Leading change

Derbyshire Community Health Services NHS Foundation Trust (DCHS) provides a wide range of community-based inpatient and outpatient services. Nurses within DCHS supported the creation of the “Quality Always – the DCHS Way” model leading on implementation in practice to ensure they continued to provide high quality care and drive improvement for patients, whilst developing pride for staff in the care they deliver. The strategy for change aligns with the NHS Change Model combining engagement, leadership, measurement and improvement against a set of common standards and has led to improved outcome and experiences for patients using the Trust’s services.

Where to look

DCHS senior nurse leaders identified an opportunity for frontline clinical, nursing and care staff to become more directly involved in quality assurance. The senior nurses saw the opportunity to capture the imagination and motivation of the workforce, empower them to set clear and measurable standards and support them to lead or contribute to improvements to patient care.

What to change

The “DCHS Way” encompasses the organisation’s visions and values statement which, along with the Foundation Trust’s “Caring Always” promises to patients. It sets out aspirations to deliver high quality health care and patient experiences throughout all of the services they deliver all of the time. The Trust Board undertook a review of performance to support continuous quality improvements within its clinical services, to measure and make sure they were meeting patients’ aspirations.

Comparing their own methods of continuous quality improvements against other comparable Trusts, the nursing leaders identified unwarranted variation both in agreed standards of clinical care across DCHS and in the Trust’s related assurance processes. They saw an opportunity to develop a model to drive improvements across diverse care settings involving a range of different staff across the Trust. A small team of clinical and strategic leads worked to develop the ‘Quality Always’ model which includes a Clinical Assessment and Accreditation Scheme (CAAS) and a Leadership Development Scheme (LDS). There was full engagement from Executive level to operational teams on the front line, and patient representatives via our Public Governors.

How to change

The ‘CAAS’ gave opportunity for good practice to be identified and shared widely. The aim of this scheme is to support teams to achieve Gold Accreditation, and maintain it for 12 months, by consistently demonstrating harm-free care, through the metrics identified relevant to their service area.

Since the pilot phase, there have been 146 CAAS assessments of 39 teams and services, across all eight of DCHS’s widespread localities. Thirteen teams have achieved Gold Accreditation. The ‘LDS’ model uses 360° appraisal, a development centre and feedback to measure the qualities and behaviours of front line clinical leaders. Everyone on the scheme has an agreed personal development plan linked to the model and is supported to develop and improve all staff in their leadership abilities.

Nurses and care assistants have been key to success and acted as Quality and Safe Care Champions to embed best practice in areas across the Trust, by focussing on key aspects of harm-free care e.g. falls prevention, medication safety and patient experience.

A rewards and recognition process was felt to be a key part to supporting engagement across the whole nursing, clinical and care staff workforce. A ‘Quality Always’ digital tool and dashboard has also been developed which monitors trends, shares achievements and learning. This data  is then used to support the Trust’s clinical assurance processes. To support feedback and sharing of good practice an interactive database and Facebook page support communication with staff which has been well received.

Adding value

Better outcomes – The progression of teams’ CAAS ratings demonstrates how ‘Quality Always’ is contributing to improvements in care quality and safety. For example, the time taken for risk assessments to be completed following admission has been reduced from 6 hours to 2 hours across all wards, meaning patients are cared for safely within 2 hours of admission.

Better experience – DCHS now has more than 400 Quality and Safe Care Champions – about 10% of the entire workforce. Staff report greater confidence, new skills and a noticeable difference in their places of work. Patients and family members involved in Gold Accreditation panels regularly provide personal testimony of the difference the champions have made.

Better use of resources – The robustness of CAAS assurance has been confirmed by triangulation with recent CGC findings. The programme has also contributed to better use of resources due to risk assessments being conducted earlier in processes and actions taken to mitigate these.

Challenges and lessons learnt for implementation

‘Quality Always’ has been highly effective in encouraging full engagement with patients, clients and carers. It has led to a wealth of examples of improvements in practice, which have delivered real benefits for patients.

The champions role has been a particular success and has supported staff to become empowered to identify unwarranted variation in practice and take action to minimise these.

For more information contact:

• Sally-ann Coope, Clinical Lead Quality Always DCHS, Sally-ann.coope@nhs.net