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Our quality priorities 2023/24

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    Help us decide our quality priorities for the year

    Each year, we set out our quality priorities and we would like to know what you think of these.

    Providers of NHS healthcare are required to produce an annual quality account which describes how we deliver high-quality care to people who use our services. View our reports.

    In our quality account, we will identify 12 priorities. These are projects which span either one or two years and are aligned to KCHFT’s quality strategy objectives, which are:

    1. focus on continuous improvement
    2. make sure information drives continual improvement
    3. promote positive staff experience
    4. improve patient and carer experience
    5. reduce health inequalities
    6. effective use of resources
    7. prioritise patient safety
    8. promote clinical professional leadership.

    The quality account regulations say there must be priorities in the following three areas:

    1. patient safety
    2. clinical effectiveness
    3. patient experience.

    We have added a fourth priority: 4. staff experience.

    Complete the survey

    Working with our services, we have created a long list of potential priorities for 2023/24. You can read these below.

    Once you have read them, please complete our survey by 5pm on Friday, 31 March, so your feedback can help us shape our shortlist of priorities for 2023/2024.

    1. Patient safety

    We will… What does this look like? Why are we doing this? How does this support our quality objectives?
    Patient safety culture: Embed our patient safety culture through the implementation of the Patient Safety Incident Response Framework and the application of system-based approaches to learning. 85 per cent of staff will be trained in the level 1 Patient safety syllabus.

    85 per cent of relevant staff will be trained in the level 2 Patient safety syllabus and Duty of Candour.

    90 per cent of staff, patients and families will be involved in the incident management process.

    Use of hot briefs and observational audits. Metric to be agreed.

    This ambition supports the implementation of NHS England’s Patient Safety Incident Response Framework. This will strengthen our patient safety culture through the education and empowerment of staff to identify and implement improvements.

    Developing the feedback process to include staff, patients and families will provide opportunities to improve our patient safety culture in a compassionate way.

    To prioritise patient safety and focus on continuous improvement.
    Liberty protection safeguards: We will make sure colleagues are experienced and qualified to support a patient’s best interest.

     

    In 2023/24, we will train two staff to become qualified best interest assessors and complete at least six best interest assessments in partner organisations.

     

    As an organisation, our staff will be familiar with the application of the proposed Liberty Protection Safeguards and how to apply this in practice. Experienced team members will be available to advise and assist.

    Liberty protection safeguards will need to applied for the right individuals, in the right circumstances, and will include service users age 16 or over.

    To deliver this service, KCHFT needs qualified and experienced staff that can support its services in the application of liberty protection safeguards.

    To prioritise patient safety and focus on continuous improvement.
    Omitted and delayed medicines: We will reduce the number of delayed or omitted doses of medication.

    This will be a two-year quality priority.

     

     

    In year one: We will implement the Electronic Prescribing and Medication Administration (EPMA) system and undertake omitted and delayed medication audits to provide a baseline.

    In year two: We will reduce omitted and delayed medicines. Metric to be agreed Q4 2023/24.

    Medicine doses are often omitted or delayed in hospital for a number of reasons. For some critical medicines, delays or omissions can cause serious harm. Harm can arise from missing one dose or repeated doses and is determined by a combination of the patient’s condition and prescribed medication.

     

    Therefore, it is essential that patients under the care of KCHFT receive their medication in a timely manner.

     

    To prioritise patient safety and focus on continuous improvement.
    Inpatient falls: We will improve the quality of multifactorial risk assessments (MFRA) to reduce inpatient falls. XX per cent of patients will have ≥ 5 of the 6 MFRA components completed. Metric to be agreed. Falls are the most commonly reported patient safety incident in the English National Health System (NHS) and the risks increase with older age.

    One third of people aged 65 and over and almost half of those aged over 80 will fall each year and the consequences of falling whilst admitted to hospital result in poorer clinical outcomes, morbidity and psychological distress.

    85 per cent of people who falls whilst admitted to a community hospital have a completed multifactorial risk assessment, but this quality priority will make sure that these are of high quality and aligned to the recommendation in the National Audit of Inpatient Falls and NICE clinical guidelines.

    To prioritise patient safety and make sure information drives continual quality improvement.

     

    2. Patient experience

    We will… What does this look like? Why are we doing this? How does this support our quality objectives?
    Preparing for adulthood: We will develop a programme to make sure that young people with long-term healthcare needs feel prepared when moving from children’s to adult services.

    This will be a two-year quality priority.

     

    In year one: We will develop and co-design the procedure and pathway for young people transitioning to adult services.

    In year two: Using quality improvement methodology, the process will be implemented in all relevant services and key performance indicators agreed to measure outcomes. Metric to be agreed in Q4 2023/24.

