Always focusing on quality

I hope that, like me, you enjoyed the first episode of our new TV series ‘Geordie Hospital’ on Monday. The feedback from staff and viewers has been very warm, and it’s been lovely to share the feeling of pride and passion about what we do together.

Five-year-old Kit Matthews who featured in the first episode of Geordie Hospital

I’ve been very pleased that we were able to feature a very broad range of staff in the series, and I’m looking forward to the next episode. You can see the whole series now on All4.

Watching the wonderful stories of Kit being cared for so compassionately in our children’s heart unit and Kimberley receiving a donated kidney from her sister Debra, was truly life affirming and it brought home to me how crucial it is for our patients that we continue to excel.

Over the past year, alongside fighting the COVID-19 pandemic, we’ve not compromised on our high standards or our desire to improve. One important way that we’ve done this is by working closely with the internationally renowned Institute for Health Improvement (IHI) on three strategic areas – our Quality Improvement approach, our focus on What Matters To You (listening and responding to staff), and more recently developing our leadership approach.

The amount of progress we’ve made in each of these areas during a time when the NHS and the trust has been under such acute pressure shows how important it is to us all. I wanted to take some time in my blog today to recognise that hard work, and update everyone on the developments we have made.

1. Quality Improvement

As an Outstanding organisation, we can be confident that our services are high quality, but we also know that this is something we want to keep improving. We want to have a clear and consistent approach to enabling everyone in the organisation to contribute to making improvements in an evidence based way.

The IHI takes a unique approach to working with health systems, countries, and organisations on improving quality, safety, and value in health care. This approach is called the ‘science of improvement.’

The ‘science of improvement’ is an applied science that emphasises innovation, rapid-cycle testing in the field, and spread, to generate learning about which changes, in which contexts, produce improvements. It is characterised by the combination of expert subject knowledge with improvement methods and tools. It is multidisciplinary – drawing on clinical science, systems theory, psychology, statistics, and other fields.

It starts by identifying a clear aim for improvement and a measurement plan, and then immediately begins with small tests of the changes we think will lead to improvement over a short period of time. As these small tests are refined and successfully implemented, we begin to broaden the testing and scale up of the changes. This often involves starting improvement efforts on a small scale, and leveraging all the generated learning to plan for spread and, later, scale up.

The Model for Improvement asks three questions

  1. What are we trying to accomplish?
  2. How will we know that a change is an improvement?
  3. What changes can we make that will result in improvement?

It then employs Plan-Do-Study-Act (PDSA) cycles for small, rapid-cycle tests of change.

Training and gaining confidence in this approach is the first step to embedding this culture, and this year we’ve seen 36 colleagues complete the initial ‘Improvement Coach Programme’ to develop the confidence, skills and experience they need to support teams across the organisation.

Fifteen teams are already taking part in the ‘Improvement Programme for Teams’ – a 10 month programme with workshops and virtual coaching and 30 leaders have taken part in our ‘Leading for Improvement Programme’.

The IHI team have also visited Newcastle on a number of occasions to meet senior leaders and team members to understand the context we work in and the challenges we face.

It’s energising to talk to colleagues who are taking part in the programmes as they share their enthusiasm for the subject and the skills they are developing, but the real inspiration comes from hearing about the changes they are making in their service areas which are life changing for patients.

I’ve been hearing about the work in ward 43 at the RVI where they want to ensure that 90% of staff receive training in psychological support so that they can improve the psychological wellbeing of their patients; two of our older people’s medicine wards are focussing on reducing gram-negative bloodstream infections related to catheters while other projects are concentrating on supporting people with frailty within the trust.

These are all very practical examples of where an improvement has been identified and tackled with skill and science.

Each month, our Improvement Learning and Sharing Events are an opportunity to hear about the changes teams are making and the learning that they would like to share. These sessions are currently held virtually on Teams and are open to everyone and I would encourage you to attend for a regular dose of inspiration. The next session is on Thursday 17 February for more information contact nuth.newcastleimprovement@nhs.net

Of course, this is an area where we continue to develop, and throughout this month we’ll be looking at how we more closely align quality improvement, quality planning, quality assurance and quality control across the trust. Specifically, we want to look at how we can best use quality improvement science to implement change ideas to improve patient safety.

2. What Matters to You

Since I joined the trust almost 4 years ago, I’ve been determined to improve the experience of staff, so that Newcastle Hospitals truly becomes one of the best places to work in the NHS. Our #FlourishAtNewcastleHospitals framework underpins this ambition and we have made lots of changes to help, including focusing on the things that staff have told us are important, like our climate emergency work, supporting health and wellbeing and improving facilities for staff.

