Thursday, 23 February 2017

Our journey to excellence

This week we announced our annual Nurse & Midwife of the Year Awards, to celebrate and recognise NUH’s nurses and midwives who make up nearly 50% of our Trust workforce.

I’m delighted to report that today (23 February) marks a significant milestone: the official announcement of our intention to apply for Magnet Accreditation. Magnet is an American recognition programme® that ‘recognises care organisations for quality patient care, nursing excellence and innovations in professional nursing practice’.

Our goal is for Nottingham’s hospitals to become the first in the UK to achieve this accreditation. It will be a long, yet worthwhile process, with our journey to excellence anticipated to take approximately two years to gather the necessary evidence to support our application. It will require participation and input from all areas of our organisation and will develop our nursing and midwifery colleagues and us as a Trust.

On this Journey to Excellence® we will be able to celebrate the areas of work where we are excelling, such as Shared Governance, but we will also be able to reflect on areas we want and need to improve. The journey will underpin our nursing and midwifery strategy, helping us to make improvements that will further enhance experience for our patients and staff, building on the solid foundations that have been laid in recent years.

Under the leadership of Mandie Sunderland, our Chief Nurse, we want Nottingham’s hospitals to be known for delivering world-class nursing and midwifery care to patients.

We are only able to embark on this journey thanks to our colleagues from Nottingham Hospitals Charity, who are kindly supporting us to take this application forward. Nottingham Hospitals Charity has been committed to supporting world class care for Nottingham for over 10 years, contributing over £30million of charitable investment in our local healthcare community over this time.

Our Magnet journey truly is a partnership effort – between TeamNUH, the Nottingham Hospitals Charity, our patients, and the public – and one from which we will all benefit.

CQC’s constructive criticism supporting our continuous improvement

We learn from and welcome every external inspection of our hospitals; using the constructive criticism and helpful observations from inspectors to inform further improvements to our services. And this is exactly our approach to the Care Quality Commission (CQC) Report published today following an inspection of urgent and emergency care services at QMC in December last year.

Inspections are always a test of how well we know our organisation and the issues facing our frontline staff, and can very often bring a different perspective and ‘take’ on the challenges our teams face and potential solutions to unblocking them.

It is refreshing to know that, notwithstanding all our challenges with capacity, flow and environmental constraints (with an Emergency Department that was built for 350 patients a day now seeing in excess of 550 patients daily), NUH has been rated ‘Good’ in the ‘Caring’, ‘Well-led’ and ‘Effective’ domains. Inspectors observed staff caring for patients with “compassion, patience and kindness.”

We were rated ‘Requires improvement’ for ‘Safe’ and ‘Responsiveness’, and ‘Requires improvement’ overall for Urgent and Emergency Care services. And while significant numbers of patients continue to face extended waits in our Emergency Department, I don’t think any of us would disagree with that assessment.  Reassuringly, there were no surprises for us in what the inspectors found. We are using their feedback to accelerate recent improvements in our 4 hour performance so that our patients and their families and indeed our staff get a better experience in our care.

The CQC’s feedback is helping us to build on the work we are doing in collaboration with the Emergency Care Improvement Programme (ECIP), who are supporting Nottinghamshire health and social care organisations to deliver the necessary system-wide changes that will further improve 4 hour performance.

There are signs of green shoots. Our 4 hour performance is improving; but there is some way to go. We know we have work to do to improve the consistency of our internal systems and processes and are giving this relentless focus. Our pre-noon discharge rates are improving (we hit a record of 33% vs our 35% target early February). We have rolled-out red and green days across 66 of our 90 wards; a red day being when nothing positive happens to contribute to reducing a patients’ length of stay and ‘green’ a day that gets them closer to being medically safe and going home or their next place of care.  We are using new technology to manage our bed capacity in real-time. We recently launched a new video to remind our staff that flow is everyone’s responsibility, reinforcing the message that patients’ time is precious. View this video here.

More specifically addressing the CQC’s observations, we have enhanced our streaming service so that more patients with less serious injuries/illnesses are treated by primary care clinicians working on-site. Emergency nurse practitioners now work at the front door and stream the most unwell patients as a priority.  We have introduced named nurses to ensure timely observations of patients waiting for beds and treatments in the main ED.

