Measuring quality in healthcare: A Foundation Trust approach · Measuring quality in healthcare: A Foundation Trust approach Chris Fokke Director of Clinical practice/Nursing Bath
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Measuring quality in healthcare: A Foundation Trust approach
Chris Fokke
Director of Clinical practice/Nursing
Bath United Kingdom
The RNHRD
• Specialist Rehabilitation NHS Foundation Trust
– Rheumatology
The RNHRD
• Specialist Rehabilitation NHS Foundation Trust
– Neurological Rehabilitation
The RNHRD
• Specialist Rehabilitation NHS Foundation Trust
– Pain Management
Being an NHS Foundation Trust
• Autonomy
• Entrepreneurial
• De-centralised
• Collective ownership across the teams
• Set own standards and benchmarks
Key components in measuring quality of healthcare
• Committed executive board
• Systemisation of clinical practice
• Solid infrastructure– IT/IS
– Effective communication channels
– Dedicated and skilled middle managers
• Operational staff owning the processes associated with measuring
Vital Aspects of Clinical safety (VACS)
A systems approach to measuring quality
Background/Context
• Unrelated clinical incidents
• Chasing audits and initiatives
• Difficult to quantify quality
• Service manager’s perspective on nursing function
• 5 year development of creating a useful system
What is VACS
• It’s a system, an illustration of how well vital components within a service are working
– Clinical benchmark
– Shows vital knowledge, skills and experience
– Provides information regarding the environment and the tools used within specific areas
What is VACS
• It’s a methodology that:
– Shows quality in quantifiable measurements
– Promotes/ embeds ongoing auditing bottom-up
– Aggregates quality measurements
– Transcribes data into useful information
VACS components
• Domains: Specific to individual areas
• Audit questions: Yes/No specific
• Processes associated with responsibilities/ authorities: Who collects what and feeds back where
• Action plans: Who manages/monitors
• Regular monthly assurances: (board, service, unit, ward, patient specific)
Full process/Nursing pilot
• The data is collected into a spreadsheet which has formulas and findings are represented as figures, percentages and Graphs (Radar Chart)
Audit questions
• Questions are derived from local clinical guidelines, national initiatives, vital knowledge, skills and experience
• Yes/No questions are formulated by expert champions who know the specific unit
• Questions are categorised into domains
– Wound care, Infection Control, Respiration etc.
Questionnaire Example(Domain: Respiration)
Radar Chart: All Scores
0%
20%
40%
60%
80%
100%
Management
Questions, HIU
Respiration for
tracheostomy patients
Difficult behaviour
Environmental hazards
Skin health
Continuity of CareAt risk from treatment
Nourishment & hydration
Homeostasis.
Elimination
Mobility
Data collection
• Junior staff set up structure to assess/ score against domains, (on-line or hard-copy)
• In RNHRD night staff do this (2 hrs per ward per month)
• Data doesn’t need to be collected at once, but it needs to be consistently done
75%Target Performance
76%Overall Performance
SeptMonth
Board Report
73%Vital aspects of care for Rheumatology
72%Management Questions, VP
73%Violet Prince
79%Vital aspects of care for HIU
83%Management Questions, HIU
74%Average patient Questions for HIU
82%CQ
67%Cambridge
74%HDU
Ward Averages.
Benchmarking
• Benchmark standards are agreed
– By the executive directors for Board
– By Lead nurses/Matrons for Unit/ Services
– By Ward managers for ward/area
Action Plans
• Action plans are formulated following benchmarking according to standards i.e. RNHRD VACS standard is 75%
• Agreed flags are in place deviating from the above:– Green: Monitor pressure points
informally
– Amber: Local action plan
– Red: Board report
Roles and responsibilities
Outcomes
• Pro-active- rather than reactive interventions to risks
• Meaningful information regarding complex functions
• Early warning system to ensure patient safety
• Provides operational, tactical and executive decision making platform
The future
• Apply throughout interdisciplinary function
• VACS can be used in any setting that wishes to capture quality
• Package system and systemisation approach as a product
Contact details
Chris Fokke
Director of Clinical Practice/ Nursing
Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
Upper Borough Walls
Bath United Kingdom
Tel: +44 1225 465941
Email: Chris.Fokke@rnhrd.nhs.uk
Web: http://www.rnhrd.nhs.uk
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