Focussing on quality and safety

Quality has always been at the heart of what we do in Newcastle, and I know it’s what drives each of us to do our best for our patients and colleagues. I’m proud that so many members of the team recommend Newcastle Hospitals as a place to receive treatment in our staff survey. At 91% this represents one of the highest scores in the country and is a real mark of confidence in our clinical excellence and high standards.

Many of us instinctively use the benchmark of whether the service we provide would be ‘good enough’ for our own families, and it’s important that we are able to maintain those aspirations and deliver the very best care and outcomes. Alongside that, earlier this week we heard that we have once again been listed by Newsweek in the top 10 UK Hospitals, with the Freeman Hospital featuring in the world’s top 250. We’re in a positive and envious position – but we still have much more to do.

I know that in some particularly pressured weeks during the pandemic we found it hard, if not impossible, to meet our own high standards. That’s something that we have been open about, and I know that despite these challenges, everyone did the very best they could. It’s vital that as we look to the future, we are able to see our ambitions to be the very best realised.

So, in this blog, I want to focus on how we are continuously improving the quality and safety of our services and share some examples of the brilliant work that teams are undertaking.

Improving safety and quality is absolutely part of everyone’s role, every day. It’s healthy to start from a position of believing that we can all improve, no matter how good we are at our jobs, or how much experience we have – everyone has the opportunity to learn and be better. The NHS Patient Safety Strategy, published in July 2019 sets out how the NHS has been on a journey from talking about ‘harm’ to actively developing ‘safer systems and cultures which provide the right care every time’. The strategy sets out an ambition to see patient safety as the golden thread running through healthcare.

Transforming our approach

The work we have been progressing in the trust to move from investigating problems towards continuous improvement gives us a strong foundation. Over the next 12 months we will continue to embed a patient safety culture which is open to learning, challenge and change. This sits well alongside the leadership development and behaviours work which has been codeveloped with staff through our What Matters to You work and which I highlighted in a previous blog. This is all part of the continuous quality improvement approach that we have invested in through our partnership with the Institute of Healthcare Improvement (IHI). Together this becomes a complementary part of our overall organisational development approach.

We’ve built close links with the Healthcare Safety Investigation Branch (HSIB) to transform our approach to incident reporting, investigation and learning and so far 16 senior clinical leaders have undertaken advanced level training to become future incident investigation experts. A programme of cascade training is now underway to increase the pool of patient safety investigation experts so that we can undertake deep and thorough investigations to maximise learning and make changes to improve.

We have developed this infographic which illustrates how team members have been getting involved in training and events on quality improvement techniques, so our capacity and organisational knowledge is improving all the time.

Another key element of our safety approach is the involvement of patients and patient safety partners. We need to make sure that our patient safety partners and specialists are actively involved in the design of safer healthcare delivery systems and contribute to safety governance to challenge us to learn and improve. In these ways, we will be able to accelerate our work and ensure that the changes we make are the best ones for our patients.

The role of digital technology

Over the last two years, digital technology has enabled significant safety improvements across our services, particularly as we have introduced e-obs and a digital patient record. There is much more potential here as we continue the roll-out of e-record universally including to maternity, paediatrics and dental services, and we continue to enhance the technology we already have. The next steps currently in development are:

1. Management of abnormal test and investigation results
Developing a fail-safe long-term solution for effective and efficient closed loop investigations to ensure that patients always receive timely and appropriate care as a result of their planned investigations.

2. Improved clinical documentation
Whilst the implementation of a ‘Paperlite’ electronic health record has already transformed the way we capture and share clinical information, there is more to do to gain maximum benefit from our electronic patient record.

3. Point of care bar code scanning
Benefits include complete patient and product traceability, speedy and accurate recall, reduction of error and avoidable harm, improving routine observations and patient identification.

4. Implementation of electronic early warning systems in maternity and paediatrics.
We implemented an electronic deteriorating patient ALERT in adult inpatient areas in June 2021 which provides real time ward level data and helps to improve early recognition and treatment of deterioration, improving patient safety. In 2022/23 we aim to implement electronic early warning systems in maternity and paediatric areas.

Of course, all of our safety and quality improvement work is fundamentally about improving patient experience, so it’s extremely important that our culture has a positive impact for all of our patients and reduces the health inequalities and disparities that they experience. We need to make sure that all of our work takes into account the needs of our most vulnerable and complex patients. This year we will be specifically developing a mental health strategy which, thanks to support from Newcastle Hospitals Charity, will be co-produced by experts with lived experience, including young people and their families as well as with colleagues with specialist mental health expertise.

It’s at the clinical frontline where the impact of all this hard work is apparent. Earlier this week I visited our ophthalmology department at the RVI, touring the emergency eye department, outpatients and theatres. I was so struck by the attention to quality and safety that the team described throughout the visit – paying attention to the speed at which some symptoms need to be treated and developing new urgent care pathways, improving the environment so that clinical staff can be more aware of patient needs and inviting peer support in areas where they had identified challenges.

Through our QI programme, we’re gathering and sharing case studies of improvement projects so that we can capture and share the learning and achievements. Our latest case study looks at how our radiotherapy department has transformed how they gather and act upon patient feedback. You can read the case study, and others in the series here.