The A&E Delivery Board (chaired by NUH’s Chief Executive Peter Homa and attended by Nottinghamshire health and social care system leaders) is overseeing the system changes that are required to further improve performance against the national emergency access standard and thereby patient and staff experience.

You can access the full CQC Inspection Report here.

Tuesday, 21 February 2017

Silence is golden

Noise and disruption on our wards can have a detrimental effect on patients’ rest and recovery.

The World Health Organisation recommends that noise on wards should not be above 35 decibels; the equivalent of a loud whisper.

Understandably, there are times when noise levels on our busy wards exceeds these levels and for very legitimate reasons, not least staff going about their duties to deliver the best possible patient care and during visiting times, when friends and families come to see their loved ones.

Latest figures show that 29% of patients say they are disturbed by noise at night from other patients and 13% of patients are bothered by noise at night from staff. We are not meeting the targets we have set ourselves. 

We have more work to do, even after taking some steps to reduce unnecessary noise through simple activities like putting phones on vibrate, ensuring bins on wards have soft closing lids and that doors are closed slowly and quietly.

So we’ve launched a Trust-wide ‘quieter wards’ campaign to encourage staff, patients and visitors to keep noise to minimal levels on our wards to aid patients’ recuperation.

Reducing noise at night is key to patients having a restful and peaceful night’s sleep. That said, reducing noise during the day is just as important in helping patients’ recovery.

We’re asking patients and visitors to do all they can to play their part. This includes not taking phone calls on wards (wherever possible), speaking quietly and being generally aware of patients who need rest and quite literally peace and quiet when on our wards.

It’s time to nominate your nurse or midwife of the year

It’s time once again to pay tribute to our nursing & midwifery colleagues working across NUH as nominations for our annual Nurse & Midwife of the Year Awards open to the public. I know from first-hand experience that fantastic work goes on at NUH every day. But reading the stories of those who take time to nominate is always humbling. I would encourage everyone to get behind these awards so that our healthcare assistants, nurses and midwives, EU & international staff, exceptional leaders and rising stars of the future get the recognition they deserve. 

We’re delighted to be working with the Nottingham Post and Nottingham Express Transit (NET) for the fourth consecutive year and for the first year we welcome sponsors for individual awards.

We have seven categories – including student nurse of the year, healthcare assistant of the year and international nurse/midwife of the year. In the year we mark the 40th anniversary of QMC, we have introduced a special award to recognise a long-serving nurse or midwife who has made an exceptional contribution to patient care across the Trust over many decades.  

For further information and details of how to nominate you can visit our website here. Nominations close on 19 March. A shortlist of nominations will be decided by a panel of judges chaired by our Chief Nurse, Mandie Sunderland. Staff, patients and the public will then be able to vote for their winner in each category. The winners will be announced at a special award ceremony on 18  May at the Nottingham Conference Centre. The overall winner will go on to have their name on a Nottingham tram for a year, following in the footsteps of previous winners Aprille Jones, Kim Helm and Julie Poulter.

Please watch out for news and updates on our website and via social media -   #NAMY2017  @nottmhospitals and

Thursday, 9 February 2017

Flow is everyone’s responsibility

It’s fair to say January has been a month of two halves. We had an incredibly challenging first 10 days of the month when our services were under the most intense pressure after the holiday period. In the second half of the month pressures have eased, with patients receiving more timely care and fewer delays for beds. I am pleased to report there are green shoots, with NUH’s performance against the national four hour emergency access standard improving. Our job now, and our determination, is to continue this progress to ensure our patients consistently receive the timely care they expect and deserve in our care.

Patient flow is everyone’s responsibility - from front line staff in our Emergency Department (ED) to pharmacists who are preparing take home drugs and cleaners who are preparing beds for the next patient. Good flow through our ED to our wards and out of our hospital requires a whole hospital and indeed a whole system response. Every minute counts in a Trust the size of ours; the cumulative benefit of making small changes, or bringing forward decision-making by just 10 minutes across 90 wards, is significant when it comes to reducing discharge delays for our patients, making beds available earlier and thereby improving the timeliness of emergency patient care.

