Analysis
Trusts helped to become more transparent An NHS England programme that requires providers to publish monthly data on patient harms has improved services in the north west. Sophie Blakemore reports SCANDALS IN nursing in recent years have revolved around accusations of cover ups and failures to learn from poor treatment of patients. Care shortfalls at Stafford Hospital and Winterbourne View Hospital, near Bristol, and misuse of the Liverpool Care Pathway, are some of the high profile cases that have acted as a catalyst for change. These incidents have also thrown into the spotlight how NHS organisations share information with the public about their services and the care they provide. A programme developed by NHS England aims to help healthcare trusts become more transparent with the information they produce in relation to patient harms. Access Open and Honest Care: Driving Improvement requires organisations to publish monthly trust-wide data on their websites for the public to access on the four ‘safety thermometer’ harms: pressure ulcers, falls, blood clots and urine infections in catheterised patients. They must also publish statistics on healthcare-associated infection rates, including those concerning Clostridium difficile and meticillin-resistant Staphylococcus aureus (MRSA), alongside patient experience information gathered from the friends and family test and patient improvement stories to demonstrate how problems have been tackled. The programme started in the north of England and 23 organisations have signed up so far (see panel right). Chief nurse for NHS England (North) Gill Harris, who is leading the project, says one of the programme’s overarching aims is to minimise the data burden on nurses by ensuring the information published is the kind that trusts already collate. From this month, Ms Harris hopes 12 April 2014 | Volume 21 | Number 1
that participating trusts will also start publishing data on ‘never events’ and staffing levels. ‘We are trying to get nurses used to putting the data out into the public arena and then build on that, bringing together all this information involving harm that is already there and presenting it in a different way to improve care locally,’ she says.
The Open and Honest: Driving Improvement programme NHS England’s initiative was piloted in the north west in 2010 with eight trusts publishing information on their websites on falls and pressure ulcers, alongside commentary describing the resulting improvements to care delivery. The need for greater transparency in nursing practice was set out in the three-year nursing strategy Compassion in Practice, produced by England’s chief nursing officer Jane Cummings. From November 26 2013, 16 acute trust boards in the north of England began publishing similar information, with 23 trusts now involved. The information they share covers: ■■ The NHS Safety Thermometer. ■■ Information on healthcare associated infections. ■■ Pressure ulcers. ■■ Falls causing moderate or greater harm. ■■ Information on staff experience. ■■ Information on patient experience including that derived from the friends and family test. ■■ Patient stories. ■■ Improvement stories describing what trusts have learnt and what improvements they are making.
Trusts can also publish information about schemes and campaigns that have improved care, as well as local plans to reduce the incidence of patient harm. Tracey McErlain-Burns has been chief nurse at Rotherham NHS Foundation Trust since July last year. For her, the opportunity to join the Open and Honest programme came along at the right time. After taking up post, she reviewed the information the trust was sharing with patients and the public, and then spoke with her senior nurses about having the courage to publish all quality indicators. The trust had been in breach of license with health service regulator Monitor over its electronic patient record system, finances and governance, which Ms McErlain-Burns says had diverted attention away from quality improvements in nursing in some areas. However, the programme has helped the trust to focus on preventing the cause of patient harms, particularly pressure ulcers, falls and infections. ‘The real driver for signing up was being able to look for the opportunity for improvements,’ she says. ‘We saw it as a chance to work with like-minded colleagues at different trusts to publish the same information, each month, in the same easy-to-read format.’ Pressure ulcers The trust published its first data in October. Reduction in the incidence of pressure ulcers was a priority, and Open and Honest enabled colleagues from other trusts to come in and advise on how care in this area could be improved. Data are collated by the trust and sent to Ms Harris’s team at NHS England to ensure all hospital statistics are published online in the same format. ‘This allows the public to challenge our pace of improvement compared to others, and it is easy for them to interpret the data,’ Ms McErlain-Burns says. ‘But the programme is not about benchmarking trusts; it is about being transparent with our data and using that as an opportunity to drive improvements.’ NURSING MANAGEMENT
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‘This is not about apportioning blame; it is about diagnosing problems and starting a conversation to fix them’
example, compared to where we are meant to be’. Ms Filby, who oversees Open and Honest in her trust, says: ‘I thought it would be a big challenge trying to get up-to-date data, but we are now delivering robust and accurate data every month. It gives our local population an idea of how we are performing and helps us to identify where we need to make improvements to patient care.’
