. We also complete, for willing
money and needs to be measured as part of the
patients, a quality of life questionnaire (QoL)
quality agenda. Traditionally outcomes have
pre and post surgery. The collation of data is
focused on failures such as mortality and re-
still in phase 1 and questionnaire two will be
admission rates but increasingly they are being
sent out during May 2012 in order to evaluate
used to measure the effect of health
the QoL scores. We have not managed to
interventions and identify unsatisfactory
achieve the 80% participation rate for
treatments.
CLIMBs (Clinical outcomes audit); however
we have refocused the project and made this
It’s incredibly valuable to review all of this
much larger in order to capture richer data.
information together so that a holistic view can
We have achieved 100% participation in the
be made and as such we have endeavored to
nationally Patient Reported Outcome
collect and share with the clinical units their
Measures (PROMs) for both Hernia and
clinical outcome data. We contact all eligible
Varicose Vein procedures.
patients at 28 days post surgery to ask them a
series of questions in relation to their recovery
We are unrelenting in the pursuit of excellence.....
17
Review of Quality
Performance in 2011/2012
Best Clinical Outcomes
Clinical Excellence
We know the most important concern is the recognised ability of our clinicians and the quality of
care you individually receive. That's why we have over 150 experienced Consultants who are
leaders in their specialist fields. By bringing together excellent clinical leadership and empowering
our Doctors, Nurses and Allied Professionals, we have created an environment at the Nottingham
Treatment Centre where you can be sure of the best possible care.
Incident Reporting
Incident reporting provides a valuable opportunity to learn from mistakes and poor patient
outcomes. In order to have effective reporting systems staff need to feel supported and free from
retribution and blame. An organisation that has a good reporting culture has staff that care and will
use the information they have to make positive changes to improve patient safety and experience.
Therefore an organisation with a high number of no harm incidents (including near miss) reported is
a safe place to be.
The Nottingham NHS Treatment Centre reported a total of 1,897 incidents during 2011/12;
demonstrating a 120% increase in incident reporting rates from the previous year. This dramatic
rise in reporting is not a coincidence as we have pro-actively canvassed staff through training aimed
at increased reporting. Every incident is reviewed by the clinical unit leads in order to improve
practice and share learning across the facility.
250
200
150
100
50
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
We are unrelenting in the pursuit of excellence.....
Jan
Feb
Mar
18
Review of Quality
Performance in 2011/2012
A review of the incidents reported for 2011/12 demonstrates that the top 5 incident categories were:
Treatment/Procedure,
153
Access/Appointment/
Transfer/Discharge,
447
Patient Information,
398
Infrastructure or
Resources, 184
Clinical assessment,
137
The incident trends were reviewed during 2011-12 and the Nottingham NHS Treatment Centre has
taken the following actions to improve the quality of healthcare provided:

The lack of bays available in day case for patients when five theatres are running was reported on
a regular basis as the cause of delays and discharge issues. As a clinical unit, day case reviewed
their working practices and completed a business case to fund a redesign of the patient areas to
improve patient flow and allow for more flexibility in the patient journey and relieve some
pressures on the ward area.

The provision of decontaminated equipment from Sterile Services has been reported as a
recurring issue causing disruption to services provided. Regular meetings have been established
with the contracted service to work through issues and to try to reduce service disruptions and
cancelled procedures.
We are unrelenting in the pursuit of excellence.....
19
Review of Quality
Performance in 2011/2012

Whilst it is accepted practice to consent patients for an endoscopic procedure on the day of their
procedure, the question was posed to the unit as to whether this was considered ‘great’ practice.
To improve the experience for patients an experienced endoscopy nurse now undertakes preassessment and consent on the day that patients visit the digestive diseases clinic. This now
means that patients are better informed and have considered their options for treatment and feel
fully prepared for the procedure. This has led to a decrease in the number of patients not
attending for their procedure and improved compliance with the bowel preparation requirement.

Patient Information is a valuable asset and as such needs to be secure at all times. We learnt that
although Information Security training was being delivered to staff, further consolidation of
learning was required as staff sometimes didn’t apply learning to real situations. We therefore updated the training packages to provide real examples, providing pictures as examples which
generated much deeper discussion and gave the opportunity for staff to ask questions.

When reviewing our incident data administrative booking errors were a recurrent theme as were
multiple changes to patient appointments that delayed patients in seeing their clinicians. This has
led to a review and regular monitoring of clinician annual leave booked under the 6 weeks
agreement with a robust escalation process being put in place. The administration process
(Access Policy) has been reviewed and updated to ensure that patients care is not compromised
by delays and that patients are re-scheduled within 28 days of their cancelled appointment.

Although each patient appointment made generates a letter, our incident process has identified
that patients have not always received the letter and as such miss their appointment. Also, the
Radiology Department (Gateway C) have recently introduced a confirmation caller to ensure that
patients have received their appointment and are intending to attend, therefore reducing the
waste of valuable diagnostic time.
We are unrelenting in the pursuit of excellence.....
20
Review of Quality
Performance in 2011/2012

The Day Case Department (Gateway G) noted that some patients being referred to the
Nottingham NHS Treatment Centre had not received a pre-assessment. They therefore
implemented a training competency package for their staff so that more staff were trained which,
has increased the numbers of patients pre-assessed.

Due to the increased demand in the digestive disease clinic, the safe storage of medical notes
became compromised. As such building work has taken place to convert a room adjacent to the
main reception so that medical records can be safely stored. In addition more digital locks have
been fitted in the area to ensure confidentiality is maintained.
Infection Prevention & Control
The Nottingham NHS Treatment Centre remains fully compliant with the Health & Social Care Act
2008: Code of Practice for Health and Social Care on the prevention and control of infections and
related guidance.
The Code of Practice, which came into force on 1st April 2010 for the NHS and October 2010 for all
other registered providers, sets out the criteria against which a registered provider will be assessed
by the Care Quality Commission. It also provides guidance on how the provider can meet the
registration requirements relating to healthcare acquired infection (HAI) set out in the regulations.
The Nottingham NHS Treatment Centre continuously strives to improve on its current record of
excellence.
Apr – June
July - Sept
Oct – Dec
Jan – Mar
2011
2011
2011
2012
Eligible patients
1912
2123
2056
1752
7843
No. Screened
1912
2123
2056
1752
7843
% Screened
100%
100%
100%
100%
100%
3
3
6
6
18
0.2%
0.1%
0.3%
0.3%
0.2%
No. Colonised
% Colonised
We are unrelenting in the pursuit of excellence.....
Total
21
Review of Quality
Performance in 2011/2012
Safety Alerts
Alerts issued via the Department of Health Central Alerting System (CAS) relate to key safety issues
that have the potential to harm patients and staff if not acted upon promptly. Safety alerts are an
important source of information which enables the Nottingham NHS Treatment Centre to maintain a
safety as a key priority for all of patients. Implementation of safety alerts form part of the CQC (Care
Quality Commission) Essential Standards of Quality and Safety. Failure to implement safety alerts
could result in incidents, complaints and/or claims/inquests and have a significant impact on both our
patients and staff.
135 safety alerts have been received by the Nottingham NHS Treatment Centre during the financial
year 2011/12; all which applied to the Treatment Centre were implemented fully within the required
timeframe.
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22
Review of Quality
Performance in 2011/2012
Best Patient Experience
Claims
There were no successful claims against the Nottingham NHS Treatment Centre during 2011/2012.
Patient Surveys
Patient feedback is essential and provides a rich source of information about the quality of the
services we provide. As an organisation we have set out our key principles in our Credo to ensure
we listen and take action from what our patients tell us. We have developed a number of ways to do
this but feel that by far the most effective way has been through the development of a rapid response
card providing real time information which is promptly acted upon by the clinical teams.
Every patient is offered the opportunity to provide ‘real time’ feedback following each attendance via
the postcard; this asks 3 simple questions:

What did we do well today?

What could we have done better?

Would you recommend us to family/friends?
During 2011/2012, 15% (24,133) of our patients completed a feedback card. Of those 23,938 patients
responded to the question, would you recommend us to you family and friends; a staggering 99%
stated they would.
When we asked our patients what did we do well:

2,570 comments related to the seamless service that was provided to our patients

1,626 comments related to the excellent customer care and communication that our patients
received.

955 comments related to the excellent clinical care that was provided to our patients by our
medical and nursing staff
We are unrelenting in the pursuit of excellence.....
23
Review of Quality
Performance in 2011/2012
All patients are asked to provide us with suggested improvements. The following section provides a
sample of the feedback per clinical unit received and the action they have taken to improve their
services.
Dermatology (Gateway A)
You Said:
“Suggest email or
text could be usefully
be used for
confirmation of
appointments…”
We Did:
Whilst we do not yet send e-mails or text messages to patients confirming
appointments, we do capture this information on our database. We are
upgrading our patient administrative system so that in the near future we will
be able to use these methods of communication in order to inform all
patients of their upcoming appointments.
“Waiting time for my
appointment was a
little longer than I
expected”
The time that a patient is waiting in the Treatment Centre for their
appointment with their doctor is very important to us. We take every
opportunity to look at areas of our patient pathway that could be streamlined.
We have a Twitter feed on the television behind the reception desk that we
update as soon as we are made aware that a clinic is running late. This
helps to keep patients informed as to how long they should expect to be
waiting. A waiting times project is being carried out by our Gateway
Coordinator to determine the length of time patients wait on average and
understand some of the causes so that we can address them.
“I didn’t receive my This is a major problem for all of the gateways in the Treatment Centre. Due
appointment letter…”
to the high number of patients that are seen in the Dermatology department,
this problem is highlighted more so than anywhere else.
Waiting room chairs
pretty but hugely
uncomfortable.
We do strive to make every appointment when the patient comes to the desk
but unfortunately it is not always possible for this to happen.
High backed chairs are being bought for the sub-waiting rooms.
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24
Review of Quality
Performance in 2011/2012
Cardiology, Vascular, and Respiratory (Gateway B)
You Said:
Provide more car
parking spaces for
patients
Improve waiting
times/Keep to
appointment
times/Waiting
times/appointment
delays
Make appointment for
date and time to suit
me
We Did:
We have secured more off site car parking for our staff, to free up more car
parking spaces for our patients
Any clinic delays are shown on our TV screens and also verbal updates by
both admin and nursing staff
Timings of some clinics have been changed to allow more time between
appointments to try and avoid clinics running late
Nursing staff are now advising reception staff of late running clinics, the
reception team then update the Twitter feed and verbally inform patients of
when they arrive. The nursing team discuss timings with patients as they
bring them through to clinic and give them updates on timings in the sub wait
area.
All patients will now be given the choice of date and time at the reception
desk or when making appointments by phone
Diagnostic (Gateway C)
You Said:
Would be useful to
have appointment to
see doctor at other
Gateway and not have
to come back.
Gowns are not
appropriate to wear
Patients asked if we
could improve our
signage in the car
park and in the
Treatment Centre
Information regarding
appointments
We Did:
We are now working closely with other specialties to provide patients with
Radiology appointments on the same day as their appointment in the
requested Gateway.
The Gateway is currently acquiring suitable alternatives for patients to wear
so they feel more comfortable, and are informing patients they are welcome
to bring their own dressing gowns to their appointments.
We have changed the white direction arrows to be made clearer to improve
entry and exit to the car park.
In October we redesigned all our internal signs and undertook a survey to
ask patients what they thought. Patients thought internal signage adequate
but the signage on QMC Campus could be improved. We are currently
liaising with Nottingham University Hospitals NHS trust to improve this.
We are currently developing systems to enable appointment reminders to be
sent via text. If you are interested please ensure that our administration staff
have up to date information for you.
We are unrelenting in the pursuit of excellence.....
25
Review of Quality
Performance in 2011/2012
Orthopaedics (Gateway D)
You Said:
Comments about
waiting times and
being informed about
delays
We Did:
An audit is currently under way to look at waiting times. Staff members have
been encouraged to provide communication around waiting times, to keep
patients updated. Feedback given to staff to ensure information is accurately
given to patients.
Not have to wait so
long to be seen
As a Treatment Centre we are working on a project that is looking at where
the delays occur to allow us to try and fix them. We try to keep to your
appointment times but delays are going to occur if a patient needs more
than their allotted time. If no one has explained why, patients are
encouraged to ask a member of the team and they will try to find out what
the delay is.
The staff have agreed to keep patients in the main atrium and only bring
them through into the sub waiting area when there is a clinic room available
for them. If patients wish to wander about the building and worry about being
called while they are not in the location of the Gateway a pager system is
operated.
Plenty of seating but
sometimes difficult to
hear the name being
called by staff,
depending on where
you sit
As a female patient
examined by a male
doctor it would have
been nice to have a
chaperone
If patients would like someone in the clinic room during their examination to
support or chaperone the nursing staff are more than happy to support.
Rheumatology & Endocrinology (Gateway E)
You Said:
Long delay at
Pharmacy.
We Did:
A poster has been produced by Pharmacy explaining waiting times and
explaining the reasons.
Re: hooks in toilets.
Hooks outside is not
sufficient. I would not
leave coat and
handbag outside.
Can appointments be
made on the day or
sent via email or text.
Hooks have now been placed in toilets.
Could you put a water
machine in 2nd
waiting room please
We offer patients the opportunity to either make an appointment on the day
if the clinic has been scheduled on our electronic booking system.
Alternatively for patients who have a long term follow up appointment we will
contact them within 6 weeks of their required appointment schedule to
request that they book an appointment.
We are currently developing systems to enable appointment reminders to be
sent via text. If patients are interested administration staff check they have
up to date information.
A water machine is now available in the second waiting room.
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26
Review of Quality
Performance in 2011/2012
Gynaecology and Colposcopy (Gateway F)
You Said:
16 % of patients who
responded via the
rapid response cards
commented on waiting
times and the waiting
area provision
We Did:
We have reviewed a number of specialist clinics and are considering the
best way to ensure patients attend appropriate sessions.
We are also reviewing the current agreement on the time allocated to
specific clinics and whether they need to be extended.
We are utilising the buzzer system where suitable.
Communicating through Twitter on the TV screen.
Nursing staff are to ensure that the admin team are aware when there are
specific delays.
Please could we be
A patient information leaflet has been written and is now available. It will be
sent information in
included with patient’s appointment letters.
regard to the Bone
Density Scan (DEXA)
appointments i.e. what
to wear, how long
does it take
Day Case (Gateway G)
You Said:
You said we check
your identity too many
times
You said the
information at
Discharge could have
been better
Why did I ‘fast’ for so
long?
We Did:
We are following the recommendations of the world healthcare organisation
(WHO) for correct site surgery
We have looked at all our patient leaflets and have updated them, where
necessary
We have updated the fasting times on our patient letters and have put
together a leaflet which has both the morning and afternoon fasting
instruction stated.
We are unrelenting in the pursuit of excellence.....
27
Review of Quality
Performance in 2011/2012
Endoscopy (Gateway H)
You Said:
Patient concerns
about waiting times
Can we have patient
information leaflets to
incorporate frequency
asked questions?
How do you decide
what improvements
to make?
We Did:
We are currently reviewing our admission times within the unit. We are to
adapt list timings to avoid delays between those patients who do not attend
and quicken up start and finish times of lists.
We have now changed our Endoscopy procedure leaflets to incorporate
frequently asked questions.
We have also developed a Pre-assessment clinic where those seen in the
out-patients department are invited to attend, to go through any questions or
concerns prior to booking the procedure.
We have given out an in depth questionnaire to 150 Endoscopy patients to
consider all aspects of our department. We are implementing areas of
improvement which have been identified.
Digestive Diseases (Gateway I)
You Said:
You said you wanted
more information
about the expected
wait times on the day
for clinics
You said that our wait
times were sometimes
too long
We Did:
We have improved the communication between the nursing staff running the
clinics and the reception staff to enable more effective feedback. We have
also looking at putting the wait times on a feed on the TV screen in the
waiting room
We are undertaking an audit regarding wait times in clinic to enable us a
better understanding why some clinics run slowly and to help us to solve this
problem.
We are unrelenting in the pursuit of excellence.....
28
Review of Quality
Performance in 2011/2012
Complaints, Concerns, Comments and Compliments
We believe that all feedback is valuable and if utilised well is an ideal opportunity to make positive
change. Therefore we view complaints and concerns as positive and encourage our staff to inform
our users how to actively tell us about their experience. In 2011-12 we received 138 complaints/
concerns compared to 140 in 2010-11 (equating to a rate of 0.08% of our annual activity).
The resolution of complaints and concerns in a timely and effective manner is of utmost importance
to us. All complaints and concerns received are acknowledged within 3 working days and a plan for
management agreed with each complainant. The clinical leads investigate and provide solutions to
prevent recurrence.
The data demonstrates that we are receiving more complaints than previous years; this is due in part
to a move away from the triaging tool and implementation of advice received from the East Midlands
Complaints Forum for any patients verbalising a wish for their issues to be dealt with as a complaint;
this request should not be overridden.
The main themes identified from complaints and concerns were:

