1. Leadership in Clinical Practice Quality of Care Rounds Improving Quality Programme and Ward Accreditations Deborah Carter Deputy Director of Nursing (Quality)

2. What did we want to achieve? Improve our patients experience Empower ward leaders to gather their own data about the environment of care Ward teams able to directly influence the quality of care and the environment Patients and staff giving direct feedback Board level assurance on the quality of patient care

3. Where Did We Start? In 2008 ~ no Trust wide approach to data collection on the environment of care or patients view of this Review of results from 5 years inpatient survey Analysis of complaints feedback Understanding the national picture Choosing which aspects to measure

4. Understanding What Matters Environment of Care Privacy and Dignity Clean Infection control Communication Food Pain

5. Quality Care Dashboard

7. Monthly Snap Shot

8. Continuous improvement Review of process with matrons and ward managers Understand what adds value to the patient experience Improve report functions Spread to non-ward areas Developed the tool further Board Assurance

9. Improving Quality Programme NHSi Productive Ward –whole hospital roll out pilot site 2007-2010 Recognised some good ideas started but not spread –Lacked standardisation Not embedded as a culture –Seen as a project Had become another performance measure –Rated red, amber or green Reviewed sustainability –What did we want to sustain?

10. Key Elements Well organised environment (WOW) Improving Quality data board Patient Status at a Glance (PSAG) Shift Handover

11. Key Elements

12. Improving Quality Programme Set minimum standards with flexibility to apply in all areas Developed agreed Trust wide ‘gold standards’ Provide teaching in methods: Provided a 14 week programme of master classes and facilitation to all wards Provide resources: Provided handbooks, data collection tools and electronic resource files Establish 30 day project mentality: Feedback sessions after 30 days with expectation of further learning and improvements Create motivation: Assessments to achieve Bronze, Silver or Gold

13. Layered Approach

14. Layered Assessments Wards are assessed and rated as: White Bronze Silver or Gold Standardisation: At end of 14 weeks assessing successful implementation of standards (with facilitation) Embedding knowledge: 12 weeks later assess ability to apply methods to issues identified in data (without facilitation) Align to normal business: 12 weeks later comprehensive ward accreditation process

15. Clinical Leadership In wards that were successful in achieving and maintaining silver or gold: Leaders with clear vision and good communication High level of staff involvement and engagement in IQP work Good understanding of data and methodology

16. Ward Accreditation Process Data review Observation Culture of continuous improvement Environment of care Communication about and with patients Nursing processes Discuss findings of observation and review in context of data Score standards as White, Bronze, Silver or Gold Overall score validated at panel review

17. Aims to… Support ward leaders and their staff in…. achieving the best patient experience on their ward through continuous improvement work thus provide a level of assurance to the board about the quality of care on wards and departments

18. As measured by… Number of wards assessed and rated Improvements in Quality Care Dashboard data Findings of external assessors including CQC Staff and Patient survey results

19. How are we doing?

20. Achieving Good Standards

21. Communication About Patients

22. Improving Risk Assessments

24. Focus on Process

25. Supporting White Wards Understanding that areas are safe Diagnostic assessment Individual support for ward manager Blended approach to providing support to ward team to achieve improvement

26. Celebrating Gold

27. “Never tell people how to do things. Tell them what to do and they will surprise you with their ingenuity” George S Patton