Our improvement journey - April 2016

It's over two months since the Care Quality Commission (CQC) gave us feedback on our services following their inspection last autumn and we've already made some good progress in the areas where further improvements are needed. 

Our existing plans are also being further developed to address our bigger challenges such as recruitment and managing the high demand for our services. 

As one of our absolute priorities we've already kick started a series of changes to improve the experience of patients in our Emergency Department and to support the great team of staff we have working there who are extremely busy throughout the year. 

This is an update on our initial Improvement Journey document which highlights our main priorities for improvement and what we will be doing to address each of these areas. 

Staffing

CQC icon - Staffing

Making sure we have the right number and mix of staff across all services at all times 

Although over the last three years we have increased the number of staff on our wards and in the community, recruitment remains a significant challenge.

Since January we have:

  • Finalised plans to recruit up to 70 nurses from India. 
  • Increased the number of nursing staff in the Emergency Department by a using agency nursing. 
  • Agreed an investment of around £800,000 for approximately 20 additional nurses in the Emergency Department. 
  • Agreed an investment of £650,000 for around 14 additional midwives and two maternity support workers over the next two years.
  • Recruited 25 additional healthcare assistants following a special open day for people interested in becoming healthcare assistants.
  • Recruited 100 more staff to our internal staffing agency (The Bank) since 1 January, meaning 1,835 of our staff now have the opportunity to take extra shifts and gain experience in different areas.
  • Launched a Refer a Friend scheme offering £500 to staff who refer a friend who joins us as a nurse.
  • Continued the careful use of premium staffing agencies. Premium agency staff were used in just 16 shifts in February, compared with 108 in February 2015.  Instead we are introducing incentives to attract staff to our own internal staffing agency (The Bank).

Over the next couple of months we will be:

  • Offering 30 of our health care assistants the opportunity to train to become assistant practitioners. Over the course of two years trainees will develop the skills and experience to become qualified for this exciting new nursing role supporting clinical teams. 
  • Paying staff who work extra shifts through our own internal staffing agency (The Bank) weekly as oppose to monthly from 1 April.
  • Planning a range of recruitment events targeted at local people who may be interested in joining us as healthcare assistants, apprentices, allied healthcare professionals or nurses. 

Patient flow and emergency care 

 CQC icon - patient flow

Making sure patients experience a smooth journey of care through our services and beyond remains a challenge for the whole local health and social care system

Demand for all of our services is high all year and one of our biggest challenges is discharging patients who no longer need to be cared for in a large acute hospital, so we can make space for those who do. 

More of our emergency patients now need to be admitted onto a hospital ward. In March our team in the Emergency Department saw around 237 patients a day, with around one in three needing to be admitted into hospital.

Since January we have:

  • Launched our Home for Lunch campaign which asks local people for their support in helping patients leave hospital in a timely, well-planned and supported way when they are well enough. 
  • Created a new section on our website about leaving hospital which provides local people with a whole range of information about what to think about before coming into hospital and free local support services available. 
  • Reviewed our internal escalation policy and introduced a full hospital protocol in response to a high number of patients needing to be admitted into hospital, to ensure consistency in how we manage patient flow through our services. 
  • Been working with our partners and local media to encourage actions which are likely to help prevent potentially avoidable attendances and admissions. These include staying well, seeking advice as soon as you feel unwell and looking out for the elderly and those with long terms conditions.
  • Made changes to the way the team works in the Emergency Department, to help ensure patients receive an initial assessment within 15 minutes of arrival. This helps us to ensure that patients are seen in order of urgency and are as comfortable as possible while waiting.   
  • Introduced an additional senior nurse coordinator in the Emergency Department to oversee and prioritise patient care and treatment. 
  • Expanded our training so more staff can work in our specialist children's area in the Emergency Department. 
  • Extended the opening hours of our new expanded Ambulatory Care and Triage Unit which is now open 24/7, seven days a week. 
  • Introduced new nursing documentation in the Emergency Department to help ensure consistency in recording information and give nursing staff more time with patients. 
  • Introduced personal alarms and an additional security presence in the Emergency Department to further protect staff.

Over the next couple of months we will be: 

  • Recruiting to fill additional nursing and specialist children's nursing posts. 
  • Introducing an additional senior matron to the nursing team in the Emergency Department.

Caring for patients with mental health needs

 CQC - icon - mental health

Making sure we adapt our care to meet the individual needs of patients

Since January we have:

  • Provided 80 per cent of staff in the Emergency Department with specialist with mental health training. This is focused on improving how we care for patients with mental health needs, in a way which keeps them safe, while protecting staff and others close by. 
  • Recruited an interim mental health nurse to be based in the Observation Unit in the Emergency Department, who will provide the specialist support we need until we can recruit a permanent member of staff with these specialist skills. 

Over the next couple of months we will be:

  • Reviewing how the environment in the Emergency Department meets the needs of patients with mental health needs, with a view to creating a dedicated area. 
  • Continuing to ensure all staff within the Emergency Department have completed mental health training. 
  • Working with Avon and Wiltshire Mental Health Partnership NHS Trust to source further specialist mental health staff to strengthen our mental health liaison service. 

Learning and effective governance

 CQC -icon - Learning

Making sure we are open, learn, share and improve 

Since January we have: 

  • Launched a Quality Improvement Coaching and Peer Support Network to build on our culture of openness and transparency and encourage staff to share ideas in relation to quality improvement.
  • Reviewed governance arrangements across departments and divisions to make sure reporting arrangements are robust. 
  • Established an Improvement Committee chaired by our Deputy Medical Director and supported by a programme manager to drive further improvements. 

 Over the next couple of months we will be: 

  • Raising awareness of the importance of incident reporting to build on our culture of transparency, learning and quality improvement. 
  • Introducing a group focused on improving consistency in learning and quality improvement across the whole local healthcare system.
  • Raising the profile of our internal risk register and how it should be used by all teams as a key part of how we manage risk and improve the safety and quality of our services.

The above information is available in a downloadable PDF file:

Our improvement journey - April 2016

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