31 patients felt that the standard of medical care was lacking

22 patients were displeased with the attitude of the staff caring for them

22 patients were unhappy with their appointments (cancellation / delay / waiting times)

17 patients were unhappy with the communication between staff and patients.
We are unrelenting in the pursuit of excellence.....
29
Review of Quality
Performance in 2011/2012
The following are examples of improvements made during 2011-12:

Development of 2nd opinion process - Following several complaints from patients it was identified
that there was no clear process for patients requesting a second opinion from another doctor. On
each occasion this request came following a breakdown of the relationship between the patient
and original doctor. It was agreed that a check would be made with the patient to ensure that the
relationship was beyond repair. If the relationship could not be reconciled the clinical lead, for that
area, would be consulted with to determine an appropriate clinician for the patient to be seen by.
Feedback would be provided to the initial clinician for them to understand the reasons why the
patient wished to be seen by someone else. The new clinician would be contacted to confirm that
they were in agreement to take over the patients care. The new process outline determined the
required timeframes for the process to be completed in. The process was approved via the
Clinical Governance and Risk Management Committee meeting and then communicated
throughout the facility.

Review of sedation process for flexible sigmoidoscopy - It is not always clinically necessary for
patients attending for a flexible sigmoidoscopy to be administered sedation but patients can
choose to have sedation, if they wish. From complaints it was highlighted that patients did not feel
that they were given a choice and that their decision was being over-ridden without discussion or
clear communication. The process was reviewed with the assistance of the healthcare
professionals who complete the consent process. It was agreed that if a patient requested
sedation at the consent stage then this would be documented within their records and
communicated verbally to the clinical team in the endoscopy suite. If a clinician had a clinical
reason for not wanting to administer sedation the other staff present within the suite ensured that
this was discussed with the patient and a joint decision made between the clinician and the
patient. The clinical lead for endoscopy discussed this new process with all endoscopy staff at
their regular clinician meeting.
We are unrelenting in the pursuit of excellence.....
30
Review of Quality
Performance in 2011/2012

Implementation of ‘ward’ rounds in Day Case - The Treatment Centre received a number of
complaints regarding the time that patients were spending in the Day Case unit when attending
for a procedure. Complaints were normally in relation to the time spent in the unit prior to their
procedure commencing. Although staggered arrival times were implemented to reduce waiting
times, patients were still commenting on the time period that they were waiting. Therefore the unit
have also commenced regular ‘ward’ rounds. This will involved the Day Case staff visiting each
patient on a regular basis (no less than hourly) to update them on progress and check that they
are OK. The nursing staff will document the rounds that are completed and any issues that arise.

Review of partial booking letter with involvement from Patient and Public Engagement Group The Treatment Centre implemented a partial booking system for the management of follow up
appointments. Patients who require a follow up appointment are provided with a choice as to
whether they wish to receive an appointment date and time prior to leaving their last appointment,
on the understanding that it may have to be rescheduled or whether they wish to arrange their
appointment closer to the attendance date, booking an appointment on a time and date that is
convenient to them. If patients choose this option, the Treatment Centre writes to them
approximately 6 weeks prior to when they are required to attend asking them to telephone and
arrange an appointment. Patients have commented regarding the tone of this letter and the
arrangements that are in place around this process. It was identified that the letter needed to be
improved and the Patient and Public Engagement Group have been involved in this process.
We are unrelenting in the pursuit of excellence.....
31
Review of Quality
Performance in 2011/2012
Most Engaged Staff
The Quality Quartet is the tool we use to track the monthly key performance indicators of clinical
units. The “Most Engaged Staff” quadrant tracks the Human Resource (Staffing) indicators such as
vacancies, sickness absence, turnover, mandatory training and Circle Operating System projects
ongoing within the gateways. The indicators are updated every month so that the Clinical Unit
leadership team can see at first hand any trends that are emerging.
The Nottingham NHS Treatment Centre undertakes an annual staff survey, as part of the
performance management process and staff appraisals. We ask our staff to score the following
statements (1=strongly disagree: 5=strongly agree)

At work I have clear, well understood objectives

During the last week, I have received praise for my work

I am consistently free to make ethical decisions

I feel that my opinions at work are valued

I have adequate material and equipment to do my work

I have the opportunity at work to do the best every day

My immediate manager is supportive of me
We are unrelenting in the pursuit of excellence.....
32
Review of Quality
Performance in 2011/2012
Nottingham
2009 H2 2010 H1 2010 H2 2011 H1 2011 H2
Actual Scores…
At work I have clear, well understood, objectives.
4.0
4.1
4.0
4.1
4.2
During the last week I have received praise for my work.
3.5
3.6
3.6
3.8
3.9
I am consistently free to make ethical decisions.
3.8
3.8
3.9
4.0
4.3
I feel that my opinions at work are valued.
3.8
3.9
3.8
3.9
4.1
I have adequate materials and equipment to do my work well.
3.7
3.7
3.7
3.8
4.0
I have the opportunity at work to do what I do best every day.
3.8
3.9
3.8
4.0
3.9
My immediate manager is supportive of me.
4.2
4.2
4.2
4.3
4.5
3.8
3.9
3.9
4.0
4.1
How much do you enjoy working at Circle?
4.0
% responses scoring 5
26%
23%
26%
28%
% responses scores 4+
72%
71%
77%
79%
% responses scores 3+
93%
91%
95%
95%
Employees who would not recommend Circle as a place to work
11%
8%
Employees who would recommend Circle as a place to work
89%
92%
*H denotes a half year period between either January and June or July and December
From the data it appears that our staff felt supported and clear about their objectives. We have
continued to ensure that our staff feel empowered. We listen to their feedback and implement, where
possible, their suggestions for change:

Introduced staff discount scheme in our catering outlet “The Atrium”

Continued with the production of the staff newsletter ‘What’s up Doc’ which includes information
about the Treatment Centre, Clinical Units, and staff updates.

We held a successful Staff Awards Ceremony in 2011, recognising staff in ten award categories
related to the three aspects of the Circle Credo – Agents of our patients, Unrelenting in our pursuit
of excellence and empowering our people to do their best. We are continuing these themes for
second year and the next event is planned for July 2012.
We are unrelenting in the pursuit of excellence.....
33
Review of Quality
Performance in 2011/2012

Installed a cash dispensing machine in the Treatment Centre which benefits both staff and
patients.

Supporting charities nominated by our staff: in 2011 we supported the Lincolnshire and
Nottinghamshire Air Ambulance and raised over £800 for the charity. In 2012 we have supported
the Alzheimer’s Society, so far raising over £1000. In July 2012 we will ballot the staff to choose
our next charity.

We have continued with our monthly massage days for staff which have proved very popular.
Training and Development
As part of our commitment to developing our staff, in addition to our comprehensive mandatory
training, we also offer development activities for all our staff.
During 2011 we partnered with New College Nottingham to develop a tailored Institute of Leadership
Management (ILM) Certificate for our first line managers. We ran two successful courses for 24 staff
and plan to run further courses in 2012. Staff took part in 72 hours of intensive training over three
months, during which they worked on the skills required to effectively manage their teams, make
important decisions about resourcing, coaching team members and strategic planning.
On being presented with his award, Nick Gullick from the Information Technology Team, said: “I did
the course to gain experience in management techniques. I found it useful to learn how to plan,
delegate and free up time to do other elements of my job. Since doing the course, I have been
promoted from Information Coordinator to IT Report Developer. I’d definitely recommend the
programme as it teaches people different management styles and can help further their careers.”
Work Experience and supporting the NHS Graduate Management Scheme
During 2011/2 we have implemented a work experience program for students wishing to pursue
careers in medicine and nursing. We have offered tailor-made programs for students, focusing on
their development needs and providing support for their applications to University courses through
mentorship and mock interviews.
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34
Review of Quality
Performance in 2011/2012
The Nottingham NHS Treatment Centre has worked in partnership with the NHS to provide
development opportunities for individuals through the NHS Graduate Management Scheme, which is
committed to developing the future leaders of healthcare in the UK.
The Circle Operating System
COS Methodology
Clinical Units
Quality
Quartet
Problem
Solving Tool
Patient Hour
Decision
Making Tool
Plan
Circle
Best clinical
outcomes
Patient
Clinical Unit
Most
engaged staff
Best
patient
experience
Act Swarm Do
Best value
•
Better
•
Simpler
•
Smarter
value
Check
Journey towards Continuous Improvement
The Circle Operating System or COS, is a unique continuous improvement model designed to
support partners bring the Circle Credo ‘to life’ and improve patient safety and quality. Some of the
key foundations have been created from the ideas and principals of the Toyota Product System
(TPS) and the TPS inspired Virginia Mason Product System (VMPS).
The engagement of partners is a key principal within the COS methodology, particularly in a clinically
led organisation. All the activities are designed with the concept of devolving the decision making and
ability to make changes directly to the front line.
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Review of Quality
Performance in 2011/2012
COS helps eliminate waste and identify failures in the process and systems currently in place. These
are then implemented as projects by the staff members, with the ultimate aim of standardising
processes which consistently occur and can then be improved upon.
How COS works
A key component to success is that the staff who do the work know what the problems are and have
the best solutions. COS projects or “tasks” range from small-scale ideas tested and implemented
immediately to long-range planning that redesigns new spaces and processes.
COS uses several continuous improvement activities such:

Patient Pathway Mapping where staff utilise their knowledge of the systems and processes within
their own area of work to map the current patient pathway in order to identify variation and
process failures. This also ensures that staff go and see for themselves that is happening
throughout each stage of the process. We call this ‘Go, Look, See.’