    Young people face plenty of challenges when preparing for adult life. Children with complex health needs, have often been looked after by a small number of teams, however, when they access adult services, care is often provided by several teams, across sectors and in different environments.

    Developing a robust transition process for children who use our services as well as their families will mean that they will feel supported an understand what their care will look like once they become an adult. It will provide a framework for our teams to follow to be better able to support their patients as well as to build relationships with adult service partners. Over all this will provide a more integrated and joined up experience for patients and their families.

    Improve patient and carer experience.
    Increasing feedback: We will use digital technology to improve the number of patient survey responses received by the trust.

    This will be a two-year quality priority.

     

    In year one: We will implement automatic patient surveys and text reminders and evaluate using QI methodology.

    In year two: We will increase the number of patient survey responses. Metric to be agreed in Q4 2023/24.

    Making sure people who use our services receive the very best care is essential and being at the centre of the healthcare process they can provide valuable insights into the quality and delivery of our services.

    Given the nature of our services, it is not always appropriate or easy for patients to complete a feedback survey when they are discharged and often, despite wanting to provide feedback, the opportunity to do this may have passed.

    Our electronic record system, Rio, has the functionality to send patient surveys and reminders electronically and for those who have the means to use electronic devices for communication this will make the process easier. Traditional means to collate paper feedback will remain to make sure that all patients have the opportunity to feedback their experience of care in a way that is effective for them.

    Improve patient and carer experience, effective use of resources and information that drives continual quality improvement.

     

    Volunteers: We will increase the number and diversity of our volunteers to make sure they are representative of the populations we serve

    This will be a two-year quality priority.

    In year one: We will increase the diversity of our volunteer workforce to reflect the populations we serve.

    In year two: We will actively recruit 10 volunteers to support projects in integrated neighbourhood teams for people that do not access healthcare.

    The contribution of volunteers make to KCHFT services is key and we are keen to explore to scale and diversity of our volunteers to support the reduction of health inequalities.

    The aim of this quality priority is to use the contributions of KCHFT volunteers to improve the experience and access for people with protected characteristics and from diverse back grounds.

    We will recruit volunteers representative of the communities we serve and include them to codesign services to increase equity for specific patient groups.

     

    Improve patient and carer experience and reduce health inequalities.
    Observe and act: We will engage with Healthwatch to deliver a programme of observations to obtain feedback from the people who use our services.

     

    This will be a two-year quality priority.

     

    In year one: We will train 6 patient/service users, carers or participation partners to undertake observations and carry out and evaluate using QI methodology 3 observations.

    In year two: Undertake a further 5 observations where all action plans are coproduced with patients and carers.

    Observe and act is a tool which explores a person’s total experience of a service from the perspective of people who use services. Observations are used to share good practice and where necessary to act to make improvements. This can be used alongside patient/carer experience surveys as a means to gain feedback.

    The tool has been designed by Shropshire Community NHS trust and has been shared by them nationally. The tool is supported by NHS England.

    Improve patient and carer experience and reduce health inequalities.
    Health inequalities: Contribute to the reduction in health inequalities by increasing contacts with vulnerable young people in East Sussex

    This will be the second year of a two-year priority.

    We will pilot early interventions and make sure young people who are school age but not attending school due to their emotional health and wellbeing have individual health care plans. Emotionally Based School Avoidance (ESBA) is a significant concern for children and young people in East Sussex.

    This view correlates with national findings which state that over a fifth of young people have reported to have experienced a high level of emotional problems and difficulties. This highlights the increasing need for the East Sussex School Health service to engage seldom seen groups who are of school age but may not be attending school due to their emotional health and wellbeing.

    Improve patient and carer experience and reduce health inequalities.

     

    3. Clinical effectiveness

    We will… What does this look like? Why are we doing this? How does this support our quality objectives?
    Planned care clinic use: We will reduce the number of ‘was not brought’ and patient cancellations in planned care services to increase clinic use. We will make sure appointments are made following contact with the patient or carer to agree the date/time. This will be followed up with a phone or text reminder to allow cancellations to be successfully rebooked.

    Clinic use will increase and the percentage of was not brought/patient cancellations and un-booked slots will decrease. Metric to be agreed.

    We want to make it easy for people to book appointments for planned care on a date and time that is convenient. We also understand that there are times when appointments need to be cancelled and rescheduled, and so reminding patients of their appointment by SMS prompts contact with the service and clinic utilisation is maximised.

    Reducing the proportion of patients who do not attend or are not brought to their appointments, means that appointment can be filled by others on the waiting list.

