Welsh Ambulance Services NHS Trust Quality Improvement Strategy 2015 - 2018 Quest for Quality Improvement Staying Healthy Safe Care Effective Care Timely Care Individual Care Staff and Resources Welsh Ambulance Service NHS Trust Staying Healthy Safe Care Effective Care Dignified Care Timely Care Individual Care Staff and Resources Person Centred Care Consultation Document September 2015
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Welsh Ambulance Services NHS Trust Quality Improvement ... · Welcome to our quality improvement strategy 2015/18 consultation document. This is the Trust‟sfirst quality improvement
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Outcome: Our service users have timely access to services
and we will care for those with the greatest health need first.
Our service users are actively involved in decisions about
their care .
Timely access to clinical care based on clinical need is key to the delivery
of a quality service. To ensure we respond rapidly to service users with
time critical conditions we need to review the appropriateness of our whole
clinical model and implement changes accordingly.
Service users of our Non-Emergency Patient Transport Services need to
shape the service to ensure an effective, efficient service with a positive
experience is provided.
How will we know we are making progress?
We will continue to monitor our response times 24/7.
Response times and patient outcomes are formally reported in our
Integrated Performance Report on a monthly basis and we will see
incremental improvements in timeliness and outcomes
Outputs of the evaluation work undertaken in relation to the new Clinical
Response Model
We will develop a quarterly quality report to monitor our plans and quality
indicators focusing on outcomes in addition to targets and timescales.
• Transforming our Clinical Response Model to ensure our
service users have timely access to services based on the greatest
health need first, in line with the 5 Step Clinical Response Model
• Transforming our Non-Emergency Patient Transport Services Care,
listening to patients to determine what changes are needed
• Commission „deep dives‟ into quality of care issues and use peer
review as appropriate to provide assurances regarding our
services.
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Step 1 –Help me to
Choose
Step 2 –Answer my
Call
Step 3 –Come to See
Me
Step 4 –Give me
Treatment
Step 5-Take me to
Hospital
Individual Care
What do we want to achieve?
Why is this important?
Outcome: Our service users are treated as individuals with
their own needs and responsibilities and we will work in
co-production with service users, partners and stakeholders.
We want people to experience personal care. Information provision
will be tailored to the individual. We will see the person and not
just the reported condition.
Engaging with patients on an equal basis and ensures the service
fits the needs of patients in line with Prudent Healthcare.
People will be treated with dignity, their privacy will be maintained,
they will be respected.
How will we know we are making progress?
We will develop and monitor the implementation our Community
Engagement Strategy
We will achieve Bevan Advocate status by August 2016 and
Exemplar Status by August 2018.
Experience reporting will demonstrate positive outcomes and
individual experiences of using Trust services
Higher levels of patient engagement and experience
measures as part of the delivery of care.
• Continued work in line with the National Service User Framework
• Closer working between the Partners in Healthcare Team (PIH) &
Putting Things Right (PTR) team to enhance organisational
learning capability
• Implementation of the Bevan Commission Framework & identify
advocates across communities to influence the Trusts services and
plans.
• Build on capturing „real time‟ reporting working with partners including
transformation programmes, projects and plans.
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Our Staff & Resources
What do we want to achieve?
Why is this important?
Outcome: People in Wales can find out information about how
our services are resourced and make careful use of them
Staff education, training and development underpins our strategic plans,
alongside workforce planning which focuses on having the right staff with
the right skills at the right time.
Our staff are our greatest resource and engaging, supporting and
developing them is crucial to quality improvement and sustainable
change.
How will we know we are making progress?
We will log and monitor all quality improvement projects and
review the effectiveness and opportunities for wider implementation
Staff development and personal appraisal development reviews will
be monitored through our Finance and Resources Committee and
engagement with the Partnership Team / Trade Unions
We will have programmes in place to obtain staff feedback to
continually inform this strategy
We will develop a quality report to monitor our plans via quality
indicators/measures which will be available publically.
