UNLOCKING OUR POTENTIAL Monthlyprogressreport, June2014

Our Improvement Plan for King George and Queen’s hospitals June 2015 progress report

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HOW WE’RE IMPROVING YOUR LOCAL HOSPITALS In June we held our Quality Summit with key stakeholders and partners following the Care Quality Commission’s re-inspection of our hospitals earlier this year. Overall we have been rated as ‘Requires Improvement’ and the outcome of the inspection is that we will remain in special measures for an extended period. I am extremely pleased, however, that CQC saw real improvements over the last year and acknowledged the enormous amount of hard work our staff have put in to provide better care for our patients. CQC outlined several areas of outstanding practice, a real milestone for us as an organisation, including: Our PRIDE values Our Elders’ Receiving Unit had improved care for frail, elderly patients Our end of life care service operates across both sites. There are also 30 new ‘Must do’ actions listed in CQC’s reports, including a focus on reducing waiting times and strengthening clinical governance processes. We’re working with our partners to refresh Unlocking our Potential to address these actions and will share our new plans with you shortly. Inspectors will be back in the coming months to reassess our situation. In the meantime I would like to thank you for your ongoing support as we continue on our journey to provide outstanding healthcare to our community, delivered with pride.

Improving care for our patients This month’s key highlights include: – Our Guardian Service celebrates its two year anniversary – The opening of our new Emergency Department observation ward – Clearing the backlog of serious incidents Adopting an open, honest culture is vital to keep our patients safe from preventable harm and our unique Guardian Service offers our staff a safe way to raise concerns. Since launching two years ago, more than 140 staff have accessed the service to talk in confidence about issues or concerns around patient care, safety or work. We’re privileged to have the service led by National Patient Champion Ashley Brooks, who has recently been named as one of the Health Service Journal’s top 50 Patient Leaders. Quality care means making sure our patients are treated in the right place at the right time. Over the last 12 months we have implemented a raft of initiatives, and most recently opened an observation ward near Queen’s Hospital Emergency Department. Working in partnership with our Ambulatory Medicine team, this allows us to offer an even wider range of safe and effective treatments, which will improve our patients' experience by allowing them to stay in the comfort of their own home, rather than spending the night in hospital. One of the key areas highlighted for improvement by CQC was in relation to our governance processes, including managing serious incidents (SIs) and learning from these. In April the backlog of investigations had reached 103; we have now eliminated this, which is a fantastic achievement and will allow us to share our learnings more quickly, helping to keep our patients safer. Read on to find out how else we have been improving your local hospitals this month. Matthew Hopkins, Chief Executive Tweet me @M_J_Hopkins Page |3

WORKSTREAM UPDATES

1. Leadership and Organisational Development Workstream overview To create a high performing leadership team that will ensure we put the right systems, structures, checks and balances in place to make sure our Trust is properly managed from Board to ward. Executive lead: Deborah Tarrant Director of People and Organisational Development

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Key achievements Our Guardian Service celebrated its two year anniversary in June. Over 140 staff have accessed the service to talk in confidence, about issues or concerns raised about patient care, safety or work. Personal Performance Review (PPR) training has been rolled out across the workforce, with a new focus on staff meeting our vision and values, as well as delivering our corporate objectives and performing well in their roles. The People and Organisational Development (OD) service redesign is now underway. We have begun recruitment to the new posts of People and OD Business Partners and expect to have a full complement by the end of July. These innovative roles will work closely with the new divisional senior leadership teams to develop and deliver workforce and OD aspects of divisional strategy and plans. They will focus

Next steps Work continues on the establishment of a Management Development Service. We are currently recruiting a Management Development Advisor who will provide advice, guidance and support to managers from aspiring and team leader level upwards. We plan for the Intranet section on management development, which will provide information on a range of programmes and current management topics, to go live in July. We are planning PRIDE Engagement Workshops with teams across our hospitals. These will focus on team and process effectiveness, supporting our work around culture change and ongoing embedding of our PRIDE values.

on coaching leaders and managers in good people management and support delivery of workforce KPIs, employee engagement and effective change management.

2. Outpatients Workstream overview To ensure effective management of our outpatient services so appointments run on time, every time. Executive lead: Steve Russell Deputy Chief Executive

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Key achievements We’ve listened to our patients and made the chairs in our outpatient clinics more comfortable. They told us that the chairs were too hard, so we now have padded seats in all of our waiting areas on both hospital sites. A task force has been set up to engage staff in improving our outpatient service. The cross-site, multi-level outpatient champions meet regularly and feed into a Bright Ideas scheme to improve the service for patients. They are empowered to resolve local issues they come across, and use their unique viewpoint to offer an insight into the bigger challenges. A standard operating procedure has been drawn up to ensure that we regularly review and update our Directory of Services, helping GPs to access our services when they use Choose and Book.

