Patients First Always
Care Assurance and Accreditation System
Acute Standards Launch
Rosslyn Crocket MBE
Board Nurse Director
Wednesday 22nd July 2015
“Let whoever is in charge keep
this simple question in her head
not, “how can I always do this
right thing myself
but
“How can I provide for “this
right thing to be always done?”
Florence Nightingale 1859
Adult Acute CAAS Standards
Care Assurance and Accreditation System (CAAS)
Why? “Provide Person Centred Care for every Patient Every Time”
 The CAAS Standards developed with staff and patients approval will for
the first time allow us to evidence the standard of care we deliver.
How?
 Implement a system which effectively measures and assures the
standard of patient care within NHSGGC
 Implement the care standards that were developed in consultation with
staff that meet the requirements of patients and national regulators
 Develop and Implement an assurance system to ensure the agreed care
standards are consistently applied for all patients every time across
NHSGGC.
CAAS Adult Acute Standards
Implementation
When?
 Acute Standards presented to Clinical
and Managerial teams July 2015
 SCN’s and Lead Nurses will present and
discuss the CAAS Standards with their
teams including multidisciplinary teams
 SCN’s, Nurse Leaders and Management
commence the process of identifying
what requires to be in place to support
frontline staff implement the standards
 All acute wards in NHSGGC will
implement the CAAS Standards in
September 2015
CAAS: Benefits
The content is not new, its just a new way of delivery and
assessment
 Supports the multi-professional team understand how they deliver
care, identify what works well, and replicate to spread improvement
 Provides teams with clear expectations of the care that is required
within a supportive framework.
 Reduce duplication of audits and inspections
 Increase the quality of patient and staff experience
 Reliable assurance of quality from point of care to the Board, our
national regulators and increases transparency with the public.
13 Adult Acute Standards
Pressure
Area
Care
Working
Effectively
with the
MDT
Effectively
Managing
resources &
staff
Governance
End of life
care
Falls
CAUTI
Deteriorating
patient
Adult Acute
CAAS
Standards
Person
centred
care
Medicines
management
Older People in
Acute Care &
Adult
Protection
FFN
Infection
Prevention
and
Control
Pain
Control
CAAS Progress : Staff Support
 CAAS is a framework that
supports staff to achieve,
develop and identify gaps in
capacity and capability
always with a view to
service improvement.
 In consultation with staff
NHSGGC is supporting
clinical teams implement
CAAS in the following ways.
CAAS Progress : Staff Support
 Salford Visits - key staff have experienced the softer touches of CAAS with a
view to replicating in their area i.e. Patient experience/compliments, staff pride in
the care they deliver
 CAAS Web Information - can be found in the nursing and midwifery section
on NHSGGC website. Sited here for easy access for all staff as well as providing the
public with information on the service improvement program
 4 Test Site Wards – Set up, to test the language and content of the standards
support was provided by PD, L&E and OD in order to identify the needs of the
teams and also to further inform the board wide implementation plan.
 Team Dynamics: “How good is the Team” benchmarking supported by OD
was
undertaken in the 4 test sites. All wards found this a useful exercise on which to
build on
NHS GGC CAAS Website link:
http://www.nhsggc.org.uk/our-performance/celebrating-nurses-midwives/
CAAS Progress : Staff Support Cont’d
 Staff Engagement Events
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Link Nurse/Midwife Framework
Support for Link Nurse
Lead Nurse/ Midwife
Work plans
Powerful Conversations
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SCN/M, Lead Nurse/M & Team Leader Network
Communication Strategy
Capacity for Improvement Group
CAAS IT
What Nursing Teams are Saying!
As set of standards
that provide the
opportunity to get
it right for our
patients in an
open and honest
way.
PD Nurse
Happy to do make
changes and do my
bit to support the
ward to help the
patients
Housekeeper
Help us to regain
patients
confidence in our
service
SCN
This is what we do
anyway, however it
will help us to deliver
on what we need to in
a more efficient way.
Staff Nurse
“Caring for
patients” is
everyone's job,
delighted to hear
that the wider AHP
team will also be
involved.
SCN
An ideal way of
keeping up to date
with a wide range
of topics/issues.
It’s what I have
been needing
Staff Nurse
What Senior Management Teams are Saying!
Will help identify
areas of
Improvement.
CSM
Hugely positive, it
will change the
ethos of how
everyone works.
CSM
CAAS will provide
reliable assurance
across all our wards
and community
teams.
CSM
CAAS will provide a
positive framework and
structure for SCN/M’s &
their teams, but also
support management to
understand requirements.
GM
CAAS will allow for more
consistency across all
areas for direct care and
management work plans.
Both are inconsistent at
the moment and CAAS
will provide a framework
for ALL to follow.
CSM
What the Corporate Nursing Team are Saying!
I visited the CAAS test
wards - to hear the
experiences of the SCN’s &
teams on what it's like to test
the CAAS standards, their
feedback was invaluable & I
loved their enthusiasm! It was
great hear what we can achieve
together.
