Clinical Director – Emergency & Acute Care Group Draft CQC Presentation Miss R Joshi Clinical Director – Emergency & Acute Care Group 3 July 2017 Brief overview as to how we have arrived

Safe ARE WE SAFE New Governance structure in place to support improvements through Emergency Care with the ED Task Group Staffing investment of £1.2m to Nurse and Medical workforce to develop a sustainable skilled workforce Introduced a Paediatric Nurse Team into the department to work towards 24/7 cover in the team Developed IT systems to ensure “clinical priority” through Triage using Fusion Whiteboard Governance Framework developed to monitor standards of compliance for audits including Triage and Pain Scoring and reporting through Oversight and Care Group Meetings – end of year compliance showing 98% average for Triage compliance and 95% for Pain Score completion in 2016 Increase shared learning with the team from incidents and reporting using monthly News Letters, regular Team Meetings and teaching sessions with Patient Safety and increased visibility in the department of updates and reports with new notice boards Set and established Professional Standards within the ED to maintain safety and quality of care for our patients

Safe ARE WE SAFE cont. Developed IT to show “real-time” activity for the team leaders to manage pressures in the department Introduced a new Risk Management system and meet regularly with Patient Safety to manage and review risks and mitigations   Priorities going forward: Develop the Band 6 Nurse Team Leaders to manage our patients from within the team Develop regular Nurse In Charge and Team Leader Meetings to support consistent approaches and continuous improvements Continue to develop ways of working within our Paediatric Area using the Paediatrics Focus Group Implement a sustainable medical model by introducing alternative ways of working and reducing Consultant vacancies 

Responsive ARE WE RESPONSIVE New segregated Paediatric Department in line with National Requirements Regular LIA sessions with the teams as a tool for change Champions established in many areas including Learning Difficulties, Dementia Daily “Huddles” in place for the Team of 3 to respond to the days activity in the department Regular Friends and Family Forum Meeting with service users and ED Team Development of new ED Patient Record to improve clarity of clinical information of our patients Improved model of care with Urgent Care Services to provide clinical streamer and reduce confusion of inappropriate referrals to ED – framework established for weekly reviews with Matrons from both services

Responsive ARE WE RESPONSIVE cont. Development of Estates business case for a new improved department Introduced new IT “Real Time” activity for the department to help manage patient flow and safety in the department Priorities going forward: Continue to work with our patients and service users to make continuous improvements Work with the clinical team to increase shared learning and learn from incidents and excellence within the service Develop the Estates Business Case with the Executive Team and establish clinical leads for the workstreams (Equipment, IT, Construction, Design)

Caring ARE WE CARING Improved Friends and Family Testing system to obtain clear feedback from our patients, with  month on month top “positive” theme since its implementation being “Staff Attitude” Friends and family test results reviewed at Team Meetings and with service users as part of the developed Friends and Family Forum New toys and “distractions” for our child attendances provided and purchased through charity fundraising by the team “Memory Boxes” implemented by the Paediatrics Focus Group for patients being supported at End of Life Introduction of Butterfly system to help care for our Dementia patients

Caring ARE WE CARING cont. Introduction of “listening and learning” 1-2-1s with our Champions where they meet service users (for example recently parent of Autistic child and daughter of Dementia patient that both attend ED) to listen and learn from their experiences Developed the ED Waiting room to improve patient experience with new seating and better communication with leaflets, posters and waiting time displays now in place  Priorities going forward: Develop further improvement of patient experience from our Friends and Family Testing Develop the CQC Champions to ensure continuous improvement within the service Expand the Focus Groups and LIAs within the team focusing on CSWs and Team Leaders initially

Effective ARE WE EFFECTIVE? Implementation of MDT group for Frequent Attenders with Social Care, Drug and Alcohol Networks and Primary Care GP’s to produce Care Plans for regular service users – saving 73% reduction in A&E admissions , 51% reduction in hospital admissions  and 63% reduction in bed days over 12 month period (cohort 2) – zero SI relating to suicide, self-harm or avoidable mortality for this group Implementation of Focus Groups to develop, manage and monitor standards within service areas such as Paediatrics, Resus, Waiting Room Engagement developments with the team throughout the year to produce 5 year plans and vision for the service Continual Benchmarking carried out with the Network and neighbouring Trusts to develop effective pathways and Models of Care for the Service based of best practice End of year targets achieved for Mandatory Training and IPDR completions Carry out regular “Team Building” sessions and coaching support for the clinical and non-clinical team

Effective Priorities going forward: Development of objectives within the service vision to ensure best standards of practice and compliance of recommendations from governing and improvement bodies Develop our Learning and Development framework further to support the team within our clinically led service Ensure best practice standards are in place for: Rapid Assessment and Triage Triage times To be Seen Times Ambulance Handover

Well-Led ARE WE WELL-LED Front line visits to ED services by Divisional Management and Executive Team as part of Board Walks Continual support and engagement with the ED Team from Team of Three to develop improvements Regular Focus Groups and LIA sessions to engage and support the ED Team Regular Team Meetings and Engagement sessions with the ED Team to listen and support Ongoing feedback and information provided through Newsletters, Text Messaging service and 1-2-1s Training and Development programme being established for ED Reception Team

Well-Led ARE WE WELL-LED cont. Leadership and coaching development plans with the Clinical Leads targeting Band 6s initially Personal development Plans/Reviews in place with 100% compliance for Medics and Non-Clinical Staff and achieved target at year end for Nurse completion Divisional and Care Group Leadership in place with visible Team of 3 Priorities going forward: Embed new workforce model and ensure sustainable robust workforce is established Provide close leadership and management support to the ED Team on a daily basis through “Huddles” and “Being Seen” through good times and bad…

Feedback from the Current CQC Inspection Evidence of Good Practice: They saw better availability of equipment Good medicines management Good nurse training Good sepsis pathway Good clinical leadership and direction

Feedback from the Current CQC Inspection Things to work on: They didn’t like the use of the large cubicle for multiple patients Handover needed to be improved further to cover whole pathway They were disappointed that we hadn’t sorted the sticker issue out for the PEWS chart and that the PGD for nursing drug admin was not yet signed off.