The Patient Hour is where the staff take dedicated time to discuss issues which affect the patient
experience and consider what the quality metrics in the Quality Quartet are showing them. They
then review and agree what changes should be made to improve patient care.

SWARM Plan Do Check Act (SPDCA) is a problem solving tool which enables staff to develop
solutions and redesign their own working practices. This is an empowering tool by which staff are
more likely to execute changes if they have designed them.

Quality Quartet is a range of measures designed by Clinical Units to enable them to track
progress and improvements in quality. This tool measures everything that matters for patients.
Since its launch in the Day Case Unit in November 2010, COS has now been rolled out to all but two
of the nine Gateways, it is also being used to make improvements Treatment Centre wide, within the
Cancer Centre, Front of House, IT Help Desk , Phlebotomy and the Registration and Referrals team.
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36
Review of Quality
Performance in 2011/2012
By the end of 2012 COS will have been rolled out across the whole facility encompassing both
Clinical and Non- clinical departments.
Below is the rolling COS activity for the whole Treatment Centre for the last quarter of 2011/12.
Jan 2012
Feb 2012
Mar 2012
COS Projects Complete
49
46
46
COS Projects in Progress
80
78
79
COS Projects still to commence
235
214
215
Highlights from these projects are –

Establishment of the Abdominal Aortic Aneurism (AAA) screening programme in the
Cardiovascular Clinical Unit in under two weeks from commencement of the project to referral of
first patient.

Gynaecology space utilisation project providing additional capacity for clinics, and development of
shared services with the Colposcopy team. Improved patient pathway design and an increased
number of clinics within the department enabling clinicians to provide services to more patients.

Redesign of Magnetic Resonance Imaging (MRI) Helper services within the Diagnostic
department, delivering improved patient flow and ensuring service are streamlined and efficient
and prevent patient delays.

A full systematic review of the Dual-energy X-ray absorptiometry or DEXA Pathway (assessing
bone mineral density) to ensure it was meeting the needs of its patients. The outcome
determined that in 95% of cases, the approach proved to be a one stop service receiving 100%
positive feedback from patients.
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37
Review of Quality
Performance in 2011/2012

A series of mapping exercises within the Decontamination facility associated with the JAG
checklist to ensure compliance with Joint Advisory Group (JAG) accreditation. 137 individual
steps within the decontamination process were identified and the team have worked through the
JAG standards to ensure that any failures or safety issues highlighted within the mapping
exercises are improved in accordance with the best practice guidelines.

Introduction of hospitality programmes to support the Front of House services which touch the
patient journey many times during their attendance. Front of House have many contacts with our
patients, including transfers, switchboard, car parking and general assistance. A revised
Information Technology infrastructure, new phone systems and the introduction of swarm as a
more organic approach has increased value of team from the organisational perspective; staff are
enthused and will now buddy with gateways to further develop and support patient pathways to
increase awareness and understanding of our patients.
GP Educational Events
An increased demand on NHS frontline services and a significant reduction in budget allocation
means it is essential that providers of healthcare services to NHS patients offer streamlined
approaches, utilise financial resources efficiently, and work with healthcare partners to reduce any
wastage and increase efficiency of partnership working.
During financial year 2011/12, the Nottingham NHS Treatment Centre organised a programme of
events led by the Consultant staff to support GP colleagues and decrease the number of
inappropriate referrals.
The programme was so successful, it has lead to a number of sessions such as:

The Management of Menstrual Disorders

Managing Thyroid Disease

Fitness for Anaesthesia – Optimising Common Conditions

Current Thinking in Acute Coronary Syndrome (ACS)

Common Hand Surgery Conditions and their Management

What is New in Vascular Surgery
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38
Review of Quality
Performance in 2011/2012

Update on GMC and Revalidation

Dyspepsia and 2 Week Wait Referral for Endoscopy

Reducing Referrals to Secondary Care for Patients with Vascular Disease

Disorders of Calcium and Vitamin D Metabolism
Further interest from GP colleagues has also prompted the delivery of additional sessions relating to
CQC Registration which were well attended by both GPs and Practice Managers.
All sessions have received positive feedback, with comments including: concise and helpful, very
clever speaker, really useful, informative and energising speaker, the presentation was very
interesting and nice to have an insight into what is happening with patients, interactive session, easy
to ask questions, excellent learning points and practical focus, very helpful content, very relevant to
general practice and will alter my management.
We are unrelenting in the pursuit of excellence.....
39
Objectives for Quality
Improvement in 2012/2013
This year we set out to identify our priorities using the Circle methodology and in accordance with our
Credo. Each of the 9 Clinical unit leads were asked to review the quality of care they delivered with
their teams during 2011-12, examine their achievements and fully understand their opportunities and
develop their own Quality Account. They have arrived at their objectives through careful and
balanced consideration of the quality equation (outlined in the below diagram) in the context of the
service delivered within the clinical unit. The objectives identified have been agreed as their priorities
for 2012-13 and the measures will be incorporated into their ongoing practice. These will be
monitored at their clinical unit meetings and achievements reported to the Clinical Governance and
Risk Committee. The local priorities are identified within the Clinical Unit Executive Summary which
are appended at the back of this report.
In addition we have carefully considered feedback from patients, staff and undertaken consultation
with our Patient & Public Engagement Group, Commissioners other key stakeholders in our global
review of the quality of care provided. Building on the achievements for the 2011-12 we have
identified 7 strategic objectives that will indicate the success of the local priorities for 2012-13.
We are unrelenting in the pursuit of excellence.....
40
Objectives for Quality
Improvement in 2012/2013
Quality Domain
Best Patient
Experience
Best Clinical
Outcome
Most Engaged Staff
Our Quality Priorities
for 2012/13
Include net promoter
score as part of our
rapid cycle feedback
process
Continue to improve
wait times for patients
visiting outpatient
clinics
Compassionate Care
Improve patient safety
through
Stop the Line and
Shine the Light
innovation projects
Provide the highest
quality Endoscopy
Service for our patients.
Drive quality
improvements in skin
cancer services as part
of the Cancer Peer
Review Program
Implementation of a
nurse leadership and
development
programme
Success Measures for 2012/13
Survey 10% of patients that visit
the facility
Achieve an NPS score of 75%
Monitoring
&
Reporting
Responsibilities
Clinical Governance and Risk
Management Committee
75% of patients should not wait
no longer than 30 minutes from
their appointment time to first
contact with a clinician
Improved skill and competency of
workforce and identification of
named champions to lead on
compassionate care
Development of care &
compassion assessment tool,
implementation of pilot and roll
out
Provision of training to 100% of
frontline gateways and front of
house
Number of occasions that ‘Stop
the Line’ has been activated,
Number of improvements
identified,
Number of improvements
implemented with success
measures.
25% increase in incident reporting
During 2012-13 achieve the Joint
Advisory Group (JAG)
accreditation in Endoscopy.
Achieve 85% of measures
identified in the Peer Review
Assessment tool
Clinical Governance and Risk
Management Committee
Launch of Circle Nottingham
Preceptorship Programme
Executive Board
We are unrelenting in the pursuit of excellence.....
Executive Board
Clinical Governance and Risk
Management Committee
Executive Board
Executive Board
41
Objectives for Quality
Improvement in 2012/2013
Best Patient Experience
Include Net Promoter Score (NPS) as part of our rapid cycle feedback process
Why we chose this
As an independent sector organisation we understand the value of providing patients with a good
experience so that we become their healthcare provider of choice. Obtaining patient feedback is a
vital source of information in order that we can continuously improve our services. In order to
measure patient satisfaction we offer patients the opportunity to provide ‘real time’ feedback via a
postcard that asks 3 simple questions; what did we do well, what could we have done better, and
would you recommend us to family/friends. In 2011-12 we received feedback from (24,133) patients
of which 99% said they would recommend our facility.
In order that we can benchmark our customer satisfaction rates against other NHS facilities Circle
has committed to including the Net Promoter Score as part of our rapid cycle feedback, which has
been advocated by NHS Midlands and East, SHA cluster. Net Promoter is a research based industry
wide tool that measures how likely service users would be to recommend a facility, therefore
providing a good indication of the degree to which the organisation’s services are patient focused.
Whilst our satisfaction rates are currently very high, we welcome any evidence-based tool which we
can use to challenge ourselves to do even better. We will continue to use the rapid feedback cycle to
develop patient-focused projects to improve selected elements of care.
What success looks like
We aim to survey a minimum of 10% of patients that visit the facility
We aim to achieve an NPS score of 75% (subject to regional baseline data being published, this
figure may alter in order to provide a realistic target and stretch for the organisation)
Actions

Amend the rapid feedback card to include Net Promoter Score question

Undertake a baseline study for 1 month to establish NPS Score

Amend database to enable accurate calculation of NPS scores

Publish NPS Score on patient feedback notice boards and website
We are unrelenting in the pursuit of excellence.....
42
Objectives for Quality
Improvement in 2012/2013
Best Patient Experience
Continue to improve wait times for patients visiting outpatient clinics
Why we chose this
On reviewing patient feedback, a number of clinical units identified wait times as a recurring theme.
This prompted numerous projects to be undertaken in order that clinical units better understand the
length of waits experienced by patients, and the causes of delays. As part of the study a “look back”
exercise was undertaken to review comments by patients who mentioned wait times, ranging from
those who were highly satisfied and those who were not. It was apparent that 30 minutes was seen
as the point at which satisfaction turned to dissatisfaction. We therefore committed to ensuring our
patients not wait no longer than 30 minutes from their appointment time to first contact with a
clinician.
A baseline study was undertaken to measure adherence with the internally set standard of 30
minutes to establish a success measure for each clinical unit to meet. In order to do this we have
proposed to build upon the waiting time priority from last year to further improve the experience for
our patients. We have set ourselves an ambitious target of 75% but will continue to pursue this until
wait times are no longer the main feedback theme.
What success looks like
75% of patients should not wait for more than 30 minutes
Review patient feedback monthly and improve Network Promoter Score (NPS)
Actions

Each outpatient clinical unit will undertake a baseline study of wait times

Each outpatient clinical unit will identify the causal factors for delays

Each clinical unit will develop an improvement program to reduce delays and improve satisfaction
rates.
We are unrelenting in the pursuit of excellence.....
43
Objectives for Quality
Improvement in 2012/2013
Best Patient Experience
We are committed to improving our patients’ experience of care and providing them with the highest
level of compassion through provision of privacy and dignity in care.
Why we chose this
We are committed to providing high quality care to our patients at all times. We know our patients’
experience depends on a combination of components, such as the services we provide, the
individual healthcare professionals involved in their care and specific factors unique to each patient.
While most patient contact is with clinical staff, they will also come into contact with non clinical staff
who will also have an effect on their experience of care. We recognise the important work many of
the clinical teams are already doing so this is not about starting again; it’s about building on what we
already have in place.
Patients are at the heart of everything we do. They inspire us to change. We are committed to
improving their experience of care and providing them with the highest level of compassion through
provision of privacy and dignity in care.
The newly published guidance and quality standards from the National Institute for Health and
Clinical Excellence (NICE 2012) focuses on generic patient experience and is based on best
available evidence. It applies to patients using adult NHS services including outpatient and day case
facilities like those offered at the Treatment Centre. Particular attention is needed to ensure that our
increasing population of older patients receive equally high levels of compassion through provision of
privacy and dignity in care. We wish to take the learning from these reports and expand on the NICE
guidance.
The concept of dignity is related to how people think, feel and behave in relation to their worth and
how they value themselves. We believe it is fundamental to respect these values and provide
individual care that is personal and focused for each patient. Therefore we wish to take direct account
of patients’ views with patients overseeing the process and providing external scrutiny. We want to
ensure that effort is put into establishing a relationship with individuals that ensures their needs will
be acknowledged and met.
We are unrelenting in the pursuit of excellence.....
44
Objectives for Quality
Improvement in 2012/2013
What success looks like
Improved skills and competence across the workforce identifying named champions who will be
accountable for ensuring older people are treated with respect and dignity
Development of a robust Care and Compassion assessment tool
Implementation of systematic training across all frontline gateways and Front of House facilities.
Actions

Undertake a review of all complaints from older people in the last year to identify any themes for
action

Informing and raising awareness amongst staff of unacceptable standards of care on behalf of
older people and their families through case studies and patient involvement in partnership days

See this from the eyes of the patients. Explore their insights to gain individual feedback on how
we can make improvements

