Parallel Session 2.9 Scrutiny and Improvement – The Integrated Cycle

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  • (Image) Relatives of those who have died at Stafford general hospital stand in front of a tribute wall. An independent inquiry found patients routinely neglected, humiliated and in pain as the trust focused on cutting costs and hitting government targets.Healthcare Commission found that between 400 and 1,200 more people died at the Mid Staffordshire NHS Foundation Trust than at other hospital trusts between 2005 and 2008.The report found that:• Patients were left in sheets soiled with urine and faeces for considerable periods of time.• There was striking evidence of the incidence of falls suffered by patients, some of which led to serious injury. Many took place unobserved by staff• The attitude of nursing staff left much to be desired• Relatives took to taking sheets home to wash• There was insufficient care for patients' dignity, with some left in degrading conditions and others inadequately dressed in view of passersby• Families were forced to remove used bandages and dressings from public areas and clean toilets themselves for fear of catching infections.
  • you will be familiar with this diagram – the integrated cycle. Evidence – Scrutiny - Improvement Mechanisms which underpin Evidence Local self assessment Local inspection reportOlder People in Acute Care Clinical Standards National Care StandardsReview of literature: CAAP process (April 2012) Relevant reports eg Audit Scotland
  • Remember that scrutiny processes, which ever they are:Identify strengths and weaknesses.It not just the negatives , but often that is all that people rememberAction plans and activities focus on the areas for improvement Boards and leaders also need to reflect on the positives , the things that teams do well …..
  • (Images)Translate patients and carers experiences and stories into case studies, and use the learning to develop ideas for change. Take concepts and characteristics from best practice in other settings and specialities - Adapt these Find examples of good practice, ideas which have been developed by you, but which have not been shared. Work with the service to understand the problems on the ground and commit to develop solutions. Use the research evidence from published guidelines.
  • We know what they are - Robbies earlier slide mentioned the themes and concerns Staff don’t always act to safeguard the best interests of patients with dementia, their families and carersFood, fluid and nutritionPressure ulcer careFalls
  • Which approach do we use ? - the older peoples programme is about spreading good practice, the ideas and good practice that the reports have captured and the ideas and good practice which we know should be done consistently – so the method of choice will be working together in a collaborative, to support teams to make changes.
  • Key themes from reports and self assessments : the actual areas of concern:Continence – management of incontinence Falls – avoidance of fracture Nutrition – best possible chance of health and healingTissue viability – avoidance Pressure ulcersCare for the people with dementia - and identification of delirium The improvement plan, what needs to happen along the pathway :What happens at assessment and admission What happens during care and treatmentWhat happens at points of transitionThe Improvement programme- a 2 year national improvement programme : Built around the same themes The same core areas of care.Intention to :Help teams to introduce the right care To know what should be done and make changes in care delivery Identify and spread good practice from one site to others To help with the how to make the changes not just what changes to introduce
  • The nutritional care programme highlighted key areas for improvement which have been restated in the recent scrutiny – how can we embed improvements on a continuous basis? There are examples of good practice across NHS Scotland challenge continues to be spreading the good practice across the whole system.
  • We know the importance of nutritional care – unfortunately this picture is not consistently replicated across NHS Scotland – how can we spread these smiles across every ward?
  • Evidence of the critical requirements to reduce the number of falls in hospitals continues to be witnessed as part of the inspection. Evidence has provided approaches which can be taken to reduce the number of falls. The implementation of a continuous cycle of improvement at local level is a key factor in embeding change at local level.
  • Remember that scrutiny processes, which ever they are:Identify strengths and weaknesses.It not just the negatives , but often that is all that people rememberAction plans and activities focus on the areas for improvement Boards and leaders also need to reflect on the positives , the things that teams do well …..
  • Parallel Session 2.9 Scrutiny and Improvement – The Integrated Cycle

    1. 1. SCRUTINY: AN INTEGRAL PARTOF IMPROVEMENT
    2. 2. CONTEXT• the Scottish context• Quality Strategy• external confidence and assurance at a time of financial constraint and rising expectations• shifting balance in power between health professionals and patients• integration of care - regulation & scrutiny with fewer boundaries
    3. 3. MID STAFFORDSHIRE
    4. 4. INTEGRATED CYCLE OF IMPROVEMENT
    5. 5. TIMELINE6th June 2011Cabinet Secretary announcement directing HIS toundertake inspections of care of older people in acute care29th November 2011Scottish Parliament Health and Sport Committee Reportpublished on Inquiry into the Regulation of Care for OlderPeople1st December 2011Letter to Chair HIS setting out the policy context fromDirector General
    6. 6. TIMELINEOctober – January 20126 test inspections completed3rd February 2012Letter to Chief Executive, HIS asking for the formalprogramme of inspections to commence as swiftly aspossible
    7. 7. 6 INSPECTIONS UNDERTAKEN• Western Infirmary 21st February• Hairmyres Hospital 5th March• Royal Alexandra Hospital 14th March• Western General Hospital 11th April• Glasgow Royal Infirmary 2nd May• Wishaw General Hospital 28th MayReports published with improvement action plans
    8. 8. INTEGRATED CYCLE OF IMPROVEMENT • Improving Older People’s Care in Acute Hospital programme •Key themes adapted to other work• Local self assessment•Local inspection report•Older People in AcuteCare Clinical Standards•National Care Standards •Inspection of Older People’s•Review of literature: Services in acute careCAAP process (April 2012) •Learning from other reports•Relevant reports eg AuditScotland
    9. 9. AREAS OF STRENGTH• Caring behaviours of staff, taking account of privacy, dignity and respect AREAS OF IMPROVEMENT• Staff don’t always act to safeguard the best interests of patients with dementia, their families and carers(legal and ethical implications)• Food, fluid and nutrition• Pressure ulcer care
    10. 10. BUILDING THE IMPROVEMENT PROGRAMME
    11. 11. USING THE EVIDENCE• Patient and User feedback• Observation in the ward• Research and evidence• Reports and Reviews• Standards of practice and care• Common Sense
    12. 12. WHAT NEXT ?• We know the size of the problem• We know where we want to get to• What are the few things which we know will make a difference ?• How do we bring them together ?
    13. 13. BUILDING THE IMPROVEMENT PROGRAMME Research and Development. Driven by need Prototype Ideas shaped by small scale tests of change Spread Good practice supported by Quality Improvement Sustainability Part of normal working ensured by Scrutiny
    14. 14. Improving care for older people in acute hospital Integration of Scrutiny and Improvement3 Improvement Plan Admission and In-patient2 Transitions Assessment care Inspection Themes Continence Nutritional Falls Tissue Dementia care Viability1 Local NHS board test sites
    15. 15. Improving care for older people in acute hospital Integration of Evidence and Improvement MUST screen in 24 hours Nutritional care Assistance at meal times Hydration
    16. 16. Improving care for older people in acute hospital Integration of Evidence and Improvement Environmental issues Falls Falls Prevention Assessment
    17. 17. THANK YOUAny Questions ?
    18. 18. QUESTIONS• What are the challenges/opportunities in integrating inspection and improvement ?• What opportunities do you see in integrating inspection and improvement of older people?• How do you ensure the patient/carer is central to all scrutiny and improvement work?

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