BMI Harbour 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 Today that work has been superseded by the Private Hospitals Information Network which is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
6 June 2014
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Helene
Cross
Director of Nursing/BMI Healthcare
Dear Helene
Quality Account 2013/14
Thank you for asking NHS Dorset Clinical Commissioning Group (CCG) to review and comment
on your Quality account for 2013/14. Please find below the CCG’s statement for inclusion in the
final document:
BMI Harbour Hospital has continued to focus on improving the clinical outcomes, safety and
experience of patients during 2013/14. The work that the hospital has done throughout the year
is reflected in high levels of performance in relation to infection prevention and control and
compliance with Venous Thromboembolism risk assessments in particular. The CCG also
supports the continued use of the Enhanced recovery programme, which supports people to
achieve a safe and early discharge from hospital following surgery. The hospital has low levels
of complaints and high levels of patient positive feedback. It is further observed that by the
end of 2013/14 financial year there were no areas of non-compliance with any quality
requirements.
In relation to the priorities identified for 2014/15 the CCG supports the areas for improvement
over the coming year. The CCG looks forward to working with BMI Harbour hospital during
2014/15 to maintain and improve high quality healthcare services.
Please do not hesitate to contact me if you require any further information.
Yours sincerely
Suzanne Rastrick
Director of Quality
BMI HARBOUR HOSPITAL
BMI The Harbour Hospital in Poole, Dorset is part of BMI Healthcare, Britain's leading
provider of independent healthcare with a nationwide network of hospitals & clinics
performing more complex surgery than any other private healthcare provider in the
country. Our commitment is to quality and value, providing facilities for advanced
surgical procedures together with friendly, professional care.
BMI The Harbour Hospital has 37 beds with all rooms offering the privacy and comfort
of en-suite facilities, broadband, TV and telephone. The hospital has three theatres,
including an endoscopy suite and high dependency rooms and 24 hour inpatient doctor
cover.
These facilities combined with the latest in technology and on-site support services, enable our
consultants to undertake a wide range of procedures from routine investigations to complex
surgery. This specialist expertise is supported by caring and professional medical staff, with
dedicated nursing teams and Resident Medical Officers on duty 24 hours a day, providing care
within a friendly and comfortable environment.
BMI The Harbour Hospital also benefits from:
Three operating theatres (two with laminar flow ultra clean air systems)
On-site pharmacy
Imaging suite
Endoscopy facilities
Phlebotomy service
Eight consulting rooms
Dedicated MRI and CT scanning unit
Two minor treatment rooms
Radiology
Physiotherapy centre
Phlebotomy
Health screening
Paediatric consultation facilities
Outreach clinic services at Shelly Manor Consulting Rooms, Bournemouth
Clinical specialties
Bariatric surgery
Breast services
Cardiology
Chest medicine
Colorectal surgery
Cosmetic surgery
Dental surgery
Dermatology
Endocrinology
ENT surgery
EVLT (Endovenous Laser Therapy for varicose veins)
Gastroenterology
General medicine
General surgery
Gynaecology
Haematology
Histopathology
Immunology
Microbiology
Neurology
Oncology
Ophthalmology
Oral/maxillofacial surgery
Orthopaedic surgery
Plastic and reconstructive surgery
Spinal surgery
Vascular surgery
Services
Allergy testing
Audiology
Breast screening
Chemotherapy
CT scanning
Diabetology
Diagnostic imaging
Emergency admissions
Endoscopy
Fertility consulting and scanning
Health screening
Mammography
MRI scanning
Pain management
Pharmacy
Physiotherapy
Pre-admission clinic
Prostate screening
Respiratory medicine
Rheumatology
Sports injuries clinic
Ultrasound
X-ray
Approximately 12 % of the hospital net revenue is from NHS caseload . The Harbour Hospital
offers the following services on the Choose and Book network:•
•
•
•
•
•
•
•
Ophthalmology
ENT
General Surgery
Gastroenterology
Pain Management
Carpal Tunnel Surgery
Knee replacement surgery
Imaging & Diagnostics
BMI Healthcare are registered as a provider with the Care Quality Commission (CQC) under the
Health & Social Care Act 2008. BMI Harbour Hospital is registered as a location for the following
regulated services:•
•
•
•
Treatment of disease, disorder and injury
Surgical procedures
Diagnostic and screening.