    Improve patient and carer experience and effective use of resources.
    The virtual ward: We will enable more people to receive the care and treatment they would normally receive in a hospital setting, safely in their own home. We will reduce hospital admissions and confidence in the virtual ward. This will be measured by the number of avoided hospital admissions. Metric to be agreed. Hospital is not always the best place to be and for older people, who can become deconditioned, staying in hospital may mean losing muscle mass resulting in difficulty returning to normal daily activities. For individuals with other underlying health conditions, which make them more susceptible to infection and anyone who is confused or anxious, this may make symptoms worse. For people at the end of their life, staying at home is their preferred choice. Reduce health inequalities and effective use of resource.
    Clinical debrief: We will implement clinical debriefs for all community teams. 100 per cent of debriefs will held within three working days.

    Impact to staff will be evaluated through qualitative measures.

    Learning from debriefs will be shared to reduce end of life patient safety incidents. Metric to be agreed.

    Debrief sessions are a recognised tool to provide emotional support, improve communication, identify safety risks and ultimately improve patient care.

    Over the previous 18 months, there has been an increase in the proportion of people needing end of life care as well as the need to provide care of greater complexity. Whilst vacancy levels have reduced, a more junior workforce is manging this demand. By introducing debrief sessions for community staff who are providing EOL care it would provide support for staff, an environment to improve clinical knowledge and support teams to identify learning from events to improve patient care.

    Make sure information drives continual quality improvement, improve patient and staff experience and effective use of resources.

     

    4. Staff experience

    We will… What does this look like? Why are we doing this? How does this support our quality objectives?
    Implement a new model for clinical supervision across our community hospitals An effective clinical supervision model will be implemented and used through our learning management system: TAPs.

    100 per cent of colleagues will have attended a minimum of four supervision sessions.

    Clinical supervision provides an environment in which staff can explore their own personal and emotional reactions to their work; reflect on and challenge their own practice in a safe and confidential environment as well as receive feedback on their skills and engage in professional development. Promote positive staff experience

     

    Our people of the future: We will attract and recruit colleagues who are representative of the communities we serve.

    (This will be the second year of a two-year priority)

     

    Applicants from a Black, Asian or minority ethnic (BAME) background, or those who have a disability, are as likely as other colleagues to be appointed to roles. In July 2020, NHS England published – We are the NHS: People Plan for 2020/21 – action for us all. It sets out that the equality, diversity and inclusion focus should include recruitment and promotion practices result in a workforce that is representative of the communities they serve.

    We will make sure there is clear representation in the recruitment process, workforce and other groups making the decisions in the organisation that would have an impact on colleagues from minority communities.

    Promote positive staff experience and reduce inequalities.
    Nobody left behind: We will support a culture where everyone is comfortable to be themselves.

    (This will be the second year of a two-year priority)

    Fewer than 10 per cent of colleagues experience harassment or abuse at work. This is the case for all colleague groups – those from minority communities do not experience higher rates of harassment or abuse. Our people are our most valued asset. Being the best employer for them means making sure all our colleagues experience fairness and equity at work.

    In July 2020, NHS England published – We are the NHS: People Plan for 2020/21 – action for us all. It details the expectations our people should have of their leaders and colleagues and explains the importance of an open and inclusive culture.

    Promote positive staff experience and reduce inequalities.
    Quality statements: We will empower teams to evaluate the service they deliver in line with the new CQC regulatory model. All teams will have completed an evaluation of the CQC quality statements and are empowered to promote their work and value quality assurance as an approach to improve quality. Measured through survey. The CQC quality statements will replace the key lines of enquiry (KLOE). Quality statements are the expectations that providers, commissioners and system leaders should deliver. They are expressed as ‘we statements’ and demonstrate what is needed to deliver high-quality, person-centred care. These will be linked to regulations and used from the point of registration through regulation of quality.

    We will develop a self-assessment process to support the quality assurance approach. The self-assessment tool supports colleagues to use the language of the quality statements, referring to ‘I’ and ‘we’ in the assessment of their own services.

    Processes will be aligned to make sure self-assessment at service level, reflects and supports the well-led quality statements, which will reflect the CQC’s priorities in reviewing integrated care systems; relating to leadership, the integration of services and the quality and safety of services, as stated in the Health and Social Care Act,2022.( Part 1, Section 31).

    Make sure information drives continual improvement and promote clinical professional leadership.
    Vision and voice: We will make sure colleagues feel there are frequent opportunities to show initiative and improve the work of their teams and departments.

    (This is a two-year priority)

    In year one: Programmes of work will be developed with specific teams and their leads to understand what brings joy at work.

    In year two: Staff experience feedback will be gained using the NHS staff survey alongside turnover and retention rates. Metrics to be agreed.

    Burnout affects all aspects of the pursuit of better health and healthcare. It leads to lower levels of staff engagement, productivity and patient experience. An important part of the solution is to focus on restoring joy to the healthcare workforce by creating safe, humane places for people to find meaning and purpose in their work. Promote positive staff experience, promote clinical professional leadership.