Performance and operational oversight
Matrons support their staff in monitoring quality and safety, operational performance and financial stability.
The matron should review operational performance for their area and ask:
- What is the state of our operational performance?
- Where are we heading and where do we want it to be?
- What have our improvement initiatives achieved?
- How do we explain the increase or decrease in operational performance? Answers to questions like these contribute to planning the next steps in service and patient care delivery to meet the operational performance indicators, also called key performance indicators (KPIs). Matrons have a major role in leading their staff to achieve KPIs by working with the senior management team in monitoring practice to preserve quality of care, using various improvement tools including risk assessments and checklists.
Operational performance should be in line with the accountability framework based on the CQC domain, including:
- responsive – cancer and elective referral to treatment times (RTT), delayed transfer of care (DTOC)
- effective – dementia, mortality, readmission reduction
- safe – harm-free care, incident management, IPC, VTE, pressure ulcers
- caring – Friends and Family Test, complaints, mixed-sex breaches, end-of- life care
- well-led – workforce, training and development, leadership.
- For further information on CQC’s strategy in operational delivery: Shaping the future
CQC’s strategy for 2016 to 2021
Improving flow through the emergency care pathway
Measures the matron may consider introducing locally to improve flow through the emergency care pathway are:
- Red to Green (Rapid Improvement Guide to: Red and Green Bed Days, Red2Green campaign)
- identifying and managing frailty at the front door and virtual wards (Principle 3: Establish systems and processes for frail people)
- senior multidisciplinary board rounds for daily dashboard review and monitoring
- using a rapid assessment treatment centre at the weekends
- using ‘Healthcare at Home’ to take patients out of hospital
- learning from other organisations by buddying with them
- embedding criteria-led discharge as part of discharge planning and implementing a discharge facility
- reducing DTOCs
- seamless referral processing and streaming
- stranded patients’ protocol and seven-day working.
Leading services to improve the care pathway is a key component of ensuring care quality – the central point of the matron’s role. Designated professionals should
take the lead on operational patient flow, which will free the matron’s time to focus on care quality. Matrons should contribute to bed, ward, department and service reconfiguration, while taking into consideration demand and capacity throughout the care pathway. This will have an impact on how staff are used across the organisation and benefit quality and safety, reducing the likelihood of incidents through effective safeguarding processes.
Finance, budget and business planning
Sound knowledge and experience in finance, budget and business planning contribute to delivering cost-effective, efficient and high quality care. The matron as a leader in the senior management team should contribute to achieving the financial plan for their area of responsibility. To do this, they must understand the financial position and meet the forecast plan for departmental and service budgets, including the overall nursing budget.
The matron should seek support from the finance team regarding commissioning of services, activity payments and performance, cost improvement programmes (CIP) and Quality, Innovation, Productivity and Prevention (QIPP) programmes. This includes assessing the impact of cost control measures on the trust’s quality and safety of care by liaising with the senior management team.
To contribute to meeting finance and activity targets, matrons should keep a schedule of expected monthly deliverables – for example, budget due dates and report deadlines – and they should know where to acquire reports and data. This includes delivering CQUIN schemes and RTT activity and reviewing workforce establishment costing as part of operational performance.
The matron’s role in finance, budgeting, strategy and business planning includes working with the senior management team to write service development and management programmes and business cases. In this way, the matron contributes to strategic and team development regarding projects in the local healthcare system.
Matrons should seek guidance on using the financial dashboard and introductory training on financial management from the internal finance team. Other guidance on financial delivery is available from NHS England and NHS Improvement.