Our interviews and document analysis revealed a sector full of innovative practice and local activity to manage and improve quality. Many providers were expanding their use of patients’ feedback and patient‐reported outcome measures, and had systems for staff and senior leaders to monitor quality on a regular basis. Many also told us of their work to develop a culture of quality and safety in their organisations, and to empower staff to take responsibility for quality and improvement.
Virgin Care sexual health service in Surrey introduced a confidential text messaging service to get feedback from its users. As a result of feedback from young people, chlamydia test results forms were redesigned to be clearer and simpler.
To capture feedback from vulnerable groups and those unable to use standard methods for giving feedback such as patient surveys, Solent NHS Trust piloted a range of methods including:
- pictorial versions for those with dementia and learning disabilities
- focus groups for the homeless
- carers' discussions in palliative care
- visual scoring scales and spoken surveys for people for whom reading or English language is a challenge.
Gloucestershire Care Services’ MSKCAT service has amassed clinically validated patient reported outcome measures (PROMs) from more than 2,800 patient responses since 2010. The condition-specific PROMs scores (measuring pain, function and impact on daily living) show improvements in every type of presenting condition from +10.5 per cent (shoulders) to +36 per cent (hips). Overall MSKCAT patients’ general health and wellbeing score (measured via EQ-5D) improves by 16 per cent. Service managers have been able to use this data to provide evidence on the quality of their services to referring GPs, and to influence their referring decisions.
The Royal Marsden has developed a quality governance system within community health services. Quality is discussed with service managers at a monthly divisional management team meeting. Relevant information is reported upwards to a monthly integrated governance review meeting chaired by the chief nurse, and this meeting in turn reports to a sub-committee of the trust board, the Quality and Risk Committee (QAR). This committee is chaired by a non-executive director and attended by members of the trust board. Quality issues identified at service-line level are reported through this chain to the QAR; those deemed urgent are flagged by a divisional risk register and escalated to the corporate risk register. Quality is also reviewed with commissioners at monthly clinical quality review meetings.
Cambridgeshire Community Services NHS Trust has implemented the Quality Early Warning Trigger Tool to flag up potential quality and safety issues within teams. The tool has been adapted for community services and consists of 22 measures that can affect the ability of teams to deliver high-quality care. Team leaders assess team performance each month against measures including stability of leadership within the team, complaints and collection of patients’ feedback every three months and the percentage of shifts covered by bank or agency staff. The scores produce a red, amber or green rating, and the trust has added a purple rating to indicate very high risk. These scores are reviewed at service level and actions to resolve or mitigate the risks are agreed. Red and purple scores are reported to the trust board each month.
Berkshire Healthcare NHS Foundation Trust introduced a pressure ulcer prevention campaign, providing training for nursing staff and identifying a pressure ulcer prevention champion in each team. Champions are led by tissue viability clinical nurse specialists to share knowledge and support new ways of working, using the ‘Plan Do Study Act’ cycle to ‘Do something different’ and delivering 10-minute ‘power talks’. Teams measure the number of days free from pressure ulcers. Incidents reported on community inpatient wards have reduced significantly, with two wards reporting more than a year free from pressure ulcers.
Bromley Healthcare challenges each of its services to make three quality improvements each year, enabling frontline staff to identify the improvements that would be most beneficial for their patients. Examples of initiatives developed by staff include a phone app to help patients find their nearest sexual health clinic and the addition of pictures to the food menus in the stroke unit.