BMI Chaucer Hospital Quality Accounts
April 2013 to March 2014
Chief Executive’s Statement
Welcome to our Quality Accounts 2014, the fifth year we have published this
data. The information presented here on a broad range of quality measures
continues to grow in importance and usefulness for patients and
commissioners. Quality accounts already provide a key metric for people to
assess the strength of our 66 hospitals and clinics against other facilities - NHS
and independent - from which they might receive their care.
For BMI Healthcare and every other private provider the importance of
comparable quality data was recently reinforced by the conclusions of the
Competition Commission’s market investigation into private healthcare. From
the outset of the inquiry BMI Healthcare supported the principle that
competition in the sector would be enhanced if private hospitals produced
comparable quality data and that competition amongst hospitals would drive up
service standards. We were therefore fully supportive when the Commission
announced in April that it is mandating the provision of greater information on
the performance of hospital operators and consultants. We wholeheartedly
agree when the Commission says that “a more transparent market with
patients actively making choices will drive hospital operators to compete on the
things that matter to patients”.
Whilst we are yet to see how the Commission will ensure that this is enacted, the private sector continues
to take its own steps. Five years ago BMI Healthcare was at the forefront of the sector’s efforts to be more
open about sharing comparable quality and pricing data when we sponsored the launch of the Hellenic
Project. Today that work has been superseded by the Private Hospitals Information Network which is
working towards publishing data that will allow patients and commissioners to make informed choices - a
challenge that the sector must now rise to. We at BMI Healthcare will continue to play our part in these
important developments, which we believe can have a significant role in driving higher quality standards.
I remain proud, but certainly not complacent, about the quality of care our hospitals provide. Last year
BMI Healthcare invested £40m in our hospitals, supporting our committed staff and consultants to meet
the challenge of providing consistently safe, high quality care. We constantly measure our patients’
experience, and I am pleased to note that in the three months to the end of March 2014, 97.3% of
patients independently surveyed expressed satisfaction with their care and 97.9% said they would
recommend us to others. There is however always room for improvement, and publication of comparable
quality data across the independent sector can only help.
The information available in these quality accounts has been reviewed by the Clinical Governance Board
and I declare that as far as I am aware the information contained in these reports is accurate. I thank all
the staff whose energy and devotion to improvement is represented here and, more importantly, in the
experiences of every patient who steps across our threshold.
Stephen Collier
Chief Executive Officer
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BMI The Chaucer Hospital in Canterbury, Kent is part of BMI Healthcare, Britain's leading
provider of independent healthcare with a nationwide network of hospitals & clinics performing
more complex surgery than any other private healthcare provider in the country. Our
commitment is to quality and value, providing facilities for advanced surgical procedures
together with friendly, professional care.
BMI The Chaucer Hospital has 55 inpatient rooms. Our patient rooms offer the privacy and
comfort of en-suite facilities, satellite TV and telephone. The hospital has three theatres, 11
consulting rooms, a standalone Colposcopy Suite and an HFEA licensed Assisted Conception
Unit.
These facilities combined with the latest in technology and on-site support services enable our
consultants to undertake a wide range of procedures from routine investigations to complex
surgery. This specialist expertise is supported by caring and professional medical staff, with
dedicated nursing teams and Resident Medical Officers on duty 24 hours a day, providing care
within a friendly and comfortable environment.
Of the total number of patients treated at BMI The Chaucer Hospital, around 32% are NHS
patients. We provide a full directory of services on Choose and Book, along with being AQP
accredited to treat cataract patients in East Kent and provide direct access for MRI scanning.
The hospital is currently working developing further capacity through our Minor Operations and
Endoscopy Services. Works are underway to a dedicated Endoscopy unit and completion is
expected towards the end of July 2014.