N Director
THE FUTURE
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Exciting
Putting Patient First
Support Staff
Everyone’s Responsibility
Celebrate Success
Be Proud
Patients First Always
Care Assurance and Accreditation
System
Test Site Ward Experiences
John Stuart
CAAS Adult Acute Lead/
Chief Nurse North Sector
22nd July 2015
CAAS Working at Various Levels
Patients – receive safe, effective
personal care every time.
Ward Teams – ownership of
improvement work and enhanced
job satisfaction.
Directorates/Sectors –
reliably assess nursing
provision in their areas.
can
care
NHS Board – demonstrate the
quality of nursing care in the
whole organisation and provide
assurance
CAAS: Test Site Ward Experiences
 Progress supported and monitored through a CAAS Acute Operational
Steering Group.
 Four Adult Acute Wards tested the standards
Ward 2 Inverclyde
Ward 6 VOL
Ward 43 GRI
Ward 45 GRI
These wards were asked to participate, chosen for their diversity to ensure the test was spread
as broadly as possible across adult acute service.
 Test wards have provided vital feedback
 Allowed for collaborative strategic planning for staff support and the
CAAS Implementation framework
 Helped identify areas of current strengths within nursing, beneficial has
prevented duplication of support
 Clearly identified some gaps which are receiving a focus for
improvement.
CAAS :Link Role Framework Testing
Definition: Link Role
A link nurse/person is a “nurse/midwife/ person that is, or is moving towards being a
subject specific champion, a resource, improvement and monitoring person for an
identified topic of practice or care”
The 4 wards have been vital in testing the link role framework
 Allowed for the testing of efficiency support mechanisms for the learning
and development of staff in relation to their allocated standard.
 Testing of mechanisms to ensure CNS support capacity is spread across
the teams
 Allowed for the testing of the CAAS resource folders
Burns Unit
Situated in Glasgow Royal Infirmary
The Burns Unit is a specialist regional 13 bedded facility with the capacity to Care for 3 high
dependency patients and is part of a Managed Clinical Network. (Care of Burns Injury in Scotland)
What was good about CAAS?
 Link persons having shared goals and knowing what was expected of them.
Ensuring high standards of care through evidence based practice.
 Shared learning, support and education involvement of our Lead Nurse and
Practice Development Nurse for Burns and Plastic Surgery, also networking
within GG&C.
 Staff ownership and increased professional and clinical responsibility
through link role framework and sharing of ideas for clinical improvement.
Jacqui Bellew
Senior Charge Nurse
Burns Unit Cont’d
What was challenging/requires further development?
 Initial staff buy in for their photographs to be used on Bed
boards.
 Allocation of protected time within current establishment;
organisation of link role when there is staff movement;
SCN time for meetings at the initial implementation.
 Further work required on the assessment tool and what
evidence is required for the portfolio.
Jacqui Bellew
Senior Charge Nurse
Ward 6
Situated in The Vale Of Leven a Small District Hospital.
A short stay Elective Surgery (Minor and Intermediate) 10 bedded plus 4 trolley ward. We are a
Multi-Specialty surgical facility for: General, Orthopedic, Gynecology, Ophthalmology and
Urology surgery.
What was good about CAAS?
 A great opportunity as a team to review our practices in line with the
standards and reassure ourselves we are providing the best
 A vehicle to re-establish our public and self confidence
 A way to demonstrate our continued improvements allowed us to see where
we need focus.
Elizabeth Fettes
Senior Charge Nurse
Ward 6 cont’d
What was challenging/requires further development?
 Identifying the link person - some volunteers, some link roles not
popular, a little persuasion required.
 Collection of Evidence: Clarification on what evidence will be
required.
 Some standards don’t fit our area:
(e.g. End of life care - we have adapted the evidence we will provide
to ensure it is meaningful and will guarantee a patient centered focus
– i.e. team will attend Sage and Thyme communication workshops in
order to ensure we have a strong focus on support - as we are often
in the position of being with patients when bad news about test
results are delivered.)
Elizabeth Fettes
Senior Charge Nurse
Ward 43
Situated in Glasgow Royal Infirmary
A large cardiology ward within the Jubilee building in GRI (40 beds which include
acute receiving and step down beds)
What was good about CAAS?
 Empowering link nurses to take the lead in improving nursing
care/standards.
 Increased staff knowledge of evidenced based care.
 Improved team work within ward, including AHP's etc
 Encouraged 'good ideas' approach from all staff
 Excellent support from some of the CNS's
 Focus on quality of patient care
Liz Campbell / John Murtagh
Senior Charge Nurse
Ward 43 cont’d
What was challenging/requires further development?
 Time resource within a busy cardiology ward. Protected time issues
for link nurses.
 Workload commitments from each link nurse and SCNs
 Support issues for some of the standards from CNS's.
 Clarity around evidence requirement and the adopted assessment
tool.
