IMPROVING NURSING & MIDWIFERY QUALITY

- My Journey, 3 English NHS Trusts

Mandie SunderlandChief Nurse

Nottingham University Hospital

Nottingham City Hospital

QMC

• 14,000 staff • 1,200 volunteers• 14,500 public members• 1,700 beds• 90 wards• Annual income:

£848million• 2 Biomedical Research

Units

Who we are

What we do

• District General services for local people• Regional specialist centre for:- Cancer- Major trauma- Children’s & neonatal services- Renal- Neurosurgery- Heart- Stroke- Spines

• We’re part of the Olympic Legacy project: working with partners on the National Centre for Sports & Exercise Medicine Centre at Loughborough University

Activity

• 563 patients a day (elective, day case and emergency)

In 2014/15:

• 14,546 emergency operations• 28,811 planned operations• 187,577 Emergency Department attendances

Little known facts

• 1.9m meals served a year• 2m switchboard calls• 27 miles of corridor at QMC• City Hospital is the single

biggest hospital site in Europe • 7.8m pieces of linen a year• Spend £4.5m on electricity a

year

Challenges for Nursing• Build public trust and confidence in the nursing profession particularly in light

of national adverse media coverage

• Robust Board Assurance – lots of data not much info

• Professional concerns re nursing practice

• Nursing largest workforce- Biggest pay bill- Patient contact 24/7

• Efficiency challenge- temporary staffing costs- maintain care quality

We can mix these up……

Proposition that is taken for granted as if it were known to be trust

Comfort, faith

A declaration to inspire full Confidence, freedom from doubt, based on evidence

Challenges for Nursing Challenges for Nursing

Build public trust and confidence in the nursing profession particularly in light of national adverse media coverage

Robust Board Assurance – lots of data not much info

Professional concerns re nursing practice Nursing largest workforce

− Biggest pay bill− Patient contact 24/7

Efficiency challenge

Knowing how we are doing - Where did we start?

Review of what we had

Multiple audit tools reports, shared drives, Evidence base, NICE guidelines, NPSA, RCN….

Implementation of the NW Indicators using an in house developed IT solution, with a back to the floor approach.

Falls AssessmentNutrition

Pain ManagementPressure Area Care

Medicine AdministrationObservations

Infection PreventionAdded:

ContinenceDiabetes

Developments• Developments of new metrics

- Maternity- Community- Neonates- Paediatrics- Theatres- Outpatients- A&E- Endoscopy

Progress – Heart of England NHS Foundation Trust

Reporting – Heart of England NHS Foundation Trust

ASSURANCE

Target not achieved - Unsatisfactory progress with action plan?Any extenuating circumstances? Has it been flagged? e.g. Auditor competence, Staffing issue, Dependency

Special measures – Month 1Inform Chief Nurse

Head Nurse: Set up meeting with Senior Sister, CD, Matron, General Manager create an Action Plan

Action Plan agreedMonitored monthly via Head Nurse

Chief Nurse updated on progress at NMB

Achieved – back to monthly monitoring

Not achieved

Special Measures Month 2Report to Nursing and Midwifery Board

Diagnostics – performance dashboard etc.‘Confirm and Challenge’ meeting with Chief Nurse

Continue monthly monitoring of results

Two months’ poor performance: Special Measures• Weekly Monitoring• Senior Nurse Support• New LeadershipResult: Improvement

July 2014 Nursing Care Indicators – Pennine Acute Hospitals

Fairfield July 2014

NMGH July 2014

Nurse Staffing

*1 Hard Truths: The Journey to putting patients first (DOH 2014)

HOWEVER…

We recognised that we were measuring process which had its limitations

What else could we triangulate?

What would we do with all of this information?

Nursing and Midwifery performance committee

• Co-Chair – Deputy Director of Finance and Performance

• TOR adapted form Finance and Performance committee

• Monthly meet with head nurses

• Forward planner for suite of indicators/Triangulated scorecards

• Exception reports

• Performance notices

• Real sense of business like accountability

Outcomes

• Measuring to improve really does work

• Huge benefits with working with performance team

• Increased accountability ward to board

• Healthy competition

• Opportunities to celebrate

• Opportunities to share

• Shared accountability

• Robust proactive assurance both internally and externally

Shared Governance & Shared Leadership

From Bedside to Boardroom.

History of Shared Governance

•Shared Governance originated in business and management theories.

•US MAGNET Model of Care- 1970’s

•Implemented in UK during brief periods in UK- Kettering, Leicester, Rochdale.

•Dr Hess found a way to measure shared governance

Why Shared Governance?

•Time out days•Francis Report

•Shape of Caring Review- 2015•NUH Engagement survey

•69% of nurses felt management didn’t follow through on nurse suggestions

for improvement

•48% felt nurses didn’t have an active role in ward decision making

•65% felt NUH weren’t doing enough to manage nurse burnout/stress

Nurse led CouncilsOur Unit/Speciality Practice Councils

Compromises of 5-15 members of staff across the clinical area from Afc Bands 2-6.

Meet on average of 6.5hrs a month All councils are expected to have a Chair & Secretary. The Chair is

expected to attend our monthly Leadership Council- which is our governance structure.

Professional & Personal Professional & Personal DevelopmentDevelopment

81%- “I have had the 81%- “I have had the opportunity to develop opportunity to develop leadership skills”.leadership skills”.

““I feel Shared Governance I feel Shared Governance has helped with my has helped with my confidence”confidence”

Our Staff Implement Our Staff Implement the Changesthe Changes

Staff work alongside Staff work alongside senior leaderssenior leaders

““76%- I feel more able 76%- I feel more able to develop and to develop and change practice”change practice”

Culture of Culture of TransparencyTransparency

Face to Face Face to Face CommunicationCommunication

““It’s just the way It’s just the way we do things we do things around here…”around here…”

““It ensures everyone’s voices are heard”- It ensures everyone’s voices are heard”- Mandie Sunderland, Chief Nurse NUH.Mandie Sunderland, Chief Nurse NUH.

Other Council Achievements…• Reduced Moisture lesions and saved the ward money

• Reduced pressure ulcers on the nose and ears by working across wards and sharing practice.

• Developed a new way of giving feedback to staff

Role of the Facilitator-Advocates for Shared Governance Trust Wide-Recruit and Maintain councils when they’re set up-Project Leads-Researchers-Deliver training & education

Our Council Members Receive•Team Building•Problem Solving & Project Management Skills•Change Management•Coaching Skills•Education & Welcome Packs•Peer Support/Buddy Systems

Nursing & Midwifery Badge – Heart of England NHS Foundation Trust

Nursing & Midwifery Badge – Heart of England NHS Foundation Trust

Click here to View Video on Shared Governance –Our Journey HEFT