Family Planning
The CQC carried out its most recent unannounced inspection on the 7th January 2014 and
found full compliance
Standards of treating people with respect and involving them in their care
Standards of providing care, treatment & support which meets people's needs
Standards of caring for people safely & protecting them from harm
Standards of staffing
Standards of management
The BMI Harbour Hospital has a local framework through which clinical effectiveness, clinical
incidents and clinical quality is monitored and analysed. Where appropriate, action is taken to
continuously improve the quality of care. This is through the work of a multidisciplinary group
and the Medical Advisory Committee.
Regional Clinical Quality Assurance Groups monitor and analyse trends and ensure that the
quality improvements are operationalised. There has been development of
At corporate level the Clinical Governance Board has an overview and provides the strategic
leadership for corporate learning and quality improvement.
There has been ongoing focus on robust reporting of all incidents, near misses and outcomes.
Data quality has been improved by ongoing training and database improvements. New reporting
modules have increased the speed at which reports are available and the range of fields for
analysis. This ensures the availability of information for effective clinical governance with
implementation of appropriate actions to prevent recurrences in order to improve quality and
safety for patients, visitors and staff.
At present we provide full, standardised information to the NHS, including coding of procedures,
diagnoses and co-morbidities and PROMs for NHS patients.There are additional external
reporting requirements for CQC, Public Health England (Previously HPA) CCGs and Insurers
BMI is a founding member of the Private Healthcare Information Network (PHIN) UK – where
we produce a data set of all patient episodes approaching HES-equivalency and submit this to
PHIN for publication. The data is made available to common standards for inclusion in
comparative metrics, and is published on the PHIN website http://www.phin.org.uk. This website
gives patients information to help them choose or find out more about an independent hospital
including the ability to search by location and procedure.
1. Safety
1.1 Infection prevention and control
The focus on infection prevention and control continues under
the leadership of the Group Head of Infection Prevention and
Control, in liaison with the link nurse in BMI Harbour Hospital.
The focus on infection prevention and control continues under
the leadership of the Group Director of Infection Prevention and
Control and Group Head of Infection Prevention and Control, in
liaison with the Infection Prevention and Control Lead BMI
Harbour 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
•
Zero E.coli bacteraemia cases/ 100,000 bed days
• Zero 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
o
0% Hips
0% Knees
Infection control audits are undertaken on a monthly basis by the Infection Control lead and link
staff from the varying hospital departments. These include
Sharps audit
Waste audit
Environment assessments of all ward areas and clinical departments
Care bundles have been introduced and are in place for
Urinary catheters
Peripheral cannula insertion
Surgical site
Hand hygiene
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. Results of the hospital……
Cleanliness
Food
Privacy and dignity
Facilities
92.76%
95.37%
79.31%
87.50 %
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 Harbour Hospital. BMI Healthcare was awarded the
Best VTE Education Initiative Award category by Lifeblood in February 2013 and were the
Runners up in the Best VTE Patient Information category.
We see this as an important initiative to further assure patient safety and care. We audit our
compliance with our requirement to VTE risk assessment every patient who is admitted to our
facility and the results of our audit on this has shown 100% compliance with this audit
BMI Harbour Hospital reports the incidence of Venous Thromboembolism (VTE) through the
corporate clinical incident system. It is acknowledged that the challenge is receiving information
for patients who may return to their GPs or other hospitals for diagnosis and/or treatment of VTE
post discharge from the Hospital. As such we may not be made aware of them. We continue to
work with our Consultants and referrers in order to ensure that we have as much data as
possible. There have been no notified incidents of VTE or PE in the current reporting year.
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.
At the Harbour Hospital, we currently only participate in the Groin Hernia PROMS evaluation.