Getty
‘Quality walls’ One matron leads on falls and another on pressure ulcers so they are responsible each month for delivering the data, which are then tested for quality assurance by Ms Filby. The trust has also started
This is something that Ms Harris feels strongly about: ‘One important thing to remember is that this is not about apportioning blame; it is about diagnosing problems, being transparent and starting a conversation to fix them. It’s about leadership and learning. ‘We help in aligning the data and will be measuring the progress of organisations against their own aspirations, not against other trusts, as all trusts set their local ambitions.’ As well as giving the public an insight into how their local healthcare organisations are performing, the programme also helps trusts to pinpoint where recurrent problems may be happening and to take action. The data can also be used to make a case to trust boards for more nurses if there is evidence that harm has been done to a patient in an area with the wrong skill mix or staffing level, Ms McErlainBurns adds. For Tara Filby, deputy chief nurse at Northern Lincolnshire and Goole NHS Foundation Trust (NLAG), one of the main benefits of becoming involved in Open and Honest is being able to see ‘where we are in relation to infection targets, for NURSING MANAGEMENT
The 6Cs ■■ Care. ■■ Compassion. ■■ Competence. ■■ Communication. ■■ Courage. ■■ Commitment. providing ward-level data on ‘quality walls’, erected on individual wards, in relation to areas of potential patient harm, such as falls, and the friends and family test. Patient stories are also pinned up to show other patients and visitors how issues have been addressed. ‘We are already quite an open and transparent trust,’ says Ms Filby, ‘but the Open and Honest programme has helped us to build on that and demonstrate it to our local population and staff more effectively.’ Breaking the data down to ward level has enabled the trust to identify where there are incidents of avoidable harm and undertake work to combat this, she adds. However, for both Ms Filby and Ms McErlain-Burns, patient stories are the most important and beneficial aspect of the Open and Honest programme.
Ms Filby decided to present NLAG’s monthly patient stories by theme: publishing a story about avoidable falls in the trust’s first Open and Honest publication in November; one about pressure ulcers in December; one about C difficile in January; and one about MRSA in February. ‘We have highlighted how at-risk patients have been identified and the actions we have taken to prevent further harm, with links to campaigns running in the trust, such as our red-socks campaign to prevent falls, and where nurses have received additional training,’ Ms Filby says. ‘We hope that through the patient stories the public can see we are focused on making improvements and I can then revisit these stories later in the year, to show how further steps have been taken. ‘It is still early days but collecting and publishing the data has been positive so far, but there is a lot more we can do to use Open and Honest to drive up improvements in our patient care.’ Ms McErlain-Burns also says that it is too early to tell whether improvements in pressure-ulcer care and falls at Rotherham are a direct result of the scheme. Public meeting However, one clear benefit of the programme is that the board now hears patient stories at every public meeting, placed in the context of England’s chief nursing officer’s 6Cs (see panel left). ‘As chief nurse at the trust, it is my role to tell the board about the experience of care received by our patients, and the determination of nurses and midwives to prevent harm and improve care,’ says Ms McErlain-Burns. ‘This hopefully gives the local community greater confidence in us.’ Ms Harris says the eventual aim is for the initiative to become multidisciplinary so other professionals also report their progress. If a patient who needs April 2014 | Volume 21 | Number 1 13
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Analysis
Signing up Acute trusts in the south and east of England, and the Midlands, have also expressed interest in signing up to Open and Honest. Ms Harris says: ‘I would like to see all trusts doing this reporting; it is very important that we are open and honest with our public, and willing to learn from avoidable mistakes or incidents. ‘The data are there to kick off a conversation about improving care and how we can do that, and then to provide support from other trusts and NHS England to achieve it. ‘We want to make the whole programme and process as easy as possible and meaningful for trusts, without creating an extra burden for them.’ Ms McErlain-Burns says the power of the scheme lies in its simplicity and the fact that Rotherham’s senior nurses have been supportive of the programme from day one. ‘Everyone knew that being transparent with our patients and their families was the right thing to do, and we have tried to build on this by sharing the results of ward nursing accreditation programmes,’ she says. ‘The programme is still developing. Hopefully in the next few months there will be an opportunity to include data on the numbers of nurses on duty at the time of a harm.’
