General Comments Received for Each Strategy
Consultation on Quality Improvement Priorities 2014-15
Staffordshire and Stoke on Trent Partnership Trust
Consultation on Quality Improvement Priorities 2014-15 report
January - February 2014
Robin Sasaru, Quality Team Manager
Chris McKeown, Effectiveness Officer
Contents
Aim
The consultation
General comments received for each strategy
Priority 1: Safety – Reducing Avoidable Pressure Ulcers
Consultation measures and questions
Responses
Priority 2: Experience – Customer Satisfaction
Consultation measures and questions
Consultation responses
Priority 3: Effectiveness – Improving Outcomes
Consultation measures and questions
Consultation comments
Priority 4: Effectiveness – Supporting Independence by Personalised Care
Consultation measures and questions
Consultation comments
Priority 5: Safety – Workforce
Consultation measures and questions
Consultation comments
Aim
The aim of this report is to
- log all comments received during the consultation for the Quality Improvement Priorities 2014-15
- highlight the Trust response to all comments received
The consultation
The consultation ran from 20January to 20February 2014, and made use of the following mechanisms to disseminate and gain comment on the Quality Improvement Priorities 2014-15 consultation report:
- Emailing stakeholders and inviting them to comment and forward the documents to their colleagues
- Holding consultation sessions that included Partnership Trust staff, Clinical Commissioning Group leads, partner agencies and Trust members
- Posting the consultation documents on the Trust internet site.
The substance of each consultation response is copied into this report, correcting for spelling where appropriate.
Names of respondents are not included, although comments have not been altered to strictly preserve anonymity unless explicitly requested.
Comments were aligned with the closest matching consultation question where possible.
Where possible all comments were incorporated into the final version.
Table 1 logs the individuals and groups that were contacted for the consultation. In addition to the consultation comments, the Quality team made additional amendments to the draft torefine the measures and objectives, and check for consistency, readability and grammar.
We thank everyone who commented on these priorities.
We appreciate the many insightful comments received that have strengthened our approach to quality improvement.
Table 1: Consultation summary
Cohort / Who was contactedStaff, committees and groups / Effectiveness Group
EMT
Articles in “the word” and Trust internet site via communications
Chief Operating Officers
Professional Leads
Quality Team
Equality & Inclusion Manager
Engagement & Membership Manager
Trust Members
Service user representatives / Community Health Voice, HealthWatch Stoke, HealthWatch Staffordshire
Partner organisations / Keele University
Staffordshire University
Shropshire and Staffordshire Area Team
South Staffordshire and Shropshire Healthcare NHS Foundation Trust
Burton Hospitals NHS Foundation Trust
Mid Staffordshire NHS Foundation Trust
North Staffordshire Combined Healthcare NHS Trust
University Hospital of North Staffordshire
West Midlands Ambulance Service
Age UK (South Staffs), Chase Council for Voluntary Service, Lichfield & District Community and Voluntary Sector Support, Tamworth Centre for Voluntary Service, The Community Council of Staffordshire, South Staffordshire Community and Voluntary Action, Newcastle under Lyme Community and Voluntary Support, Staffordshire Moorlands Community and Voluntary Services, Voluntary Action Stoke on Trent (VAST), East Staffordshire Community and Voluntary Service, Lichfield and District CVS, Newcastle 50+ Forum, DEAF Vibe,
Children and Young People's Voice Project, Children with Disabilities, Jigsaw, Staffordshire Fire and Rescue, Staffordshire Girl Guiding, Staffordshire Police 100 Club/Citizens Panel, Staffordshire Thru Care, Staffordshire UK Youth Parliament, Staffordshire Youth Action Kouncil (YAK), Staffordshire Youth Offending Service, Staffordshire Council for Youth Voluntary Services, North Staffs Young Carers, Newcastle Young People's Association (NYPA), Youth of the Moorlands Action Council (YOMAC), Rona Borland, Tamworth Early Years, West Midlands Consortium of Travellers, East Staffs District Forum, South Staffordshire District Youth Council (DYC), Stafford and Stone District Youth Forum, Tamworth District Youth Forum (TDYF), VOICE (Cannock Chase District Youth Forum), Young People Today (Lichfield District Youth Forum), Children & Young People (CYP) Partnership
Werrington Patient Participation Group
Stafford and SurroundsPPG
Kingsbridge Medical Practice PPG
East Staffordshire PPGs
Trent Meadows PPG
Weeping Cross PPG
The Donna Louise Children's Hospice Trust
St Giles Hospice
Katharine House Hospice
Douglas Macmillan Hospice
HMP Stafford
HMYOI Brinsford
HMYOI Swinfen Hall
HMP Featherstone
HMYOI Werrington
Commissioning / Stafford and Surrounds Clinical Commissioning Group
North Staffordshire Clinical Commissioning Group
Stoke on Trent Clinical Commissioning Group
East Staffordshire Clinical Commissioning Group
NHS South East Staffs and Seisdon & Peninsula Clinical Commissioning Group
Cannock Chase Clinical Commissioning Group
Leicester City Clinical Commissioning Group
Staffordshire Council
Stoke on Trent City Council
General comments received
Comments / ResponseAll priorities link together and need to.A prologue is needed to say how they all are measured together/ against each other / As last year, our Quality Account 2013/14 will have information on how we decided our quality priorities, and this section will show how they link together.