Develop an audit tool to establish baseline of compliance and ongoing compliance

Develop and launch an awareness campaign

Develop and implement a training programme for staff

Identify and train local dignity champions
We are unrelenting in the pursuit of excellence.....
45
Objectives for Quality
Improvement in 2012/2013
Best Clinical Outcome
Improve patient safety and focus on learning through ‘Stop the Line’ and ‘Shine the Light’ innovation
projects.
Why we chose this
We have committed to delivering high quality, harm free care and as such have identified ‘Stop the
Line’ as one of our safety priorities. We have chosen this concept because of its proactive and
responsive approach to managing safety events, and will empower our work force to take ownership
of managing safety events giving them the autonomy to develop their own safety solutions. It will
ensure that everyone involved in care, including staff, patients and carers are empowered to draw
attention to unsafe acts or events. The concept will ensure engagement from the Senior Management
Team who will commit to ensuring that staff are supported and safety events are addressed by the
right people, at the right time, making the right decisions to prevent future harm.
In order to drive local safety improvements the ‘Shine the Light’ approach will be used to help identify
topics or themes for in depth review. Staff will be able to see how their reporting directly influences
organisational decisions and changes practice, which will boost levels of reporting as frontline staff
will see this as directly relevant to them.
We are unrelenting in the pursuit of excellence.....
46
Objectives for Quality
Improvement in 2012/2013
What success looks like
Number of occasions that ‘Stop the Line’ has been activated,
Number of improvements identified,
Number of improvements implemented with success measures.
25% increase in incident reporting levels
Actions

Awareness sessions to share concept with all staff

Define the concept

Implement a reporting mechanism for patients and carers

Pilot ‘Stop the Line’

Review of pilot and make adjustments accordingly

Roll out across the Treatment Centre
We are unrelenting in the pursuit of excellence.....
47
Objectives for Quality
Improvement in 2012/2013
Best Clinical Outcome
Provide the highest quality Endoscopy Service for our patients.
Why we chose this
We currently see and treat approximately 10,000 patients per annum in our Endoscopy Unit with
procedures including Colonoscopy, Flexible Sigmoidoscopy, Gastroscopy, Bronchoscopy, and
biopsy removal. We have a state of the art building and aim to provide the highest quality of care
possible.
In 1994 the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) was established to agree and
accept standards of competence and provide quality assurance to units in terms of training
undertaken and services provided. The accreditation programme ensures that policy and practice is
safe and is compliant with national best practice.
JAG accreditation will mean that the Endoscopy Clinical Unit will become a Centre of Excellence and
therefore a provider of choice for patients. Accreditation will also enable the Nottingham NHS
Treatment Centre to participate in the bowel cancer screening programme.
What success looks like
During 2012 -13 achieve the Joint Advisory Group (JAG) accreditation in Endoscopy.
Actions

Building work to improve privacy and dignity identified and undertaken

Annual, quarterly and monthly decontamination testing to be put in place

Move to three sessional days to accommodate increases in capacity such as bowel screening
We are unrelenting in the pursuit of excellence.....
48
Objectives for Quality
Improvement in 2012/2013
Best Clinical Outcome
Drive quality improvements in skin cancer services as part of the Cancer Peer Review Program.
Why we chose this
Driving improvements in the quality of cancer services was identified as a key priority for the National
Health Service (NHS). In order to deliver world class services a series of national programs were set
out in the National Cancer Reform Strategy 2007, one of these being a quality assurance program
through Cancer Peer Review. This is a self assessment by which members of cancer networks score
themselves against a number of measures. This self assessment requires internal validation to
ensure that the data is reliable, supported by targeted review. The measures ensure that services are
clinically led and that there is national consistency in delivery of cancer services so that the once
suggested ‘post code lottery’ no longer applies and that patients are now able to make informed
choices on access to teams and services.
The Nottingham NHS Treatment Centre holds the Multi Disciplinary Team (MDT) Meeting for skin
cancer services and is therefore required to undergo peer review according to the National Cancer
Action Peer Review Program. In 2010-11 we were assessed as 55% compliant against the measures
and in 2011-12 this improved to 76%. We continuously strive to improve and have set an ambitious
target for 2012-13.
What success looks like
To achieve 85% of measures identified in the Peer Review Assessment tool
Actions

Improve attendance of oncologist at the MDT – Implementation of video conferencing

Ensure patient literature is designed according to diagnosis – Implement information prescriptions

Record the information given to patients and relevant updates – Implement information
prescription front sheet which is to be filed in the health care records and updated accordingly.
We are unrelenting in the pursuit of excellence.....
49
Objectives for Quality
Improvement in 2012/2013
Most Engaged Staff
Introduction of a preceptorship programme to enhance the competence and confidence of newly
registered practitioners as autonomous professionals.
Why we chose this
We are appointing more and more newly qualified Registered Nurses and have in the past utilised
NUH Preceptorship programme. Therefore we are also now developing a Circle Nottingham
Preceptorship programme. Preceptorship was introduced following the implementation of Project
2000, the outcome of a previous review of nurse education. Preceptorship is now embedded in a
range of existing professional regulatory and employment guidelines for example: NMC. The aim of
preceptorship is to enhance the competence and confidence of newly registered practitioners as
autonomous professionals. Preceptorship will support the Circle Credo of placing ‘quality at the heart
of everything we do

Care Quality Commission registration requirements for providers require that providers take all
reasonable steps to ensure that workers are appropriately trained and competent to undertake
their roles.

Preceptorship is also within the spirit of the staff pledges made in the NHS Constitution, and the
value and importance of preceptorship was recognised in A High Quality Workforce: NHS Next
Stage Review 2010.
What success looks like
Benefits of Preceptorship for staff include: develop confidence, professional socialisation into working
environment, increased job satisfaction leading to improved patient/client/service user satisfaction,
feel valued and respected by their employing organisation, feel invested in and enhance future career
aspirations, feel proud and committed to the organisation’s corporate strategy and objectives,
develop understanding of the commitment to working within the profession and regulatory body
requirements, personal responsibility for maintaining up-to-date knowledge, engenders a feeling of
value to the organisation, newly registered practitioners and patients, identify commitment to their
profession and the regulatory requirements, support their own lifelong learning and enhances future
career aspirations.
We are unrelenting in the pursuit of excellence.....
50
“We are
unrelenting in
the pursuit of
excellence”
“Although the Treatment Centre has historically provided outpatient care and
diagnostic services to patients with shoulder complaints, 2012 saw the
introduction of shoulder surgery. In the past, although the patient would remain
under the care of the same Consultant, the patient would be referred onto an
alternative organisation for their NHS surgical care. In developing a new surgical
service and pathway many patients are now able to have their surgery here at
the Treatment Centre as a day case procedure who historically may have had to
stay in another hospital overnight. To compliment the new service patients have
their pre operative assessment on the same day as the decision is made that
surgery is required, negating the need to come back for a second visit, and an
intensive Physiotherapy led service precedes the surgery to help patients return
to their normal activities as soon as possible”.
Mr Paul Manning BM BS DM FRCS, Consultant Orthopaedic Surgeon
Part 3
We are unrelenting in the pursuit of excellence.....
51
Mandatory Statements
Review of Services
During 2011-12 the Nottingham NHS Treatment Centre provided 12 NHS Services (identified in Part
1 of this report).
The Nottingham NHS Treatment Centre has reviewed all the data available to them on the quality of
care provided in 12 of these NHS Services.
The income generated by the NHS Services reviewed in 2011-12 represents 100% of the total
income generated from the provision of NHS services by the Nottingham NHS Treatment Centre for
2011-12.
Participation in Clinical Audits
During 2011-12, 8 National Clinical Audits and 1 National Confidential Enquiries covered NHS
Services that the Nottingham NHS Treatment Centre provides.
During that period the Nottingham NHS Treatment Centre participated in 100% of relevant National
Clinical Audits and 100% National Confidential Enquiries of the National Clinical Audits and National
Confidential Enquiries which it was eligible to participate in.
The National Clinical Audits and National Confidential Enquiries that the Nottingham NHS Treatment
Centre were eligible to participate in, actually participated in and for which data collection was
completed during 2011-12 are indicated below alongside the number of cases submitted to each
audit or enquiry as a percentage of the indicated:
We are unrelenting in the pursuit of excellence.....
52
Mandatory Statements
Name of National Clinical Audit/National Confidential Enquiry
Peri-and Neo-natal
Perinatal mortality (MBRRACE-UK)
Neonatal intensive and special care (NNAP)
Children
Paediatric pneumonia (British Thoracic Society)
Paediatric asthma (British Thoracic Society)
Pain management (College of Emergency Medicine)
Childhood epilepsy (RCPH National Childhood Epilepsy Audit)*
Paediatric intensive care (PICANet)*
Paediatric cardiac surgery (NICOR Congenital Heart Disease Audit)
Diabetes (RCPH National Paediatric Diabetes Audit)*
NCAPOP
audit?
Participated
Yes/No?
Yes
N/A
N/A
N/A
Yes
Yes
Yes
Yes
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Acute care
Emergency use of oxygen (British Thoracic Society)
Adult community acquired pneumonia (British Thoracic Society)
Non invasive ventilation -adults (British Thoracic Society)
Pleural procedures (British Thoracic Society)
Cardiac arrest (National Cardiac Arrest Audit)
Severe sepsis & septic shock (College of Emergency Medicine)
Adult critical care (ICNARC CMPD)
Potential donor audit (NHS Blood & Transplant)
Seizure management (National Audit of Seizure Management)
Long term conditions
Diabetes (National Adult Diabetes Audit)*
Heavy menstrual bleeding (RCOG National Audit of HMB)*
Chronic pain (National Pain Audit)*
Ulcerative colitis & Crohn's disease (UK IBD Audit)*
Parkinson's disease (National Parkinson's Audit)
Adult asthma (British Thoracic Society)
Bronchiectasis (British Thoracic Society)
Elective procedures
Hip, knee and ankle replacements (National Joint Registry)*
Elective surgery (National PROMs Programme)
Intra-thoracic transplantation (NHSBT UK Transplant Registry)
Liver transplantation (NHSBT UK Transplant Registry)
Coronary angioplasty (NICOR Adult cardiac interventions audit)*
Peripheral vascular surgery (VSGBI Vascular Surgery Database)
Carotid interventions (Carotid Intervention Audit)*
CABG and valvular surgery (Adult cardiac surgery audit)*
We are unrelenting in the pursuit of excellence.....
If yes, % of
cases
submitted
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Yes
Yes
Yes
Yes
Yes
Yes
Yes
N/A
Yes
N/A
N/A
N/A
Yes
N/A
N/A
Yes
N/A
N/A
N/A
N/A
N/A
N/A
100%
100%
100%
53
Mandatory Statements
Name of National Clinical Audit/National Confidential Enquiry
Cardiovascular disease
Acute Myocardial Infarction & other ACS (MINAP)*
Heart failure (Heart Failure Audit)*
Acute stroke (SINAP)*
Cardiac arrhythmia (Cardiac Rhythm Management Audit)*
NCAPOP
audit?
Participated
Yes/No?
Yes
Yes
Yes
Yes
N/A
Yes
N/A
Yes
Renal disease
Renal replacement therapy (Renal Registry)
Renal transplantation (NHSBT UK Transplant Registry)
Cancer
Lung cancer (National Lung Cancer Audit)*
Bowel cancer (National Bowel Cancer Audit Programme)*
Head & neck cancer (DAHNO)*
Oesophago-gastric cancer (National O-G Cancer Audit)*
Trauma
Hip fracture (National Hip Fracture Database)*
Severe trauma (Trauma Audit & Research Network)
Psychological conditions
Prescribing in mental health services (POMH)
Schizophrenia (National Schizophrenia Audit)*
Yes
Yes
Yes
Yes
N/A
Yes
N/A
N/A
Yes
N/A
N/A
Yes
100%
100%
N/A
N/A
N/A
N/A
Health promotion
Risk factors (National Health Promotion in Hospitals Audit)
N/A
End of life
Care of dying in hospital (NCDAH)
We are unrelenting in the pursuit of excellence.....
100%
N/A
N/A
Blood transfusion
Bedside transfusion (National Comparative Audit of Blood
Transfusion)
Medical use of blood (National Comparative Audit of Blood
Transfusion)
Total: 51
If yes, % of
cases
submitted
N/A
23
8
54
Mandatory Statements
The reports of 8 National Clinical Audits were reviewed by the provider in 2011-12 and Nottingham
NHS Treatment Centre intends to take the following actions to improve the quality of healthcare
provided:

Share the outcome of the National Clinical Audits at the Clinical Risk & Governance Committee to
encourage staff engagement and share the learning.

