1. The North West Transparency Pilot

2. Policy Context Transparency and the Outcome Framework A culture characterised by openness, transparency and comparability Service Delivery – informs patient choice and holds public servants to account. Give patients access to the data they need to make meaningful choices about their care. Focus on outcomes - enables professionals to drive improvement.

3. Challenges for Nursing Build public trust and confidence in the nursing profession Zero tolerance for poor care and patient experience Improve Quality Innovation Productivity & Prevention in nursing practice, healthcare and patient outcomes Identify critical metrics for nursing practice which linked with patient and staff experience - opportunity to lead the process.

4. Get Staffing Right Get Staffing Right Deliver Care Measure Impact Patient Experience Staff Experience A Call to Action A Framework for Quality Improvement Tools, Metrics and Programmes Transparency and Accountability

5. The bold and pioneering participants Thank you Aintree University Hospital Blackpool, Fylde & Wyre Hospitals Royal Bolton Hospital East Lancashire Hospital Liverpool Heart & Chest St Helens and Knowsley Hospitals Salford Royal Wrightington Wigan and Leigh

6. Publish the incidence of harms Improve outcomes for patients Capture the staff experience when the harm occurred Capture patient experience when the harm occurred Participating sites take responsibility for publishing the number of harms that they identify Review care provided Improve quality and safety Build public trust and confidence in the nursing profession Identify the areas where the nursing profession needs to improve the experience of patients Identify the areas where the nursing profession needs to improve the experience of staff What did the Transparency Pilot set out to do?

7. Transparency Pilot Increase public confidence in nursing Voluntary Openness & Honesty The journey……………

8. Project Measures Care ExperiencePatient questionnaire Staff questionnaire SafetyNursing Care Indicators Number of falls and level of harm Number of pressure ulcers and level of harm EffectivenessNursing Care Indicators Getting the Staffing right

9. Challenges………….. Definitions Barriers to Implementation Practicalities of Implementing

10. Barriers to Implementation Board Challenges………….. The current media climate Risk Management Systems Organizational Cultures Data capture Leadership challenge Allowing local autonomy Interpreting the definitions without Specialist Nurse support Responding to the increasing acuity & dependency of patients Quality improvement journey ‘learning the lessons, measuring for improvement’

11. Challenges………….. Our patient is the most important visitor on our premises. He is not dependent on us. We are dependent on him. He is not an interruption in our work. He is the purpose of it. He is not an outsider in our business. He is part of it. We are not doing him a favour by serving him. He is doing us a favour by giving us an opportunity to do so. Mahatma Gandhi (Amended)

12. Operational Challenges…………..

13. Practicalities of Implementing Operational Challenges………….. When is a pressure ulcer not a pressure ulcer Are all pressure sores reported...how do we really know? Are there unavoidable pressure sores? Device related sores, especially in Critical Care Some patients will fall as part of their rehabilitation package Will require continually testing and refinement

14. Clarification… Definitions………….. To continue to work to develop a SOP What to report / what to exclude Assurance of data capture Clarity of how to sample for patient and staff experience data Real time identification of harm How to maintain competence as numbers reduce…PU can be difficult to diagnose Falls – recognising the seriousness of the impact

15. Quotes….. Learning lessons…………..  ‘It is perhaps not surprising that staff morale is adversely affected when untoward incidents such as Falls and Pressure Ulcers are experienced by patients in our care’.  ‘The implementation of intentional rounding has arisen from the Trust’s focus on reducing harm’  ‘We acknowledge the importance of ensuring we are accurate with our risk assessments’.  ‘The impact of introducing a Falls Specialist is evident by the significant reduction in falls and also in the level of harm caused as a result of a fall  ‘A patient commented that by the time the drinks were Served to them the drink was cold. Staff bought a number of thermal flasks for the hot water so drinks could be served still fresh and hot’

16. What we did & found……….. Pressure Ulcer 100% of grade 2,3,& 4 Falls 100% of moderate, severe & death Feb 58,141 March 64,890 Patients cared for - inpatient admissions North West Nursing Care Indicators forming part of Case note and RCA reviews 125769 164965 Trust Narrative: Local Results Local Circumstances Quality Improvements

17. The agreed publication narrative.…

18. The 8 patient experience questions 1.Were you involved as much as you wanted to be in decisions about your care and treatment? 2.When you had important questions you ask a nurse did you get answers that you could understand? 3.Were you given enough privacy when being examined or treated? 4.Did you have confidence and trust in the nurses treating you? 5.If you were ever in pain, do you think the hospital staff did everything they could to help control your pain? 6.Did you get help from staff to eat your meals? 7.On reflection, did you get the care that mattered to you? 8.If a family or friend needed treatment, would you be happy with the standard of care on the ward?

19. 1. Were patients involved in their care March Feb

20. 2. Did nursing staff provide easy to understand responses to patient questions? March Feb

21. 3. Privacy when being treated? March Feb

22. 4. Were Patients confident in nursing staff providing the care? March Feb

23. 5. Did Patients have their pain controlled well? March Feb

24. 6. Did patients get the help they needed to eat their meals? March Feb

25. 7. Receiving the Care that Mattered?

26. 8. Recommending Ward?

27. The 3 Staff Experience Statements 1.I would recommend the ward as a place to work. 2.If a friend or relative needed treatment, I would be happy with the standard of care provided by the ward. 3.I am satisfied with the quality of care I give to Patients/Service Users.

28. 2. Happy for a friend or relative to receive care in the ward where they work March Feb

29. 1. Recommending their place of work to other staff March Feb

30. 3. Staff satisfaction with the care that they provide March Feb

31. Next Steps………….. E4E- inform the strategy Clarify definitions Spread and expand Improved Patient Experience of receiving Nursing Care Improved Staff Experience of delivering the care Objectives of the pilot Standard operating procedures

32. Group discussion Please post your comments on flip charts provided