Culture of Quality Event Thursday 16 May 2013

A definition of Culture Culture = the beliefs, behaviours, norms, dominant values, rules and climate within an area of work Culture of Quality EventThursday 16 May 2013

“Listening event” post Francis Inquiry Opportunity for senior healthcare leaders to reflect and debate "the culture of quality" required within partnership working across the system Capture partner agencies views and ideas Agree next steps Culture of Quality EventThursday 16 May 2013 Purpose of event

Chairman Worcestershire Healthwatch Culture of Quality EventThursday 16 May 2013 Peter Pinfield

Patient stories and views Culture of Quality EventThursday 16 May 2013

If we want to know what it is like to be a patient then the one solution is to listen to patients. A patient story is where a patient, or carer, describes their experience of healthcare in their own words. The idea is to gain an understanding of what it is like as a patient, what was good, what was bad and what would make the experience more positive (Gilbert 2006) Culture of Quality EventThursday 16 May 2013 Benefits of using patient stories in healthcare

Taking patient stories is not a negative exercise. It is not just about trying to find out where things go wrong, but listening to stories also provides an opportunity to learn about the things that we do well and share them. Culture of Quality EventThursday 16 May 2013 How should we use patient stories?

Understand that I’m a human being and not just a body in a bed Treat me with respect, dignity and care Remember I’m a person, not a patient Allow nurses to spend more time caring than doing paperwork Make sure the environment is clean Read my patient notes before seeing me Culture of Quality EventThursday 16 May 2013 What does quality look like to Worcestershire patients?

Be aware of my mental health needs Give me the confidence to know that I’m receiving the correct treatment Don’t ignore my family, acknowledge them Make sure I have all the information I need at all times Listen to me Tell me the truth Culture of Quality EventThursday 16 May 2013 What does quality look like to Worcestershire patients?

REMEMBER We are individuals– no two of us are the same We don’t just want good treatment, we want to feel that we are being cared for We have emotional as well as physical needs What does quality look like to Worcestershire patients?

Head of Commissioning NHS England Culture of Quality EventThursday 16 May 2013 Michelle Mello

Commissioning Response to Francis Michelle Mello, Head of Commissioning, Chief Nursing Officers Directorate, NHS England Worcestershire CCGs 16 th May 2013

What Are We Here To Do? Statutory bodies commissioning healthcare services for local populations Understand need & variation (collaborative commissioning) Ensure quality & safety of healthcare services including primary care (quality governance) Transform the way services are delivered Involvement & engagement of local people & clinicians Sound finances Corporate governance NHS | Presentation to Worcestershire CCGs | May

That Wouldn’t Happen Here? 372 NHS | Presentation to Worcestershire CCGs | May Do quality & safety influence all commissioning decisions? Do assurance systems work?

Quality – A Nursing Concern? NHS |Presentation to Worcestershire CCGs| May

Quality is Everybody's Business Everyone’s behaviour is a reflection of the culture of the organisation they work for NHS | Presentation to Worcestershire CCGs| May

Overview of Francis Report NHS | Presentation to Worcestershire CCGs| May Key Themes 1SAFETY Explicit fundamental quality standards which ensure patients are safe from harm 2INFORMATION Reliable, useful and full information reporting to support the attainment of and compliance with clearly identified fundamental and enhanced standards of quality and safety. 3TRANSPARENCY Openness, honesty, truthfulness and candour in sharing of information to ensure issues with safety and quality are identified, acknowledged and mitigated as early as possible 4ACCOUNTABILITY Clear lines of organisational, professional and individual responsibility and accountability understood by everyone in the local health community 5CONSISTENCY Proactive and practical approaches to managing poor quality and safety issues with providers that ensure patients can expect and feel confident in receiving consistently high standards of care 6ASSURANCE That any changes to services driven by requirements for cost-effectiveness do not impact adversely on patient safety and service quality and that financial pressures are never prioritised over patient care 7CULTURE CHANGE An honest, open and positive culture in organisations towards performance management in order to drive the delivery of high quality care and always to do the right thing for all patients 8STRENGTHENED REGULATION Refreshed and new approaches/mechanisms to regulation and monitoring of all providers by all appropriate bodies in a co-ordinated manner