Deliver individual ‘Academy Training Sessions’ targeting the learning from key National Clinical
Audits.
The local clinical audits that the Nottingham NHS Treatment Centre participated in during 2011-12
are as follows:
Name of Local Clinical Audit
Dermatology
Mycophenolate Mofetil Audit
Audit of Nice Biologic Guidelines in the treatment of psoriasis
Isotretinoin and Monitoring of Psychological Side Effects
Prescription Audit
Audit of Acitretin prescribing
Audit of Fumaderm Monitoring
Photodynamic Therapy
Tacrolimus & Pimecrolimus for atopic eczema
Alitretinoin for the treatment of severe chronic hand eczema
Cardiovascular
Clinical-Patient Diagnosis
Chronic Obstructive Pulmonary Disease (COPD)
28 Day Questionnaire
Foam Sclerotherapy Outcomes
We are unrelenting in the pursuit of excellence.....
Status
Completed
Completed
% of cases
submitted
Completed
Completed
Completed
Completed
Completed
Completed
Completed
100%
100%
100%
100%
100%
100%
100%
100%
100%
Ongoing
Ongoing
100%
100%
Completed
Completed
100%
100%
55
Mandatory Statements
Name of Local Clinical Audit
Diagnostics
Audit of completion of all radiology request cards
Cannulation Audit
Reporting turnaround for MRI and CT
DNA (Did not attend) rates for appointed studies
Cards v E-requesting
Review of Orthopaedic letters
Audit of Consultant availability for CT/MRI
Orthopaedics
ROM pain scores Total Hip Replacement, Total Knee Replacement & Tar
Oxford Hip and EQ5D Scores
Oxford Knee and EQ5D Scores
AOFAS, & FFI, EQ5D for Tar
Oxford Elbow Score for TER
Quick dash scoring for carpal tunnels
Status
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
% of cases
submitted
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Rheumatology & Endocrinology
Steroid Audit
28 Day Patient Questionnaire
Growth Hormone in Adult Patients
Tuberculosis Audit
Nurse Prescribing Audit
Overview of Biologic Use
Biologics in Rheumatoid Arthritis (Anti-TNF)
Biologics in Ankylosing Spondylitis (Anti-TNF)
Biologics in Psoriatic Arthritis (Anti-TNF)
Biologics in non NICE indications
RA in ethnic minorities
Use of Teriparatide
Audit of generic nurse lists
Gynaecology
CA125 Marker Audit
Surgical Termination of Pregnancy (STOP) Audit
We are unrelenting in the pursuit of excellence.....
Ongoing
Completed
Completed
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Completed
Completed
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
56
Mandatory Statements
Audit of Clinic Waiting Times
Completed
100%
RAD Alerts Audit
Colposcopy Follow Up Audit
Ovarian Cancer Screening
Endometrial ablation as per NICE Guidance
Bone density scanning – Audit of acceptance criteria
Completed
Completed
Completed
Completed
Completed
100%
100%
100%
100%
100%
Completed
Completed
100%
100%
100%
Clinical Details from a 24 hour follow-up phone call
Staff Feed Back Questionnaire
Endoscopy
Number of procedures performed by each operator
Success of intubation of OGD (oesophagogastroduodenoscopy)
Completion of OGD (oesophagogastroduodenoscopy)
Colonoscopy completion rate
Adenoma detection rate
Sedation and analgesia for colonoscopy
Quality of bowel preparation
Completed
Completed
100%
100%
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
100%
100%
100%
100%
100%
100%
100%
Repeat endoscopy for gastric ulcers within 12 weeks.
Colonic polyp recovery
Correct identification of position of colonic tumours
Patient Survey
Ongoing
Ongoing
Ongoing
Completed
100%
100%
100%
100%
Staff Survey
Patient comfort and anxiety scores
Digestive Diseases
Completed
Ongoing
100%
100%
Hernia Audit
Clinic Start Times Audit
Patient understanding diagnosis and management audit
Completed
Completed
Completed
100%
100%
100%
Day-case
WHO Check List Compliance
Admission Rates and Reasons
Total
67
Many of our users have a shared care pathway moving between the Treatment Centre and
Nottingham University Hospitals NHS Trust. Where the Treatment Centre only manages a small part
of a patient’s pathway, data has been provided for the relevant Audits as part of the Nottingham
University Hospitals NHS Trust submission.
We are unrelenting in the pursuit of excellence.....
57
Mandatory Statements
The reports of 67 local clinical audits were reviewed by the provider in 2011-12 and the actions
identified by the Nottingham NHS Treatment Centre to improve the quality of healthcare provided are
identified within the appendices.
Many of our users have a shared care pathway moving between the Treatment Centre and
Nottingham University Hospitals NHS Trust. Where the Treatment Centre only manages a small part
of a patient’s pathway, an agreement is in place that information will be utilised from the shared
healthcare record and included in the relevant shared audits.
In addition to the 67 local clinical audits, the Nottingham NHS Treatment Centre also undertake
facility wide audits relating to health & safety, information governance, infections prevention &
control, hand hygiene, fire safety, medical gases, controlled drugs and decontamination.
Participation in National Confidential Enquiries
We have reviewed 1 National Confidential Enquiry (Peri-Operative Care; Knowing the Risks, 2011)
that relates to the activity at the Nottingham NHS Treatment Centre and noted the findings;
recommendations identified were already in place.
Participation in Clinical Research
The Nottingham NHS Treatment Centre jointly hosts clinical research in conjunction with Nottingham
University Hospitals NHS Trust.
The number of projects related to NHS services provided by the Nottingham NHS Treatment Centre
in 2011-12 that were undertaken during that period and that related to research approved by a
Research Ethics Committee were 23.
All research proposals undergo rigorous checks before clinical research can be undertaken at the
Nottingham NHS Treatment Centre. Applications are made via the Local Research Ethics
Committee before approval is considered.
We are unrelenting in the pursuit of excellence.....
58
Mandatory Statements
The increasing level of agreement to support clinical research demonstrates our commitment to
improving the quality of care we offer and contributing to wider health improvement.
Registration and External Review
The Nottingham NHS Treatment Centre is required to register with the Care Quality Commission and
its current registration status is Compliant.
The Care Quality Commission has not taken enforcement action against Nottingham NHS Treatment
Centre during 2011-12.
The Nottingham NHS Treatment Centre has the following conditions on registration:
Site
Regulated Activity
Conditions
The Nottingham NHS Treatment Centre,
Lister Road,
Nottingham
NG7 2FT
Treatment of disease, disorder or
injury
Regulated activity
must not be
undertaken on
persons under
the age of 14
years
Diagnostic and screening
procedures
Surgical procedures
Termination of pregnancies (of
pregnancy for patients at no more
than fourteen weeks (14) gestation
within the Nottingham NHS
Treatment Centre)
Lister House Surgery, 207 St Thomas Road,
Peartree, Derby, Derbyshire, DE23 8RJ
Nottingham Road Clinic, 195 Nottingham
Road. Mansfield, Nottinghamshire, NG18 4AA
Parkview Medical Centre, Cranfleet Way, Long
Eaton, Nottinghamshire, NG10 3RJ
Southwell Medical Centre, The Rope Walk,
Southwell, Nottinghamshire, NG25 0AL
Stoneleigh House, 209 Victoria Avenue,
Borrowash, Derby, Derbyshire, DE72 3HT
The Meadowfields Practice, Fellow Lands
Way, Chellaston, Derby, Derbyshire, DE73
6SW
Diagnostic and screening
procedures
Treatment of disease, disorder or
injury
We are unrelenting in the pursuit of excellence.....
None
59
Mandatory Statements
The Nottingham NHS Treatment Centre has not participated in any special reviews or investigations
by the CQC during the reporting period.
Data Quality
The Nottingham NHS Treatment Centre maintains a high level of data quality and on an ongoing
basis will be taking the following actions to continuously improve data quality:

Quarterly (at minimum) performance meetings to review performance data, identify any areas of
improvement and monitor implementation of those improvements.

Data challenges with Clinical Units, cleansing of data and re-submission where necessary.
Accurate and reliable data about the healthcare we provide is essential for the safe and efficient
management of our organisation. The existing verification and independent validation process
remains in place and there has been no other circumstance that call into question the quality of the
data that underpins performance.
Secondary Users Service
The Nottingham NHS Treatment Centre submitted records during 2011-12 to the Secondary Uses
Service for inclusion in the Hospital Episode Statistics which are included in the latest published data.
The percentage of records in the published data which included the patient’s valid NHS Number was:

100% for admitted patient care

100 % for outpatient care
The percentage of records in the published data which included the patient’s valid General Medical
Practice Code was:

99.4 % for admitted patient care

99.6 % for outpatient care
The Nottingham NHS Treatment Centre is monitored on a monthly basis at the Patient Safety and
Quality Sub-Group with NHS Nottingham City and NHS Nottinghamshire County.
We are unrelenting in the pursuit of excellence.....
60
Mandatory Statements
Target*
Apr
2011
May
2011
Jun
2011
Jul
2011
Aug
2011
Sep
2011
Oct
2011
Nov
2011
Dec
2011
Jan
2012
Feb
2012
Mar
2012
<2.0%
2.2%
2.3%
1.9%
2.3%
1.5%
1.8%
1.8%
1.6%
1.7%
2.6%
1.8%
2.3%
<5.0%
5.5%
6.0%
6.0%
5.7%
6.7%
4.1%
6.5%
5.6%
4.8%
6.1%
3.3%
3.5%
<0.5%
0.1%
0.5%
0.5%
0.2%
0.4%
0.9%
0.0%
0.0%
0.2%
0.1%
0.4%
0.3%
<0.5%
0.5%
0.5%
0.0%
0.5%
0.3%
0.1%
0.2%
0.0%
0.1%
0.2%
0.1%
1.5%
KPI 3
Clinical
Cancellations
Day-case (%)
<0.65%
0.2%
0.1%
0.2%
0.1%
0.2%
0.2%
0.1%
0.1%
0.0%
0.1%
0.4%
1.0%
KPI 3
Clinical
Cancellations
Endoscopy (%)
<0.65%
0.1%
0.0%
0.0%
0.3%
0.3%
0.0%
0.0%
0.0%
0.0%
0.1%
0.2%
0.0%
KPI 6
Rejected
Referrals (%)
<10.0%
4.8%
3.4%
3.6%
4.8%
3.6%
5.3%
4.7%
4.2%
6.4%
3.9%
3.3%
3.3%
<2.0%
0.1%
0.4%
0.3%
0.5%
0.3%
0.2%
0.2%
0.2%
0.5%
0.5%
0.4%
0.4%
<0.5%
0.07%
0.04%
0.10%
0.13%
0.04%
0.02%
0.07%
0.06%
0.06%
0.04%
0.07%
0.09%
<0.0%
19
16
22
24
33
24
33
32
31
40
29
34
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
N/A
0.2%
0.2%
0.1%
0.0%
0.0%
0.4%
0.3%
0.2%
0.4%
0.5%
0.4%
0.1%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
80.0%
78%
79%
80%
80%
82%
83%
83%
86%
86%
83%
83%
85%
-
0
0
0
0
0
0
0
0
0
0
0
0
98.0%
99%
99%
98%
99%
99%
99%
99%
99%
99%
99%
99%
99%
KPI Metric
KPI 1
DNA Day-case
(%)
KPI 1
DNA
Endoscopy (%)
KPI 2
Non-Clinical
Cancellations
Day-case (%)
KPI 2
Non-Clinical
Cancellations
Endoscopy (%)
KPI 7
Inpatient
admission to
another provider
Day-case (%)
KPI 19a
Overall
Complaint &
Concern Rate
(%)
KPI 26
Treat by Date
(N)
MRSA
Screening (%)
MRSA
Colonisation
(%)
MRSA
bacteraemia (N)
Clostridium
difficile
MSSA
bacteraemia
Mandatory
Training (%)
CAS Alerts
outside
Timeframe (N)
Recommendation
Rate (%)
*< denotes less than and reflects that the target is for less than or below the tolerance
We are unrelenting in the pursuit of excellence.....
61
Mandatory Statements
Use of the Commissioning for Quality and Innovation (CQUIN) Payment
Framework
The Nottingham NHS Treatment Centre income in 2011/2012 was not conditional on achieving
quality improvement and innovation goals through the Commissioning for Quality and Innovation
payment framework because the facility is an Independent Sector Treatment Centre and therefore
not on the NHS Standard Contract for Acute Services.
Information Governance Toolkit
The Nottingham NHS Treatment Centre Information Governance Assessment Report score overall
score for April 2011 – March 2012 was 70% and was graded Green.
Payment by Results
The Nottingham NHS Treatment Centre was not subject to the Payment by Results clinical coding
audit during 2011-2012 by the Audit Commission.
Safeguarding Children and Vulnerable adults

The Nottingham NHS Treatment Centre meets the statutory requirement with regard to the
carrying out of enhanced Criminal Records Bureau checks on all staff.

All staff (including administration staff) have undertaken and are up to date with safeguarding
training at Level 2.

There is a Board-level executive director lead, Clinical Lead (Consultant) and Lead Nurse for
safeguarding, who have undertaken safeguarding training at level 3.

The Board-level executive director for Safeguarding Children & Vulnerable Adults attends the
Local Safeguarding Children’s Board and other Nottingham Wide Safeguarding Sub-Committees.

The Treatment Centre has undertaken the Markers of Best Practice self assessment developed
by NHS East Midlands for both children and vulnerable adults, and visited by Nottingham NHS
(Primary Care Trust, PCT, Commissioners) & NHS Midlands & East (Strategic Health Authority).
We are unrelenting in the pursuit of excellence.....
62
Mandatory Statements

Actions were identified, which were routinely monitored by the Commissioning PCT and a
reassessment is currently awaited for 2012/13.

The Treatment Centre will continuously review its practice to ensure compliance with Outcome 7
(Safeguarding people who use services from abuse) of the Care Quality Commission’s Essential
Standards for Quality and Safety.
Eliminating Mixed Sex Accommodation
The NHS Operating Framework 2011-12 requires all providers of NHS funded care to confirm
whether they are compliant with the national definition ‘to eliminate mixed-sex accommodation except
where it is in the overall best interest of the patient, or reflects their patient choice’.
The Nottingham NHS Treatment Centre is pleased to confirm that it is compliant with the
Government’s requirement to eliminate mixed-sex accommodation. Sharing with members of the
opposite sex will only happen when clinically necessary, for example in theatre recovery where a
short period of close observation is required, or if there is a high risk of a drug reaction. We have
ensured that same sex waiting rooms and toilet facilities are close to bed areas and that the passing
through of opposite sex areas has been reduced.
Patients who attend our Centre will only share toilet facilities with members of the same gender, or in
some specialist areas, unisex toilets for use by patients of one gender at a time such as disabled
toilets.
We believe that every patient has the right to high quality care that is safe, effective and patient
centred, respecting the individual’s right to privacy, dignity and independence. If our care falls short of
the required standard, we will report it. We also undertake compliance audits on a monthly basis to
ensure that we do not misclassify any of our reports.
We are unrelenting in the pursuit of excellence.....
63
Statement from NHS
Nottingham City
‘NHS Nottinghamshire City monitors quality and performance at Nottingham NHS Treatment Centre
throughout the year. The information contained within this quality account is consistent with
information supplied to commissioners throughout the year.
There is a well established patient safety and quality group and a joint service review meeting to
review and monitor performance, governance arrangements and quality standards and there is
frequent ongoing dialogue as issues arise. These are supplemented by visits to the Provider as
required to obtain further assurances of the quality of services provided to patients.
The Nottingham NHS Treatment Centre works constructively with commissioners and other partners
to develop integrated care pathways that improve the health of the local community. Quality goals
and indicators are jointly agreed in order to reduce health inequalities and improve the health of
Nottingham and Nottinghamshire residents.
When serious incidents, including those reportable under the Department of Health criteria for
Independent Sector Treatment Centres and complaints occur, robust investigations are undertaken
by skilled and trained staff so that improvements can be made. The lessons learned from these are
shared in an open, transparent and systematic way with both staff and those affected and monitored
appropriately.
The Nottingham NHS Treatment Centre continues to demonstrate a high level of commitment to
improving patient safety, clinical effectiveness and to enabling patients / service users to feedback
their experiences of services and care. This is reflected at all levels of the organisation with gateway
staff involved in making suggestions and setting objectives to improve quality. This is clearly reflected
in this quality account and is to be commended.
Commissioners have seen a number of initiatives which have resulted in changes to culture, practice
and patient outcomes and these are adequately reflected in this quality account. We will continue to
work with the Treatment Centre in 2012 – 2013 to assure ourselves of continual quality of services’
NHS Nottingham City Executive Board (May 2012)
We are unrelenting in the pursuit of excellence.....
64
Statement from the
Health Scrutiny Committee
The Committee welcomes the opportunity to comment on the Nottingham NHS Treatment Centre
Quality Account for the first time.
The information contained in the Quality Account is well presented and we are pleased to see the use
of clear and accessible language. The layout makes the document easy to read and the use of
patient and staff comments provide welcome additional information and serves to provide a ‘peoplebased’ focus.
We welcome the Treatment Centre’s ongoing work to empower frontline staff to address issues and
solve problems, as well as your commitment to the pursuit of excellence.
We are particularly pleased to see how incident reporting is used to learn from mistakes and improve
patient outcomes. It is also gratifying to see the Treatment Centre using the Quality Account to
highlight some of the very difficult problems that you face such as the recurring disruption caused by
the provision of decontaminated equipment. The aspiration to deliver ‘great’ practice rather than just
good practice (e.g. regarding endoscopy consent) is to be commended.
The Committee welcomes the opportunity to continue to develop its relationship with the Nottingham
NHS Treatment Centre over the coming year.
Councillor G Klein (Chair)
Joint City & County Health Scrutiny Committee (May 2012)
We are unrelenting in the pursuit of excellence.....
65
Appendices
“Good
enough
never is.....”
As a Clinical Lead for Cardiovascular & Respiratory Services, I am passionate
about playing a fundamental role in the development of innovative, effective and
workable patient safety and quality systems that deliver excellent clinical care for
my patients.
At the Nottingham NHS Treatment Centre, I have had firsthand experience and
can see that developing the best clinical pathways requires the expertise of
healthcare staff and the ability to truly listen to the needs of our patients and place
at them at the heart of the service.
As such, it is with great pride and enthusiasm that I chair the Clinical Governance
& Risk Committee. Over the past year, I have seen significant improvements in
the way in which we assess and monitor quality, which assures us that we have
skilled and competent staff delivering the best possible clinical care in the right
environment.
Mr Bruce Braithwaite MChir FRCS, Chair of Clinical Governance & Risk Committee
Part 4
We are unrelenting in the pursuit of excellence.....
66
Dermatology Quality Account:
Executive Summary
About the Clinical Unit
Dermatology Services are situated in Gateway A of the Nottingham NHS Treatment Centre and offer
a diverse range of clinical expertise (for example light therapy, psychodermatology, specialist
biological and psoriasis, skin and Mohs surgery, nurse led systematic and biological monitoring) in
both an outpatient and day case setting. We place the Circle Credo at the heart of the service we
provide and the cohesive team approach is focussed on ensuring that all patients with skin diseases
are treated in an environment where they are not ashamed of their skin and are not subjected to the
stigma they experience outside the healthcare setting. We aim to develop and build upon existing
support mechanisms from both staff and, other patients with similar skin conditions and similar
experiences thus providing increased confidence in what is often an emotional time in a highly
supportive and professional environment.
Achievements from 2011-12
 We publicise developments made to the services offered to patients on the notice board within the
Clinical Unit to promote the positive improvements taken to both staff and patients

We hold weekly meetings, review all quality information monthly and, identify and implement
changes in practice to enhance the quality of clinical services provided to all patients

Our patient feedback data (patient satisfaction cards) is reviewed, acted upon and outcomes
featured on local notice boards and published on the website.

Our staff have received targeted Datix e-reporting training to improve incident reporting rates and
provide further opportunities for learning

Our ongoing work programme is in place examining the organisational efficiency of the outpatient
clinics; many improvements have already been made and the project has provided plenty of
opportunities for improved waiting times for patients

We have re-configured our nursing auxiliaries framework to facilitate a smoother operation of our
outpatient clinics

Information relating to waiting times for all our clinics is now available to patients on TV screens in
the waiting area.

Our clinical services are audited and results are shared at the clinical unit quality meetings.
We are unrelenting in the pursuit of excellence.....
67
Dermatology Quality Account:
Executive Summary
Priorities for 2012-13
We have reviewed the quality of services we have provided to our patients in 2011-12 and have
undertaken to develop our own Quality Account 2012-13 so that we can progress priorities we feel are
important to our staff and patients. We will commit to delivering the 9 local priorities identified as a
team and the strategic priorities set out in the main body of the overarching document.
Quality
Domain
Patient
Safety
Our quality priorities
Why we chose this
What success is
Ensure patients are
booked onto the
correct clinic lists
Continuity of care is
important for patients
and booking errors
compromises care
All patients been given
appointments on the correct
clinics
Ensure healthcare
records are available
for all patients
Having health records
is vital to the safe
documentation of
patient care and
effective continuity and
safety of clinical care
Health records accompany
patients to all clinic
appointments
Administrative
Team
Ensure pathology
results from NUH are
sent back to the
correct doctor
This is an issue that
has been identified
through incident
reporting
The correct doctors codes
on requests and results
being returned to the
correct doctor
Clinical Unit
Management
Team and NUH
Pathology
Department
Ensure that patients
are safely monitored
when on systemic
therapy
A significant number of
patients in dermatology
are on systemic therapy
which requires careful
monitoring to ensure
patient safety
This was highlighted as
a risk through incident
reporting
Adherence to recognised
guidelines for the
prescribing of systemic
therapy
Clinical Unit
Management
Team
The correct dosing of light
therapy to be administered
to all patients
The Light
Therapy Team
We aim to provide
excellent care for our
patients
Patients have
commented about
waiting times
This is a requirement
as part of NICE
Guidance
10% return rate of feedback
cards and achieve 99%
satisfaction rates
Reducing waiting times
by optimising the efficiency
and way we work in clinics
Compliance with
recommendation in the
guidance
Clinical Unit
Management
Team
Clinical Unit
Management
Team
Audit Lead
This is an ongoing audit
which will be revisited
annually
Compliance with standard
Audit Lead
The safe
administration of light
therapy
Patient
Experience
To have excellent
satisfaction feedback
from patients
Improve waiting times
Clinical
Effectiveness
Audit of biologic
prescribing
Audit of
appropriateness of 2
week wait referrals
We are unrelenting in the pursuit of excellence.....
Who will make
this happen
Clinical Unit
Management
Team
68
Cardiology, Respiratory &
Vascular Quality Account:
Executive Summary
About the Clinical Unit
The Cardiology, Respiratory & Vascular Clinical Unit is situated within Gateway B of the Nottingham
NHS Treatment Centre and provides a range of services as outlined below. We aim to provide a high
quality service to patients and a commitment that they leave the Gateway with an understanding of
their diagnosis and management plan.
Services Provided
Cardiology outpatients
Cardiac testing
Respiratory outpatients
Lung function testing
Vascular outpatients
Vascular testing
Local anaesthetic vein treatments
Venesection service
Achievements from 2011-12

We have established monthly governance meetings, which cover the whole governance agenda,
together with quarterly summaries to the wider team at partnership events

We publish developments made to the service on the notice board within the Clinical Unit to
promote the positive improvements made as a result of learning from incidents to both staff and
patients

We participate in Circle COS sessions

All out staff have received targeted Datix e-reporting training to improve incident reporting rates
and provide further opportunities for learning

We hold monthly patient hour sessions where feedback cards are reviewed and themes and
trends analysed. Actions are taken forward by COS groups

We have created a new letter for patients relating to waiting times

We have amended the Cardiology booking rules to reduce wait times

We have completed the Foam Sclerotherapy Audit
Priorities for 2012-13
We have reviewed the quality of services we have provided to our patients in 2011-12 and have
undertaken to develop our own Quality Account 2012-13 so that we can progress priorities we feel are
We are unrelenting in the pursuit of excellence.....
69
Cardiology, Respiratory &
Vascular Quality Account:
Executive Summary
important to our staff and patients. We will commit to delivering the 3 local priorities identified as a
team and the strategic priorities set out in the main body of the overarching document.
Quality
Domain
Patient
Safety
Our quality priorities
Why we chose this
What success is
Who will make this
happen
Home visits to NIV
patients by specialist
nurse
To ensure the
continuity of care for
patients who are unable
to attend clinic.
Respiratory team
alongside the
clinical unit
management team.
Patient
Experience
Transfer of appropriate
day-case procedures to
OP environment
To provide a smarter,
simpler, better value
service for our patients.
A cohort of patients
regularly accessing this
service. The reduction
of unnecessary hospital
admissions.
Patients are safely and
efficiently treated in the
outpatient environment.
Clinical
Effectiveness
Introduction of
Abdominal Aortic
Aneurysm (AAA)
screening programme
To be able to provide
an efficient one-stop
service for patients
diagnosed with an AAA.
Service is easily
accessible and
regularly used by
patients.
Director of AAA
screening service
We are unrelenting in the pursuit of excellence.....
Clinical unit
management team.
70
Radiology Quality Account:
Executive Summary
About the Clinical Unit
Radiology Services are situated in Gateway C of the Nottingham NHS Treatment Centre and provide
a valuable and highly efficient diagnostic service to all clinical units. We provide access to a range of
diagnostic services which are outlined below. We aim to provide a timely and high quality service to
all of our patients, ensuring their privacy and dignity is maintained at all times, and that they receive
the best possible service in preparation for future treatments.
Services Provided
MRI (Multi Resonance Imaging)
Ultrasound
X-Rays
Fluoroscopy for interventional cases
CT (Computerised Tomography)
Achievements from 2011-12

We use our incident data effectively to learn lessons and implement improvements; as a result,
we have implemented a number of efficiencies within the appointment process to minimise delays
and provide an increasingly effective service to all out patients.

We have appointed ‘confirmation callers’ to assist in the reduction of DNA (Did Not Attend) rates
and ensure that all patients access the services provided at the earliest available opportunity.

We have organised additional training sessions for all administration staff on the CRIS system.

We have implemented Best Practice sessions for all staff.