Find out more For more information on Open and Honest, go to www.england.nhs.uk/ourwork/pe/ohc For information on the nursing strategy, Compassion in Practice, visit www.england.nhs.uk/nursingvision 14 April 2014 | Volume 21 | Number 1
Marks & Spencer business guru turns his eye to the health service Sir Stuart Rose has plans to transform the culture of the NHS and improve leadership, writes Nick Triggle THE APPOINTMENT of former Marks and Spencer boss Sir Stuart Rose to carry out a review of NHS leadership means different things to different people. For health secretary Jeremy Hunt, it is a chance for health service managers to learn from ‘one of the country’s most inspirational leaders’. But for Unison’s head of health Christina McAnea, it is another sign of a government obsessed with the ‘cult of celebrity’. This, of course, is not the first time a leader from the world of business has been brought in to review NHS practices. In the early 1980s, Sainsbury’s boss Sir Roy Griffiths carried out a review of management, which paved the way for a more defined structure involving doctors and general managers. More recently, in 2002, then prime minister Tony Blair invited former Confederation of British Industry director general Lord Turner to look at roles and responsibilities. His findings were never published, but they are credited with influencing the move to give nurses and other staff extra powers to free up doctors’ time. So what can the NHS expect from its latest private sector guru? Sir Stuart’s remit is likely to be narrow – he has been asked to focus on the 14 trusts currently in special measures to identify how the NHS can transform the culture in under-performing hospitals. He will also give his views on what the health service should do to develop and recruit future leaders. Sir Stuart, who is not being paid, has committed to producing a ‘short’ report by the end of the year. He is likely though to have an immediate impact. When his appointment was announced, Sir Stuart made clear his ethos: ‘The NHS is a very different institution from M&S, but leadership, motivating staff and creating a culture where people are empowered to do things differently are crucial to the success of any organisation.’
PA
physiotherapy has not received it, for example, other teams can ask what they can do to help. There is also a plan to introduce the programme in community, mental health and maternity services across the north of England, and NHS England has started working with maternity units to make this happen in relation to the reporting of still births.
