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

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When we look at the negatives we have to look at the culture. We are too shy about celebrating the good. A member of this group described their work in learning disability as “second to none” but that they don‟t get enough compliments A table included patient representatives from the LINKS. They talked about models of partnership and their visits to care homes which worked very well, was well received, and had a great outcome. The Information was used by the NHS Derby County. They talked about the need for witnesses and to be reactive. They hold coffee mornings where people can talk freely. Delegates were story-telling and talked of the need not to understate the good things, and that we need a platform for raised expectations. In the mental health field, professionals can visit groups go to where the patients are and try to understand the real issues. Conversation 2: When and how are we letting our patients down? Conversation 3: What is needed and how will we know we are delivering good quality care consistently? Examples of conversations summarised together It was thought to be critical that in care we have an open, no blame culture, maintain open attitudes however some delegates can we even to this today? Some people thought yes but others thought no. One person was very concerned and said its different when you have to answer to everybody, when you do speak you have to be corporate. The problems are similar in every area and we “need the truth of the matter”. It was thought that not enough nurses was considered „an old chestnut‟ and that culture „shouldn‟t be mentioned‟. Time was considered to be a key issue in terms of providing high quality care but again, it was a big taboo. The new language of lean was perceived to be useful, but it was recognised that there are not enough bodies, especially with the impact of the aging population, in order to provide good quality care. Recognition of the need for proper discussion was stated, but this was deemed impossible because of QIPP, economics and politics and the fear of reprisal. Moreover, whilst the need to look at the basics was recognised, there was little certainty about what is needed, what opportunities could be taken, and how could the focus be shifted. The problem of mental health and accountability issues in acute settings was highlighted. People 20
often do not take responsibility and need to acknowledge the limitations and clear up misunderstandings between different areas. It was highlighted that we need evidence to show that things are not in place. There is lack of ownership; we need to explore what prompts good care, and put time-frames on care as it can go on for too long. We should sharpen up our thinking, and avoid silos but also consider the impact on the patient at the same time. However, does sharpening up thinking „kill‟ the Darzi principles? What can we do from a service user perspective to make their lives less stressful? One suggestion was to try to avoid admission in the first place, promote best practice in the community. It was considered that we need people that understand both systems and use to care pathways that translate into people‟s everyday thinking. One key area that should be looked at was thought to be admission and discharge, and there was potential here to change the processes to improve care. Discharge planning needs to start even before patients go in to hospital, for example, start thinking about pain relief and so on, however this requires a huge amount of communication, a culture shift and to think proactively. Think about long term chronic conditions, the transferability of an approach, the key principles should be the same. Learn from patients who talk about the reality of their discharge with personal budgets. People should be named in discharge packages so they can be identified if needed. We let people down by asking repeated questions, there has got to be a better way than tick boxes; one person said “I blame the managers”. 21
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 and 16: Report of the Day’s proceedings T
Page 17 and 18: 11. Variable quality of monitoring/
Page 19: 2. Delegate: Are things worse? DEF:
Page 23 and 24: Delegates from learning disability
Page 25: About CLAHRC-NDL The Collaboration

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