• Our staff will be equipped with tools to improve quality through the
continued implementation of Improving Quality Together (IQT) training
• Development of a senior management quality improvement team
equipped with Silver IQT training
• Continued staff engagement programmes
• All staff have personal appraisal development reviews
• The study leave policy / process is embedded
• Continued delivery of the leadership development programmes.
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Service user experience
& our Partners in Healthcare
Team
The work undertaken by the Partners in Healthcare team (PIH) is of significant
benefit as it proactively seeks out what people think of our service. Its work
supports the Trusts quality, clinical excellence and patient safety agendas. As
well as engaging with and sharing messages with the general public, active
engagement with a variety of different groups, organisations and communities is
undertaken.
Through the Equality Act, our engagement work will include those who belong to
the following protected characteristic groups:
Age;
Disability;
Marriage or civil partnership (only in respect of eliminating unlawful
discrimination);
Pregnancy and maternity;
Race;
Religion or belief;
Sex;
Sexual orientation and;
Gender identity and
gender reassignment.
Other groups include:
3rd sector;
Voluntary sector
Health Boards and Trusts;
Local authorities;
Community Health Councils;
Patient groups;
Carers and;
Homeless. (This list is not exhaustive)
Our vision is to capture and enhance service user experience through the following:
Giving service users a greater voice in driving quality
Enabling communities to become involved in the planning, design and delivery
of services
Involve and engage with people learning from their experiences and opinions
Improve patient experience and outcomes
Improve people‟s health and well-being through local partnership working
Provide evidence on the influence our work and people‟s views have had on
decisions and developments within the service
Foster increased understanding, confidence and trust with the public around
sound principles and good practice demonstrated within the service
Be transparent, open and honest about our work
Measure our work using patient reported data.
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Embedding Bevan Commission
Advocates
To enable services users to further
influence the organisation design &
delivery by providing suggestions &
feedback we will identify patient
groups & communities to work with.
Listening & learning
Listening to patients and learning from their experiences has been an
important part of our work. Experiences of patients have been captured in
various ways for example:
Compliments
Complaints
Adverse incidents;
Experience questionnaires and feedback;
Patients have also shared their own personal stories at our Trust Board and
committee meetings. Listening to patient‟s voices is driving our model of
delivering improved patient centred services.
We have built a strong foundation in our Service-user Experience
Network that offers a menu of activities and opportunities for people
to get involved in influencing the future direction of the service.
The National Principles for Public Engagement in Wales were launched by Participation
Cymru in March 2011. The principles, which we have fully signed up to, offer all Public
Service organisations a consistent approach and best practice guidance for undertaking
public engagement activities across Wales.
As part of our engagement activities we include and promote public health messages in
line with „Our Healthy Futures‟ and the „Annual Quality Framework‟.
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Improving quality together
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Quality is everyone‟s business and requires collaboration at every level across the NHS in
Wales. The 1000 Lives Improvement Service (Part of Public Health Wales), health boards
and NHS trusts in Wales have agreed a set of national priorities for improvement in their
integrated plans:
Improving patient flow
Reducing inequalities (long-term condition management and end-of-life care)
Improving Quality Together – Model for Improvement.
Quality improvement draws on a number of approaches and tools and fundamentally
means reducing or removing waste and variation in the system. This includes reducing
delays and waiting times and ensuring care is equitable across Wales. In order to
implement sustainable quality improvements firm foundations must be in place including
good governance with robust reporting systems and a culture of openness and
transparency.
The Trust has adopted the Model for
Improvement and is working with
colleagues in 1000 Lives Improvement
Service to implement a senior quality
improvement team with Silver Improving
Quality Together accreditation.
Additionally, the Trust is committed to
participating in 1000 Lives + projects
nationally. We will develop quality
indicators / measures that inform both
our processes, providing firm
foundations for our services and
outcome indicators / measures to
ensure we are delivering and improving
the quality of our care.
