SL Judith Audrey Audrey Audrey Audrey Audrey Reception: SL Early Early Early Early Early Early SPA: SL Late Late Late Late Late Late Urines Put up: SL Late Late Late Late Late Late Waste collection / autoclave: SL Core Core Core Core Core Core Stool Put up & CDT: SL Core Core Core Core Core Core Blood Cultures: SL Core Core Core Core Core Core Fluids NW+FU: SL Core Core Core Core Core

1. Simon Rattenbury
Head of Laboratory Service
Microbiology
Seven Day Services supporting
Improved Outcomes in Prevention
and Early Diagnosis 4th March
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

2. RFH Founded in 1828 Royal Charter 1837
Clinical Instruction for Women
The Royal National
The Royal Free
Throat, Nose and
Hospital
Ear Hospital

3. • ~600 beds Reduced from 1200.
• 700,000 patients a year from all over the
world.
• Employ around 4,600 people and have a
turnover of about £450m.
• Major A&E.
• All branches of surgery and medicine
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

4. What am I Going to Cover
• Scientists / Pathology & its Role
• What was the need & why consider 24/7?
• What was the clinical need?
• The outline planning of the 24/7 case?
• What the key points/take home message?
• What did it deliver / measure success today?
(time, Money, efficiency etc)
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

5. Why 24/7 Why Microbiology
• Patients aren't ill 9 to 5:
– Better patient outcomes
– Fit with patients care pathways
– Antibiotic Stewardship
– The new system of working was developed over
several years. It involved changes to staff roles,
training and contractual arrangements and was a
major restructuring exercise
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

6. The 63 heroes who saved our son: Revealed in the heart-
tugging story of a critically ill baby and the astonishing
army of NHS staff needed to save one life
To save one life: 7 doctors, 9 consultants, 18 nurses, 5
support staff, 22 scientists, 1 professor and 1 receptionist
The Royal National
The Royal Free Throat, Nose and
6 Hospital Ear Hospital

7. Pathology Challenge
• Organise services around the patient/users,
– not disciplines, staff groups, hospital labs
• Transform structures and practices
Reduce variability
Provide evidence of progress
• No change is not an option
• Take ownership and drive the agenda
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

8. Delivering “end-
Vision of 24/7
to-end” Pathology
Service
Pathology
Services enabling
better NHS care
Better patient outcomes Transforming the
& commitment to a existing path
quality 24/7 operating model
Providing quality Increasing productivity
services at PATIENT & delivering continuous
competitive prices improvement
Providing a A Department Developing Providing an
Service for the employees are proud scientific & clinical integrated service
Future to be part of knowledge end to end
Innovation R&D
Target Markets:
Core pathology services in chosen geographies
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital Specialist reference services nationally & internationally

9. Improvement Cycle
User
Pathology Service Satisfaction
Improvement
Pathology
Modernisation
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

10. Current Service Provision
Departments philosophy
Molecular Rapid Microbiology
• Chlamydia/GC
• TB Patient
• MRSA
• Enteric Panel Real time
• 16s RNA sequencing
• Fungal 18ITs Sequencing
• Typical & Atypical respiratory
• C difficile toxin
• MALDI ToF
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

11. The Past
• Staff turnover………..high
• Staff cover at weekend and out of hours was
on a voluntary rather than a contractual basis.
• Reliance on high cost locum staff and high
turnover meant the training and staff
experience was variable and at times services
had to be withdrawn due to lack of staff
available to perform the work
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

12. The Past
• 2000 all new contracts were changed to 24/7
working including bank holidays
• Staff titles were changed to ‘Health Care
Scientists’ in an attempt to remove glass
ceilings and introduce equality and to gain
greater job satisfaction
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

13. The Past
• Two on call systems were in operation (routine and
High Secure Pathology Unit) plus additional staffing
for
– Blood cultures
– MRSA
– C difficile
– Resistant Gram negative screening
• Shift Rota was complex and time consuming
• Required at least 2 .5 days to prepare but was not
EWTD compliant
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