We have re-worded and re-branded patient booklets and associated leaflets.

We have introduced an increased choice of music during MRI scans.

We have purchased a new X-ray step.

We have purchased additional supportive chairs.
Priorities for 2012-13
We have reviewed the quality of services we have provided to our patients in 2011-12 and have
undertaken to develop our own Quality Account 2012-13 so that we can progress priorities we feel are
We are unrelenting in the pursuit of excellence.....
71
Radiology Quality Account:
Executive Summary
important to our staff and patients. We will commit to delivering the 3 local priorities identified as a
team and the strategic priorities set out in the main body of the overarching document.
Quality
Domain
Patient
Safety
Our quality priorities
Why we chose this
What success is
Implementation of
Privacy & Dignity
action plans
Patient
Experience
Extension to the MRI
working day
National requirement to offer
same sex accommodation whilst
waiting for MRI, CT and
Ultrasound scans.
To bring down National waiting
times, and to offer patients
improved access to their
appointment
Clinical
Effectiveness
To seek opportunities
to improve all aspects
of our service and
learn from any
incidents
Patients will feel
more comfortable
with the same
sex present
More options to
patients and
improved
feedback on
waiting times
Better patient
experience and
outcomes
To continuously strive to improve
our patients’ experiences,
reduce the risk of errors and
improve efficiency
We are unrelenting in the pursuit of excellence.....
Who will make this
happen
Multi-Team
Multi-Team
All
72
Orthopaedics Quality Account:
Executive Summary
About the Clinical Unit
The Orthopaedics Clinical Unit is situated within Gateway D of the Nottingham NHS Treatment
Centre; we provide a number of services as outlined below. We strive to support all patients with
their needs, especially with regard to mobility due to the nature of their disease. We treat all patients
as individuals, respecting their privacy and dignity at all times.
Services Provided
Foot and Ankle Outpatient service
Hip and Knee Outpatient Service
Hand and Wrist Outpatient service
Podiatry
Sports Medicine
Soft Tissue Disorders
Physiotherapy
Occupational Health
Nurse Specialist service providing advice on day case
and long term follow ups.
Achievements from 2011-12

There has been a continued improvement in the numbers of actual incidents reported or near
misses that allow learning.

We offer a variety of clinic times and have established a number of clinics in the community to
support the White Paper initiatives

We have made progress with the waiting times in clinics and undertaken work jointly with
Radiology to smooth the pathway for patients

We have held joint Partnership Sessions to support learning across clinical units

We have introduced telephone contact with patients where alterations to appointments are made
with less a week’s notice.

The team support 6 quality of life audits following hip, knee, elbow and carpal tunnel surgery. The
hand nurse specialist is supporting the anaesthetic department in an audit on block anaesthesia
and the recovery from this.

Clinical Outcome Data is collected by the theatre team
We are unrelenting in the pursuit of excellence.....
73
Orthopaedics Quality Account:
Executive Summary
Priorities for 2012-13
We have reviewed the quality of services we have provided to our patients in 2011-12 and have
undertaken to develop our own Quality Account 2012-13 so that we can progress priorities we feel
are important to our staff and patients. We will commit to delivering the 3 local priorities identified as
a team and the strategic priorities set out in the main body of the overarching document.
Quality
Domain
Patient
Safety
Patient
Experience
Clinical
Effectiveness
Our quality priorities
Why we chose this
What success is
Who will make this
happen
Ensure patients
receive their
appointments in a
timely manner.
Look to reintroduce the
patient pager
systems.
Improve the notes
availability to the
gateway.
This appeared to be a recurring theme
in the patient comments and complaints
made to us.
Reduction in
complaints.
Administration
team
This was highlighted many times by our
patients as feedback on the rapid
response cards.
Improve patient
confidentiality and
net promoter score.
The Gateway
team
On occasions notes cannot be found or
delivered to us at the right time and as
such delay the patient being seen.
Notes are available
in the back and
there is more
space at reception
desk. Increased
patient
confidentiality.
Gateway teams
We are unrelenting in the pursuit of excellence.....
74
Endocrinology & Rheumatology
Quality Account:
Executive Summary
About the Clinical Unit
The Endocrinology & Rheumatology Clinical Unit is situated within Gateway E and provides the
services outlined below. We aim to provide all patients with a service that maintains their privacy and
dignity, and cares for them as an individual with no pre conceived ideas.
Services Provided
Rheumatology
Endocrinology
Rheumatoid Disease
Hypertension
Osteoporosis
Osteoporosis
Lupus
Pituitary Disorders
Ankylosing Spondylitis
Thyroid Disorders
Osteoarthritis
Adrenal Disease
Fibromyalgia
Turner’s Syndrome
Wegners Granulomatosis
Paediatric Transition Service
Gout
Achievements from 2011-12

We have been the first medical speciality to develop and run a 28-day questionnaire for patients
asking them for feedback about all stages of their pathway, including the outcome of their visit and
treatment plan.

We have altered the way in which patient feedback on the day has been collected, to ensure we
capture feedback regarding the whole visit; this gives more areas for improvement.

We discuss governance issues fortnightly at every operational meeting. This is also included in all
staff meetings and partnership sessions.

We have improved communication with patients when a clinic is delayed.

We have reviewed Clinicians booking rules to ensure they have the time needed for a safe
consultation.

We ensure that all patients receive telephone calls if a change to their appointment is made within
7 days.

We have commenced a project looking at the pathway for phlebotomy
We are unrelenting in the pursuit of excellence.....
75
Endocrinology & Rheumatology
Quality Account:
Executive Summary

We undertake all of the clinical audits recommended for the speciality. The Rheumatologists are
heavily involved in research and are supported in the Clinical Unit.

We have completed a round of the 28-day questionnaires for each speciality and shared with the
teams and patients.
Priorities for 2012-13
We have reviewed the quality of services we have provided to our patients in 2011-12 and have
undertaken to develop our own Quality Account 2012-13 so that we can progress priorities we feel
are important to our staff and patients. We will commit to delivering the 3 local priorities identified as
a team and the strategic priorities set out in the main body of the overarching document.
Quality
Our quality priorities
Why we chose this
What success is
Domain
Who will make this
happen
Patient
Phlebotomy
Incident data highlighted
All investigations
Multi team
Safety
pathway - blood
mislabeling as an issue.
requested are
approach
samples, lack of
processed.
information.
Patient
Patient pathway
Patient feedback – patient
Feedback is showing a
Nursing team and
Experience
through clinic.
comments include waiting
reduction in delays.
medical staff
Reduction in negative
Admin team
times.
Clinical
Booking process –to
Incidents and feedback.
Effectiveness
establish a robust
feedback and incidents
system.
occurring.
We are unrelenting in the pursuit of excellence.....
76
Gynaecology Quality Account:
Executive Summary
About the Clinical Unit
The clinical unit situated in Gateway F of the Nottingham NHS Treatment Centre cares for patients
with Gynaecological conditions, including those who require specialist Colposcopy care. We have
delivered care to16,860 patients during 2011-12, providing a ‘one stop’ approach so that as much as
possible care can be carried out in one visit. We are a teaching unit supporting both medical and
nursing students as well as junior doctors and the unit was recently visited by the Nursing and
Midwifery Council who deemed our approach to be outstanding. The care we provide is delivered by
12 Doctors, 20 Nurses, 7 Allied Health Professionals supported by 7 Administration staff and 5
Medical Secretaries.
Services Provided
Gynaecology:
Colposcopy:
General Outpatient Clinics
Nurse Led Smear Service
Menopause Clinics
Post Coital Bleeding Clinics
Nurse Led Sterilisation
Menstrual Disorder Clinics
Dexa-Scan Service (Bone Densitometry)
Joint Colposcopy / Dermatology Clinics
Urogynaecology
Vulval Disorder Clinics
Achievements in 2011-12

We have successfully embedded continuous quality improvements by reviewing as part of our
clinical unit governance meeting, patient safety, patent experience and clinical effectiveness
data throughout 2011-12.

We have monitored incident reporting and ensure that we take every opportunity to learn from
our mistakes and put things right when things have gone wrong. By carrying out incident
management training for all our staff we have increased reporting by 38% during 2011-12. We
are now able to identify themes and trends quickly such as broken equipment being returned
from sterile services. This has led to improved joint working in order to reduce the occurrence.

We have encouraged our staff to ask patients for feedback which has meant that Gateway F has
received the highest level of comments (4774). We received a response rate of 35% with 99.5%
satisfaction rate.
We are unrelenting in the pursuit of excellence.....
77
Gynaecology Quality Account:
Executive Summary

We ensured that robust investigations were undertaken by clinicians for patients that were
dissatisfied and raised concerns. In response we have provided patients with more information
leaflets to better explain what happens within our clinics and ensure that patients who require
support whilst undergoing procedures can have their carer or partner present.

We have participated in the Royal College of Obstetrician and Gynaecology Heavy Menstrual
Bleeding Audit, and assisted in the Osteoporosis review. We have undertaken 8 local audits
including a waiting times review as highlighted by our patients as an issue they would like us to
make improvements on. Changes to service are currently taking place with better communication
of wait times for each clinic shown on the TV screens in waiting areas.

We have developed more nurse led clinics to broaden the range of services we can provide.

We have implemented a Did Not Attend (DNA) project to better understand why patients do not
attend specific clinics and then take appropriate action.

We scored 97% against an external Infection Prevention and Control audit
Our Local Priorities for 2012-13
We have reviewed the quality of services we provided to our patients in 2011-12 and have
undertaken to develop our own Quality Account 2012-13 so that we can progress priorities we feel
are important to our staff and patients. We will commit to delivering the 3 local priorities identified as a
team and the strategic priorities set in the main body of the overarching document.
Quality
Domain
Patient
Safety
Our quality
priorities
Why we chose this
What success is
Who will make this
happen
Improve
equipment
provision
An ongoing issue, identified
through incident reporting.
Key to delivering a safe and
effective service
Lead Nurse
Colposcopy
Patient
Experience
Waiting
Times
Regular comments from patient
feedback (10% of those that
complete the feedback)
Clinical
Effectiveness
Clinical
outcome
review of
ablation
To better understand the
effectiveness of the ablation
treatment we deliver
Reduction in need to
report incidents.
Reduction in the delay
or cancellations of
appointments.
Patients waiting no more
than 30 minutes from
their appointment time.
Reduced number of
negative comments.
Increased number of
positive comments.
A 40% return rate of
questionnaires and
reported results
We are unrelenting in the pursuit of excellence.....
Clinical Unit
Management
Team
Lead Nurses
78
Day Case Unit Quality Account:
Executive Summary
About the Clinical Unit
The Day Case Unit, situated in Gateway G of the Nottingham NHS Treatment Centre provides high
quality, efficient and timely care for patients having day surgery procedures. In all we do, the patients
care, treatment, safety and wishes are at the forefront of our minds and we constantly judge
ourselves on how we perform. We are continually striving to improve the quality of care we provide to
our patients; acting on all feed back in a way that reflects modern, innovative same-day surgery.
We have delivered care to 11,383 patients during 2011-12 and many surgeons provided specialist
care in General Surgery, Orthopaedics, Pain Management, Maxillofacial, Gynaecology, Vascular,
Urology, Skin and Podiatry surgery. The Consultant Surgeons are supported by Anaesthetists, 50
Nurses (including operating department practitioners), 7 Allied Health Professionals and 12
Administration staff.
Achievements from 2011-12

We have successfully embedded continuous quality improvements by reviewing as part of our
clinical unit governance meeting, patient safety, patent experience and clinical effectiveness data
throughout 2011-12.

We have monitored our clinical outcomes and can report very low in patient admission rates not
exceeding 0.5% which is well below the national average of 3-5%.
The number of unplanned transfers from Gateway G in 2011
12
Observation
Patients
10
8
Bleeding
6
Nausea &
Vomiting
4
Pain control
2
Other
Ja
n
Fe ua r
br y
ua
r
M y
ar
ch
Ap
ri l
M
ay
Ju
ne
Ju
A ly
Se ug
p t ust
em
O ber
c
N to b
ov er
e
D mb
ec e
em r
be
r
0
2011

We have increased the level of incident reporting by 32% so that we can learn and improve. We
did this by training all our staff in our Partnership Sessions ensuring that all our staff got the same
We are unrelenting in the pursuit of excellence.....
79
Day Case Unit Quality Account:
Executive Summary
message. As a result of the improvements made include more staff being able to undertake preassessments, the day-case environment has been re-designed so that we will be able to provide
better patient flows and improve privacy and dignity, pain relief has been improved reducing the
need for an inpatient stay for patients undergoing laparoscopic cholecystetomy and staff ensure
that we have sufficient decontaminated equipment available.

We have reviewed our compliance with WHO safety check list, and have provided training
sessions for staff to ensure that this is adhered to. We intend to routinely audit compliance in
2012-13.

We have established a one stop ‘pre-assessment’ service and in January 2012 60% of patients
referred to day case had their pre-assessment completed on the day of their outpatient
appointment.