Process measure
Q u e s t f o r Q u a l i t yI m p r o v e m e n t
Outcome measure
Making it happen:
Delivering the Strategy
Quality Improvement Strategy
sets out our quality objectives
and commitment to quality
improvement
Risk Management Strategy
focuses on managing the risk
associated with providing our
services
Assurance
providing confidence the
organisation is delivering the
objectives
Quality led organisation with foundations for delivering quality
Together they put quality at the heart of the Board’s work
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Our Quality Delivery Plan & Assurance FrameworkProviding assurances to the public and Trust Board is a fundamental element of this
strategy and to deliver this we have developed a supporting delivery plan for 2015-2017
(Appendix 2) and an assurance framework (Appendix 3) which will be monitored at the
Quality, Experience and Safety Committee (QuESt) on a bi monthly basis. Following
each meeting of QuESt an update will be provided by the chair to the Trust Board.
The Board of Directors have overall
accountability for the quality of services
provided by the organisation. The
Quality, Experience and Safety
Committee (QuESt) as a sub-
committee of the Trust Board has
delegated responsibility for all matters
relating to the quality of care we
provide.
QuESt has a number of sub groups
supporting our quality agenda and
these are detailed in our quality
governance committee structure in
Appendix 6 (under review).
W e w i l l f e e d b a c k o u r p r o g r e s s t h r o u g h o u r
A n n u a l Q u a l i t y S t a t e m e n t a n d p u b l i c m e e t i n g s
Quality GovernanceQuality governance is the combination of
structures and processes at and below board
level to lead on trust-wide quality performance
which includes:
Ensuring required standards are achieved;
Investigating and taking action on sub-
standard performance;
Planning and driving continuous
improvement;
Identifying, sharing and ensuring delivery of
best practice; and
Identifying and managing risks to quality of
care.
Openness/ Transparency/
Candour
What will success look like?
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What will success look like?
1 We will be a quality led organisation adopting the principles of Prudent
Healthcare.
2 We will have effective leaders and our staff will be developed and supported to
deliver high quality care, in a high performing organisation that staff are proud to
be part of and feel valued.
3 We will have made demonstrable improvements for our service users across
all of our services, with sustainable quality improvements aligned to key
performance indicators , measures and targets supported by our research &
innovation work.
4 There will be clear lines of reporting and escalation routes with the Board
receiving the right quality assured information, in a timely manner in a format that
allows the Board and Executive Team to make informed decisions about the
quality of the services we provide.
5 We will have good governance and risk management foundations in place
which provide confidence in our systems to support decision making, planning
and quality delivery.
6 Staff will be engaged and will shape our priorities and know why they are
important. We will continue to work in partnership, fostering productive
relationships.
7 Quality indicators at station, contact centre and health board level will be
developed by staff locally, relevant to the local population / service needs.
8 Service users, our communities, partners and stakeholders will be engaged in
shaping in our goals and priorities on a continual basis.
9 Our commissioners and other stakeholders will have confidence in our services
and we will be striving to drive quality improvement through the commissioning
process.
10 We will be a credible „Go to’ organisation.
We have identified 10 overall themes in relation to what success will look like and
more detailed outcomes are included within the individual Quality Themes included
from page 10.
Q u e s t f o r Q u a l i t y 2 7I m p r o v e m e n t
Key references
National key documents
Andrews & Butler (2014) Trusted to Care. Dementia Services Development Centre &
The People Organisation.
Department of Health (2014) Hard Truths. London.
Monitor (2010) Quality Governance. London.
National Quality Board (2012) How to: Quality Impact Assess Provider Cost
Improvement Plans. London: NQB.
Public Health Wales (2014) Achieving Prudent Healthcare in NHS Wales. Wales:
Public Health Wales.
The Mid Staffordshire NHS Foundation Trust Public Inquiry (2013) Report of the Mid
Staffordshire NHS Foundation Trust Public Inquiry. London: TSO. (The Francis
Report)
Welsh Assembly Government (2015) Health & Care Standards Wales: WG
Welsh Government (2011) Together for Health. Wales: WG.
Welsh Government (2012) The Quality Delivery Plan for the NHS in Wales. Wales:
WG.
Welsh Government (2013) Delivering Safe Care, Compassionate Care. Wales: WG.
Welsh Government (2014) The Good Governance Guide for NHS Wales Boards.
