Continuing QA improvements in the eye of the storm

Case study summary

Key learnings from University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT):

  • Developing a COVID-19 assurance tool provided a supportive and compassionate approach to quality.
  • This was a successful approach to keeping colleagues and patients safe throughout the pandemic.
  • Continuing face-to-face support in collaboration with infection prevention teams, and health and safety teams was welcomed by colleagues.
  • Collective and inclusive leadership aligned with continuous quality improvement, provided innovative ways of working.

Background to learning

In 2015, the Quality Assurance Framework (QAF) at UHMBT was designed to provide an evidence-based measure of quality and effectiveness of care; and to identify practice that worked well and where further improvements were required.  The QAF also connected with UHMBT’s Quality Improvement Strategy 2019-2022 and Behavioural Standards Framework, which informs the trust with measures aligned to patient and staff satisfaction. The QAF centres on the delivery of high quality and safe care, inclusion and diversity and provides the trust with internal and external assurance.

At the beginning of 2020, UHMBT made plans to review its QAF. This work became ever more important in order to support staff and patients through the challenges of the COVID-19 pandemic, while continuing to maintain high-quality and safe standards, provide assurance of patient safety and comply with quality standards. For that reason, since March 2020, UHMBT developed changes in the delivery of Quality Assurance Accreditation Scheme (QAAS).

Learning and advice to be shared

In response to the complexities during the pandemic, a QAAS COVID-19 assessment tool evolved; this was co-designed by the Quality Assurance Matron, Quality and Service Improvement team, UHMB Infection Prevention team, and Health and Safety team.

Redesigning the assessment tool allowed the Trust to listen to and provide staff with the right tools as well as incorporating national guidance, legislation standards, and trust policy and procedures. This ensured infection prevention measures were standardised in all areas of practice and provided an electronic assurance tool and action plan. It was important that staff were provided with tools that were easy to use, allowing for more time to be spent with patients.

The tools progressed through several Quality Improvement Plan-Do-Study-Act (PDSA) cycles and were condensed to generate a set of questions that met national regulatory guidance. Similarly, this process assured those in a clinical setting that the tools were capable of rapidly responding to evolving information around COVID-19 and its variants.

The tools were devised with a focus on compliance, such as basic checks; this included fridge checks, controlled drugs checks, and resuscitation trolley checks. Infection prevention measures were also implemented to ensure a standard that aligned with the ‘Infection prevention and control board

assurance framework’ and ensured consistent, safe practice was observed. This new element of risk assessment further promoted understanding of regulatory compliance and impact on practice. For example, the correct signage in clinical and non-patient facing areas, trust-wide track and trace documentation, social distancing measures in staff areas and the use of appropriate use of PPE.

Would it be beneficial to retain these changes?

The new COVID–19 tool for assurance enabled an adaptive, outward way of thinking and working. Teamwork and the use of digital tools has supported the Quality Assurance team and staff to deliver high quality care throughout the pandemic and supported different ways of working across ward settings and care groups.

Continuing with quality visits gave assurance to the frontline and those at board level that quality care was continuing to be delivered, and that colleagues remained safe and supported in its delivery. UHMBT felt enormous pride in the determination of all staff, who strived to improve quality standards and safety throughout these challenging times.

The collaborative working and collective leadership demonstrated by staff, along with efforts to build on networks and relationships, resulted in positive feedback from both patients and staff alike. This positive change was apparent from the inspections where the inspectors, using the new tools, observed compassionate care and indicated in preliminary feedback that the tools support a well-led, quality improvement strategy. Due to the design of the tools, wards that required improvements benefited from focussed support and on subsequent visits demonstrated sustained progression.

Visible leadership, inclusion and support was invaluable to colleagues and staff throughout the pandemic. Colleagues see the value of continuing in this inclusive way of working to support the challenges ahead.

This case study is by Laura Neal, Associate Chief Nurse and Sally Young, Quality Matron, University Hospitals of Morecambe Bay NHS Foundation Trust. To find out more email, england.1professionalvoice@nhs.net