APPENDIX 3 - BOARD WORKSHOP – 27 NOVEMBER 2013 Progress More to do A culture focused on doing the system’s business – not that of the patients Listening events and team meetings have focused on quality of care for patients and have given staff an opportunity to share their issues. Improvements in quality governance have been implemented at all levels Increasingly more patient and quality focused Board agenda More focus is required on “compassionate” aspects of nursing The NHS is set up in such a way that much still happends at convenience of staff not patients. We are nowhere near doing what other service sectors do to turn this around A failure of communication between the many agencies to share their knowledge of concerns Trust is part of a Quality Review Group and Contract Review Group with Commissioners. Trust is part of the two local health and well being boards, and regularly attends local OSCs Local Area Teams are setting up systems to address this, although more to do. We need to keep our stakeholder relationships under review, especially as financial pressures build: CCG, Area Teams, Local Authority, Neighbouring Trusts An institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern The balanced score card is being developed which has a strong quality focus Assumptions that monitoring, performance management or intervention was the responsibility of someone else Progress is being made on improved accountability, including performance review sessions, but more needs to be done Standards and methods of measuring compliance which did not focus on the effect of a service on patients Regular Board reports on patient experience including compliments, complaints and friends and family test. Patient experience reference group is being established to take action, especially around FFT scores A failure to tackle challenges to the building up of a positive culture, in nursing in particular but also within the medical profession Revising Nursing Quality Metrics will feature as regular reporting outcome to Trust Board Great line management programme is still at an early stage, but has a strong focus on culture and behaviour Emerging issues around: behaviours, leadership, governance
Too a degree of tolerance of poor standards and of risk to patient Poor care is not tolerated, but there are examples in SUIs and complaints. Mortality committee has been established and is reviewing all deaths. Physical environment at DMH needs addressing because of risks around patient experience Examples of poor care being tolerated in SUIs and complaints A failure to appreciate recently the risk of disruptive loss of corporate memory and focus resulting from repeated, multi-level organisation More work needs to be done on succession planning to avoid loss of corporate memory. Points raised from KPMG’s Quality Governance Review re: Quality / Patient experience Integrated Report Progress More to do Board-level ward visits (unannounced, and taking account of intelligence on the service reviewed Executive directors frequently visit patient areas unannounced. Board visits take place but not unannounced. Triangulation with data required. Community services as well as wards should be visited. Board-level patient engagement limited to traditional route. Need to increase patient contacts and use more innovative methods Annual general meeting includes a “market where people can meet directors and find out about services. This will be explored in the patient experience forum Need for increased use of patient stories at Board level Incident reports relating to individuals are shared at Board level by nursing and medical directors. 12 patient stories to be written up as part of Quality Strategy Stories shared at the board only occasionally, more action required. Positive and negative experiences need to be shared. Need to continue to work on staff engagement challenges based on national survey This theme has been taken forward through: - Great all round events - line management - Staff survey action via model employer group - bag in Estates and Facilities Prevailing staff perception that morale is low Further work required on issues identified in Staff survey