This will be rolled out in 2014 to include Knee replacement surgery.
2.2 Enhanced Recovery Programme (ERP)
The ERP is about improving patient outcomes and speeding up a patient’s recovery after
surgery. ERP focuses on making sure patients are active participants in their own recovery and
always receive evidence based care at the right time. It is often referred to as rapid recovery, is
a new, evidence-based model of care that creates fitter patients who recover faster from major
surgery. It is the modern way for treating patients where day surgery is not appropriate.
ERP is based on the following principles:1. All Patients are on a pathway of care
a. Following best practice models of evidenced based care
b. Reduced length of stay
2. Patient Preparation
a. Pre Admission assessment undertaken
b. Group Education sessions
c. Optimizing the patient prior to admission – i.e HB optimisation, control comorbidities, medication assessment – stopping medication plan.
d. Commencement of discharge planning
3. Proactive patient management
a. Maintaining good pre-operative hydration
b. Minimising the risk of post-operative nausea and vomiting
c. Maintaining normothermia pre and post operatively
d. Early mobilisation
4. Encouraging patients have an active role in their recovery
a. Participate in the decision making process prior to surgery
b. Education of patient and family
c. Setting own goals daily
d. Participate in their discharge planning
Staff have been able to attend a locally arranged study day delivered by the NHS ERP team
with whom we work in close collaboration. There is sharing of best practice and the surgeons
and anaesthetists involved work within the Harbour Hospital.
The transfusion link practitioner for the Hospital works closely with the surgeons to aim for
optimization prior to major surgery.
All incidents of extended length of stay are looked at proactively to see whether ERP practice
could have made a difference to the outcome.
The ERP concept will be rolled out to all specialty groups and a further study day to be arranged
for ERP leads to attend from across the company.
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.
There were 8 unplanned readmissions and 11 unplanned returns to theatre
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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3.2 Complaints
In addition to providing all patients with an opportunity to complete a satisfaction survey BMI
Harbour Hospital actively encourages feedback both informally and formally. Patients are
supported through a robust complaints procedure, operated over three stages:
Stage 1: Hospital resolution
Stage 2: Corporate resolution
Stage 3: Patients can refer their complaint to independent adjudication if they are not satisfied
with the outcome at the other 2 stages.
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4. CQUINS
Goal
number
Goal Name
Description
Update
1
Friends and
To improve the experience of
Family Test
patients in line with Domain 4 of
Data is collected centrally by
Quality Health . Up until
August 1st 2014- detailed
breakdown was available for
Harbour but on
commencement of postal
survey detail have only just
been made available since
December.
the NHS Outcomes Framework.
The Friends and Family Test will
provide timely, granular feedback
from patients about their
experience. The 2011/12 national
inpatient survey showed that only
13 per cent of patients in acute
hospital inpatient wards and A&E
Friends and family question
86.8 % excellence with 98.1%
satisfaction
Goal
number
Goal Name
Description
Update
departments were asked for
2
NHS Safety
To reduce harm. The power of the
Thermometer
NHS Safety Thermometer lies in
Data sent to IMU. Survey
undertaken on a monthly
basis
allowing frontline teams to
measure how safe their services
are and to deliver improvement
3.
Dementia
To incentivise the identification of
patients with dementia and other
causes of cognitive impairment
alongside their other medical
conditions, to prompt appropriate
Screening question asked of
all relevant patients on Pre
assessment or admission to
hospital.
Monthly carers survey
completed when patient with
known dementia admitted for
care. Nil return to date
referral and follow up after they
leave hospital and to ensure that
hospitals deliver high quality care to
people with dementia and
support their carers.
4
VTE
To reduce avoidable death,
disability and chronic ill health from
venous thromboembolism (VTE)
5
Care Bundle
To demonstrate quality
perioperative
All clinically eligible patients
have assessment for VTE/
need for prophylaxis on preassessment or admission.
Quarterly BMI detailed audit
also performed in addition to
monthly return to IMU
Where urinary catheter in
situ, care bundle undertaken.