Need to consult with patient groups alone – freedom to speak openly – current meeting imbalanced? May be different comments – staff, patients, commissioners. / We recognise the need to fully engage with service users, maximising their opportunities for involvement.
Further work will be undertaken to increase service user involvement in future consultations.
How are you going to address improving services for people with mental health conditions? – How are these priorities going to evidence this? – This is stated in the document. / Although this is an important area, we did not consider this to be one of our 5 quality improvement priorities for the Trust this year.
Nothing to object wouldn’t disagree with priorities BUT may be some gaps? Complaints (see notes) / (See the section on complaints)
Issue with ambulance service – arriving in time, early and late / This comment related to services that we do not provide.
Partnership working – whole patient journey. Transition. / Our focus on outcomes and personalisation will assist us in improving our services across the whole patient journey.
[Business Development Priorities] The Staffordshire Neurological Alliance would support all these as they were all shown to be improvement opportunities following our Quality Neurology audit in 2010.
Particularly better post diagnostic counselling and psychological services are important in reducing excess morbidity in people with chronic neurological disorders / This comment related to services that we do not provide.
[Clinical Commissioning Group intentions - New pathways and models of care for Long term Conditions] These should include neurological conditions. / This comment was felt to be directed at commissioners.
Document could be shorter/ snappier / We will endeavour to ensure future consultation documents are concise.
It is very adult focussed, and at times adult community hospital focussed, which contradicts the introduction talking about prisons/children’s/expansion in sexual health services etc. Thought will need to be given about how some of this is translated in other directorate / We feel that the most of the priorities apply to all our services, and we will work with our Children’s services and Specialist Services to develop service-specific actions for these priorities.
Do your quality efforts have to fall within guidelines handed down through the NHS hierarchy together with the approaches to employee and customer involvement and monitoring of results? / National Quality Accounts guidance contains some minimum requirements for Quality Accounts.
We have picked these priorities, based on our Quality Framework, supporting strategies, and current business development priorities. National direction and commissioner intentions have also influenced our priorities.
Priorities for staff:
more robust management of attendance procedures
Priorities for partners:
to ensure performance measures accurately reflect the business & performance measures of both organisations
Need to pick priorities we would benefit from and choose ourselves rather than the ones we need to.
Priority 1: Safety – Reducing Avoidable Pressure Ulcers
Consultation measures and questions
Proposed measures for 2014/15 / Proposed 2014/15 target1A Number of pressure ulcers reported as grade 3 and 4 pressure ulcers and reported as serious incidents / Aim for Zero grade 2/3/4 avoidable pressure ulcers developed in our care[1]
1B Number of pressure ulcers reported as avoidable grade 3 / 4 pressure ulcers developed in our care and reported in our care and reported as serious incidents. / Zero grade 2/3/4 avoidable pressure ulcers developed in our care[2]
1C All pressure ulcers for people in our care and reported as adverse incident / Increase in number of incidents reported and reduction in the proportion of serious incidents / all reported incidents
Other measures we will use for Safety
1D Total number of adverse incidents reported (all incidents) / Quarterly increase in number of incidents reported
1E Percentage of reported incidents classified as serious incidents / Quarterly reduction in proportion of serious incidents / all reported incidents
Q1.1: Is the measure for ‘pressure ulcers reported as adverse incidents’ already covered by the more general measure ‘total number of adverse incidents reported’?