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BMI Healthcare is registered as a provider with the Care Quality Commission (CQC) under the
Health & Social Care Act 2008. BMI The Chaucer Hospital is registered as a location for the
following regulated services:•
•
•
•
Treatment of disease, disorder and injury
Surgical procedures
Diagnostic and screening
Termination of Pregnancy
The CQC carried out an unannounced inspection on 14th February 2013 and found compliance
in the following standards:Respecting and involving people who use services
Care and welfare of people who use services
Safety and suitability of premises
Requirements relating to workers
Complaints
BMI The Chaucer Hospital has a local framework through which clinical effectiveness, clinical
incidents and clinical quality is monitored and analysed. Where appropriate, action is taken to
continuously improve the quality of care. This is through the work of a multidisciplinary group
and the Medical Advisory Committee.
Regional Clinical Quality Assurance Groups monitor and analyse trends and ensure that the
quality improvements are operationalised. There has been development of
At corporate level the Clinical Governance Board has an overview and provides the strategic
leadership for corporate learning and quality improvement.
There has been ongoing focus on robust reporting of all incidents, near misses and outcomes.
Data quality has been improved by ongoing training and database improvements. New reporting
modules have increased the speed at which reports are available and the range of fields for
analysis. This ensures the availability of information for effective clinical governance with
implementation of appropriate actions to prevent recurrences in order to improve quality and
safety for patients, visitors and staff.
At present we provide full, standardised information to the NHS, including coding of procedures,
diagnoses and co-morbidities and PROMs for NHS patients.There are additional external
reporting requirements for CQC, Public Health England (Previously HPA) CCGs and Insurers
BMI is a founding member of the Private Healthcare Information Network (PHIN) UK – where
we produce a data set of all patient episodes approaching HES-equivalency and submit this to
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PHIN for publication. The data is made available to common standards for inclusion in
comparative metrics, and is published on the PHIN website http://www.phin.org.uk. This website
gives patients information to help them choose or find out more about an independent hospital
including the ability to search by location and procedure.
1. Safety
1.1 Infection prevention and control
The focus on infection prevention and control continues under
the leadership of the Group Head of Infection Prevention and
Control, in liaison with the link nurse in BMI Chaucer Hospital.
The focus on infection prevention and control continues under
the leadership of the Group Director of Infection Prevention and
Control and Group Head of Infection Prevention and Control, in
liaison with the Infection Prevention and Control Lead BMI
Chaucer Hospital
We have had: • Zero cases of MRSA bacteraemia in the last year (NHS
1.17cases/100,000 bed days).
• MSSA bacteraemia cases /100,000 bed days
• E.coli bacteraemia cases/ 100,000 bed days
• Zero cases of hospital apportioned Clostridium difficile in the last 12 months.
• SSI data is also collected and submitted to Public Health England for orthopaedic
surgical procedures. Our rates of infection are;
o Hips – 0%
o Knees – 0%
All clinical areas have undergone Quality improvement Tool IPC clinical audits as per the
Infection prevention Society’s guidelines. Standards audited include Environmental, Hand
Hygiene; Environmental and Observation, Aseptic Technique, Transportation of specimens and
Standard Precautions. Results indicate an average compliance of 93%. Action plans have been
devised to address areas that achieve a negative score along with risk assessments where
necessary.
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Care Bundles were audited as follows: Pre-operative, Peri-operative and Post-operative to
include Urinary Catheter Care, insertion and ongoing, Peripheral Intravenous Cannula, insertion
and ongoing and Prevention of Surgical Site Infection. A direct result of the Surgical Site Care
Bundle was the implementation of the use of 2% Chlorhexidine in 70% Alcohol for surgical skin
preparation for all Orthopaedic procedures as well as all abdominal and breast procedures.
A water safety committee has been formed which discusses all aspects of water safety within
the hospital with Pseudomonas and Legionella sampling taking place.
Infection Prevention remains high on the agenda within the hospital and all areas are continuing
to strive for improvements where necessary.