Goal
number
Goal Name
Description
Update
Audits,
care
Given nature if surgeries
undertaken at Harbour, there
has been nil use of urinary
catheter to date
Post Surgical
To reduce
Remote
Follow-
unnecessary face to face
All patients whether NHS or
not are routinely contacted at
48 hours post surgery. Follow
up appointments are on
Consultant request only. All
cataract patients are
reviewed in line with best
practice pathway at 2 weeks
post procedure.
Catheters
6
appointments
Up
Digital First
7
Health
To support healthy lifestyles and
Promotion
making every contact count
BMI of all patients is
calculated at pre-assessment.
Access to weight loss
management services is
offered where the BMI
exceeds 30.
5. National Clinical Audits
BMI Harbour Hospital was only eligible to participate in National Joint Registry audit and all joint
replacements are submitted to this. BMI hospital data is from page 196 onwards in attached
latest NJS report. Use this if appropriate with your narrative on the data and any improvement
plans.
6. Research
The BMI Harbour Hospital has been involved in amulticentre randomised controlled trial
comparing the incidence of asymptomatic and symptomatic deep vein thrombosis (DVT)
between the gekoTM neuromuscular electrostimulation (NMES) device and Thrombolism
Deterrent Stockings (TEDS) in post-operative patients recovering from elective Total Hip
Replacement (THR) surgery working inpartnership with First Kind who have developed the
device. This study has been extended in March 2014 for a further six month period.
7. Priorities for service development and improvement
The Harbour hospital will be focusing on developing and enhancing its services in the following
clinical areas in addition to maintaining effective working relationships with its partners locally
and providing continued quality and choice for our patients:Oncology
Acute medicine
Orthopaedics and Imaging
Musucloskeletal services
The clinical strategy embeds the principles of the 6 Cs
Care, compassion, courage, communication, competence and commitment.
Oncology
The lead oncology nurse and team have been instrumental in developing corporate policy and
procedures in the management of cancer services. Working together with the Group director for
Oncology and in alignment with the Group Cancer strategy, the Harbour provides clinical
excellence for patients from diagnosis to end of life care. We are looking also to develop a
domiciliary service to enhance the patient journey at a point in their lives when time is of the
essence.
Acute medicine
By working collaboratively with the physicians we are able to offer quick access to inpatient care
thereby relieving the Trust of bed pressures and offering an alternative to the self -funding or
privately insured patient.
Orthopaedics and Imaging
The new CT and MRI scanners offer direct access for patients to have quality imaging and
reporting available for early diagnosis and assessment. The ERP pathways are already in place
for Hip and Knee joint replacement surgery and major colo-rectal and gynaecology.
Musculoskeletal services
The physiotherapy team are able to offer a wide range of services to the public. Self- referral
routes are easily accessible and the Alter G treadmill technology sets the Harbour apart from
other private units in the south region. Benefits are already being experienced by joint
replacement patients encouraging early mobilisation and effective rehabilitation. Spinal patients
are also being introduced to this service early in their post-operative recovery.
8. Mandatory Quality Indicators
8.1 The value and banding of the summary hospital-level mortality indicator (SHMI) for the
Hospital for the reporting period.
Unit
Reporting Periods
(at least last two
reporting periods)
Oct 11 – Jun 13
National
Average
Highest National
Score
Lowest National
Score
1.0006
1.1822
0.6735
The Harbour Hospital’s considers that this data is as described for the following reasons :
The figure stated is for expected deaths. There is an Oncology service at the Hospital where
palliative patients are admitted for end of life care. There was only one elderly medical patient
admitted who had end of life care.
8.2 The Harbour Hospitals patient reported outcome measures scores for
(i) Groin hernia surgery
Unit
0.035
Reporting Periods
(at least last two
reporting periods)
Apr 12 – Mar 13
National
Average
Highest National
Score
Lowest National
Score
0.083
0.157
0.014
The Harbour Hospital’s considers that this data is as described for the following reasons
Low uptake of PROMs questionnaire at six month return rate is not good.-We are working with
patients to encourage their participation.
