nhs quality conference - david wood
DESCRIPTION
“#CWPZeroHarm” Cheshire and Wirral Partnership NHS Foundation Trust (CWP) – a provider of mental health and community physical health services – has responded proactively with an initiative to tackle the patient safety challenge posed by Hard Truths. Its #CWPZeroHarm ‘Stop, Think, Listen’ campaign, underpinned by the 6Cs, aims to drive cultural change to deliver improvements in safe care and provide better outcomes. The case study describes how CWP has invested in a number of plans to tackle unwarranted variations in health care by helping staff to deliver continuous improvement. The campaign has already started to make a positive difference – CWP achieved the highest score in the country for ‘overall experience of services’ in the CQC survey of users of its mental health community services.TRANSCRIPT
#CWPZeroHarm
NHS Quality: Improving Patient Care conference26 November 2014
David WoodAssociate Director of Safe Services
CWP – provider contextand challenges
Provider of mental health and physical health services Established in 2002 as a result of five local NHS bodies merging Became a Foundation Trust in 2007 (first mental health trust in the
North of England) Operates across 3 local authority areas Works with 5 CCGs and 4 acute hospital trusts 3,500 staff Membership base of 15,000 people Serves a population of 1 million people CHALLENGES:
Geography Culture Complexity of services and pathways Lower profile
Quality drivers Hard Truths – Francis, Berwick CQC: state of care Local recurrent themes from serious incidentsand complaints correlating to national recurrentthemes from the same sources NHS Outcomes Framework 2014/15 The measurement and monitoring of safety Open and honest care
Tactical approaches Major cultural change focusing on continuous improvement Appointment of a Clinical Expert Champion for Zero Harm Board investment in staff to support them in delivering the best care
possible, as safely as possible, and in doing so reducing unnecessary avoidable harms
Quality strategic goals reflecting an aspiration of zero harm Unchanged for at least the next three years
To achieve a continuous reduction in avoidable harm and make measurable progress to embed a culture of patient safety in CWP, including through improved reporting of incidents
To achieve a continuous improvement in health outcomes for people using the Trust’s services by engaging staff to improve and innovate
To achieve a continuous improvement in people’s experience of healthcare by promoting the highest standards of caring through implementation of the Trust’s values
Strategic plan 2014/19
CWP strategic directionPopulation Needs
Approach to Integration
Strategic Enablers (internal and external)
CWP Approach to Quality:Zero Harm Strategy
Service Transformation
IT Enabling
Val
ues
High Quality Data
Continuous Improvement
Culture
Models of Delivery
Workforce Transformation
Values – the 6Cs
Department of Health – Compassion in Practice Adopted by CWP in 2013 – embedding the 6Cs into CWP culture
care... compassion... courage...communication... competence... commitment
Staff have signed up to be Care Makers to act as ambassadors for the 6Cs
Incorporated into supervision, appraisal and recruitment and selection processes
TeamCWP 6Cs
CWP approach to quality –‘Zero Harm’ strategy
Proactive response to tackle the patient safety challenge described in Hard Truths
Aspire to drive cultural change further and faster through our ‘Stop, Think, Listen’ campaign
Underpins 5-year strategic vision and aims to deliver improvements in safe care and provide better outcomes by encouraging staff to:
Stop: don’t rush in
Think: weigh up the risk, benefits and
options
Listen: hear the views of other staff, people
who use our services and partners
Support for effective care planning
Appointed a care planning lead Support delivery of more proactive, co-produced care and support
for people with long-term conditions Aim to ensure individual, person-centred care and treatment is
offered and delivered to all people accessing the Trust’s services Facilitate the delivery of effective care planning techniques to deliver
the best, sustainable outcomes
Intelligent analysis
Appointed quality surveillance analysts Help and support staff to understand variance in care delivery and
outcomes Promote positive variance and reduce negative variance Use triangulation Reduce risk through application of modern improvement methods:
PDSA cycles, statistical process control, human factors Reduce inefficient service delivery Surveillance of what works well and leads to good outcomes, not
just identification of ‘failings’…
Quality assurance v.continuous quality improvement
Developing and supporting staff
Organisational development and training to deliver safe and effective care to build a culture of zero harm
Human Factors awareness training
Human factors example
“Culture carriers” make three pledges to support delivery of safer practices through behavioural and cultural change in their clinical areas
Celebrating success and promoting best practice Annual Big Book of Best Practice and Best Practice event
Patient experience – continuous improvement
Higher Organisation Rank OPES Change
Cheshire and Wirral 1 81.5 3North Essex 2 80.1 9Humber 3 79.7 24Tees, Esk and Wear Valleys 4 79.5 14Cumbria Partnership 5 79.5 16Rotherham, Doncaster and South Humber 6 79.4 62gether 7 79.3 27Mersey Care 8 79.3 0Plymouth Community Healthcare CIC 9 79.1 -6Lancashire Care 10 78.9 -8Bradford District Care 11 78.9 8Dudley and Walsall 11 78.9 8Northumberland, Tyne and Wear 12 78.6 1Camden and Islington 13 78.1 40Dorset 14 78.1 0Somerset 15 77.9 33Manchester 16 77.9 -10Pennine Care 17 77.6 5Oxleas 18 77.4 -1Oxford Health 19 77.4 31Black Country 20 77.0 20
Cultural change
Ideal…
Interventions that lead to the maximum number of people achieving good
outcomes and positive recovery and the smallest number of people experiencing
adverse outcomes
The provider challenge Delivery of quality orientated services, ethically and economically Improve the health and well-being of local communities Competitive – winning commissioned services Keeping up with rapidly changing evidence bases Meeting local demand in line with funding and commissioning
models – best value money provider available
Understand varianceAspire to be a positive outlier
I m p r o v e m e n t/ P o s i t i v e o u t l i e r
Factors for success Board support Medical and Nursing
Director leadership Clinical engagement Stakeholder support Strategy – join up the
dots Behaviour, culture and
human factors Be in it for the long haul Continuous quality
improvement/ aim for positive variance not just consistency