Liz Campbell / John Murtagh
Senior Charge Nurse
Ward 2
Situated in Inverclyde Royal Hospital
A medicine for the Elderly Care Ward within Inverclyde Royal in Clyde Sector.
This ward caters for the assessment and rehabilitation of the elderly.
What was good about CAAS?
 Staff satisfaction has increased with their increased knowledge of the
standards.
 Link nurses feel empowered with their remit and their increased
knowledge.
 Staff generally feel care has improved particularly in relation to PURA and
as a result of active care.
Julie Bruce
Senior Charge Nurse
Ward 2 cont’d
What was challenging/requires further development?
 Mainly challenged with capacity to free up time for staff to undertake
learning, and staff to be available for link nurse to cascade their
knowledge with fellow team members.
 Other wards currently not working to the standards has impacted on
ward 2 when patients have been transferred.
Julie Bruce
Senior Charge Nurse
Patients First Always
Care Assurance and Accreditation
System
CAAS Implementation
Framework
Elaine Love
Chief Nurse for Governance and Regulation
22nd July 2015
CAAS : Tri – Board Assurance Process
 The Tri- Board Assurance process is
in development, it’s anticipated
the principles will be the same
across the boards with provision
incorporated for flexible local
implementation, as each board has
different structures and support
mechanisms
 The Tri-board collaborative will
continue to support each other as
the standards are implemented
and each board moves towards
their assurance phase.
CAAS : NHS GGC Assurance Process
Adult Acute Clinical
teams will have time to
familiarising themselves
with the content of the
CAAS standards from
July 2015 prior to
implementation.
CAAS : NHS GGC Assurance Process
 Wards first unannounced Lead Nurse Assurance Visit will
determine a wards baseline
 The Chief Nurse Governance & Regulations team will plan a
GGC Adult Acute schedule of assurance Visits over a 10-12
week period
 Practice Development will take the lead for forming and
developing a team to undertake the unannounced visits
 Lead Nurses will participate within their clinical sessions in
areas out with their responsibility
 The emphasis of these visits is on identifying where
improvement support is required
CAAS : NHS GGC Assurance Process
Benefits to this approach
This will:
 Provide a consistent process in support of identifying a
baseline
 Provide the opportunity to develop LN capacity for
undertaking future assurance visits
 Shadow opportunities for all LN’s and for Chief N’s/M
 Identify what further development/support may be required
by Lead Nurses in undertaking the role of assurer
 Allow us to establish bespoke support for wards. Critically
we must ensure ownership is maintained at a local level
with wrap around support measures being in place.
Under starter Orders on the Road to Success
This is nothing new, just a new way of working.
CAAS is not a quick fix, the journey is for the long term and its everyones
responsibility, from point of care to the Board.
CAAS : Time Lines
CAAS Component
Time Scale
Responsible Person
CAAS Standards Launch
July 2015
Nurse Director
CAAS Standards
Introduced to Clinical &
AHP Teams
July 2015
Senior Charge
Nurse/Lead Nurses/
Chief Nurses
CAAS Standards
Implementation
September 2015
Senior Charge Nurse &
Multidisciplinary Team
CAAS Ward Self
Assessments
July - October 2015
Senior Charge Nurse
CAAS Ward Unannounced
Improvement Assurance
Visits
October 2015 - January
2016
Lead Nurse
Improvement Support
February 2016
Chief Nurse
Governance/Regulation
CAAS & NMC Revalidation
 The Tri- Board Collaborative
considered the NMC Nursing
& Midwifery
Revalidation
plans when developing the
CAAS Framework
 CAAS aims and objects
support the 4 domains of the
new NMC Code.
 CAAS will support Nurses &
Midwives in their reflective
evidence & PDP development
for Revalidation.
Questions
Patients First Always
Care Assurance and Accreditation
System
Closing Remarks
Robert Calderwood
Chief Executive
22nd July 2015
Acute Adult Standards Launch
 Its great to be launching this new approach to improving care for our
patients in this fabulous building.
 As you know the standards have been developed in collaboration with
our neighbouring health boards of NHS Lanarkshire and Ayrshire & Arran.
 Congratulations to all our staff who have been involved and contributed
to their development.
• We must be clear the quality of care delivered to patients is everyone’s
business – Directors Managers, all clinicians & all support staff – WE ARE
ALL HERE TO WORK TOGETHER.
• CAAS will be crucial in assuring the quality of care our patients receive
which must be safe effective and person centred.
• Its vital everyone no matter what their role feels empowered, motivated
and supported to deliver on the CAAS standards.
NHS GGC Board & Senior Management Message
 We ask that you engage and work with us as we progress
this approach to improvement for our patients.
 On behalf of the Board I would like to thank you for all
your hard work and assure you of our full support in
carrying out your crucial role implementing CAAS Acute
Care Standards within NHS GGC.
 Good luck with taking this exciting approach forward and I
wish you all every success.
In the Lecture Room Beside Aroma Cafe