We have reviewed our patient complaints and concerns monthly and identified acted upon the
themes and trends seen. We have implemented staggered arrival times so that our patients do
not wait too long and reduced the number of comments from patients that feel their discharge was
rushed.

All patients are screened for MRSA; those patients who are colonised with MRSA are treated
accordingly prior to undergoing treatment/procedure.

In response to our patient feedback and raised concerns we have designed an hourly ‘walkaround’ so that nurses regularly visit patients so that we can attend to basic needs and improve
their experience.

We have ensured that our patients and their carer’s are informed about what will happen on the
day and where necessary that carer’s are able to stay with them whilst recovering.

We have piloted and implemented a ‘Quality of Life’ survey which is given to the majority of our
patients so that we can analyse the effectiveness of the care we provide. .

We continued to reduce our Did Not Attend (DNA) rate, with DNA’s at less than 3% in the first
quarter of 2012.

We have worked really hard in engaging and empowering our staff holding 8 Partnership sessions
and now hold weekly patient hour meetings where we review as a team all information relevant to
our patients in order that we can quickly improve their experience.
We are unrelenting in the pursuit of excellence.....
80
Day Case Unit Quality Account:
Executive Summary
Our Local Priorities for 2012-13
We have reviewed the quality of services we provided to our patients in 2011-12 and have
undertaken to develop our own Quality Account 2012-13 so that we can progress priorities we feel
are important to our staff and patients. We will commit to delivering the 3 local priorities identified as a
team and the strategic priorities set in the main body of the overarching document.
Quality
Domain
Patient
Safety
Our quality
priorities
Why we chose this
What success is
Who will make this
happen
100%
Compliance
with WHO
safety check
list
Safety is our priority
Audit at 100%
compliance
All staff are
involved
Patient
Experience
To ensure all
patients
receive
optimum care
during their
stay
From the patient feedback
that we have received and
the inclusion of national
recommendations into
nursing practice
Positive patient
feedback on their
experience and
100% patients
visited at regular
intervals
All staff
Patient
Experience
Reduce wait
times on the
day of
surgery
This is a direct response
from our patients
concerns
Increased patient
satisfaction rates.
Reduction in the
number of
complaints
regarding rushed
discharge.
Lead Nurse
Reporting
infection
rates,
admission
rates and
other
concerns,
complaints
and
comments
We undertake a 28 day
follow up phone call to
collect data relating to the
patient’s recovery
Ensuring infection
rates remain
negligible, patient
satisfaction
remains excellent
and that clinical
recovery is as good
as it can be
Clinical
outcomes caller
and the clinical
unit team
Clinical
Effectiveness
We are unrelenting in the pursuit of excellence.....
81
Endoscopy Quality Account:
Executive Summary
About the Clinical Unit
Endoscopy services are situated in Gateway H. We have delivered the best quality care to 9,576
patients in our state of the art suites which are equipped with a modern high definition video
endoscopy system. The unit has 1 pre-assessment room, 4 admission rooms, separate male and
female pre-procedure waiting area, 2 enema rooms, a recovery area for 9 beds, a discharge lounge
and a quiet room. We have on site decontamination facilities so that our equipment can be sterilised
quickly and efficiently. Care is delivered by 14 Endoscopists, 5 Nurse Endoscopists, 14 Nurses and 9
Healthcare Assistant which are supported by 7 administration staff.
Services Provided
Colonoscopy
Flexible Sigmoidoscopy
Gastroscopy
Polyp Removal
Haemorrhoidal Banding
Cystoscopy
Endoscopic Mucosal Removal
Bronchoscopy
Varices Banding
Achievements from 2011-12

We have, during 2011-12 progressed our application for JAG accreditation and are due to be
assessed in July 2012.

We continuously review data to ensure that we closely monitor the quality of care provided and
share this with our team to enable us to change practice and improve. We regularly update
partners through partnership sessions sharing and learning from one another.

We hold regular training sessions with our staff, a recent one focusing on incident reporting, to
ensure that all staff understand the value of reporting when things prove challenging so that they
can be rectified and lessons learnt. This has resulted in a 30% increase in reporting during 201112, compared to 2010-11. The Lead nurse is also trained in root cause analysis investigation
techniques.

We strongly believe in investing in our people and we have worked very hard to improve the
experience for Endoscopist trainees by implementing Endoscopy Nurse education and
competency package.
We are unrelenting in the pursuit of excellence.....
82
Endoscopy Quality Account:
Executive Summary

So that we can review clinical outcome information quickly, even at endoscopist level we have
implemented an electronic report tool called Endobase which allows the unit to collate in depth
audit information and share this regularly. We have been able to create individual
endoscopist audit cards which enable a clinician’s practice to be reviewed every 6 months.

We scored 97% in an external Infection Prevention and Control audit demonstrating high rates of
compliance, however it did highlight an issue with disposal of sharps which is now resolved.

We received 2222 comments from our patients during 2011-12 of which 99.5% were satisfied.
Feedback from patients has prompted us to provide better communicate any waits that they may
have whilst waiting for their procedure.

We identified in 2011 that our Did Not Attend rates (DNA) were around 6% each month and we
wished to reduce this. In discussion with patients it was obvious that they wished to be more
informed and have their fears allayed regarding what is perceived as an unpleasant procedure.
We therefore established a pre-assessment service to see patients prior to their procedure
providing them with an opportunity to ask questions. This has resulted in a reduction in the DNA
rate to around 3.5% in March 2012.
Our Local Priorities for 2012-13
We have reviewed the quality of services we provided to our patients in 2011-12 and have
undertaken to develop our own Quality Account 2012-13 so that we can progress priorities we feel
are important to our staff and patients. We will commit to delivering the 3 local priorities identified as a
team and the strategic priorities set in the main body of the overarching document.
Quality
Domain
Patient
Safety
Our quality priorities
Why we chose this
What success is
Who will make this
happen
Improve
Endoscopist
training
experience and
Endoscopy Nurse
education and
competencies
To ensure patient
safety is the most
important priority within
the unit in order to offer
consistently high
quality care to every
patient we treat
Patient feedback shows we
provide a motivated,
knowledgeable and highly
skilled workforce for every
procedure undertaken within
the unit
The clinical unit are
responsible to
provide the tools to
facilitate the changes
and education
required for all
members of staff
We are unrelenting in the pursuit of excellence.....
83
Endoscopy Quality Account:
Executive Summary
Patient
Experience
Redesign of unit
As a result of patient
feedback to enhance
the experience, flow
through and capacity of
the unit
The changes show reduced
bottlenecks whilst
maintaining privacy, dignity
and confidentiality for each
of our patients
Funding from Circle
with external
contractors to put in
place the vision for
the future perceived
by the clinical unit
team
Clinical
Effectiveness
Achieve JAG
Accreditation
To achieve national
recognition for the
improvements and
excellent service we
provide to the local
population
To undertake an agreed
annual audit timetable to
show consistently high
standards of care can be
maintained and built upon
year after year
Every member of the
team will play a part
to ensure the high
level of care given to
our patients is
delivered by
motivated individuals
We are unrelenting in the pursuit of excellence.....
84
Digestive Diseases
Quality Account:
Executive Summary
About the Clinical Unit
Digestive Diseases and Urology Out Patient services is situated in Gateway I of the Nottingham NHS
Treatment Centre and provides a safe, professional and discreet care to 25,602 patients who have
presented with health concerns of a sensitive nature. We provide access to a range of interlinked
specialties which are outlined below. Our aim is to ensure that each patient is treated as an individual,
with respect and compassion, and to ensure they feel confident they are getting the best treatment
and advice.
Services Provided
Digestive Diseases:
Urology:
Colorectal
General Urology Clinic
Gastroenterology
Flow rate Measurement
Hepatology
Bladder Scanning
One stop clinic for Endoscopy
Achievements from 2011-12

We have successfully embedded continuous quality improvements by reviewing as part of our
clinical unit governance meeting, patient safety, patent experience and clinical effectiveness data
throughout 2011-12. We review the quality dashboard and quality quartet, enabling the unit to
review issues, identify solutions and implement improvements.

We hold quarterly partnership sessions with the unit team to cascade quality data and involve the
team in improvements. We have focused on different topics such as Information Governance. As
a result of incident reporting we identified that information may not be as safe as we would like
due to space issues in the unit. We have redesigned the reception area to provide a new storage
room for medical records so that sensitive information is kept safe.

We feedback to our patients in our ‘Gateway in Focus’ notice board monthly to share our quality
data and progress on improvements made.
We are unrelenting in the pursuit of excellence.....
85
Digestive Diseases
Quality Account:
Executive Summary

We have undertaken incident management training sessions to ensure that all staff are competent
on reporting incidents, which has resulted in a 47% increase in reporting during 2011-12,
compared to 2010-11. Due to ongoing issues with equipment being lost at sterile services, we
sought and implemented single use rigid rectal scopes. In order to ensure safe practice we
developed a standard operating procedure, which was ratified at the Clinical Governance and Risk
Management Committee.

We received 2291 patient comments of which 99% of patients said they would recommend
Gateway I. Based on this information we have made improvements to patient waiting areas
including the installation of a hot drinks machine, and changed the layout of the waiting area to
accommodate space for wheelchair users.

We have listened to our patients concerns and reviewed the amount of patients being cancelled
and re booked. We have implemented a robust appointment cancellation process, to ensure that
patient care is not adversely affected.

An in-depth waiting times audit has been commenced as this has been a constant issue raised by
patients. TV screens in main waiting area are being used to communicate delays and staff have
been pro-actively informing patients but feedback is still being received.

We have participated in National Bowel Cancer Audit (NBOCAP).
Our Local Priorities for 2012-13
We have reviewed the quality of services we provided to our patients in 2011-12 and have
undertaken to develop our own Quality Account 2012-13 so that we can progress priorities we feel
are important to our staff and patients. We will commit to delivering the 3 local priorities identified as a
team and the strategic priorities set in the main body of the overarching document.
We are unrelenting in the pursuit of excellence.....
86
Digestive Diseases
Quality Account:
Executive Summary
Quality
Domain
Our quality
priorities
Why we chose this
What success is
Who will make this
happen
Patient
Safety
Implement a
robust process
to manage
Clinic
Cancellations
Issues with patients
having appointment
rescheduled a number of
times
Patients will not have
appointments rescheduled a
number of times and will not
have to wait a prolonged
period of time for their
appointment
Patient
Experience
Reduction in
wait times
during clinic
A recurring theme in
feedback from the
patients.
Clinical
Effectiveness
Dedicated
phone number
for patient’s
queries
regarding
test/scan/x-ray
results.
Concerns from patients
who have waited for
longer than 4 weeks for
results of tests.
Dedicated telephone
number has been piloted
by one consultant and
proven effective.
That patients will not wait
longer than 30 minutes to
see a doctor from their
appointment time
Patients will have their test
results with minimum delay.
That they are reassured
there is a process in place if
concerned.
Clinical Unit
Management team
through
implementation of
Clinic Cancellation
Process and audit of
effectiveness
Gateway I team
We are unrelenting in the pursuit of excellence.....
Lead Nurse/Gateway
Coordinator
87
Jargon Buster
Apps/Applications A specialised piece of software (which can run on the internet, on your
computer, or on your mobile phone or other electronic device) and is designed
to undertake a specific task. For example to monitor waiting times in clinic.
Credo
A set of fundamental beliefs or a guiding principle. For Circle, a credo is similar
to a mission statement that guides the way in which we deliver healthcare.
Dashboards
An easy read, often single page, real-time user interface, showing a graphical
presentation of the current status (snapshot) and historical trends of an
organisation’s key performance indicators (KPIs) to enable instantaneous and
informed decisions to be made at a glance.
Joint Advisory
The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) operates within
Group (JAG)
the Clinical Standards Department of the Royal College of Physicians. JAG
has a wide remit and its cores objectives include: to agree and set acceptable
standards for competence in endoscopic procedures and, to quality assure
endoscopic units, training and services.
Partnership
Educational, discussion and solution focused sessions held within clinical units
Sessions
and open to all staff involved in the patient pathway. The purpose of the
sessions is to improve competence and educate staff, enable discussions of
any issues that have arisen and provide the opportunity to develop realistic and
effective solutions.
Peer review
A process of self-regulation by a profession or a process of evaluation involving
qualified individuals within the relevant field. Peer review methods are
employed to maintain standards, improve performance and provide credibility.
Preceptorship
A period (of preceptorship) to guide and support all newly qualified practitioners
to make the transition from student to develop their practice further.
Rapid cycle
A quality improvement technique that allows staff to identify areas for
feedback
improvement in existing patient pathways and allows prompt, effective
solutions to be implemented which improve the patient flow and enhance the
quality of care that patients receive.
We are unrelenting in the pursuit of excellence.....
88
We are unrelenting in the pursuit of excellence.....
89
We welcome your feedback:
Nottingham NHS Treatment Centre
Queen’s Campus
Lister Road
Nottingham
NG7 2FT
Email: PALS.Nottingham@circlepartnership.co.uk
Website: www.circlepartnership.co.uk