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Being Reviewed By CHI: A First Hand Experience November 2000 - July 2001 John Coakley Medical Director Homerton Hospital.

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Presentation on theme: "Being Reviewed By CHI: A First Hand Experience November 2000 - July 2001 John Coakley Medical Director Homerton Hospital."— Presentation transcript:

1 Being Reviewed By CHI: A First Hand Experience November 2000 - July 2001 John Coakley Medical Director Homerton Hospital

2 CHI n Established in 1999 to help the NHS in England and Wales to assure, monitor and improve the quality of clinical care.

3 CHIs role n Leadership n Scrutinise local clinical governance arrangements n Ensure local and national implementation of national guidelines n External NHS incident enquiries in England and Wales

4 The Clinical Governance Review n National programme of four-yearly reviews to: –examine clinical governance arrangements –publish a report for each Trust –facilitate the Trusts action plan for improvement –process began at Homerton in November 2000

5 CHI: a first hand experience n Effective Clinical Governance should lead to: –Continuous improvement of patient services and care –A patient centred approach treated with courtesy involved in decision making kept informed –Commitment to quality –Prevention of errors where possible, learning form mistakes and sharing that learning

6 CHI: a first hand experience

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8 n What aspects did they examine? –Consultation and patient involvement –Clinical risk management –Clinical audit –Research and effectiveness –Staffing and staff management –Education, training and development –Use of clinical information

9 CHI: a first hand experience n CHIs areas of interest –general surgery –general medicine –maternity and neonatal care –radiology, pharmacy, anaesthetics, pathology, therapies

10 CHI: a first hand experience n The Assessment Team –Doctor –Nurse –Manager –Other clinical professional –Lay member –CHI Review Manager n Methodology –information collection, interviews, observation,

11 CHI: a first hand experience n The Clinical Governance Review –Long process –Paperwork + + + + –Time consuming –Homerton in first wave - > 50 reports published to date

12 CHI: a first hand experience The 24 Week Timetable! n Data collection November 2000 n Self AssessmentDecember 2000 n Data analysisDec - Jan n Community involvementJanuary 2001 n Patient diariesFebruary 2001 n Pre visit brief/reportJan-Feb 2001 n Assessors visit (5½ days)19th March 2001 n Final report publishedMay 2001 n Action planJuly 2001

13 CHI: a first hand experience n Outcomes –Published report –Identification of areas of good practice and key issues –Action plan for change management –Monitoring by London Regional Office

14 CHI: a first hand experience n The draft report –nice noticeboards –the Trust has a high mortality –stillbirth and neonatal death rates high –emergency readmission rates higher than average

15 CHI: a first hand experience n The draft report n Action is required to: –improve supply of TTAs –streamline admissions process –improve monitoring of feeding –to ensure that consideration continues to be given to cultural issues regarding minority groups

16 CHI: a first hand experience n Action stations!

17 CHI: a first hand experience n Final report layout –Trusts context –Patients experience –Use of information –Resources and processes –Strategic capacity –Action following the review

18 CHI: a first hand experience n Trusts context –deprived area –inequalities, including access to and outcomes from healthcare –lots of illness ( e.g. TB) –unemployment high –ethnic minority profile –new buildings –financial balance

19 CHI: a first hand experience n Patients experience –many examples of good practice (BAP, WL) –high post-op surgical mortality –stillbirth and neonatal deaths high (clinical practice good) –readmission higher than average –need to improve patient pathways particularly for stroke and #NOF –notable practice in cultural issues

20 CHI: a first hand experience n Use of information –use of patient experience is made at strategic and planning levels, but not at operational level –action required to ensure cohesive approach to involving clinical staff and the public –complaints –confidentiality –IM + T ×

21 CHI: a first hand experience n Resources and processes (users) –good strategic grasp of the need for consultation –community feels sense of ownership –advocacy services an example of notable practice –many patient surveys, little evidence of coherent strategy –need to use patient feedback other than complaints

22 CHI: a first hand experience n Resources and processes (risk) –clinical risk management - staff felt confident to report incidents –bottom up approach OK, but cautions apply –resuscitaires bad, disconnected nitrous oxide in A+E good –urgent action on histopathology –urgent action by wider health community on neonatal deaths

23 CHI: a first hand experience n Resources and processes (audit) –worthwhile development of clinical audit at operational level, but little link with strategy and planning –widespread commitment to clinical audit –several examples of audit leading to changes in practice –few examples of multi-disciplinary or cross-directorate audit –open and constructive discussion of audit

24 CHI: a first hand experience n Resources and processes (effectiveness) –significant progress in development at strategic and planning levels –more work needed to develop process by which effectiveness of clinical procedures is evaluated –how do we ensure NICE and NSF implementation –Trust in a unique position to contribute to national body of research

25 CHI: a first hand experience n Resources and processes (staff) –good strategic grasp of staffing issues –very good working relationship between executive and staff at all levels –Trust attempts to overcome recruitment difficulties by providing support for education and professional development –appraisal for all staff, staff felt valued, IIP –Stress - no formal system to identify it

26 CHI: a first hand experience n Strategic capacity –enthusiasm and strong leadership for clinical governance –Trust supports CG as a grass roots activity, with real benefits and progress in terms of staff commitment. Not clear how it is all brought together –no vision of how it will lead to improvement of patient services –needs to be evaluated - will it meet the needs of the future

27 CHI: a first hand experience - what else did they pick up? n Staff work hard despite shortages relative to comparable Trusts n There is evidence of staff stress - some surrounding workload and some because of violent and abusive behaviour of users n Trusts partner organisations universally complimentary of our participation in cross- boundary partnerships

28 CHI: a first hand experience - what else did they pick up? n Local PCT found us to be a good partner n Senior clinical staff generally accessible for advice and support n A confidential issue

29 CHI: a first hand experience - Action Plan n Review Clinical Governance Strategy n Review information management n Improve patient experience of admission process n Understand reasons for high re-admission rates and high post-emergency surgery death rates n Attempt to understand reasons for high stillbirth and neonatal death rates and reduce them

30 CHI: a first hand experience - Action Plan n Modernise medicines management n Histopathology review n Feeding n User involvement n Stress in the workplace

31 CHI: reflections n Hard work n Potentially damaging n Stressful n Praise seems a little grudging at times n Press handling n Ultimately OK

32 CHI: suggestions n Be honest n Make sure you allocate enough management time - 1 WTE! n Work hard at detail of draft report - contest where you can with hard evidence n Be prepared for stressed staff n Try to use the visit to achieve change to the benefit of your organisation


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