Sir Stuart’s CV During the 1990s and early 2000s, Sir Stuart held chief executive roles at the Burton Group, Argos, Arcadia and Booker. He became M&S chief executive in 2004 and immediately fought off several takeover bids by Philip Green. He was named 2006 Business Leader of the Year by the World Leadership Forum and was knighted two years later. He left M&S in 2011 after a period as chair. Since then he has held several non-executive roles before become chair of online grocery retailer Ocado a year ago. At M&S, one of his tactics was to encourage managers to go on the shop floor to connect with staff and customers. Sir Stuart is also known to be a fan of coaching and training, once remarking that the demands on senior managers were so broad that people needed somewhere to ‘learn all this stuff’. But NHS Confederation chief executive Rob Webster believes it is wrong to focus solely on Sir Stuart’s advice. Salford Royal NHS Foundation Trust chief executive Sir David Dalton has also been recruited to carry out a review. He will look at how the NHS can make better use of its existing leaders. Mr Webster says Sir David is ‘one of our finest leaders’, so the combination of the two knights will be ‘very powerful’. Nick Triggle is a freelance writer NURSING MANAGEMENT
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Trusts helped to become more transparent An NHS England programme that requires providers to publish monthly data on patient harms has improved services in the north west. Sophie Blakemore reports SCANDALS IN nursing in recent years have revolved around accusations of cover ups and failures to learn from poor treatment of patients. Care shortfalls at Stafford Hospital and Winterbourne View Hospital, near Bristol, and misuse of the Liverpool Care Pathway, are some of the high profile cases that have acted as a catalyst for change. These incidents have also thrown into the spotlight how NHS organisations share information with the public about their services and the care they provide. A programme developed by NHS England aims to help healthcare trusts become more transparent with the information they produce in relation to patient harms. Access Open and Honest Care: Driving Improvement requires organisations to publish monthly trust-wide data on their websites for the public to access on the four ‘safety thermometer’ harms: pressure ulcers, falls, blood clots and urine infections in catheterised patients. They must also publish statistics on healthcare-associated infection rates, including those concerning Clostridium difficile and meticillin-resistant Staphylococcus aureus (MRSA), alongside patient experience information gathered from the friends and family test and patient improvement stories to demonstrate how problems have been tackled. The programme started in the north of England and 23 organisations have signed up so far (see panel right). Chief nurse for NHS England (North) Gill Harris, who is leading the project, says one of the programme’s overarching aims is to minimise the data burden on nurses by ensuring the information published is the kind that trusts already collate. From this month, Ms Harris hopes 12 April 2014 | Volume 21 | Number 1
that participating trusts will also start publishing data on ‘never events’ and staffing levels. ‘We are trying to get nurses used to putting the data out into the public arena and then build on that, bringing together all this information involving harm that is already there and presenting it in a different way to improve care locally,’ she says.
The Open and Honest: Driving Improvement programme NHS England’s initiative was piloted in the north west in 2010 with eight trusts publishing information on their websites on falls and pressure ulcers, alongside commentary describing the resulting improvements to care delivery. The need for greater transparency in nursing practice was set out in the three-year nursing strategy Compassion in Practice, produced by England’s chief nursing officer Jane Cummings. From November 26 2013, 16 acute trust boards in the north of England began publishing similar information, with 23 trusts now involved. The information they share covers: ■■ The NHS Safety Thermometer. ■■ Information on healthcare associated infections. ■■ Pressure ulcers. ■■ Falls causing moderate or greater harm. ■■ Information on staff experience. ■■ Information on patient experience including that derived from the friends and family test. ■■ Patient stories. ■■ Improvement stories describing what trusts have learnt and what improvements they are making.
Trusts can also publish information about schemes and campaigns that have improved care, as well as local plans to reduce the incidence of patient harm. Tracey McErlain-Burns has been chief nurse at Rotherham NHS Foundation Trust since July last year. For her, the opportunity to join the Open and Honest programme came along at the right time. After taking up post, she reviewed the information the trust was sharing with patients and the public, and then spoke with her senior nurses about having the courage to publish all quality indicators. The trust had been in breach of license with health service regulator Monitor over its electronic patient record system, finances and governance, which Ms McErlain-Burns says had diverted attention away from quality improvements in nursing in some areas. However, the programme has helped the trust to focus on preventing the cause of patient harms, particularly pressure ulcers, falls and infections. ‘The real driver for signing up was being able to look for the opportunity for improvements,’ she says. ‘We saw it as a chance to work with like-minded colleagues at different trusts to publish the same information, each month, in the same easy-to-read format.’ Pressure ulcers The trust published its first data in October. Reduction in the incidence of pressure ulcers was a priority, and Open and Honest enabled colleagues from other trusts to come in and advise on how care in this area could be improved. Data are collated by the trust and sent to Ms Harris’s team at NHS England to ensure all hospital statistics are published online in the same format. ‘This allows the public to challenge our pace of improvement compared to others, and it is easy for them to interpret the data,’ Ms McErlain-Burns says. ‘But the programme is not about benchmarking trusts; it is about being transparent with our data and using that as an opportunity to drive improvements.’ NURSING MANAGEMENT
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‘This is not about apportioning blame; it is about diagnosing problems and starting a conversation to fix them’
example, compared to where we are meant to be’. Ms Filby, who oversees Open and Honest in her trust, says: ‘I thought it would be a big challenge trying to get up-to-date data, but we are now delivering robust and accurate data every month. It gives our local population an idea of how we are performing and helps us to identify where we need to make improvements to patient care.’
