“#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.

1. #CWPZeroHarm
NHS Quality: Improving Patient Care conference
26 November 2014
David Wood
Associate Director of Safe Services

2. CWP – provider context
and 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

3. Quality drivers
 Hard Truths – Francis, Berwick
 CQC: state of care
 Local recurrent themes from serious incidents
and complaints correlating to national recurrent
themes from the same sources
 NHS Outcomes Framework 2014/15
 The measurement and monitoring of safety
 Open and honest care

4. 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

5. CWP strategic direction
Population Needs
Approach to Integration
Strategic Enablers
(internal and external)
CWP Approach to Quality:
Zero Harm Strategy
Service Transformation
IT Enabling
Values
High Quality
Data
Continuous
Improvement
Culture
Models of
Delivery
Workforce
Transformation

6. 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

7. 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

9. 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

10. 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’…

11. Quality assurance v.
continuous quality improvement

12. 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

14. Patient experience –
continuous improvement
Higher Organisation Rank OPES Change
Cheshire and Wirral 1 81.5 3
North Essex 2 80.1 9
Humber 3 79.7 24
Tees, Esk and Wear Valleys 4 79.5 14
Cumbria Partnership 5 79.5 16
Rotherham, Doncaster and South Humber 6 79.4 6
2gether 7 79.3 27
Mersey Care 8 79.3 0
Plymouth Community Healthcare CIC 9 79.1 -6
Lancashire Care 10 78.9 -8
Bradford District Care 11 78.9 8
Dudley and Walsall 11 78.9 8
Northumberland, Tyne and Wear 12 78.6 1
Camden and Islington 13 78.1 40
Dorset 14 78.1 0
Somerset 15 77.9 33
Manchester 16 77.9 -10
Pennine Care 17 77.6 5
Oxleas 18 77.4 -1
Oxford Health 19 77.4 31
Black Country 20 77.0 20

15. Cultural change

16. 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

17. 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 variance
Aspire 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

18. 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

19. Thank you
david.wood@cwp.nhs.uk
@DavidWood_CWP
#CWPZeroHarm
@cwpnhs