Environmental cleanliness is also an important factor in infection prevention and our patients
rate the cleanliness of our facilities highly.
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1.2 Patient Led Assessment of the Care Environment (PLACE)
We believe a patient should be cared for with compassion and dignity in a clean, safe environment.
Where standards fall short, they should be able to draw it to the attention of managers and hold the
service to account. PLACE assessments will provide motivation for improvement by providing a clear
message, directly from patients, about how the environment or services might be enhanced.
In 2013 we introduced PLACE, which is the new system for assessing the quality of the patient
environment, replacing the old Patient Environment Action Team (PEAT) inspections.
The assessments involve patients and staff who assess the hospital and how the environment
supports patient’s privacy and dignity, food, cleanliness and general building maintenance. It focuses
entirely on the care environment and does not cover clinical care provision or how well staff are
doing their job.
The results will show how hospitals are performing nationally and locally. BMI Chaucer Hospitals
PLACE assessment was carried out in May 2014 and at the time of release results were not yet
available
PLACE 2013 – This was the first year of completion. BMI The Chaucer Hospitals overall score
was 57%. This reflected and frank and honest review of the care environment. The areas that
needed improvement were in OPD with soft furnishings that were non-compliant and the
general look of the building.
1.3 Venous Thrombo-embolism (VTE)
BMI Healthcare, holds VTE Exemplar Centre status by the Department of Health across its
whole network of hospitals including, BMI Chaucer Hospital. BMI Healthcare was awarded the
Best VTE Education Initiative Award category by Lifeblood in February 2013 and were the
Runners up in the Best VTE Patient Information category.
We see this as an important initiative to further assure patient safety and care. We audit our
compliance with our requirement to VTE risk assessment every patient who is admitted to our
facility and the results of our audit on this has shown. Our VTE assessment remains at 100%.
Regular quarterly audits and feedback to the National Group are standard practice.
BMI Chaucer Hospital reports the incidence of Venous Thromboembolism (VTE) through the
corporate clinical incident system. It is acknowledged that the challenge is receiving information
for patients who may return to their GPs or other hospitals for diagnosis and/or treatment of VTE
post discharge from the Hospital. As such we may not be made aware of them. We continue to
work with our Consultants and referrers in order to ensure that we have as much data as
possible.
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BMI Chaucer VTE incident rates:
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2. Effectiveness
2.1 Patient reported Outcomes (PROMS)
Patient Reported Outcome Measures (PROMs) are a means of collecting information on the
effectiveness of care delivered to NHS patients as perceived by the patients themselves.
PROMs is a Department of Health led programme.
The latest results for April to December 2013 were published in May 2014.
The Chaucer Hospital encouraged patients under- going Total Hip and Knee Replacement as
well as Hernia Repair, to complete the PROMS pre- operative questionnaires. However, the
number taking up these procedures via the NHS were low, resulting in too few returns to create
valid data in relation to the published Oxford Hip and Knee scores.
2.2 Enhanced Recovery Programme (ERP)
The ERP is about improving patient outcomes and speeding up a patient’s recovery after
surgery. ERP focuses on making sure patients are active participants in their own recovery and
always receive evidence based care at the right time. It is often referred to as rapid recovery, is
a new, evidence-based model of care that creates fitter patients who recover faster from major
surgery. It is the modern way for treating patients where day surgery is not appropriate.
ERP is based on the following principles:1. All Patients are on a pathway of care
a. Following best practice models of evidenced based care
b. Reduced length of stay
2. Patient Preparation
a. Pre Admission assessment undertaken
b. Group Education sessions
c. Optimizing the patient prior to admission – i.e. HB optimisation, control comorbidities, medication assessment – stopping medication plan.
d. Commencement of discharge planning
3. Proactive patient management
a. Maintaining good pre-operative hydration
b. Minimising the risk of post-operative nausea and vomiting
c. Maintaining normothermia pre and post operatively
d. Early mobilisation
4. Encouraging patients have an active role in their recovery
a. Participate in the decision making process prior to surgery
b. Education of patient and family
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c. Setting own goals daily
d. Participate in their discharge planning
We continue to review our implementation plan on a monthly basis, as part of our commitment
to the ERP programme.