Wales: WG.
Welsh Government (2015) Green Paper Our Health Our Health Services. Wales: WG
Welsh Government (2012) The Quality Delivery Plan for the NHS in Wales. Wales:
WG.
Welsh Government (2014) NHS Wales Planning Framework 2015/16. Wales: WG
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Openness/ Transparency/
Candour
Accurate, useful and
relevant information
Appendix 1 - Developing and
reviewing our Quality
Improvement Strategy
Plan
Agreeing our vision and strategy
Service users
Staff
Commissioners
Welsh Government
NHS WalesPlanning
Framework
Stakeholders
Design
Develop delivery plans
Milestones & timescales
Measures, performance indicators &
targets
Accountability
Test
Against strategy –
milestones & performance
Risks
Priorities
Regulation
Planning Framework
Review
Board
QuESt
Quality Governance
Organisational buy-in
External stakeholders
Communicate
Service users
Staff
Commissioners
Welsh Government
Stakeholders
Clear vision
purpose &
priorities
High quality
information
Integrated
planning
tools
Relevant skills
/ experience
Assurance
/ realismAppropriate
challenge
Underpinned by:
This strategy is about
shaping the future of the
quality of our services.
This means adopting a
continual cycle of learning
lessons and adapting to
new opportunities with
strong engagement from
service users, staff and
stakeholders.
Quality
Improvement
Strategy
2015/18
Understanding
our current
position
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Delivery Plan 2015-2017 Template
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Governance, Leadership & AccountabilitySource: Internal governance reviews, Standards for Health internal assessment (2014/15) and internal & external audits.Outcome: The right quality assured information is reported in a timely manner in a format that allows the Board and Executive Team to make informed decisions about the quality of the services we provide
Improvement Year 1 2015/16
Mile
sto
nes
& T
imes
cale
s Year 2 2016/17
Mile
sto
nes
& T
imes
cale
s Measures & Reporting
Mechanism
Executive Lead & Nominated Lead
Baseline
Measures / KPIs /Targets
Appendix 2
Delivery plan template
Quality Improvement Assurance Framework
2015 – 2017 Template
Description / Outcome Aggregate position Historical Variation
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Appendix 3 – Assurance
framework template
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Appendix 4
Quality Impact Assessments
Appendix 5
Organisational chart
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Appendix 6
Quality Governance
organisational chart
Organisational chart once agreed with QuESt sub groups / panels.
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Appendix 7
Integrated Medium Term
Plan – Key priorities 2015/16
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Number Priority
1 Developing a community engagement strategy and implementation plan to
enable us to interact with all relevant stakeholders and promote community
ownership of the service.
2 Agreeing, embedding and sustaining new clinical models in EMS, NEPTS
and the transition from NHSDW, establishing the role of the Trust as a
healthcare provider and clinical service rather than simply a transport service.
3 Developing plans that localise the delivery of the IMTP (LDPs) minimising
demand on the Ambulance Service, promoting choice for patients and
improving the quality of patient outcome.
4 Developing and implementing a Quality Improvement Strategy that
promotes better service user/patient experience and outcomes and forms the
backbone of the transformation agenda.
5 Developing an integrated service, workforce and financial planning
framework, delivering a balanced financial and workforce plan for 2015/16
that ensures safe and affordable establishments and demonstrates value for
money and secures ongoing financial stability.
6 Developing a robust performance management framework that
demonstrates accountability and transparency, meets the needs of the Trust
and Commissioners and is timely and sufficiently detailed for a range of
stakeholders within and outside the Trust.
7 Developing a workforce, OD and improvement transformation
programme that is aligned to delivering the IMTP, and enables the Trust to
achieve its aspiration to become a high performing organisation.
8 Strengthening the infrastructure required to support delivery e.g. governance
framework, estates strategy, health informatics.
Our 2016/17 planning cycle has started and we will be looking to refresh
our priorities.
Contacts
and information
Personal Experiences/StoriesTo share your experiences/stories of using any of the Welsh Ambulance
service you can contact our „Partners in Healthcare Team‟