Salford Royal NHS Foundation Trust’s improvement work has resulted in it being in the top 10 per cent of NHS organisations on risk adjusted mortality, and receiving the highest staff satisfaction/engagement rating of any acute trust for three consecutive years. Over 90 per cent of patients rate their care as ‘excellent’ or ‘very good’, and over 97 per cent receive harm-free care. The trust has benefited from continuity of leadership and consistent pursuit of its vision to be a safe and high-quality provider of care.
How did Salford’s improvement journey start?
Salford’s journey of improvement began in 2007 when one of its senior leaders spent time at the Institute for Healthcare Improvement in Boston to learn about its work on patient safety and quality improvement. On her return, the trust developed its first quality improvement strategy, with the ambitious aim of becoming the safest organisation within the NHS. The strategy was based on four key goals:
- to reduce mortality
- to improve patient experience
- to reduce harm
- to improve reliability.
Changing the organisational culture
Salford pursued these goals by developing an organisational culture focused on delivering safe care (the trust’s watchwords being ‘safe, clean and personal’). The culture embraces a number of values that staff are expected to exhibit – namely, being patient- and customer-focused, supportive of continuous improvement, respectful, and accountable. Staff receive training and development (much of it delivered in-house) to help them put these values into practice. The content includes improvement skills, understanding of Lean methods and tools, and statistical measurement. These skills are then applied in a rolling programme of quality improvement projects.
What did the changes mean for clinicians?
During its improvement journey, the trust changed the way it organised its work to create four clinical divisions, each headed by a clinical chair supported by a managing director and nursing director. Responsibility for budgets and services was devolved to these divisions, and unusually, there is no director of operations on the executive team. There were significant investments in developing medical leaders to ensure that clinical chairs and clinical directors had the skills needed to operate in the new structure. This included developing an explicit compact with medical staff.
Members of the executive team are associated with each of the divisions, but as coaches and advisors rather than managers. Executive team members play their part in implementing the quality improvement strategy through safety walkarounds and by spending time at the ‘front line’. The trust board monitors progress on the strategy through regular performance reports, revising goals for improvement as necessary. Use of the patient safety thermometer enables the board to track progress in reducing incidents of harm.
Working in partnership
Salford Royal has also tried to achieve greater alignment between the trust’s strategy and the contribution of the 6,500 staff who work for the organisation. It has benefited from a partnership with GE, adapting GE’s approach to objective setting and appraisals, with a focus on values and behaviours. This has been challenging – not least for medical staff – but is seen by the chief executive as fundamentally important in taking quality improvement to the next level. Good performance is rewarded, with pay progression dependent on the outcome of appraisals.