We want to make sure that every member of team NUH knows they can contribute to good flow – and have produced a new video (featuring NUH colleagues and patients) to get this message across. The video covers topics that I have discussed previously such as our
red and green days, where a ‘red day’ is when nothing happens to positively contribute to minimising a patients’ length of stay with us and ‘green’ a day that gets them closer to being medically safe and going home or to a more appropriate place of care. It also includes some of the new technology we are using across our hospitals to manage our bed capacity in real-time, including Nervecentre. 

The video includes insights from staff on what causes blockages and actions we can each take to help make it a ‘green day’. Patients’ time is precious. It is the most important currency in healthcare. Minutes and hours count.  View the video here.

Thursday, 12 January 2017

New year, new opportunities

We’ve welcomed in the new year with interviews for an exciting new role for our aspiring nurses. NUH is one of 11 test sites in England to be piloting the Trainee Nursing Associate role, which will complement the care provided by our fully-qualified registered nurses and care support workers. These new recruits will deliver hands-on care for patients whilst undergoing a two year programme of study.

This a fantastic opportunity for our healthcare assistants to progress into a new nursing role, allowing us to retain their knowledge but develop them further within the Trust. The trainees will attend the University of Derby one day a week undertaking a foundation degree as part of their course. They will spend the remainder of their time working in clinical practice as a member of the nursing team. At the end of their training they will qualify as a Nursing Associate and will increase from a Band 3 to a Band 4 (subject to the national job description going through job matching).

The Band 4 Nursing Associate role will help to plan, coordinate and deliver care in different settings. It is not a substitute for a registered nurse, but will support the existing teams in primary, secondary and community care.

There are 62 places available across Nottinghamshire and 230 in the East Midlands. Other providers in Nottinghamshire include Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham CityCare, Social Care and Primary Care.

I’m proud that our nursing colleagues are taking the lead on the pilot for the East Midlands. Mandie Sunderland, our Chief Nurse, is the regional lead, Sue Haines, Assistant Director of Nursing and Rachel Tennyson, Nurse Lead for Healthcare Assistants and Wider Workforce careers, are co-ordinating the implementation and evaluation of the role for NUH. As part of this we will work closely and collaboratively with colleagues across Nottinghamshire and the East Midlands to ensure consistency in how the role is delivered and developed.

Interviews took place last week and the candidates were all of an exceptional standard. For all those who applied and weren’t successful, thank you for putting yourself forwards and there will be more opportunities in the future, I am sure.  To the 20 new trainees who will start their exciting journey at the end of January, I would like to extend my warmest congratulations, and wish you every success in the development of your future career.  I look forward to hearing all about your experiences over the next two years.

Tuesday, 10 January 2017

Preventing Flu starts with you

You might think getting the flu jab in January is too late to help fight the virus. However, each year the flu season starts in October and finishes around April, and in 2016, the peak of the flu season hit us at the beginning of March. There are signs last week and this that the 2017 flu season is now starting to bite at NUH.

Did you also know that, as a healthy, symptom-free individual you can pass on the flu virus to critically ill patients? Flu is a devastating illness that can lead to death in what may have been a healthy individual, and as healthcare professionals it is our duty to make sure we take the appropriate steps to protect our patients.

Just 57.4% of NUH staff have had their jab (versus our 75% target). Our peer trusts are doing better. And while it’s by no means the most important issue, it’s worth noting that NUH will lose significant income (over £1million) if we do not achieve the 75% target.

It’s now our last chance to try to keep everyone safe from contracting the virus and adding to our present pressures. I am encouraging those who haven’t yet had their jab to do so. I’ve had mine. It was quick, easy and painless!

Over the next three weeks roaming clinics are being offered by Occupational Health. Workplace vaccinators will come to your ward if you and your team would prefer. You can call them on x55957 to arrange a group session for your ward (consider inviting multi-disciplinary colleagues to join you). Names and numbers of your local vaccinator are available on the intranet. There is no shortage of options. If you’ve already have had your jab at your GP or pharmacy, please let your manager know so that this can be recorded and accounted for.

My final plea: There is still time to be vaccinated. This is about keeping your patients, your family, your colleagues and yourself safe. Please be vaccinated, and remind your teams.