Next steps New, simplified outcome forms will be rolled out across the Trust in July. The new process will help to ensure that patients are on the right pathway, and receiving appropriate care and treatment as soon as possible. This will improve the patient experience, and will also help us to capture all of our activity. All of the departmental standard operating procedures are being reviewed to reflect all of the process changes and developments which have taken place over the past year. Bar codes are being put onto all of our patient notes, with electronic trackers across our sites which will automatically pick up the movement of records. This will make finding patient notes far easier, and dramatically reduce the time it takes to file records. We will continue our review of how our clinics are structured. This ‘re-profiling’ involves Outpatients staff working closely with consultants, specialty leads and managers to make sure that clinic times, locations and appointment types closely match our projected requirements, to significantly improve the efficiency of our clinics.

3. Patient Care and Clinical Governance Workstream overview To support all our care with effective management of patient care records, and information and systems which alert us quickly to problems with the quality of our services. Interim Executive leads: Jason Seez Director of Planning and Governance

Key achievements We eliminated the backlog of investigations into our Serious Incidents (SI). The backlog had reached 103 during April, so this is a fantastic achievement. We hosted a Documentation Awareness week at Queens Hospital, as part of our work to improve the quality of our healthcare records. Clinicians visited wards to raise awareness of documentation standards and to capture baseline scores using the CRABEL scoring system, a simple standardised way to assess the quality of records. Following walkarounds by our deaf patients and their carers, we have identified various actions to make our hospitals more user-friendly for this group of patients.

Next steps We will launch our revised adult sepsis screening tool. In particular we will focus on making sure it is consistently applied in our Emergency Departments and assessment areas. We will embed our revised processes to prevent SI backlogs building up again in the future. This will be supported by robust tracking of SI status against our internal deadlines. We will complete our second series of listening events, co-hosted with our local Healthwatch organisations.

Wendy Matthews Interim Chief Nurse

4. Patient Flow and Emergency Pathway Workstream overview To make sure our patients are Page |6

Key achievements We opened our new Emergency Department

Next steps We will hold workshops to develop a single point of

assessed and treated promptly, are supported to return home as soon as they are medically fit to leave hospital, and ensure that patients are cared for in the right place with the right follow up care. Executive lead: Sarah Tedford Chief Operating Officer

observation ward, which is helping us to treat our patients in the right place. Working in partnership with our Ambulatory Medicine Team, we are now able to offer an even wider range of safe and effective treatments, which will improve our patients' experience by allowing them to stay in the comfort of their own home, rather than spending the night in hospital. In June 94.6 per cent of our patients were seen and treated within four hours in our Emergency Departments, an increase from May which saw 93.1 per cent of patients seen and treated within four hours. We have had a significant success with our length of stay reviews. The amount of patients with a length of stay greater than 20 days has been reduced, meaning our patients are returning to the comfort of their own homes quicker or to a place of care best placed to support their ongoing needs.

access (integrated front-door) to our Emergency Departments, to improve the support we give to our patients from specialist teams including the Community Treatment Team, Intensive Rehabilitation Service, and Frail Older People’s Advice and Liaison Service and Mental Health Liaison Service. We will introduce improvements for patients who need treatment in our Urgent Care Centre (UCC). This includes testing our revised protocols for enhanced nurse practitioners who stream patients to the UCC, to ensure patients are seen by the right staff in the right facility. We are continuing discussions with our commissioners around funding to provide a High Dependency Unit for children.

5. Workforce Workstream overview To recruit, retain, develop and deploy the right number of permanent staff we need to provide high quality care 24/7 Executive lead: Page |7

Key achievements We held three large recruitment open days in June to attract nurses and doctors to work in various roles across our hospitals. Through these events we were able to offer 43 posts; this is in addition to local recruitment activity undertaken by individual wards and departments.

Next steps We will finalise our draft plan for the forthcoming year, aligning it to the newly developed Resourcing Strategy document and to the outcomes of the CQC report. On 20 July we will launch a new way of engaging external suppliers of agency doctors. The new Master Vendor arrangement is intended to reduce “off-framework”

Deborah Tarrant Director of People and Organisational Development

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We have re-launched a Collaborative Working Group with public sector organisations from the local area to develop collective approaches to recruit and retain staff. This combined approach will help us to attract new staff to the organisation and share resources to make sure our recruitment advertisements have the maximum impact. We have been working hard to improve our time to hire by streamlining our recruitment process. This work has been extremely successful and a new way of conducting our pre-employment checks has reduced our time to hire even further, from a high of 59 days down to 38 days (from advert to agreed start date). A shorter time to hire helps prevent losing good candidates during the recruitment process and reduces gaps between people leaving and starting in post.

agency use, improve the quality of agency doctors supplied, and reduce the cost to our organisation. We will host a recruitment open day for Hertfordshire University students, to attract newly qualified registered nurses to our Trust.