2.3 Unplanned Readmissions within 31 days and unplanned returns to theatre.
Unplanned readmissions and unplanned returns to theatre are normally due to a clinical
complication related to the original surgery.
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3. Patient experience
3.1 Patient satisfaction
BMI Healthcare is committed to providing the highest levels of quality of care to all of our
patients. We continually monitor how we are performing by asking patients to complete a patient
satisfaction questionnaire. Patient satisfaction surveys are administered by an independent third
party.
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The Chaucer Hospital has a patient satisfaction focus group that meets monthly and
concentrate on improving the patient experience in all areas.
3.2 Complaints
In addition to providing all patients with an opportunity to complete a satisfaction survey BMI
Chaucer Hospital actively encourages feedback both informally and formally. Patients are
supported through a robust complaints procedure, operated over three stages:
Stage 1: Hospital resolution
Stage 2: Corporate resolution
Stage 3: Patients can refer their complaint to independent adjudication if they are not satisfied
with the outcome at the other 2 stages.
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4. CQUINS
CQUINS focus this year was on VTE compliance in assessment and correct treatment. The risk
assessment is an integral part of the patients care pathway and is now embedded within every
admission resulting in 100% compliance.
The secondary focus was in pain. Using the BMI Pain audit tool and care pathway. The
evidence is completed for every patient admission and can be cross referenced with the
analgesia prescribed and administered through the drug chart. Result = 97%.
The third focus was Dementia with all patients over 75 years being risk assessed using the local
tool. Any variance is reported back to the referring GP for actions. Compliance = 100%
5. National Clinical Audits
BMI Chaucer Hospital was only eligible to participate in National Joint Registry audit and all joint
replacements are submitted to this.
6. Research
No NHS patients were recruited to take part in research.
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7. Priorities for service development and improvement
•
•
•
•
On-going engagement with our local CCG’s to enhance patient choice and service
delivery to NHS patients will be measured by agreed quality indicators.
Focus on developing robust post discharge communication with patients.
Development of more flexibility within the outpatient minor operations setting, with
particular focus on WIWO patients.
Continued engagement with our CCG colleagues to look at developing patient services
closer to home.
8.5 The percentage of patients who were admitted to BMI Chaucer Hospital and who were risk
assessed for venous thromboembolism during the reporting period.
Unit
100%
Reporting Periods
(at least last two
reporting periods)
Apr 13 – Jan 14
National
Average
Highest National
Score
Lowest National
Score
96
100
79
8.6 The rate per 100,000 bed days of cases of C difficile infection reported within the BMI
Chaucer Hospital amongst patients aged 2 or over during the reporting period.
Unit
0
Reporting Periods
(at least last two
reporting periods)
Apr 13 – Mar 14
National
Average
Highest National
Score
Lowest National
Score
17.3
30.8
0
8.7 The number and, where available, rate of patient safety incidents reported within the BMI
Chaucer Hospital during the reporting period, and the number and percentage of such patient
safety incidents that resulted in severe harm or death.
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8.8 94% of staff employed by the BMI Chaucer Hospital during the reporting period, would
recommend the BMI Chaucer Hospital as a provider of care to their family or friends. This
information was captured via the yearly BMiSay staff satisfaction survey.
8. Non-Mandatory Quality Indicators
9.1 The percentage of patients who received care as inpatients or discharged from A &E during
the reporting period, who would recommend the BMI Chaucer Hospital as a provider of care to
their family or friends.
Unit
83%
Reporting Periods
(at least last two
reporting periods)
Jun 13 – Jan 14
National
Average
Highest National
Score
Lowest National
Score
81%
91%
71%
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