Managing service quality

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Managing service quality

• Dr Ian Spencer

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Context

• early operational problems
• serious untoward incidents
• adverse media coverage
• erosion of public and political confidence
• need to better understand the quality of the home
  oxygen service

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Objectives

• To achieve
• a common understanding of service quality by all
  stakeholders
• clarity of reporting frameworks
• clarity of responsibilities
• shared experience and learning

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Clinical governance

• A framework through which all NHS
  organisations are accountable for continuously
  improving the quality of their services and
  safeguarding high standards of care by creating
  an environment in which excellence in clinical
  care will flourish.
• Donaldson and Scally

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Why focus on quality?

• variation in process and outcome common
• practice too often lags behind science
• patient safety has a relatively low profile
• poor quality and performance tolerated
• organisational and professional barriers
• inequality of access to appropriate care
• slow permeation of innovation and good practice
• patient expectations as consumers
• poor information for describing quality

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A quality service

• leadership and culture
• evidence-based standards
• informed patients/users
• well-trained and motivated staff
• safe processes
• learning from mistakes at all levels
• individual
• team
• organisation

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• Human beings make mistakes
• because the systems, tasks and
• processes they work in are
• poorly designed.
• Dr Lucian Leape, testifying to the Presidents
  Commission
• on Consumer Protection and Quality in Health

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Seven steps to patient safety

• Build a safety culture
• Lead and support your staff
• Integrate your risk management activity
• Promote reporting
• Involve and communicate with patients and the
  public
• Learn and share safety lessons
• Implement solutions to prevent harm

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Management of complaints

• Need for agreed policy aligning provider and NHS
  complaints procedures
• Avoid confusion agree definitions
• What is a formal complaint?
• Oral and Written complaints
• MP correspondence
• Develop a learning culture
• Keep accurate records Complaints Register

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Management of complaints

• Align to NHS Complaints procedures
• Acknowledge in writing within 2 working days
• Advise of assistance from PALS
• Keep the complainant informed
• Formal response within 25 working days
• Explain any delays in investigation
• Indicate the right to independent review
• Offer an apology when things have gone wrong
• Indicate what action will be taken to prevent
  recurrence

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Management of complaints

• Complaints report compiled at agreed frequency
• Confidentiality apply Caldicott principles
• Internal managerial review
• Report to regional HOS steering group
• Report to PCTs joint review
• Analysis of trends
• Identification of lessons learned
• Share learning
• Complaints management included in End of
  Transition Report

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Management of SUIs

• notification of serious untoward incidents (SUIs)
  from Trusts to SHAs
• local adverse incident procedures
• near miss and patient safety incident reporting
  to the National Patient Safety Agency (NPSA)
  using the National Reporting and Learning System
  (NRLS)
• SHA briefings to DH Patient Safety and
  Investigations Unit
• complaints
• Media Alerts to DH Communications

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Aims of guidance

• ensure consistency of reporting
• provide timely notification
• enable root cause analysis
• identify the lessons learned so that these can be
  shared more widely

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A definition

• An incident or accident occurring on health
  service premises, or in relation to a health
  service provided in other settings, resulting in
  death, serious injury or harm to patients, staff
  or the public, significant loss or damage to
  property or the environment, or otherwise likely
  to be of significant public concern.
• Situations highlighting a system weakness (near
  miss), where sharing of lessons learned would be
  likely to help to avoid a future incident
  resulting in a future incident resulting in
  serious harm or damage, should also be reported.

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SUI criteria include

• media attention actual or likely
• unexpected deaths (inc. suicide, drug related
  deaths)
• patients suffering serious or catastrophic harm /
  or unexpected death during healthcare (including
  screening / radiation errors)
• homicide committed by patient receiving MH care
• allegation of professional misconduct, including
  fraud
• serious damage to NHS property
• serious injury or unexpected death on NHS
  premises
• major breaches of confidentiality
• absconding when detained under the Mental Health
  Act
• an adverse incident affecting people and/or
  business continuity including ward closure due to
  infection

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An incident or accident occurring on health
service premises or in relation to health
services provided in other settings, resulting in
death, serious injury or harm to patients, staff
or the public, significant loss or damage to
property or the environment, or otherwise likely
to be of significant public concern.
Situations highlighting a system weakness (near
miss), where sharing of lessons learned would be
likely to help to avoid a future incident
resulting in serious harm or damage, should also
be reported.
60 Working Days (excluding external delays)
3 Working Days
SUI Occurs / Trust informed of SUI
Trust report SUI on STEIS
Trust complete internal inquiry and send copy
to SHA
SUI closed when SHA Director of Clinical
Governance is satisfied
SHA may require immediate/72 hour written
briefing
Contact Details Joyce.lovell_at_ntwsha.nhs.uk
Tel. [phone] Sue.campbell_at_ntwsha.nhs.uk
Tel. [phone]
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Home oxygen SUIs

• any incident that involves the death of a patient
  where the integrity of the home oxygen service is
  challenged
• any serious failure of service delivery,
  including compromised supply of oxygen
• delayed discharge from hospital or inappropriate
  emergency readmission
• health and safety incidents relating to the use
  of oxygen equipment, including fire
• an incident where the quality of healthcare has
  been significantly compromised this may include
  severe distress to service users and their carers.

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An integrated approach
CG Lead
HOS Lead
Supplier
Comms Lead
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Action Service suppliers

• report all SUIs immediately to PCT and SHA HOS
  Leads
• written notification within 24 hours
• internal quality management systems
• reports to MHRA should be copied to PCT and SHA
  HOS Leads

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Action NHS

• establish local enhanced reporting
• SUIs to be notified to SHA HOS and Clinical
  Governance Leads
• critical incidents to be notified immediately
• written report within 24 hours
• establish robust OOH arrangements

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Action NHS

• SHA HOS Lead to notify DH MPIG
• PCTs to encourage local reporting
• SHAs and PCTs to collate complaints
• local capture of reports to NPSA NRLS
• SHA HOS lead to summarise in SITREP
• review data at local steering groups
• SHA to coordinate reporting streams

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Action NHS

• Complete the reporting cycle
• report incident
• investigate
• report outcome
• identify root causes
• share learning

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Action Department of Health

• MPIG lead responsibility for HOS
• liaison within DH
• Patient Safety and Investigations Unit (PSIU)
• Communications Unit
• Ministerial Briefing Unit
• MHRA
• PSIU liaises with NPSA
• emerging trends and learning shared

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How are we performing?

• Overview of quality
• Complaints
• Adverse incidents
• Serious Untoward incidents (SUIs)
• MP correspondence
• Compliments
• Key performance indicators
• Meeting the needs of customers
• Ministers, DH, SHA, PCT, patients and carers

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Does it ever reach the point where the bra is
good enough the way it is?

• none of this really matters, because it all
  comes down to the mechanics of the human touch
  having someone who knows what theyre doing.
  When that happens, you can be wearing a bra from
  the Dark Ages and it wont matter.
• Cassandra, Sunday Times Magazine, 2 April 2006

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..no credit can be given for predicting rain
only for building arks.Louis V Gerstner,
Jr.Former CEO, IBM
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