What’s Needed? NHS | Presentation to Worcestershire CCGs| May ACTION: Each organisation to address the recommendations in a formal response to the report and identify the priority areas which they believe are relevant to their duties and to support putting patients first. This will drive specific Action Plans/work streams ACTION: On-going planning, contracting and assessment must be refreshed and strengthened to embed the Francis 2 improvements and ensure information is available to support monitoring of performance and accountability ACTION: Need to facilitate and broker a refreshed relationship between commissioners and providers in achieving the transparency and focus on safety and quality that is required in the new NHS

Where are the Gaps? NHS | Presentation to Worcestershire CCGs May Gap 1 Soft Intelligence & information: Patients, staff, surveys GPs feedback critical – monitoring on behalf of their populations Gap 2 Contracts: A dditional information reporting requirements, KPIs and quality requirements, updated service specifications Fundamental, enhanced and developmental quality standards Gap 3 Complaints Management: More detailed exploration, trends Supporting patients in understanding how they can feedback and complain

Where are the Gaps? NHS | Presentation to Worcestershire CCGs | May Gap 4 Understanding the triggers for Intervention information & triangulation who is involved? process for escalation hospital visits /inspections /risk summits Gap 5 Communications & Engagement with Public/Patients support provider and CCGs around patient engagement increasing patient awareness of their fundamental standards and rights clarifying the complaints process and support available for them if complaining Gap 6 Culture change and organisational development developing transparency and openness with providers nursing leadership provider assurance and governance processes Quality impact assessments

Developing an intelligence driven approach to quality surveillance/early warning/continuous improvement Develop a system which provides clear, robust intelligence on all aspects of quality across the health and social care economy Make full use of routinely available and ‘softer’ intelligence drawn from across the whole system Interpret and present the intelligence so that it can be easily and quickly understood Support further action to ‘drill down’ into areas that give cause for concern Use the specialist expertise - Quality Observatory, including extensive work on PROMs, Patient Experience data and Safety Thermometer NHS | Presentation to Worcestershire CCGs | May

Relationships ‘Patients’, public, communities Membership Area Team Local Authority Providers/Clinicians Social Care HEE/LETB HWB Healthwatch Regulators NHS | Presentation to Worcestershire CCGs | May

Key Messages The ‘patient’ comes first – not the needs of any organisation Quality is everybody’s business – from ward to board, from the supervisory bodies to the regulators, from the commissioners to primary care commissioners and managers If we have concerns we speak out and raise questions without hesitation We listen in a systematic way to what our patients and staff tell us about the quality of care If concerns are raised, we listen and ‘go and look’ NHS | Presentation to Worcestershire CCGs | May

Our Shared Commitment – Compassion in Practice 24 Strategic Role Personal Leadership Culture & Values

There’s No Time Like The Present NHS | Presentation to Worcestershire May Acknowledgement: Lynn Poucher, Nurse Director, North Yorks & Humber CSU

Culture of Quality EventThursday 16 May 2013 Mari Gay and Jo Galloway Executive Nurses South Worcestershire, Redditch & Bromsgrove, and Wyre Forest CCGs

Culture of Quality EventThursday 16 May 2013

Explanation of group work Culture of Quality EventThursday 16 May 2013

Each table has a facilitator Each table will be allocated one of the NHS values that support the NHS Constitution The task is to debate and identify the behaviours we need to adopt that would support working together to achieve the value (30 mins) Feedback top 3 behaviours Culture of Quality EventThursday 16 May 2013 First group session

Working together for patients Respect & Dignity Commitment to Quality of Care Compassion Improving Lives Everyone Counts Culture of Quality EventThursday 16 May 2013 NHS values

"The manner of approach or conducting oneself“ “The way things get done around here” Culture of Quality EventThursday 16 May 2013 Definition of behaviour

Group to debate and identify current barriers to achieving the value and the vision statement presented Group to debate views of how to overcome barriers Feedback top 3 barriers Feedback 1 action from the group to overcome barriers Culture of Quality EventThursday 16 May 2013 Second group session

Collect all contribution and feedback Take reflection back to own organisations and determine own next steps, particularly in relation to partnership culture Similar event for public over the summer Quality leads to determine next steps and consult widely Annual event to support continuous commitment to the quality of culture Culture of Quality EventThursday 16 May 2013 Summary and suggested next steps