8.3.(ii)The percentage of patients aged 15 or over readmitted to a hospital which forms part of
the Harbour Hospital within 28 days of being discharged from a hospital which forms part of the
hospital during the reporting period.
Unit
0.39%
Reporting Periods
(at least last two
reporting periods)
Apr 11 – Mar 12
National
Average
Highest National
Score
Lowest National
Score
10.01
14.51
5.54
The Harbour Hospital considers that this data is as described for the following reasons The
reasons for readmission are monitored on a monthly basis. There are no perceived trends
8.4 The Harbour Hospital’s responsiveness to the personal needs of its patients during the
reporting period.
Unit
94%
Reporting Periods
(at least last two
reporting periods)
2012-2013
National
Average
Highest National
Score
Lowest National
Score
68.1
84.4
57.4
The Harbour Hospital considers that this data is as described for the following reasons
There has been enhanced customer service training focusing on the welfare and guest
experience. Patients are encouraged to give us their feedback on the service and care they
have received so we can endeavor to improve their journey and experience. Patients are visited
daily on the ward by the Head of department and quality manager.
The Harbour Hospital continues to monitor patient satisfaction proactively looking at how we can
maintain and improve in all aspects of our service. Welfare telephone calls are made by staff to
patients at 48 hours after discharge to ensure all is well and assist with any queries or concerns.
8.5 The percentage of patients who were admitted to the Harbour Hospital and who were risk
assessed for venous thromboembolism during the reporting period.
Unit
100%
Reporting Periods
(at least last two
reporting periods)
Apr 13 – Jan 14
National
Average
Highest National
Score
Lowest National
Score
96
100
79
All patients are assessed for DVT risk using the recognized assessment tools. Patients are reevaluated at 24 hours. The BMI Group were awarded exemplar status for VTE management.
8.6 The rate per 100,000 bed days of cases of C difficile infection reported within the Harbour
Hospital amongst patients aged 2 or over during the reporting period.
Unit
0
Reporting Periods
(at least last two
reporting periods)
Apr 12 – Mar 13
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
Harbour Hospital during the reporting period, and the number and percentage of such patient
safety incidents that resulted in severe harm or death.
Number of patient safety incidents reported
Unit
Reporting Periods
(at least last two
National
Average
Highest National
Score
Lowest National
Score
0
reporting periods)
Apr 12 – Mar 13
44.55
1,810
0
National
Average
Highest National
Score
Lowest National
Score
7.76
30.95
1.68
Rate of patient safety incidents reported
Unit
2.53
Reporting Periods
(at least last two
reporting periods)
Apr 12 – Mar 13
Number of patient safety incidents that resulted in severe harm or death
Unit
0
Reporting Periods
(at least last two
reporting periods)
Apr 12 – Mar 13
National
Average
Highest National
Score
Lowest National
Score
0.64
28
0
Percentage of patient safety incidents that resulted in severe harm or death
Unit
0%
Reporting Periods
(at least last two
reporting periods)
Apr 12 – Mar 13
National
Average
Highest National
Score
Lowest National
Score
0.9
2.9
0.0
8.8 The percentage of staff employed by the Harbour Hospital during the reporting period, who
would recommend the Harbour Hospital as a provider of care to their family or friends.
Unit
82.9%
Reporting Periods
(at least last two
reporting periods)
2013
National
Average
Highest National
Score
Lowest National
Score
64.58
96.43
33.73
The Harbour Hospital considers that this data is as described for the following reasons:Friends and family question is not very prominent in the current questionnaire so we are actively
encouraging completion of this response with patients to raise the response rate. We do not feel
that this gives a true reflection of our patient satisfaction in isolation.
9. Non-Mandatory Quality Indicators
9.1 The percentage of patients who received care as inpatients or discharged from A &E during
the reporting period, who would recommend the Harbour Hospital as a provider of care to their
family or friends.
Unit
85.09%
Reporting Periods
(at least last two
reporting periods)
National
Average
Highest National
Score
Lowest National
Score