14. The Past
• 2004 Introduction of more support grades and
Health Care Scientists
• Band re-profile 6 to 5
• AP
• MLA
• No A&C grades
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

15. Staff grade 07/08 08/09 2011/13
8 6 5 5
7 BS 10 13 8
7 CS 6 4 4
6 BS 15 13 14
5 BS 0 0 3
4 AP 2 2 6
3 MLA 1 1 2
2 MLA 2 8 8
A&C 4 3 3 0
A&C 2 2 0 0
Totals 50 49 47
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

16. Workload & Staffing
Year 06/07 07/08 08/09 11/12 12/13
approx
Workload 250,000 300,000 350,000 500,000 600,000
Staffing 50 50 49 47 47
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

17. Introduction of 24/7
• Major change
• Negative and some positive impacts on staff
• Time, effort and strong communication to
work through the issues with staff.
• Major concern for staff was reduction in pay;
managed by providing pay protection for up to
one year, variable lengths
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

18. Introduction of 24/7
• The benefits to staff
– self roster
– working hours 37.5hrs
– Improved staff safety.
• New ways of working and career development
– new roles to emerge e.g. the associate practitioner role.
• Continuity of staffing
– Provide better quality services and reduce the pressures that
had previously been experienced
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

19. Introduction of 24/7
• Addition of three bands 5
• Gradual introduction of band 4 to be trained as
Associate Practitioners.
• Budget
– Funding for pay protection was required Overall
the remaining staffing changes were managed
within the existing budget by re-profiling the skill
mix.
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

20. Challenges
• Unions
• Consultation
• Committee
• Staff questions
• HR A4C pay rates
• Reserve lists
• Multidisciplinary HSPU training
• Three monthly and weekly rota
• Went live 1st Aug 2009
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

21. Challenges
• Terms and conditions
• Working practices - consultants
• - technical
• Culture - professional
• - Management
» - “siteism”
• Corporate identity
• Changing job roles
• Ownership / territory
• Takeover mentality
• Disaffected staff
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

22. Staff View
WORKING
CONDITIONS
RECRUITMENT AND
RETENTION A4C/KSF
INDUCTION
STAFF CPD
FOCUS
TRAINING HEALTH AND SAFETY
LOW SICKNESS RATES
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

23. What’s Needed
• Management Support
• Resources
• Team Building
• Organisational / Personal Development
• Vision / Plan
• Leadership
• Resolve
• Time
• Stability
• Communication
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

24. In Transition: Key Objectives
• Keep the system safe in transition
• Drive sustainable innovation and service
excellence
• Modernise planning to deliver a patient
centred approach that embraces patient
pathways
• Enable service transformation
– Move general services closer to patients’ homes
– Centralise specialist services to leverage
expertise and drive economies of scale
– Integrate across health and social care
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

25. Top Tips
• Have clear and measurable goals and realistic
timeframes when planning the changes.
• Engage staff early in the change process and gain as
much agreement with the project goals as possible.
• Ensure that all meetings have minutes taken and they
are distributed to all staff
• Ensure negotiations with staff are reasonable and
managed well
• Skill changes provide positive training and
development opportunities for all staff and enable
flexible rosters
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

26. Top Tips
• Develop key baseline measures and track the
measures to demonstrate the improvements to
all stakeholders…Win/Win
• Be prepared to modify original plans where
possible so that staff are involved and are part
of the decision making
• Allowing staff to design the shift and rosters
system worked well
• Recognition of staff in their staff review
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

27. Types Time Staff numbers
of Shift
HCS MLA
Early 8.00 am to 4.30 pm 1 1
Core 9.00 am to 5.30 pm 15 7
Late 11.30 am to 8.00pm 2 2
Nights 8.00pm to 8.00am 1 0
7.30pm to 7.30am 1 0
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

28. Night Person Night Person 2
19:30 Hand over Hand over
20:30 Blood Cultures Start final put up of all left
21:30 over samples
22:30 Fluids Help with follow up
23:30 "
00:30 Follow up of both benches
Lunch
01:30 Urines
Lunch "
02:30 Any urgent samples PLUS "
03:30 Help on urines "
04:30 " "
05:30 Make sure all samples "
06:30 are booked in plus blood "
07:30 cultures put on analyses "
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

29. Sections Sat 21.04.12 Sun 22.04.12 SECTION
LEADER
RECEPTION ▲ Taufiq am –please note reception / spa done Early
Sat only sorted ▲Taufiq am –please note reception / spa done on night shift + tristel Late
on night shift + tristel No colour= Core
Night
® kumar (V) >2 ® kumar >1
Over time /
SPA Komal ☼< 1 pm ▲ Taufiq pm Xtra hours
Urines Put up
♣
▲ Taufiq pm;♣Sarah>4 ♣Sarah
Waste collection / autoclave ® kumar (V) (minimal) priority<2 ® kumar ( minimal) <1
Michelle ♦Michelle Team
Stool Put up + Stool Put up ( priority for CDT) + Stool Put up ( priority for CDT) leader:
&CDT( 12.30) + Sub SF/APW/Acetamide + Sub SF/APW/Acetamide
+ OCP Prep / Crypto stain + OCP Prep / Crypto stain
+ Send TDM levels @ 10 am and 3 pm + Send TDM levels @ 10 am and 3 pm Owen
Maria ( No Maldi) Maria( No Maldi) Please ensure
BLOOD CULTURES + IQC Oxidase / Nephelometer + IQC Oxidase / Nephelometer
+ report TDM + GC Screen / Read & record AST + GC Screen / Read & record AST
relevant plates
+ GUM +Sub ATCC Ctrls Sub ATCC Ctrls (if applicable) for closed
+ Report TDM + Report TDM sections are
placed in the
FLUIDS NW+FU *Owen( No Maldi) *Owen( No Maldi) fridge
RESPIRATORY NW+FU Rizalea ( V)
Includes reporting on Sunday *Owen
RESPIRATORY NW Putup Komal ☼>2pm Rizalea( V)
MRSA CULTURE & PCR Mohammed Mohammed
+ CDT PCR if required + CDT PCR if required
HVS Kanti 9-1 CLOSED
Read the NW only and complete the FU
RNOH & MALDI ♣Sarah<4 ( RNOH Maldi only) ♣Sarah( RNOH Maldi only/ SPA
URINES NIGHT Jasim CLOSED
WOUNDS/ E.N.T/ACIN NIGHT NIGHT
ENTERICS Komal ☼ only to Screen for Salm/ Komal ☼ start to finish + reporting
Shi < 11-45
SEROLOGY CLOSED CLOSED
VIPER CLOSED CLOSED
Computing CLOSED Owen
Night staff Lucy Lucy
• Wounds / ENT • Wounds / ENT
• Leave reporting for Sun night if • Leave FU on bench with instruction
necessary Jasim
• Night duties
Jasim: urine start to finish • Help Lucy with FU + reporting
• Read TVs/BVs and Record + Sub LIMs
Paul
• Night duties
• Read TVs/BVs and Record + Sub LIMs
• Help Lucy with + reporting
HSPU Day Maria Maria
Night Jasim Lucy
Sickness Andrew Andrew
The Royal National
The Royal Free Throat, Nose and MICROBIOLOGY WEEKEND ROTA (Prepared by ABhamra)
Hospital Ear Hospital

30. MICROBIOLOGY WEEKLY ROTA (Ed 23 March 2012) Rota Prepared by:A.Bhamra
Sections / Section-leaders Monday 23/04/12 Tuesday24/04/12 Wednesday 25/04/12 Thursday26/04/12 Friday 27/04/12
Deputy Rota Maker + weekly overdues Rajita Monica am Victoria Rajita Rajita Rajita
: SL Rajita Chris , Angela Chris Angela Chris AngelaJudith Yonas Angela Chris Angela
Victoria 0n tuesday Judith Shaila Judith Shaila Shaila, θAudrey pm Judith Andrew Judith Andrew
Fitzroy 8-9 Fitzroy 8-9 Fitzroy 8-9 Fitzroy 8-9;Rita Fitzroy 8-9 Rita
Ward Duties Jenny closed Yonas closed Yonas
URINE/ GU MED : Section leader Owen
rine Phx + Urine NW +AP •Maferim<11.30 •Maferim<11.30 •Maferim<11.30 Temitayo Temitayo
Temitayo Temitayo Temitayo
Dr Lakshi Dr Lakshi Dr Lakshi
Urine NW & FU +Microscopy Saroj ♥Komal>4.30 Saroj γRizalea<4.30 Saroj♥ Komal>4.30 Saroj⊗Kanti >4.30 Saroj ⊗Kanti >4.30
HVS+ GC+ settle plate < 4 Alan Vicky Alan Alan Alan
+ MALDI SPOTTING GC ONLY
SWAB CULTURE: Section leader Kanti
read / report Kanti, ♥Komal Kanti ♥Komal Kanti, ♥Komal ⊗Kanti,Komal ⊗Kanti,Komal
follow-up < 3 Kanti, ♥Komal Kanti ♥Komal ♦Vicky >11 ♦Vicky >11 ♦Vicky >11
up (SPA) ↓Samer >10 Andrew JennyChika>4.30 ♦Vicky <11 Jenny ♦Vicky <11 ♦Vicky <11
•Maferim>11.30 •Maferim>11.30 •Maferim>11.30 ↓Samer >10 ↓Samer >10
Dr Anna pm ↓Samer >10 Andrew Andrew↓Samer >10 Shaila°Mod >2 Shaila°Mod >2
HAI : Section leader Gemma
(am/pm) Kumar/ωMonica brief Kumar Kumar Kumar Kumar
+ MALDI SPOTTING
culture) +transferx2 runs ωMonica am θAudrey am/2 pm θAudrey am/2 pm θAudrey am/2 pm θAudrey am/2 pm
MYCOLOGY: Section leader Rebecca
(Tues & Fri) Shanti ♠Shanti koh Dr Daniel=dopsx2 * Rebecca/Shanti
↓Samer 9-10 ↓Samer 9-10 ↓Samer 9-10 ↓Samer 9-10 ↓Samer 9-10
(Mon & Thu) Rebecca/Shanti+koh Rebecca/Shanti+koh
BLOOD / FLUID: Section leader : Monica Victoria 0n Tuesday pm
+ MALDI SPOTTING Sirilaksmi Sirilaksmi Sirilaksmi Sirilaksmi Sirilaksmi
Fluids + MALDI SPOTTING Harry Emma Monica am /Dr Anna ♠Shanti +koh Anna Emma Anna Emma
am Victoria Emma
<2 Sini /Mohammed Sini /Mohammed Sini/ Mohammed+caf °Mohammed °Mohammed
Main Lab cover 1-2 Kanti/Komal Purnima/Gemma Harry Sirilaksmi Anna Sirilaksmi Rajita Audrey
RESPIRATORY / TB: Section leader Kanti
+ MALDI SPOTTING Manpreet Manpreet Manpreetam Victoria Manpreet ManpreetDr Anna am
RNOH Tissues + MALDI SPOTTING Anna /Rachel Anna Rachel Rajita Rachel Rajita Rachel Rajita Rachel
Xpert-CepheidPCR) Rizalea/Chika+ind -AL γRizalea&Chika<4.3 Rizalea Chika Harry Chika Harry Chika
ENTERICS / IQC: Section leader : Purnima Gemma ( Wed)
+ CDT/HP transfer 4-4.15 Purnima Gemma Purnima Gemma Gemma Purnima Gemma Purnima Gemma
H.pylori prep only( Mon & Thu) ◊ Michelle ◊ Michelle
Stool/CDT /OCP prep &CDT assay ◊ Michelle Yonas Michelle ◊ Michelle Michelle
IQC am (all day Wednesday) Ω Rajita am till 7pm θAudrey pm Harry θAudrey pm θAudrey pm
SEROLOGY: Section leader Rajita( Purnima on Tuesday)
/ TDM (if closed) Rita Rita Rita Night(Paul) Night(Sini)
MLA Serology prep + send aways Fitzroy 9 -4.30Kristine Fitzroy9 -4.30 Fitzroy 9 -4.30 Fitzroy9 -4.3Kristine Fitzroy 9 -4.30
i DS2 on Mon/Thu only +H.Pylori DS2 Kristine Kristine +H.Pylori DS2 Kristine
MOLECULAR (VIPER): Section leader Victoria( Mon-Wed),Gemma( Thu-Fri)
Chlamydia Viper / CDT & HPYL via DS2 Night( Sarah) Night( Sarah) Night( Sarah) Jenny Jenny
CT/GC Transfer results Night( Sarah) Night( Sarah) Night( Sarah) Night( Lucy) Night( Lucy)
MOLECULAR (Other): Section leader Victoria( Mon-Wed),Gemma( Thu-Fri)
Molecular (16s & others) / Atypical PCR ↑Damion Kevin ↑Damion Kevin Damion Kevin Damion Kevin Damion Kevin am
( half day 2 staff ) Anna Rob Rizalea Rob Rizalea Rob
Other Activities + R&D Rebecca=maldi sort Monica am =caf sort Monica =caf sort Rebecca/♣Owen
ΩRajita 7pm =Audit +dops for Dr Daniel- Maria pm= audit ‘f’ std maldi sort ,Abh= Rota
writMonica pm =caf sort see Amrat Sini= audit –see mk Monica =strep phx
Victoria =Eucast plan Abh= Rota Maria till 7= audit
: ↑ Damion =CoSurv Owen↑Damion pm Owen ICE+CoSurv Owen/Maria am ♣Owen +CoSurv
MEDIA / WASH-UP: Section leader Adrain
Media stock Tues / delivery Weds Taufiq Taufiq Taufiq Taufiq Taufiq
Registrars office /Enquiries Kelly, Valeria Kelly, Valeria Kelly, Valeria Kelly, Valeria Kelly, Valeria
SR,Abh,Mk am,AL Abh Mk AL Abh,Mk am AL SR,Mk AL Mk AL
Lucy Sarah Paul Sarah Paul Sarah Paul Lucy Sini Lucy
LEAVE (Med) = Medical (S) = Study L:Yonas,Dallas,Audrey L:Dallas, Gina L:Dallas,Gina, L:Dallas,Gina, O: L:Dallas,Gina,Jasim
(E) = Emergency (O) = off duty due to 24/7 GinaPaulO:TomMaria, O:,Michelle, RebeccaO:TomLucy, Maferima,Tom,Sarah Kevin pm, SR,Chika
(L) = Annual / Time-In-Lieu Leave Owen,Jasim , Mk pm Tom,Lucy,Maria, Purnima,Jasim, Victoria,Jasim, MP: O: Maferima,Tom,
(MP) = M/Paternity (MT) = Meeting S:VickyRob MP Jasim Rajita MP: MK pm,Monica pm Anthea MT:Monica Sarah,Victoria,Paul,
Francis @georgeds,Fenella rfh –virology, AntheaMT:Michelle/Ab AntheaSHarry,Manar S: Maria, Manpreet 10-11.30 & 1-2 MP: Anthea
Catherine r&d @ rfh,Ingrid@Barts,Manar @ ccrp1-2,Sini & Abh Alan,EmmaSamantha pm MP: Anthea S: Manpreet pm
Over time Kristine Mon 9- 12.15-12.30, Sam/Abh RobMT:Yonas/Abh MT:SR
Thu/Fri 9-11.30,Judith tue 9- 12-12.15 ccrp 12-1,Monica
pm,SR,AL10.30-11
Night Training Late shift Early HCS 1.5hrs Dr Rita Oladele: observer from ECCMID in dept for I month
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital

31. Sections / Section-leaders Monday 23/04/12 Tuesday24/04/12 Wednesday Thursday26/04/12 Friday 27/04/12
25/04/12
Deputy Rota Maker + weekly overdues Rajita Monica am Victoria Rajita Rajita Rajita
RECEPTION: SL Rajita Chris , Angela Chris Angela Chris AngelaJudith Yonas Angela Chris Angela
Monica am Victoria 0n tuesday Judith Shaila Judith Shaila Shaila, Judith Andrew Judith Andrew
Ward Duties Fitzroy 8-9 Fitzroy 8-9 θAudrey pm Fitzroy 8-9;Rita Fitzroy 8-9 Rita
Fitzroy 8-9
Jenny closed Yonas closed Yonas
URINE/ GU MED : Section leader Owen
Urine Phx + Urine NW +AP •Maferim<11.30 •Maferim<11.30 •Maferim<11.30 Temitayo Temitayo
Urine NW & FU +Microscopy Temitayo Temitayo Temitayo Dr Lakshi Dr Lakshi
Saroj ♥Komal>4.30 Saroj γRizalea<4.30 Dr Lakshi Saroj⊗Kanti >4.30 Saroj ⊗Kanti >4.30
Saroj♥ Komal>4.30
GU MED HVS+ GC+ settle plate < 4 Alan Vicky Alan Alan Alan
+ MALDI SPOTTING GC ONLY
SWAB CULTURE: Section leader Kanti
Wounds / Ent read / report Kanti, ♥Komal Kanti ♥Komal Kanti, ♥Komal ⊗Kanti,Komal ⊗Kanti,Komal
Wounds / Ent follow-up < 3 Kanti, ♥Komal Kanti ♥Komal ♦Vicky >11 ♦Vicky >11 ♦Vicky >11
Swab put-up (SPA) ↓Samer >10 Andrew JennyChika>4.30 ♦Vicky <11 Jenny ♦Vicky <11 ♦Vicky <11
•Maferim>11.30 •Maferim>11.30 •Maferim>11.30 ↓Samer >10 ↓Samer >10
Dr Anna pm ↓Samer >10 Andrew Andrew↓Samer >10 Shaila°Mod >2 Shaila°Mod >2
HAI : Section leader Gemma
ACP MRSA (am/pm) Kumar/ωMonica brief Kumar Kumar Kumar Kumar
+ MALDI SPOTTING ωMonica am θAudrey am/2 pm θAudrey am/2 pm θAudrey am/2 pm θAudrey am/2 pm
HAI (MRSA culture) +transferx2 runs
MYCOLOGY: Section leader Rebecca
Mycology (Tues & Fri) Shanti ♠Shanti koh Dr Daniel=dopsx2 * Rebecca/Shanti
MLA 1
HPLC (Mon & Thu)
↓Samer 9-10 ↓Samer 9-10 ↓Samer 9-10 ↓Samer 9-10 ↓Samer 9-10
Rebecca/Shanti+koh Rebecca/Shanti+koh
BLOOD / FLUID: Section leader : Monica Victoria 0n Tuesday pm
Blood culture + MALDI SPOTTING Sirilaksmi Sirilaksmi Sirilaksmi Sirilaksmi Sirilaksmi
The Royal National
The Royal Free
Fluids
Hospital + MALDI Throat, Nose and
SPOTTING Harry Emma Monica am /Dr Anna ♠Shanti +koh Anna Emma Anna Emma
Ear Hospital
am Victoria Emma
MALDI LAB <2 Sini /Mohammed Sini /Mohammed Sini/ Mohammed+caf °Mohammed °Mohammed

32. Summary
• To ensure that workforce planning, training, &
education drive sustainable innovations
• To deliver a capable and flexible workforce
now and in the future.
• An aim to improve the quality of care and the
experience of patients and staff at all levels
and enable them to embrace change and
improvement.”
The Royal National
The Royal Free Throat, Nose and
Hospital Ear Hospital