Through the past 12 months, we’ve been very conscious of how much has changed about everyone’s experience of work because of the ongoing pandemic. We want to focus very clearly on listening to staff and working together to make sure that the NHS that emerges from COVID-19 is the one that we all want to work in, which nurtures our workforce and which enables everyone to thrive at work rather than just persevering.

With the IHI, we have been developing our ‘What Matters to You’ approach which encourages everyone to share their views in teams and at a trust-wide level so that we can respond. I’m grateful to everyone who took part in ‘What Matters to You’ conversations last year which have helped us to develop a work programme.

You told us that we could make improvements in three broad areas:

  • The autonomy and control we each have about the way we work
  • How much we are all able to engage in change and experience ‘participative management’ and
  • How safe we feel at work – physically and psychologically

On a day-to-day basis it’s the relationships that we have with our immediate team and line managers that make the biggest impact, so we’ve been concentrating on coaching 3 ‘wave 1’ teams to apply the improvement science and learning.

I’m grateful to our Dental Hospital, maternity and IT teams for taking part in this first wave, and they are being joined by catering, HR, paediatric intensive care and spinal teams in wave 2. Lots more teams, including our district nurses, are also looking at change ideas in relation to flexible working so that we can make sure our policies and strategies help people to work in the most flexible way.

Our leadership approach

The final piece of work that I want to highlight to drive up both staff experience and quality, is our leadership approach. In an organisation as big as Newcastle Hospitals, with so much complexity, we all rely on leaders each day.

Effective and compassionate leadership is an essential element of high quality care and it’s vital that there is a shared understanding of what is expected of all our leaders so that their response and behaviours are consistent across the whole organisation. This is particularly important in the context of our ‘What Matters to You’ work mentioned above.

We need to help leaders to work in a different way and to understand that there are now different expectations of what we seek from them. They also need the knowledge and experience of the model for improvement and other specific knowledge.

Over the next few months, we will align and develop all of our leadership programmes to ensure we have a clear, core curriculum to roll-out. Underpinning this work will be a revised leadership behaviours framework based on the themes that have emerged from our What Matters to You conversations; autonomy and control; participative management and physical and psychological safety.

The impact of good leaders at all levels, from our senior team to line managers throughout the organisation, have the potential to make a huge difference to the way each of us experience work on a day-to-day basis – so it’s crucial that we get this right.

I would like to encourage everyone to be curious about this work, it really will change our future and make sure that we continue to stay at the cutting-edge of NHS care.

Operational update

As I write this, announcements are being made by the Government about changes to ‘Plan B’ regulations. We will inform staff of any subsequent changes to procedures in the trust through the usual updates.

We have around 130 patients in the trust today with COVID-19. The pattern continues to be very similar, with around half of those patients being in hospital for another reason rather than their covid diagnosis. Thanks to the vaccination programme, the numbers of patients in intensive care with COVID-19 continues to be low. Thank you to everyone for your ongoing remarkable efforts to support our patients and your colleagues.

LGBT History Month

In the diversity and inclusion calendar, LGBT History Month is the celebration of lesbian, gay, bisexual and transgender achievements throughout history. Taking place from 1 to 28 February, this year’s theme centres on ‘Politics in Art’ recognising the creativity, imagination and innovation of LGBTQ+ creators throughout history.

To raise awareness and celebrate LGBT+ inclusion the following sessions are running virtually and open to all staff.

Thursday 3 February – 12.00-1pm – Time to Talk session. Book here

Monday 7 February -12.30-1.30pm – ‘Undetectable = Untransmittable – National HIV Testing Week’. Book here

Wednesday 16 February – 12.30-1.30pm – An informal online in-conversation with Newcastle-based artist Richard Bliss. Book here

If reading is your thing then take a look at Olive’s Book Club – an independent online book shop based In Newcastle, run by one of our nursing staff, Emily Clifton.

In addition an LGBT+ Ask me Anything Session will take place on Friday 18 February from midday until 1pm which you can book here and a session looking at Inclusive Leadership will also be advertised on the intranet and InBrief in the coming weeks.

In recognition the rainbow flag will be flying above our hospitals during the month of February showing our visible commitment to LGBT+ equality for both staff and patients.

MP visits and new appointments

Recently I’ve been talking to our local MPs, Chi Onwurah, Nick Brown and Catherine McKinnell about how we have worked through the pandemic and our plans for the future.

I’m grateful to Chi Onwurah for mentioning us in this parliamentary question on Tuesday. The Chairman and I also met with North of Tyne Mayor, Jamie Driscoll.

Two of our partner organisations also have welcomed new Chief Executives recently. Pam Smith has become Chief Executive at Newcastle Council, and James Duncan takes over at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust. I look forward to working with both of them.