IMPROVING NURSING & MIDWIFERY QUALITY - My Journey, 3 English NHS Trusts Mandie Sunderland Chief Nurse Nottingham University Hospital

Nottingham City Hospital

QMC

14,000 staff 1,200 volunteers 14,500 public members 1,700 beds 90 wards Annual income: £848million 2 Biomedical Research Units Who we are

What we do District General services for local people Regional specialist centre for: -Cancer -Major trauma -Children’s & neonatal services -Renal -Neurosurgery -Heart -Stroke -Spines We’re part of the Olympic Legacy project: working with partners on the National Centre for Sports & Exercise Medicine Centre at Loughborough University

Activity 563 patients a day (elective, day case and emergency) In 2014/15: 14,546 emergency operations 28,811 planned operations 187,577 Emergency Department attendances

Little known facts 1.9m meals served a year 2m switchboard calls 27 miles of corridor at QMC City Hospital is the single biggest hospital site in Europe 7.8m pieces of linen a year Spend £4.5m on electricity a year

Challenges for Nursing Build public trust and confidence in the nursing profession particularly in light of national adverse media coverage Robust Board Assurance – lots of data not much info Professional concerns re nursing practice Nursing largest workforce - Biggest pay bill - Patient contact 24/7 Efficiency challenge -temporary staffing costs -maintain care quality

We can mix these up …… Assume Assure Reassure Proposition that is taken for granted as if it were known to be trust Comfort, faith A declaration to inspire full Confidence, freedom from doubt, based on evidence

Challenges for Nursing  Build public trust and confidence in the nursing profession particularly in light of national adverse media coverage  Robust Board Assurance – lots of data not much info  Professional concerns re nursing practice  Nursing largest workforce −Biggest pay bill −Patient contact 24/7  Efficiency challenge

Knowing how we are doing - Where did we start? Review of what we had Multiple audit tools reports, shared drives, Evidence base, NICE guidelines, NPSA, RCN…. Implementation of the NW Indicators using an in house developed IT solution, with a back to the floor approach. Falls Assessment Nutrition Pain Management Pressure Area Care Medicine Administration Observations Infection Prevention Added: Continence Diabetes

Developments Developments of new metrics - Maternity - Community - Neonates - Paediatrics - Theatres - Outpatients - A&E - Endoscopy

Progress – Heart of England NHS Foundation Trust

Reporting – Heart of England NHS Foundation Trust

ASSURANCE Target not achieved - Unsatisfactory progress with action plan? Any extenuating circumstances? Has it been flagged? e.g. Auditor competence, Staffing issue, Dependency Special measures – Month 1 Inform Chief Nurse Head Nurse: Set up meeting with Senior Sister, CD, Matron, General Manager create an Action Plan Action Plan agreed Monitored monthly via Head Nurse Chief Nurse updated on progress at NMB Achieved – back to monthly monitoring Not achieved Special Measures Month 2 Report to Nursing and Midwifery Board Diagnostics – performance dashboard etc. ‘Confirm and Challenge’ meeting with Chief Nurse Continue monthly monitoring of results Two months’ poor performance: Special Measures Weekly Monitoring Senior Nurse Support New Leadership Result: Improvement

July 2014 Nursing Care Indicators – Pennine Acute Hospitals

Fairfield July 2014

NMGH July 2014

Nurse Staffing The new game in town! Hard Truths (2014) public display of nursing and midwifery staffing levels - 6 month acuity reviews (SNCT) - reported to Trust Board - monthly reporting of staffing level planned v actual – 24 hours - formal escalation policy Nice Guidance 1* – Safe Staffing for nursing and in adult inpatient wards in acute hospitals. Under development A & E Maternity Children’s Red Flags/Care Contact time *1 Hard Truths: The Journey to putting patients first (DOH 2014)

HOWEVER… We recognised that we were measuring process which had its limitations What else could we triangulate? What would we do with all of this information?

Nursing and Midwifery performance committee Co-Chair – Deputy Director of Finance and Performance TOR adapted form Finance and Performance committee Monthly meet with head nurses Forward planner for suite of indicators/Triangulated scorecards Exception reports Performance notices Real sense of business like accountability

Outcomes Measuring to improve really does work Huge benefits with working with performance team Increased accountability ward to board Healthy competition Opportunities to celebrate Opportunities to share Shared accountability Robust proactive assurance both internally and externally

Shared Governance & Shared Leadership From Bedside to Boardroom.

History of Shared Governance Shared Governance originated in business and management theories. US MAGNET Model of Care- 1970’s Implemented in UK during brief periods in UK- Kettering, Leicester, Rochdale. Dr Hess found a way to measure shared governance

Why Shared Governance? Time out days Francis Report Shape of Caring Review NUH Engagement survey 69% of nurses felt management didn’t follow through on nurse suggestions for improvement 48% felt nurses didn’t have an active role in ward decision making 65% felt NUH weren’t doing enough to manage nurse burnout/stress

Nurse led Councils Our Unit/Speciality Practice Councils  Compromises of 5-15 members of staff across the clinical area from Afc Bands 2-6.  Meet on average of 6.5hrs a month  All councils are expected to have a Chair & Secretary. The Chair is expected to attend our monthly Leadership Council- which is our governance structure.

Professional & Personal Development 81%- “I have had the opportunity to develop leadership skills”. “I feel Shared Governance has helped with my confidence”

Our Staff Implement the Changes Staff work alongside senior leaders “76%- I feel more able to develop and change practice”

Culture of Transparency Face to Face Communication “It’s just the way we do things around here…” “It ensures everyone’s voices are heard”- Mandie Sunderland, Chief Nurse NUH.

Other Council Achievements… Reduced Moisture lesions and saved the ward money Reduced pressure ulcers on the nose and ears by working across wards and sharing practice. Developed a new way of giving feedback to staff

Role of the Facilitator -Advocates for Shared Governance Trust Wide -Recruit and Maintain councils when they’re set up -Project Leads -Researchers -Deliver training & education Our Council Members Receive Team Building Problem Solving & Project Management Skills Change Management Coaching Skills Education & Welcome Packs Peer Support/Buddy Systems

Nursing & Midwifery Badge – Heart of England NHS Foundation Trust

Click here to View Video on Shared Governance –Our Journey HEFT