Q1.2: Do you agree with the minor changes made to the Quality Improvement Priority around Safety?
Q1.3: Should we include other measures? Should we delete any measures that are no longer appropriate?
Responses
Priority / Comments / Response1 / Medication error reporting – harm decreases. / The overall measures around numbers of incidents reported will also capture medication errors. Medication error information will be reviewed by our Medicines Management Committee.
1 / Consider adding medication errors, reporting and levels of harm – In Clinical Commissioning Group planning guidance.
1 / Should be measuring on outcomes not processes and be accountable for the measures. / We agree. A Grade 3/4 avoidable pressure ulcer developed in our care is a reflection offailure in our services. The number of adverse incidents reported is used as a measure of our safety culture.
1 / “Eliminate” is the key word and needs to be worded to highlight this / We have changed the wording of the aim to “eliminate avoidable grade 3/4 pressure ulcers”
1 / This is how we did against previous year – count as a reduction so would naturally expect this year’s result to [be less]. / We will continue with our aim of eliminating avoidable pressure ulcers, and agree a tolerance as for 2013/14.
Our Quality Account will outline our progress in reducing avoidable pressure ulcers.
1 / Use prologue to sell yourself.
Transparency is the focus at the minute. / Our Quality Account will openly and transparently show our progress against our priorities.
1 / Achieve numbers and shows numbers but so what? What does this mean for pressure ulcers? / We feel that reducing avoidable pressure ulcers reflects an approach to care that is safety focussed, demonstrates that we implement learning and reflect on our practice.
1 / Is it fair? Is everybody recording the same way? Inclusion of avoidable but not attributable has been included now but what teams know about this? / Our Tissue Viability Panel scrutinise all grade 3/4 pressure ulcers developed in our care, to ensure consistency of reporting. Feedback to teams is via our Safety and Effectiveness Operational Groups and all-staff communications, including our internal newsletter, “Quality Matters”.
We directly notify the team involved if we find an avoidable pressure ulcer developed in their care.
1 / NICE guidelines on Pressure Ulcers in April 2014 due- what changes will need to be made as a consequence of this. / We have reviewed the draft guidance on prevention and management of pressure ulcers and sent our comments to NICE for consideration.
We do not feel that the guidance will change our overall aim to eliminate avoidable pressure ulcers.
1 / Intravenous fluid therapy? Risk of administration, has this been addressed? NICE could provide more details [if] wanted. / There are important safety considerations around the use of Intravenous fluid therapy,
On consideration, this was not deemed as one of our top five improvement priorities for 2014/15.
1 / Order of proposed measures should be changed 1C, 1A, then 1B.
1C should be first / We have changed the order of the measures accordingly.
1A / What is avoidable/ unavoidable? / We adhere to national definitions for avoidable / non-avoidable pressure ulcers as set out at
1A / Stronger prevention. / We have changed the wording of the aim to “eliminate avoidable grade 3/4 pressure ulcers”
We have a Zero-tolerance action plan for eliminating pressure ulcers, which we will refresh for 2014/15.
1A / Feeding back to source of lesion. / We provide feedback to teams and partner agencies as part of our incident reporting system.
We also work closely with our partner agencies, including University Hospital NHS Trust (North Staffordshire) to monitor care of patients with pressure ulcers, using our incident reporting system. We also use the TRAC (Track Report Analyse Communicate) system to monitor pressure ulcers across our health economy.
1 / How is learning from Root Cause Analyses and Tissue Viability panel changing practice? We really need to link priorities to demonstrate partnership working across same journey. Link to wider health economy. Need to be explicit about deterioration of pressure ulcers. / The learning from our Tissue Viability panels feeds into our Safety and Effectiveness Operational Groups, and is disseminated via our internal newsletter, “Quality Matters”.
We will report learning and improvements for 2013/14 in our Quality Account.
1B / Are figures of Pressure Ulcersonly taken from incident reporting? / Our incident reporting system is our primary record of pressure ulcers.
We also use the NHS safety thermometer to measure the prevalence of existing pressure ulcers.
Q1.1 / Requires consistency around grading of pressure ulcers – especially grade 2. Depends to some degree on patient/ service user compliance. / We provide ongoing training for our staff on Pressure Ulcer identification, reporting and management.
