Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Staffordshire and Stoke on Trent Partnership Trust Quality Framework 2013-2018
DRAFT v1.0
Simon Kent & Robin Sasaru
Consultation .......................................................................................................................... 3
Consultation questions ...................................................................................................... 3
Introduction / Background ..................................................................................................... 4
Drivers for quality .................................................................................................................. 5
Definitions: What is quality? .................................................................................................. 9
Our values for quality .......................................................................................................... 11
The aim of the quality framework ........................................................................................ 13
How the framework fits into the Partnership Trust ............................................................... 14
What the framework means for our staff.............................................................................. 16
Safety .............................................................................................................................. 16
Effectiveness ................................................................................................................... 16
Experience ...................................................................................................................... 16
The strategic goals in the quality framework ....................................................................... 17
Empowering frontline quality ............................................................................................ 18
Front Line Continuous Improvement (FLCI) ................................................................. 20
Benchmarking .............................................................................................................. 20
Moving to Effective Outcomes ......................................................................................... 21
Assuring Essential Quality Standards .............................................................................. 22
Moving to Excellence ....................................................................................................... 23
Customer Service Excellence ...................................................................................... 24
Integrating Quality as a core part of the Organisation ...................................................... 25
Implementation ................................................................................................................... 26
Monitoring: How we measure progress ............................................................................... 27
Monitoring the implementation of the framework ............................................................. 27
Monitoring the quality of care ........................................................................................... 27
The framework monitoring grid ........................................................................................ 27
Appendix: Developing the framework .................................................................................. 29
Consultation Progress table ............................................................................................. 31
Impact and Assessment progress .................................................................................... 32
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Please respond to this consultation document! The closing date for comments is 19
October 2012
You can email your comments to quality@ssotp.nhs.uk
or call one of our Quality Managers:

Robin Sasaru (mobile: 07718 118178)

Simon Kent (mobile: 07718 118176)
This document is subject to a planned consultation process during September and October
2012. Comments are welcomed on any part of the document. In addition, specific questions for consultation are noted below:
A.
Are there any other key internal strategies or policies in health or social care that the quality framework needs to take account of? ........................................................................ 4
B.
What other drivers for quality should be referenced in this framework? .......................... 8
C.
What other definitions of quality should this framework take account of?.................. 10
D.
What should our definition of quality that encompasses health and social care be? . 10
E.
What other values for quality should we include? ......................................................... 12
F.
‘Service users’, ‘patients’ or ‘customers’? What is the most appropriate term for the people we care for across health and social care? .............................................................. 15
G.
What other local and national learning around quality should we take account of in this framework? ................................................................................................................... 15
H.
What other strategic goals, if any, should be included in this framework? ................. 17
I.
How can we empower front line teams and services to deliver quality and continuously improve the quality of their services? .................................................................................. 19
J.
How can we get all parts of our organisation to continually focus on outcomes? .......... 21
K.
How can we strengthen our assurance processes around essential quality standards?
22
L.
How can we develop a culture of excellence across the whole organisation? .............. 23
M.
What other key tools / work programmes can help us to “move to excellence”? ....... 24
N.
Which actions can we take to fully integrate quality through the organisation? ......... 25
O.
How can we most successfully bridge the culture gap between health and social care quality? ............................................................................................................................... 25
P.
What indicators (and their target directions) should we include to measure progress against this framework for the next five years?.................................................................... 27
Q.
What should we measure to tell us whether we are achieving our quality framework strategic goals? ................................................................................................................... 28
R.
Who else should be consulted? ................................................................................ 31
S.
Are there any other impact / assessment processes this quality framework should undergo before approval and ratification? ........................................................................... 32
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Staffordshire and Stoke on Trent Partnership NHS Trust was established on 1 September
2011 from three predecessor PCT provider arms of North Staffordshire, South Staffordshire and Stoke-on-Trent. The Partnership Trust has worked with Staffordshire County Council to successfully integrate Adult Social Care Services (older people, physical disabilities and sensory impairment) with community health services from April 2012.
The Partnership Trust’s primary objective over the next five years is to have fully integrated its health and social care services to drive up the quality of care and services provided and to deliver our five strategic goals. The integration of three different NHS provider bodies and social care provision brings unique challenges in relation to defining, measuring and improving quality. For this reason an overarching framework for quality is needed to ensure that quality is integral to the organisation.
Our vision is one where all health and social care provided is:

of the highest quality in terms of safety, effectiveness and experience

personalised, allowing our service users the fullest choice and control

where we can increasingly measure and improve the ultimate outcomes of care

where information on quality is acted upon rapidly and effectively to ensure continual improvement
In order to achieve organisational quality improvements we recognise the major steps to be:

setting specific aims around quality improvement and overseeing their achievement through a robust governance structure

focus on organisational aims and measures to ensure we get it ‘right by design’ first time every time

engaging all of the executive team in the agenda as well as front line staff

expanding our patient, service user and carer experience programme

building the improvement capability of the organisation to achieve our vision
This quality framework should be read alongside organisational strategies and policies related to quality, especially around the following:

Social Care quality framework

Clinical Audit and Effectiveness

Risk Management

Service user Experience

Integrated business plan
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
While there are many national and regional drivers for quality, this section references the drivers that relate primarily to the overarching quality framework. Strategies that sit under this framework will make reference to the drivers for that particular area.
The NHS Next stage review (2009) led by Lord Darzi, published “high quality care for all”.
This document advocated that quality should be the prime focus and driving force for the
NHS over the next decade. It also provided a general definition of quality under Safety,
Effectiveness and Experience. “High quality care for all” introduced a Quality Framework as the national strategy for quality improvement. The Partnership Trust has already responded to this Quality Framework in its 2011/12 Quality Account.
Figure 1: The Quality Framework and the Partnership Trust response 1
Quality Framework: guidance for community services (2009) is best practice guidance that sets the direction for implementing the national Quality Framework within community services. The guides describe evidence-based interventions, which will help make every service as good as the best. Whilst they are designed principally for front-line staff and clinical team leaders, commissioners will use them to inform service specifications, and with the indicators in the Quality Framework, track improvement. The Community Services
1 Transforming Community Services: Quality Framework: Guidance for Community Services,
Department of Health, 24 Jun 2009. Access via http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_1
01426.pdf quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Quality Framework has been embedded to deliver the transformational change throughout the new organisation. Through the implementation of the framework THE TRUST aims to:
 improve people’s experience of health and social care

enables and drives a culture of continuous improvement

embed quality as the organising principle driving the quality agenda

enable accountability across all stakeholders
Equity and Excellence: Liberating the NHS (2011) affirmed the desire to ensure that health services in England “achieve quality and outcomes which are among the best in the world” and identified a number of reforms that relate to the quality agenda, in particular:

Putting service user s at the centre of care; “no decision about me without me”

Creation of an NHS outcomes framework which will span the three areas of quality
(Safety, Effectiveness, Experience)

Establishment of Local / National Healthwatch, Health and Wellbeing Boards, Clinical
Commissioning Groups and a National Commissioning board

Disestablishment of Primary Care Trusts and Strategic Health Authorities

Strengthening the roles of the Care Quality Commission, the National Institute for
Health and Clinical Excellence, and Monitor.
The NHS Outcomes Framework sets out the national outcome goals that the Secretary of
State for Health will use to monitor the progress of the NHS Commissioning Board. The NHS
Commissioning Board will commission the National Institute for Health and Clinical
Excellence (NICE) to develop Quality Standards which will set out the evidence-based characteristics of a high quality service for a particular clinical pathway or condition. These standards will, where appropriate, look across several or all five domains of the NHS
Outcomes Framework.
The framework recognises the importance of aligning outcomes for health and social care , developing a shared accountability where appropriate. Further alignment of outcomes is stated as desirable in future years, as a means of encouraging collaboration and integration.
The Vision for Social care (2010) and Think local act personal (2010) emphasises a system that helps people to live their lives the way they want to, supported by the staff who work with them. The approach aims to free the front line from bureaucratic constraints and support local organisations to focus on the quality of care and the outcomes achieved for people using services and their carers, without the focus on targets. A particular example of this is the Making It Real 2 (2012) key themes and criteria, based on a public commitment to improving quality in social care. The key themes are based on “I” statements, which emphasise quality as dependent on service user requirements.
The National Quality Board (NQB) is a multi-stakeholder board established to champion quality and ensure alignment in quality throughout the NHS. The Board is a key aspect of the
2 See http://www.thinklocalactpersonal.org.uk/ quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT work to deliver high quality care for service users. The NQB 2012 draft paper Maintaining and improving quality from April 2013 3 highlights the nature and place for quality in a changing healthcare system, the different parts of the system together with the corresponding roles, responsibilities and expected values and behaviors to put service users and the public first.
The NQB 2010 Review of early warning systems in the NHS presents lessons to be learned from investigation and review of NHS organisations (notably the Francis Enquiry into Mid-
Staffordshire NHS Foundation Trust) and makes clear that safeguarding patients is the responsibility of every organisation and every member of staff.
The Care Quality Commission (CQC) is the independent regulator of all health and social care services in England. Its essential standards of quality and safety outline the basic essential service quality that our organisation should always achieve.
The Commissioning for Quality and Innovation (CQUIN) scheme is a key driver to ensure boards maintain a focus on the delivery of a quality service. The scheme allows commissioners to retain a proportion of a Trust’s income. The Trust is required to meet a series of pre-agreed quality markers to obtain that portion of the funding, and this allows both parties to ensure quality is integrated into the development and delivery of care.
The Monitor Quality Governance Framework was introduced into the assessment process for foundation trusts in 2010. A Quality Governance assessment is now part of the
Foundation Trust application process, and there is a requirement for the Boards of both new and existing NHS Foundation Trusts to self-certify with regards to quality governance.
Monitor is looking for evidence that:

boards accurately understand the quality of the care their organisation provides

boards are able to assess and mitigate risks to quality

quality is seen as a responsibility of the entire board, not only the medical and nursing directors

trusts are committed to continuous quality improvement, and have put in place the tools to address poor performance
Quality is central to the the Trust vision :
“We deliver personalised care of the highest quality, with the best possible outcomes for users and carers, empower ing them to remain independent”
Our values and goals run through the core of our quality framework ensuring that quality care and safety is at the heart of everything we do for our people and their families. We put quality first.
The Trust’s Strategic Organisational Goals:

we will work with users and carers to deliver services simply and effectively
3 Quality in the New Health System Maintaining and improving quality from April 2013. A draft report from the National Quality Board. 16 th August 2012. Access via https://www.wp.dh.gov.uk/publications/files/2012/08/Quality-in-the-new-system-maintainingand-improving-quality-from-April-2013-FINAL-2.pdf
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT

we will provide high quality and safe services which provide an excellent experience and best possible outcomes

our organisation will develop and deliver sustainable new services that are exciting and support independence

our workforce will be empowered and supported to deliver care in a way that is consistent with our values
Figure 2: Other drivers and the strategies / policies that will reference them
Other drivers for quality
National Patient Safety Agency
Safety thermometer
Commissioning for Quality and
Innovation
NHS institute: (including productive series)
National Institute for Health and
Clinical Excellence
National Advisory Group on Clinical
Audit & Enquiries and the Healthcare
Quality Improvement Partnership
NHS constitution
Strategies / Policies that will reference them
Risk Management
Risk Management
Risk Management
Transformation
Effectiveness
Clinical Audit
Safety express
NHS Litigation Authority
Patient Environment Action Teams
Safety Thermometer
Customer Service Excellence
Equality Delivery System
Quality, Innovation, Productivity and
Prevention
Commissioning for Quality and
Innovation Payment Framework
Making it real – Think local act personal
National Quality Board
Safety/Effectiveness/Experience/
Transformation
Safety/Effectiveness/Experience/
Transformation
Safety/Effectiveness/Experience/
Transformation
Safety / Experience
Effectiveness
Experience
Effectiveness / Experience
Effectiveness / Experience / Transformation
Effectiveness / Experience
Effectiveness / Experience
Safety/Effectiveness/Experience
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
In order to clearly define a framework for quality, a clear and trust wide definition of “quality” must be agreed that encompasses health and social care. This section aims to pull some of the key health and social care descriptions of quality into one agreed definition, on which the framework itself can build on.
Healthcare has long subscribed to the Donabedian 456 categorisation of quality into structure
(tools and resources), process (activities that go on between practitioners and service users), and outcome (change in current and future health status).
More recently, the NHS has worked around an updated shared definition of quality. This was set out by Lord Darzi in the NHS next stage review 2008 7 as comprising three elements:
Safety: The first dimension of quality must be that we do no harm. This means ensuring the environment is safe and clean, reducing avoidable harm such as reducing the number of preventable pressure ulcers and reduced injury as a result of a fall.
4 Donabedian A. Explorations in Quality Assessment and Monitoring, Volume I. The Definition of
Quality and Approaches to its Assessment. Ann Arbour, MI , Health Administration Press; 1980. pp.
1 –164.
5 Donabedian A. The quality of care. How can it be assessed? Jama. 1988;260:1743 –1748. doi:
10.1001/jama.260.12.1743.
6 Kunkel S, Rosenqvist U, Westerling R. The structure of quality systems is important to the process and outcome, an empirical study of 386 hospital departments in Sweden. BMC Health Serv Res.
2007;7:104. doi: 10.1186/1472-6963-7-104.
7 High Quality Care for all: NHS next stage review final report. Department of Health June 2008.
Access via http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_0
85825 quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Experience: Quality of care includes quality of caring. This means how personal care is – treating people with compassion, dignity and respect. It can only be improved by analysing and understanding service user’s satisfaction with their own experiences.
Effectiveness: This means understanding success rates from different treatments for different conditions. Assessing this will include clinical measures such as mortality or survival rates, complication rates and measures of clinical improvement. Just as important is the effectiveness of care from the service user’s own perspective – for instance improvement in pain-free movement after an operation, or returning to work after treatment. Effectiveness may also extend to people’s well-being and ability to live independent lives.
All three of these elements must be present at the same time to ensure high quality – delivering on just one or two is not enough.
The Social Care Institute for Excellence (SCIE) describes excellence in social care:
“Excellence in social care is rooted in a whole-hearted commitment to human rights, and a continuous practical application of that commitment in the way that people who use services are supported. People who use services are demonstrably placed at the heart of everything that an excellent service does.
” (A definition of excellence for regulated adult social care services in England, SCIE 2010)
SCIE identifies four essential elements of excellence in social care:

having choice and control over day-to-day and significant life decisions

maintaining good relationships with family, partners, friends, staff and others

spending time purposefully and enjoyably doing things that bring them pleasure and meaning.

the organisational and service factors which enable the above three outcome-based elements to be achieved and sustained.
SCIE differentiates between Essential (ie “good enough”) and Excellent services, and describes how focussing on outcomes for the individual and attempting to enable individuals to have the greatest possible control over their own life, means that the service will be doing an excellent job.
Q uality is everyone’s business.
It is not the responsibility of any one part of the system, it is a collective endeavour. Quality requires collaboration at every level of health and social care.
While there may be different definitions and descriptions of quality, everyone in our trust should have the same understanding of quality. Our view of quality uses Safety,
Effectiveness and Experience as a common starting point.
Our ultimate aim is to improve outcomes for our service users.
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
We will use the best practice around safety, effectiveness, and experience when dealing with quality, eg:

Safety: applying national best practice around investigation and prevention of incidents.

Effectiveness: focussing on outcomes, personalisation and choice in social care, as well as the clinical effectiveness of treatments and interventions

Experience: use of latest validated tools for measuring experience, such as the net promoter score
Using the underlying simple principles 8 from a variety of methodologies, our vision for Quality includes a focus on:

understanding the problem with a particular emphasis on what the data says

understanding the processes and systems within the organisation – particularly the service user pathway and whether these can be simplified

analysing the demand, capacity and flows of the service

choosing the tools to bring about change, including leadership and clinical engagement, plus staff and service user participation

evaluating and measuring the impact of a change
While there are many approaches to quality improvement, across healthcare, social care, and industry, they are often based on similar principles and a common body of tools for improvement. Drawing on work by the NHS Institute for Innovation and Improvement 9 , our common values for quality improvement are:

define quality first

identify the process

beware of the exclusive promotion of one approach to quality improvement
 think about who the “customer” is

understand the people – the individuals working in the system and their behaviours

get data about quality before you start

recognise the importance of whole system leadership
8 Quality Improvement Made Simple: Identify, Innovate, Demonstrate, Encourage. The
Health Foundation - Inspiring Improvement. 6 th September 2010. Access via http://www.health.org.uk/public/cms/75/76/313/594/Quality_improvement_made_simple.pdf?
realName=uDCzzh.pdf
9 Quality Improvement: Theory and practice in healthcare. NHS institute for innovation and improvement. Access via http://www.institute.nhs.uk/index.php?option=com_joomcart&main_page=document_product_info&pr oducts_id=403&cPath=67 quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
There are clear synergies between the approaches outlined above and the current social care quality framework:
 Only the customer can define quality; learn what’s important to customers

Define and refine standards

Measure how well we are meeting these standards

Take action to address unmet standards

Monitor customer satisfaction
Continuous quality improvement is a philosophy that intends that most things can be improved and is the scientific method of improvement in everyday work. Plan-do-study-act cycles and quality circles are examples of techniques that embrace this philosophy of quality as a journey not a destination.
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
The quality framework aim is that service users receive the highest quality of care, by ensuring that front line teams are empowered by the organisation to provide this.
This Framework aims to provide an overarching direction and coordination on quality for the organisation to enable delivery of the highest quality health and social care. It will make use of best practice around proactive and responsive quality assurance and improvement.
To set the direction for quality the following strategic goals will be pursued over the next five years:

Empowering frontline quality

Moving to Effective Outcomes

Assuring Essential Quality Standards

Moving to Excellence

Integrating Quality as a core part of the Organisation
Three strategies will directly support the quality framework:

Safety: Risk management strategy

Effectiveness: Effectiveness strategy

Experience: Service user and carer experience strategy quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Our conceptual model of the organisation is depicted through the interaction of layers against a backdrop of the quality framework. The dynamic matrix interaction of these layers with the framework ultimately influences the care that front line teams provide. This model develops James Reason’s adapted model 10 , recognising the necessity of a whole-systems approach to quality.
"Customer requirements" define Quality
Service
Users and carers
Front Line Teams Front Line Teams
Teams supporting quality
Service
Front Line Teams
Users and carers
Each layer supports high quality for the customer
Front Line Teams
Teams supporting quality
Strategies, policies, systems and processes
Organisational leadership, vision and values
The Quality Framework influences all layers to improve quality
Our service users ultimately define what quality is. They are at the heart of what we do, and we recognise that front line staff and teams deliver the care and services they require.
Front Line Teams and services are the next most important element – both clinical and managerial staff, who directly deal with service users and carers and are responsible for their competencies, conduct and for the quality of care they provide for service users.
There are many organisational teams that support quality.
The Trust benefits from these teams, which support Front Line Teams to deliver highest quality care and continuously
10 Reasons Adapted model: A Protocol for the investigation and analysis of clinical incidents,
Association of Litigation and Risk Managers , September 1999. Accessed via http://www.patientsafety.ucl.ac.uk/CRU-ALARMprotocol.pdf quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT improve quality, while simultaneously capturing and analysing information about service user requirements to improve support mechanisms.
Support mechanisms for front line staff and teams comprise of strategies, policies, systems and processes.
These provide consistency of direction, allowing the front line to provide quality care.
The Quality Framework ties the organisational objectives, strategies and processes together and provides a platform to facilitate and ensure an effective contribution to care and safety. It will catalyse the development of high quality support mechanisms, while enabling the organisational leadership to respond to service user quality requirements.
Our evolving model for quality will learn from a local and national knowledge base, taking into account any conclusions, recommendations and findings from reports such as the Mid
Staffordshire NHS Foundation Trust Public Inquiry, which is due to be published in 2013, and the Care Quality Commission Winterbourne View report (July 2011).
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
We recognise the connection between having an open culture for the organisation, quality priorities of our service users and the values, aspirations and skills of our staff.
Organisations whose staff are engaged and have job satisfaction deliver better care. There is compelling evidence that staff well-being and staff experience correlate with service user experience and outcome.
Supporting and developing our staff to feel engaged, valued and empowered in delivering quality improvements is essential for our ambition for better quality. Engaging and listening to staff is a key part of our values for empowering staff to deliver care in a way that is consistent with our values.

Staff are aware of their individual professional responsibility and corporate accountability to raise concerns and provide high quality, safe care

Staff are supported and empowered to make decisions about care and safety and they are prepared when system failures occur. When things have not gone well, staff focus on learning lessons and improving quality

Leaders avoid over simplified explanations of system failures and the need to work together in order to understand the true reasons for risk

Staff are open to raise concerns and are listened and responded to

There is an investment in clinical leaders and staff in ensuring they are developed and trained to focus on the effectiveness and outcomes their teams and services

Staff are recognised for their contribution to improving quality outcomes, in those that are ‘measured’ and where staff go the extra mile in delivering excellence

Staff appraisal and development harnessing their potential for front line continuous quality improvement

Being aware, willing to change, supported to adjust and respond to the external and internal environment where appropriate

When things go well opportunities to hear about and spread improvements and information across the organisation so others can learn and to improve equity, equality and diversity. quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
The five strategic goals in this framework provide the vision and direction for all strategy and processes in relation to quality. Each objective works in harmony with the others to enable the organisation to deliver the highest quality service.
Empowering FrontLine
Quality Effective outcomes
Integrating quality as a core part of the organisation
Assuring Essential Standards
Moving to Excellence
The strategic goals were chosen in response to national and local priorities:

Empowering Front Line Quality is a prerequisite requirement for a quality service

Moving to effective outcomes follows the national drive to measuring quality by means of outcomes in preference to process targets. This move reflects a wholesystems approach to health and social care, placing the service user (rather than the service) at centre stage.

Assuring Essential Quality Standards responds to the organisational requirement for an essential standard of quality that is placed upon us by ourselves as well as multiple external agencies. The Trust must be able to provide a robust answer to the question of quality to service users, commissioners, and regulators as well as itself.

Moving to Excellence recognises the need to continually strive for the highest quality possible, in line with our own vision “to deliver personalised care of the highest quality, with the best possible outcomes for users and carers, empowering them to remain independent”

Integrating quality as a core part of the organisation recognises the unique challenge facing the organisation as a partnership covering health and social care across a large geography.
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Quality is everyone’s business, and the front line is the biggest influence on the level of quality we deliver. Quality needs to be at the core of all teams – not an add-on.
Leadership is a key factor in developing quality teams that lead by example.
Where we are now: We have made significant progress in bringing together teams and services from different organisations, but recognise the challenge that integration will bring to front line teams over the coming years. We also recognise that teams need to build confidence in the quality of their services by benchmarking and learning from experience.
 The Trust’s transformation agenda aims to bring previously separate health and social care teams together under a new arrangement of integration.

The development of a children’s directorate will also result in new arrangements of teams. These new teams will need to have quality factored in at the outset, and have full ownership and support for improving the quality of care that they provide.

The ongoing requirement to demonstrate value for money, improving efficiency while maintaining quality in the context of a reducing financial envelope, will require every team to own the quality agenda.

The trust recognises the challenge of moving to FT status will create additional criteria for maintaining quality and safety.
The trust has multiple teams that support various elements of quality. Many of these teams are working in a unified way across the trust, with a notable example around the integration of the safeguarding team. We recognise teams that support quality will always benefit from further development and integration to become world-class in the quality support they provide to the organisation. In addition, we have a valuable set of staff knowledge, skills and experience around quality, which needs to be harnessed, maintained and improved.
Where we want to be: Our front line teams and services have a culture of quality and own their quality improvement agenda. They value the support they receive from the organisation
– teams that support quality are internally and externally recognised as experts in improving quality and safety of health and social care. Teams are recognised regionally and nationally for quality, and set the direction for effective team working in the organisation. We consistently adopt best practice quality assessment and improvement methodologies, using a range of trusted tools and techniques. We have built a track record for developing teams and services to provide quality care and support quality improvement.
How we will get there: We will provide induction training and development so that new integrated teams know how to put quality first. We will use best-practice team working and staff development techniques to empower teams to achieve their potential, acknowledging the link between effective teams and quality. We will actively support teams to ensure that quality is not significantly impacted by reconfiguration and transformation. quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
We will systematically learn from and develop the best of both health and social care quality tools and techniques. We will align health and social care quality methodologies (e.g. quality circles and clinical audit) to support Front Line Improvement.
We will make effective use of team meetings, away days, and other techniques to improve the quality of teams and services. We will develop measures that demonstrate the contribution that our teams make to the financial health of the organisation when they improve quality.
We will develop teams that support quality to have the appropriate knowledge, skills and experience to be classed as experts in their respective roles. We will also provide opportunities for our staff to develop skills across the quality disciplines, to increase resilience and promote a holistic approach to quality. We will ensure that teams supporting quality are visible to the front line, and that they develop productive working relationships across the organisation.
We will aim to publish papers in peer-reviewed journals on aspects of quality. We will support regional and national networks for health and social care. We will present at local, regional and national conferences, showcasing our work and quality improvement. We will contribute to national registers and databases related to quality, thereby benchmarking our services.
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
As pictured in framework conceptual model, front line professionals and teams most directly affect quality of care. Improvements in quality are delivered first and foremost by teams 11 .
Front line staff and teams most often know why quality and excellence are not achieved.
Efforts should centre on helping front line teams to improve quality, giving them the tools to understand and improve the quality of their service, drawing from the widest possible theory and experience base. FLCI is an essential component of this quality framework.
Through group working techniques and application of quality improvement theory at the front line, quality support teams will facilitate front line teams to suggest and make intentional and demonstrable changes that directly improve care and safety. Successful facilitation will require use of models such as the Johari Window and Betari Box to successfully influence service teams to become self-learning change teams, learning from experience to initiate their own quality improvements.
At team level, the main purpose of indicators and benchmarks is to support improvement.
High performing teams proactively benchmark themselves against other teams.
Indicators already exist, including the clinical audit programme, which enable this to happen.
We need to ensure that existing indicators are used appropriately to facilitate comparisons and minimise duplication.
Adaptation of techniques such as “Essence of Care” can help teams to look for ideas for excellence outside of their own practices and experiences.
11 High Quality Care for all – measuring for quality improvement: the approach. Department of Health.
Access via http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_09044
4 quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Our organisation aims to have a mindset of continually focussing on the outcome -
“the end result” - of any structures and processes. To improve quality front line teams we must focus on outcomes rather than outputs.
Where we are now: Some parts of our organisation are fully focussed on service user outcome measurement and improvement. Also we routinely measure outcomes by means of
CQUINS and other initiatives in some areas. We want this good practice to be enhanced and extended to encompass the whole organisation.
Where we want to be: Quality improvement activities result in demonstrable, measurable improvement in outcomes. Dashboards, indicators, and other routine measurement systems feature important outcome-based measures and staff regularly monitor and act on these measures. Best-practice methods are used to measure and understand outcomes, improving confidence in their use. Change activities are routinely assessed before implementation for their impact on outcomes in terms of safety, experience, and effectiveness. Front line teams develop, test, and use outcome measures as part of their day-job, striving for continually improving their outcomes. Key outcome measures, such as
“making it real” statements in Think local act personal , are routinely used by integrated teams to monitor and improve health and social care.
How we will get there: We will support front line teams to measure what they do, using good and timely information as a basis both to improve the care they provide and to compare themselves with other teams. We will advocate best practice techniques to develop and understand outcome measures across health and social care. We will ensure that outcome measures for safety are routinely used in all areas.
We will, with the help of national information, service user experience and a high quality evidence-base, help teams to define and measure outcomes.
Through demonstrable evidence on service improvements and lessons learned on a local and national scale, we will ensure that improvements and good practice innovations are routinely shared across all teams and services. Once proven, we intend to share our improvements and experiences with the rest of the NHS family.
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
We aim to be able to assure ourselves and others that the care we provide always meets essential quality standards of safety, effectiveness, and experience. We aim to be able to act swiftly to prevent anything from threatening our essential quality standards of care.
Where we are now: We currently have governance structures for health and social care, regular reporting on all quality issues, a quality visit programme (including responsive reviews) that provides the Partnership Trust with assurance of quality. Our social care services have a range of quality standards which are monitored on a quarterly basis with subsequent service improvement plans developed at a locality level. Social care quality improvement interviews are regularly conducted based on service user feedback. We are currently harmonising our policies and guidance documents. Our HealthAssure database is available and is in the process of being populated with evidence of compliance with essential standards for healthcare. We have started performing thematic reviews around specific quality areas. Some of these processes are still bedding-in, and other processes are in development, such as unified dashboards and our Quality Early Warning Intelligence
System.
Where we want to be: Our Quality Early Warning Intelligence System provides regular consistent intelligence on quality for every team in the Trust, helping to spot trends before they significantly impact on quality. Our databases for evidence of assurance are regularly updated by staff in health and social care, and routinely used for reporting on assurance.
Our governance processes are unified across health and social care, providing a clear line of accountability for quality from the Board to front line teams. We are compliant with all relevant health and social care external assessments, and confident of excellence in relation to future assessments. Our responsive quality visit system provides a focussed fast improvement response to any quality concerns, and is not routinely required due to high quality services and robust governance arrangements.
How will we get there: We will develop clear, consistent and concise reporting to enable committees and groups in the governance structure to see clearly any issues relating to quality. We will strengthen current processes around complaints, PALS, service user experience, incident reporting and clinical audit, learning from best practice, social care quality standards and quality improvement interviews so that they consistently provide robust intelligence on potential system failures. We will improve the existing committee structure to ensure clear migration of information ward to board and vice versa. We will work to attain and maintain NHSLA risk management standards. Our intelligence systems will be designed to cross-reference intelligence to provide information for multiple external assessments, as well as internal quality intelligence. We will use an internal responsive quality visit process to provide an additional layer of quality assessment and improvement to supplement our existing systems for quality, particularly around patient safety. We will develop a standardised quality and safety dashboard for front line teams.
quality@ssotp.nhs.uk
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Figure 1

Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Excellence surpasses the ordinary, providing a level of quality that is unusually high.
Excellence is essential; it raises staff morale, fosters goodwill with commissioners and delights service users. Today’s excellence is tomorrow’s standard 12 ; we cannot afford to stand still.
Where we are now: Processes are in place to provide assurance around patient safety, respond to service user feedback, and identify areas for quality improvement. Standardised working practices are not yet fully achieved and some processes and programmes require further development and embedding. ‘Pockets of service excellence’ exist throughout the organisation including achievements such as a National Nurse of the Year for 2012/13.
Where do we want to be: Striving for excellence is embedded into the culture of the organisation, as front line teams have a clear understanding of their essential standards, and their team-defined goals for pursuing excellence in their services. The organisation routinely finds and celebrates the successes and innovations of individuals and teams. Quality support staff are visible in across the front line of the partnership trust, fostering a culture of safety and innovation, spreading ideas for excellence. Quality visits are used to discover and promote excellence, and are positively received by front line staff as an improvement enabler; supporting not scrutinising. Continuous quality improvement philosophies such as
Lean and six-sigma are adapted and routinely used by front line teams to achieve excellence. The organisation wins national recognition in areas related to quality and excellence. The organisation has a reputation for everyday excellence as a first class foundation health and social care community provider. Services make regular use of internal and external benchmarking to help adopt innovations. The level of research and development undertaken by or supported by the Trust will increase each year. The organisation can demonstrate excellence in relation to key patient safety indicators such as avoidable pressure ulcers, harm from falls, and hospital acquired infections.
How we will get there: Teams will be supported to move from essential standards toward excellence. Trustwide initiatives and work programmes, such as the “Customer Service
Excellence” standard, aim to achieve excellence in themed areas. The quality team will develop the use of in-house programmes for excellence, such as Front Line Continuous
Improvement . The Quality Early Warning Intelligence System will be developed to contain measures for excellence in addition to essential standards. We will use clinical audit to measure and improve, ultimately demonstrating excellence in relation to national standards.
We will promote research and development within the organisation as a way to advance best practice. We will to redefine the requirements for excellence on a regular basis, raising the bar for the quality of our services.
12 1: Mehl B. Defining excellence. Am J Hosp Pharm. 1993 May;50(5):921-8. PubMed quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
(see http://www.customerserviceexcellence.uk.com
)
Customer Service Excellence is a Government standard, developed to offer services a practical tool for driving customer-focused change within their organisation.
The Customer Service Excellence standard tests in great depth those areas that research has indicated are a priority for customers, with particular focus on delivery, timeliness, information, professionalism and staff attitude. There is also emphasis placed on developing customer insight, understanding the user’s experience and robust measurement of service satisfaction.
Our customer service standards build on the national standards:
1: People are at the centre of everything we do
2: We take pride in delivering a high standard of health and social care
3: We enable people to make choices about their care by providing understandable high quality information
4: We treat each other and people who receive our services with dignity and respect
5: We all act with responsibility for what we do
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Quality must be the golden thread that stitches the organisation together. We strive, not to be seamless, but to be integrated.
Where we are now: Progress has been made in integration in many areas of the Trust, but some differences in ways of working still exist. The service user experience team using a single consistent method for gathering the “net promoter score” and other service user experience information across the Trust. Multiple work streams exist for improving quality, but these are not yet orchestrated centrally. Legacy IT systems currently hamper integration efforts. Some areas of the organisation have good levels of incident reporting and clinical audit activity, but there is progress to be made in achieving a good safety culture consistently across all areas in the Trust. The MASH (Multi-Agency Safeguarding Hub) is a notable example of integration which brings staff from external partner organisations together to share intelligence and work in harmony. Harmonisation of policies, procedures and ways of working is required across the whole Trust. Separate frameworks and committee structures exist for health and social care quality, along with significant cultural differences.
Where we want to be: , Quality is systemic, and acknowledged as the collective effort and shared responsibility of all individuals. Front line teams have a single approach to quality measurement and improvement, supported by an integrated Quality Governance structure.
Unified IT systems support quality measurement and improvement, including dashboards and benchmarking.
Single line management structures ensure managers look at quality for the whole organisation. The organisation has developed a new language of quality that combines the best of health and social care approaches. The organisation has a best-in-class safety culture that works across all areas of health and social care.
How we will get there: We will identify and share best practice on quality, especially around safety culture across the organisation. We will make use of networking opportunities to know each other’s roles, benchmark and learn from each other. We will run a series of health and social care quality summits to develop and implement a unified quality assessment and improvement methodology. We will continually use the principles of Seven Steps to Patient
Safety , Patient Safety First , Safety Express and other recognised tools for safety across the whole organisation.
We will develop a clear language for quality and quality improvement that reduces reliance on health or social care jargon. We will harmonise processes for social care quality such as the current social care quality framework along with other systems and processes for health
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
The Nursing and Quality Directorate has a work plan with key priority areas for 2012/13. The implementation of this framework will:

build on the current 2012/13 work plan, providing overall direction for this years work