Getty
‘Quality walls’ One matron leads on falls and another on pressure ulcers so they are responsible each month for delivering the data, which are then tested for quality assurance by Ms Filby. The trust has also started
This is something that Ms Harris feels strongly about: ‘One important thing to remember is that this is not about apportioning blame; it is about diagnosing problems, being transparent and starting a conversation to fix them. It’s about leadership and learning. ‘We help in aligning the data and will be measuring the progress of organisations against their own aspirations, not against other trusts, as all trusts set their local ambitions.’ As well as giving the public an insight into how their local healthcare organisations are performing, the programme also helps trusts to pinpoint where recurrent problems may be happening and to take action. The data can also be used to make a case to trust boards for more nurses if there is evidence that harm has been done to a patient in an area with the wrong skill mix or staffing level, Ms McErlainBurns adds. For Tara Filby, deputy chief nurse at Northern Lincolnshire and Goole NHS Foundation Trust (NLAG), one of the main benefits of becoming involved in Open and Honest is being able to see ‘where we are in relation to infection targets, for NURSING MANAGEMENT
The 6Cs ■■ Care. ■■ Compassion. ■■ Competence. ■■ Communication. ■■ Courage. ■■ Commitment. providing ward-level data on ‘quality walls’, erected on individual wards, in relation to areas of potential patient harm, such as falls, and the friends and family test. Patient stories are also pinned up to show other patients and visitors how issues have been addressed. ‘We are already quite an open and transparent trust,’ says Ms Filby, ‘but the Open and Honest programme has helped us to build on that and demonstrate it to our local population and staff more effectively.’ Breaking the data down to ward level has enabled the trust to identify where there are incidents of avoidable harm and undertake work to combat this, she adds. However, for both Ms Filby and Ms McErlain-Burns, patient stories are the most important and beneficial aspect of the Open and Honest programme.
Ms Filby decided to present NLAG’s monthly patient stories by theme: publishing a story about avoidable falls in the trust’s first Open and Honest publication in November; one about pressure ulcers in December; one about C difficile in January; and one about MRSA in February. ‘We have highlighted how at-risk patients have been identified and the actions we have taken to prevent further harm, with links to campaigns running in the trust, such as our red-socks campaign to prevent falls, and where nurses have received additional training,’ Ms Filby says. ‘We hope that through the patient stories the public can see we are focused on making improvements and I can then revisit these stories later in the year, to show how further steps have been taken. ‘It is still early days but collecting and publishing the data has been positive so far, but there is a lot more we can do to use Open and Honest to drive up improvements in our patient care.’ Ms McErlain-Burns also says that it is too early to tell whether improvements in pressure-ulcer care and falls at Rotherham are a direct result of the scheme. Public meeting However, one clear benefit of the programme is that the board now hears patient stories at every public meeting, placed in the context of England’s chief nursing officer’s 6Cs (see panel left). ‘As chief nurse at the trust, it is my role to tell the board about the experience of care received by our patients, and the determination of nurses and midwives to prevent harm and improve care,’ says Ms McErlain-Burns. ‘This hopefully gives the local community greater confidence in us.’ Ms Harris says the eventual aim is for the initiative to become multidisciplinary so other professionals also report their progress. If a patient who needs April 2014 | Volume 21 | Number 1 13
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Analysis
Signing up Acute trusts in the south and east of England, and the Midlands, have also expressed interest in signing up to Open and Honest. Ms Harris says: ‘I would like to see all trusts doing this reporting; it is very important that we are open and honest with our public, and willing to learn from avoidable mistakes or incidents. ‘The data are there to kick off a conversation about improving care and how we can do that, and then to provide support from other trusts and NHS England to achieve it. ‘We want to make the whole programme and process as easy as possible and meaningful for trusts, without creating an extra burden for them.’ Ms McErlain-Burns says the power of the scheme lies in its simplicity and the fact that Rotherham’s senior nurses have been supportive of the programme from day one. ‘Everyone knew that being transparent with our patients and their families was the right thing to do, and we have tried to build on this by sharing the results of ward nursing accreditation programmes,’ she says. ‘The programme is still developing. Hopefully in the next few months there will be an opportunity to include data on the numbers of nurses on duty at the time of a harm.’
Find out more For more information on Open and Honest, go to www.england.nhs.uk/ourwork/pe/ohc For information on the nursing strategy, Compassion in Practice, visit www.england.nhs.uk/nursingvision 14 April 2014 | Volume 21 | Number 1
Marks & Spencer business guru turns his eye to the health service Sir Stuart Rose has plans to transform the culture of the NHS and improve leadership, writes Nick Triggle THE APPOINTMENT of former Marks and Spencer boss Sir Stuart Rose to carry out a review of NHS leadership means different things to different people. For health secretary Jeremy Hunt, it is a chance for health service managers to learn from ‘one of the country’s most inspirational leaders’. But for Unison’s head of health Christina McAnea, it is another sign of a government obsessed with the ‘cult of celebrity’. This, of course, is not the first time a leader from the world of business has been brought in to review NHS practices. In the early 1980s, Sainsbury’s boss Sir Roy Griffiths carried out a review of management, which paved the way for a more defined structure involving doctors and general managers. More recently, in 2002, then prime minister Tony Blair invited former Confederation of British Industry director general Lord Turner to look at roles and responsibilities. His findings were never published, but they are credited with influencing the move to give nurses and other staff extra powers to free up doctors’ time. So what can the NHS expect from its latest private sector guru? Sir Stuart’s remit is likely to be narrow – he has been asked to focus on the 14 trusts currently in special measures to identify how the NHS can transform the culture in under-performing hospitals. He will also give his views on what the health service should do to develop and recruit future leaders. Sir Stuart, who is not being paid, has committed to producing a ‘short’ report by the end of the year. He is likely though to have an immediate impact. When his appointment was announced, Sir Stuart made clear his ethos: ‘The NHS is a very different institution from M&S, but leadership, motivating staff and creating a culture where people are empowered to do things differently are crucial to the success of any organisation.’
PA
physiotherapy has not received it, for example, other teams can ask what they can do to help. There is also a plan to introduce the programme in community, mental health and maternity services across the north of England, and NHS England has started working with maternity units to make this happen in relation to the reporting of still births.
Sir Stuart’s CV During the 1990s and early 2000s, Sir Stuart held chief executive roles at the Burton Group, Argos, Arcadia and Booker. He became M&S chief executive in 2004 and immediately fought off several takeover bids by Philip Green. He was named 2006 Business Leader of the Year by the World Leadership Forum and was knighted two years later. He left M&S in 2011 after a period as chair. Since then he has held several non-executive roles before become chair of online grocery retailer Ocado a year ago. At M&S, one of his tactics was to encourage managers to go on the shop floor to connect with staff and customers. Sir Stuart is also known to be a fan of coaching and training, once remarking that the demands on senior managers were so broad that people needed somewhere to ‘learn all this stuff’. But NHS Confederation chief executive Rob Webster believes it is wrong to focus solely on Sir Stuart’s advice. Salford Royal NHS Foundation Trust chief executive Sir David Dalton has also been recruited to carry out a review. He will look at how the NHS can make better use of its existing leaders. Mr Webster says Sir David is ‘one of our finest leaders’, so the combination of the two knights will be ‘very powerful’. Nick Triggle is a freelance writer NURSING MANAGEMENT
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