As for all incidents, we are looking to see increased reporting for lower grade pressure ulcers, which demonstrates that our staff are providing safer care.
Q1.1 / Keep in as grade 2 being removed want to keep focus on Pressure Ulcer reporting. / We feel that the reporting of grade 1/2 Pressure Ulcers is as equally important, as a reflection of our care.
We want the number of grade 1/2 pressure ulcers reported to increase, as our staff’s knowledge and awareness of pressure ulcer care increases, and they work to prevent these progressing to more serious Pressure Ulcers.
Q1.2 / Yes / We are concerned with eliminating all avoidable pressure ulcers developed in our care.
We want the number of grade 1/2 pressure ulcers reported to increase, as our staff’s knowledge and awareness of pressure ulcer care increases, and they work to prevent these progressing to a more serious Pressure Ulcer.
We will continue to capture data via our incident reporting system for grade 2 pressure ulcers, and act to prevent these becoming more serious. Techniques such as root cause analysis can help us to achieve this.
Grade 2 pressure ulcers show as relatively superficial damage to the skin and can happen very quickly even when care is in place. We want the number of grade 1/2 pressure ulcers reported to increase, as our staff’s knowledge and awareness of pressure ulcer care increases, and they work to prevent these progressing to more serious Pressure Ulcers.
Q1.2 / Providing reporting of 2 and 3’s is consistent.
Q1.2 / Yes but grade 2 pressure ulcers increase if grade 3 and 4 are reduced. If not including grade 2 we need to be more explicit about them.
Q1.2 / Why have we excluded grade 2’s? Because it isn’t achievable? What are our aims for grade 2’s?
Q1.3 / Community and hospitals should be separated- community can’t eliminate can only reduce. Need to be more explicit about community point of view. / We feel that a goal of eliminating avoidable pressure ulcers developed in our careshould apply to our hospital and community services, and we recognise that eliminating avoidable pressure ulcers in the community is a more challenging ambition.
Our Quality Account will provide information about avoidable pressure ulcers in hospital services and in the community.
Q1.3 / Could the organisation be more transparent about Pressure Ulcers in particular these that are attributable to the organisation and to other organisations/ / We regularly report this through our governance structures. The measures include avoidable grade 3/4 pressure ulcers developed in our care.
Q1.3 / Need to be aware of issues regarding obtaining pressure relieving equipment in community and hospitals. – Consistent across the trust / We agree.
Q1.3 / Issues around workforce capacity regarding review of individuals and equipment provided. / We feel that our processes of care are also an important factor in improving quality, as well as ensuring adequate workforce capacity.
Q1.3 / Measures to demonstrate we are treating them well – time to heal. / The focus of this measure is around safe processes of care that mean our service users do not suffer from avoidable grade 3/4 pressure ulcers.
We are continually improving the effectiveness of our pressure ulcer care (and other types of skin care). Our Tissue Viability service has produced papers on the effectiveness of therapeutic devices.
1B / Acquired in care is more difficult in community settings when patients may not be compliant with advice – or would this be then deemed ‘unavoidable’ / We adhere to national definitions for avoidable / non-avoidable pressure ulcers as set out at
According to this definition, if “the individual person refused to adhere to prevention strategies in spite of education of the consequences of non-adherence” this would not be an avoidable pressure ulcer.
We recognise the increased challenges of eliminating avoidable pressure ulcers in the community.
1C / If we are reducing pressure ulcers then there will be a reduction in reporting I would have thought? / A reduction in reporting of grade 3/4 pressure ulcers must be in the context of an overall increase in incident reporting – this demonstrates that an organisational safety culture is in place.
An increase in the number of reported grade 1/2 pressure ulcers should demonstrate that our staff are more proactive in providing high quality care of pressure ulcers.
Q1.1 / Not if we want to reduce total pressure ulcers as that will presumably reduce reporting of these kinds of incidents as they will no longer occur.
Q1.1 / Is number of incidents as important in demonstrating that we do something about those that are reported? Should there be a measure around action plans in place for SUIs? / It is important that we have robust systems for acting on incidents, including the development of action plans. However, we do not feel that measuring the number of actionplansin placein itself will correlate with improvement in quality.
We feel that a grade ¾ avoidable pressure ulcer developed in our care is a reflection of failure in our services.
On reviewing the comments we decided to make the following amendments to the Safety priority: