The Big Conversation about the Quality of Nursing ... - CLAHRC-NDL

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Plenary: Dame Elizabeth Fradd - University of Nottingham Dame Elizabeth Fradd spoke about the issue as one of the need to balance professional and corporate responsibility to provide best practice, to understand the relevance of these care issues to your service and role and the part individuals play in safeguarding and experience. Four areas of concern were highlighted: failure to communicate, pain relief, assistance to the toilet and adequate nutrition and hydration. Dame Elizabeth Fradd argued that there were no surprises in the reports from the Mid Staffordshire and CQC inquiries, and how “we don‟t know what a good service is until we don‟t get it”. The Big Conversation is about putting the jigsaw and hearts and minds together. Culture is the most significant thing that makes a difference in failing to recognise concerns; it is never about one person, it is about systems and processes. Dame Elizabeth Fradd reminded everyone of the NHS survey which shows a clear link between good HR practice and high staff engagement. There is new research based in looking at adverse events in 12 countries and they have been linked to a poor working environment. Everybody has a responsibility; it‟s always bigger than one person. Dame Elizabeth Fradd summarised the common findings in recent reviews of care: General Findings 1. There are many very dedicated staff 2. There are always pockets of good practice (but often not shared) 3. The majority of service users get good care but not all 4. There have been too many reconfigurations and restructures; an eye has been taken off the patient experience 5. Too much emphasis has been placed on targets and the financial position 6. The existence of too many committees clouds the line of decision making 7. The culture of the NHS determines the outcome 8. Insufficient emphasis has been placed on safety and quality. Quality can be hard to report but improving with the introduction of KPI‟s. The „circle‟ has often not been reported after an audit, and there aren‟t enough lessons learnt or shared. Dame Elizabeth Fradd asked people to think about what they can remember from the last audit. 9. There has been insufficient involvement of patients in key decision making/service design/policy, are you feeding the audit back to the patient? Dame Fradd informed delegates of the King‟s College Hospital exemplar 10. There has been inadequate staffing levels and inadequate leadership in some areas of health 16
11. Variable quality of monitoring/audit. There are too many action plans, diluting the focus. 12. Risk management processes are immature, with little understanding of how this gets fed into the framework or what the priorities are. 13. Boards often not aware of the frontline reality. Exemplar: Whipps Cross “In your Shoes” Clinical Findings 1. The Importance of good Clinical leadership. 2. Communication and thresholds for sharing. 3. Team Working- What is it? Who is involved? 4. Issues of training/updating, there is often confusion with supervision. 5. Use of policies, important to use intranet as paper copies can be out of date (St George‟s problem)but how? The way the intranet is navigated is often changed which makes it difficult to locate policies and procedures and other resources. 6. The patient is not seen as an individual; we need to find the person inside the patient, as a family member and a person in the community. 7. “Good service is giving customers a little more than they expect”- it‟s the little things. The White paper “Equity and Excellence- Liberating the NHS” matches closely to what we know about the expectations of patients - compassionate, dignified, respectful and individualised care. Delegates were reminded of the NMC code and accountability and that they must be able to justify the decisions that you make and consider: How do you know? How do you assure yourself? (not ensure or reassure) How can you be certain that you are not immune to poor care? It was noted that people often do become immune to what they see going on. Therefore we must consider responsibility, how certain can nurses be when they delegate and what tools are they using to determine adequate staffing levels. It‟s about raising concerns, incident reporting, whistle-blowing and communicating with professional bodies, but this is very hard to do. Dame Elizabeth Fradd told delegates about the new GMC guidance which will hopefully provide reassurance. It defines management, getting things done through and with people, and the need to create an environment in which people can perform appropriately. Management roles involve teams but all individuals have a duty of care. 17
Page 1 and 2: The Big Conversation Tit about the
Page 3 and 4: About the author Bridget Roe is a d
Page 5 and 6: Acknowledgements The author is grat
Page 7 and 8: Executive Summary Background This m
Page 9 and 10: which were complimented by groups s
Page 11 and 12: someone noted, develop an “NHS Sp
Page 13 and 14: Feedback Around 50% of delegates fi
Page 15: Report of the Day’s proceedings T
Page 19 and 20: 2. Delegate: Are things worse? DEF:
Page 21 and 22: often do not take responsibility an
Page 23 and 24: Delegates from learning disability
Page 25: About CLAHRC-NDL The Collaboration

The Big Conversation about the Quality of Nursing ... - CLAHRC-NDL

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