use a phased approach for subsequent years, ensuring progress against each of the theme areas while maintaining in-year flexibility for responding to quality issues
Each December the annual Implementation plan for the next financial year will be produced and the framework theme areas will be reviewed.
The implementation plan will be developed so that each action on the plan is Specific,
Measurable, Attainable, Relevant, and Time-bound.
Using the Framework Conceptual Model, implementation will take place according to three broad overlapping phases, drawing on Monitor’s Quality Governance Framework 13 :
1. Structure: Align strategies, policies and the capabilities and culture of support teams to fulfil framework strategic goals
2. Process: Ensure clear roles and accountabilities in relation to quality governance are in place, with clear processes for escalating and resolving issues
3. Outcome: Embed routine measurement of outcomes, with appropriate quality information being analysed and challenged
13 See “Applying for NHS foundation Trust Status – guide for applicants” Monitor 2010 quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
There are two key elements of monitoring that are attached to this framework, which will be combined into a single framework monitoring grid.
Each quarter a progress report against the quality framework annual implementation plan will be submitted to the Safety and Effectiveness Sub Committee. The progress report will note the proportion of completed actions, and provide brief exception reports for actions that are not progressing to schedule.
Monitoring of the quality of care will take place primarily using the Quality Early Warning
Intelligence System, at a team level. This system will be developed to provide regular tracking of performance relative to the strategic goals in this framework.
Each year the Trust will produce a quality account, in parallel with the annual report and financial accounts. Quarterly progress reports will provide a valuable information stream for the annual quality account. In addition, a quality framework annual report will summarise the progress that has been made in implementing the framework.
Key indicators will track the achievement of the framework aims over the next five years.
Many of the indicators are routinely collected for other strategies or purposes, Their inclusion in a dataset for the quality framework is not intended to duplicate reporting but to maintain an overview of organisational quality and achievement of the framework.
A key part of this consultation will be to define appropriate measures for the quality framework, along with their measurement methods and target / directions. quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Table: Some example indicators that could measure progress against the quality framework:
Strategic goal
Assuring Essential
Quality Standards
Assuring Essential
Quality Standards
Empowering frontline quality
Assuring Essential
Quality Standards
Number of different data elements used in the Quality Early Warning
Intelligence System
Number of Front Line
Improvements logged
Number of incidents reported
Assuring Essential
Quality Standards
Indicator
Number of quality visits
Ratio of serious / non-serious incidents reported
Moving to
Excellence
Moving to
Excellence
Assuring Essential
Quality Standards
Assuring Essential
Quality Standards
Moving to excellence
Moving to Effective
Outcomes
Integrating Quality as a core part of the Organisation
Audits – proportion of audits with completed action plans
Service user experience
– net promoter score
NICE / national guidance implementation
Research projects undertaken
Papers published in peer-reviewed journals
Service users who agree with key statements in “Making it Real” (e.g.
“I have the information and support
I need in order to remain as independent as possible”)
Number of teams working under
Single line management structures
How measured
Target / direction
Decrease in number of responsive visits
Year-on-year increase in incident reporting.
Year-on-year decrease in the ratio
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
A small group set a series of dates for planning the development of the framework. The first meeting took place on 25 July 2012. Initial development of the framework made use of a
“blank page” template with key prompts around potential strategy goals. The first iteration involved 1:1 conversations with senior quality directorate staff, using the template to bring a focus to the requirements of the quality framework and ensure high-level alignment with organisational direction. This approach was designed to enable flow of ideas in an iterative manner, while allowing for full development of the framework by subsequent consultation and engagement with all staff.
Developing a high profile, nationally acclaimed quality team
Strong Intelligence for Quality Assurance Moving towards Effective Outcomes
Where we are now
Integrating Quality as a core part of the organisation
"How we will get to where we want to be"
Organisational Objective: Deliver tangible improvements to the effectiveness, safety, and customer experience of our services.
Moving to Excellence
Where we want to be
How we will do it quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
The timetable for development below is being followed, as reported to Quality Governance in
July:
Outcome Progress
Steering group for Quality Framework established mid July 2012
Draft Quality Framework
– presented to Quality
Governance Committee on 5 September 2012
Consultation on the draft framework document,
September & October 2012
Initial planning meetings scheduled for
25 July, 1 August, 8 August
Development of draft has involved
1:1s with members of the quality directorate and key staff within social care quality.
Attendance at AGM September 17
Intentions by Quality team to consult groups and individuals according to the “consultation progress” table.
Consultation with internal and external stakeholders, including development of Equality analysis – September & October 2012
Consultation end date 19 October 2012
Final Quality Framework presented to at Quality
Governance Committee on 7 November 2012
Development of 2013/14 implementation plan:
December – March 2013 quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Name: Date:
Patient and service user groups
Outcome:
Senior Management Teams
Social care
Safety and Effectiveness
Groups
Locality Service Meetings
Annual General Meeting attendees
HR
Finance
Transformation
Medical staff
General communication to all staff
Website
Membership database
Matrons meetings
Offender health
Executive Directors
Non-executive directors
September 2012 Presented for discussion, feedback and follow up discussions required
Commissioners
Local HealthWatch
quality@ssotp.nhs.uk
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Staffordshire and Stoke on Trent Partnership NHS Trust: Quality Framework v1.0 DRAFT
Date of Assessment: Outcome of Assessment:
Equality Impact
Assessment
Financial
Implications
Assessed
Staffing
Implications,
Including Training
Needs
Compliance with
Regulation
Impact on Existing
Strategy
quality@ssotp.nhs.uk
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