Each month learning and sharing events are a chance to hear from teams about their improvement journeys and are a great chance to hear about the hard work they are undertaking and how they have overcome challenges to create positive change. The sessions that took place yesterday included: ‘When we can’t get our patients assessed – how QI helped us to redesign the liver transplant assessment service’ and ‘The COVID-19 era and its effect on staff morale – how we used a PDSA approach to improve the wellbeing of staff in Central Ops’. Both of these presentations were inspirational, and I would highly recommend watching the video of the event if you weren’t able to attend.

I want to express my personal thanks to all of the teams and individuals who have been involved in these projects – the difference you are making is enormous and your work is greatly appreciated. I am always eager to hear about the work that our teams are proud of, and you are welcome to get in touch with me about your achievements.

Summary

I started this blog by saying that quality improvement and patient safety are part of everyone’s roles, and as we all focus on improving access to our services and treating more patients, we need to be relentless in making sure that we do this in a way which also maximises safety, quality and patient experience. This will make sure that we continue to provide services which we would be happy for members of our own families to receive, and our patients can’t ask for more than that.

Flourish At Newcastle Hospitals

Brand new staff facilities opening soon at the RVI

I am delighted to announce that a new Staff Bistro is currently being developed at the Leazes Wing in the RVI. This will open in April and will provide staff with a much-needed space to grab a bite to eat and relax. It will be open from 7.30am till 2am, seven days a week – providing extended opening hours, including a night service.

We are currently engaging with staff on how these areas will look and an image of the proposed new space is shown above.

The Piano Room in Peacock Hall remains open for staff at the RVI as a space to sit and eat. This space will also be refurbished, working closely with staff, over the coming months to create a relaxing and more modern environment for everyone. In addition to this, we have opened the Bistro at Peacock Hall at weekends between 7.20am and 2.30pm and the ‘Food to go’ click and collect app is available. More information on “Food to go” is available here.

We understand that the lack of facilities at the RVI has been a frustration and our Executive team has been investigating every option to improve the facilities. I hope that these announcements are a good start.

The following handy guides on staff facilities have also been developed:

What Matters to You – inspiring meaningful conversations about flexible working

Our What Matters to You Programme aims to support and empower teams across Newcastle Hospitals to have more meaningful conversations, that inspire change. As you know, the trust is working closely with the Institute for Health Improvement (IHI) and led an exercise which found out What Matters to You by asking staff:

  • What does a good day look like?
  • What are the pebbles in your shoe? (What gets in the way of a good day?)

They also asked teams about their ‘bright spots’ – which looks at what we do well and what is great about Newcastle.

One theme that emerged from this work was flexible working. Staff told us that they wanted more autonomy and control about how they work, more permissive policies and discretion about how work is organised.

Teams across Newcastle Hospitals are now reviewing and testing ways of working more flexibly as part of What Matters to You – these include our District Nursing, North East Assisted Ventilation Service and Coronary Care Unit.

We will be sharing stories from teams who have already introduced flexible working practices over the coming weeks. Please read our first flexible working case study here, by Odeth Richardson, Head of Occupational Therapy.

If you’d like to find out more, you can access advice, support and tools on how to start and develop flexible working conversations with your teams as part of the What Matters to You Programme by emailing: nuth.whatmatterstoyou@nhs.net

Getting your feedback about what matters to you is invaluable – I will be focussing on this further in my next blog following the release of our staff survey results.

Children’s Heart Centre

This week we have begun a consultation process to support our application for planning permission for a new dedicated Children’s Heart Centre which will be next to – and part of – The Great North Children’s Hospital.

This state-of-the-art centre will become the new home of all of our children’s heart services, including heart transplants, and is an ambitious and exciting project that would bring all of our paediatric services together on one site.

More information about the building proposals, and how to share your feedback on them, along with some artist impressions of what the new building might look like will be available on the trust website later today.

The new centre is one of a number of exciting estates investments across the Trust which also includes our proposed New Specialist Hospital Building at the RVI and building work is already underway for our Day Treatment Centre at the Freeman Hospital which will be completed towards the end of the summer.

Nutrition and Hydration Week

This week our dietetics team have been supporting Nutrition and Hydration week which runs from 14 – 20 March. The team have created information boards in the Freeman restaurant and RVI Bistro packed with hints and tips on the importance of food and drink to maintaining health and wellbeing. Our patients have been involved too as wards across the trust took part in the Global Tea Party. Mary Mahon, lead specialist catering dietitian and specialist surgery dietitian, has shared why Nutrition and Hydration week is so important and how the team are supporting staff here.

Cancer Clinical Nurse Specialist Day

This week, we marked the very first national Cancer Clinical Nurse Specialist Day – an opportunity to celebrate and give thanks to all of our cancer clinical Nurse Specialists at Newcastle Hospitals.

The vital support they provide for patients with cancer and their families is often described as a lifeline. Thank you for all that you do.

Awards and achievements

Huge congratulations to our Ophthalmology team who recently partnered with Alcon to undertake the world’s first carbon neutral cataract surgery procedure. You can watch this short video to find out more about this exciting project.