Human Rights in Healthcare
Betsi Cadwaladr University
Health Board
Anne-Marie Rowlands: Deputy Director of Nursing
Sally Hughes-Jones: Head of Equality and Human Rights
Julie Smith: Associate Chief of Staff Nursing
About BCU Health Board
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Largest health organisation in Wales
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Primary, community, mental health & acute
hospital services for a population of around
676,000
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Workforce around16,000 staff
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Budget around £1.2 billion
Acute and Community services
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3 district general hospitals
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22 other acute and community hospitals
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90 health centres, clinics, community health
team bases and mental health units
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121 GP practices and NHS services
provided by North Wales’ dentists, opticians
and pharmacies.
Our Strategic Direction
“Anyone coming in contact with a public
service should be treated with respect and
dignity, have their health need assessed, be
helped and not handed off to someone else,
receive a responsive, safe and high quality
service that continually improves, is easy to
access and understand” (Strategic
Directions 2009)
Our Positive Obligation
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Positive obligations on public authorities to
take a proactive approach to human rights.
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FREDA principles (Fairness, Respect,
Equality, Dignity, Autonomy) underpin
Human Rights and public service ethos.
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Supports BCU Strategic Equality Plan & our
organisational values
Human Rights Based
Approach
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Empowers service users and staff
Protects vulnerable people
Improves experience
Improves outcomes
Bring human rights to life by applying
the principles to a clinical pathway
Leading & Defining the
Project
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Championed at Board level by the Director
of Nursing, Midwifery and Patient Services
Deputy Director of Nursing, whose portfolio
includes nutrition
Head of Equality and Human Rights
Associate Chief of Staff Nursing, lead for
transformational group
Why Human Rights, Nutrition
and Hydration?
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Patient Association, Care Quality
Commission, Ombudsman, Age Concern
No specific guidance – direct link nutrition,
hydration, human rights & obligations of
service providers
Evidence, guidance and best practice
BCU – huge organisation – different ways of
working
Quality Patient Care
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Ward staffing/ nurse : patient ratio review
Supernumerary ward sisters/charge nurses
Introduction of matrons
Strategic nutritional and catering group
Saving 1000 Lives – Intentional rounding
Striving for excellence– ‘good is not good
enough’
Project Aims
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Development of a practical toolkit
Directly links nutrition, hydration, human
rights & obligations of service providers
Increase knowledge and awareness of
human rights, nutrition and hydration
Embed dignity and human rights within
everyday ward routine
Place the patient at the centre of care.
Achieving the Aims
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Multidisciplinary project steering group
Redefined the role of nutritional sub group
BIHR Human Rights training
Brainstorming session - practical starting
point
Project plan & driver diagram agreed
Draft toolkit developed
Engagement and Involvement
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Communication & press briefing
Stakeholder event - ward staff, dietetics,
Speech and Language, education, catering,
service users, specialist nurses
BIHR training, questionnaire, workshop
Draft toolkit –questions posed – positives
and negatives? what would you change?
barriers to implementation?
Outcome of Stakeholder Event
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Event ideas and feedback discussed
Changes to toolkit made
6 pilot wards identified (mix of acute
medical, care of the elderly, acute surgical,
acute orthopaedic)
BIHR training for pilot wards, matrons and
senior nursing team
Transformational sub group
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Reporting to Human Rights steering group
Monthly meetings
Leads identified to support pilot wards
Focus on establishing the baseline,
identifying areas for change
Testing (and changing) the toolkit
Drivers to Succeed
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Over arching aim
Primary Driver (Patients receive the
required level of support with eating &
drinking)
 Secondary Drivers (Safety, Environment
etc.)
 Interventions
Cornerstone of the toolkit
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Drivers & Key Components of Nutrition &
Hydration in relation to Ward Routine
Safety
Identify vulnerable patients
and those at risk at the
beginning of every shift.
Establish an alert system.
Environment
Ensure appropriate
environment of care
including access to
equipment.
Putting Human Rights
at the Heart of
Hydration and
Nutrition
Empower patients
and their families.
Ensure and enable regular
communication. Ensure
patients autonomy and
dignity is respected.
Audit compliance and measure
improvement
MUST audit and fundamentals of care
audits. Identify, monitor and learn from
concerns.
Choice
Enable and promote
choice and ensure 24
hour access to food
and drinks.
Meal times
Ensure mealtimes are
protected. Enable and
promote appropriate
involvement of carers and
volunteers
Principles of Improvement
Methodology
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Initiative to improve patients nutrition and
hydration in various areas of practice using PDSA
cycle methodology with fast cycling
Measure it > change it > re-measure it > change it
Until you get it right!
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Aims to introduce effective processes and
systems for staff in ward environments
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Aims for culture change!
Methodology
Human Rights Strategic Group
In Patient
Transformational
Group
East
Patient Safety &
Empowerment
Central
Patient
Choice
Measurements
West
Mealtimes &
Environment
How did we do it ?
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East pilot areas
 Patient safety and empowerment work streams
in line with improvement methodology
 Wards and teams identified
 Operational definitions for measurements
developed
 Baseline measurements undertaken
 PSDA cycles - process redesign
We stacked the odds in our favour!!
Patient Safety
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3 dimensions of patients safety
 Identification of patients at risk during
safety briefing (measure 1)
 (Safety briefing – measure 2)
 Delegation of Nursing orders (measure
3)
Methodology
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Baseline measurement on pilot ward
showed identification of patients at risk at
safety briefing at 59%
Target compliance = 95%
Methodology (2)
Changes introduced
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Raise awareness of human rights approach and toolkit
development – matrons meeting/staff meetings
All Wales e learning directive for all nurses to complete
Posters for SBAR
Symbols
Letters to nurses in charge outlining roles and
responsibilities
Red jugs/lids
At a glance board
Roles and responsibilities e.g. For house keepers for data
collection, Change ward routine in relation to undertaking distribution of
red jugs/symbols
Example of reliable design
evolution
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Implement a system to ensure patients at risk are
identified at safety briefs
 Who - All team leaders
 What – ensure at risk patients are identified at safety
briefing
 When – during safety briefings (3x daily)
 Where - Pilot ward
 How 
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Design – brief the nurses regarding responsibilities of identifying patients at
risk
Redesign – re introduce safety briefing into ward 3 times daily
Redesign – develop a poster to be clearly displayed at nurses station
prompting safety brief times
Redesign - change the pm SB time to accommodate shift patterns
Redesign – introduction of symbols relating to patients at risk
Reliable Process Design
AM
.......
Don’t
forget
Don’t
Forget
Safety
Briefing
PM
……
Nights
……..
Results – weekly data
Results – monthly data
Introduced
symbols/posters
Re affirmed R&R
No SB (nights)
Delegation of need
Empowerment
Conclusion
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Through repeated testing and process
redesign, reliability and sustainability
achievable
Lessons learnt –
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At the beginning state who, what, where and
when (prevents defects being the people you
forgot to include!
Keep it simple
Spread only when processes reliable
Next Steps
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Project steering group meeting Dec 12
Agree implementation plan
Development of ward resource file/website
Communication within organisation
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Strategic Nursing and Midwifery Committee
Improving Service User Experience Committee
Evaluation of impact
Sharing across Wales and wider
Thank You
Our contact details:
Anne-Marie.Rowlands@wales.nhs.uk
Sally.HughesJones@wales.nhs.uk
Julie.Smith@wales.nhs.uk