BMI The Harbour Hospital Quality Accounts April ... - BMI Healthcare

BMI The Harbour Hospital Quality Accounts
April 2011 to March 2012
Chief Executive’s Statement
Welcome to our Quality Accounts 2012. This is the third set of BMI
Healthcare Quality Accounts and my first as Chief Executive, and I
am pleased to see their development as a really useful tool to assess
how we at BMI are performing against a broad range of quality
criteria. BMI Healthcare focuses on clinical excellence through
quality of service and efficiency. Success in these areas translates
into a consistently good patient experience and the right environment
to enable consultants to provide their best care.
Since they were first introduced three years ago, Quality Accounts
have developed amid significant changes in the national health economy. The passing into law
of the Health and Social Care Act earlier this year heralds more opportunities for BMI
Healthcare to contribute towards increased choice for patients, based on transparent quality
information. We are pleased that the Department of Health and Monitor have recently reiterated
that Quality Accounts are an increasingly important tool for strengthening accountability for
quality within provider organisations.
The recently initiated Competition Commission review of private healthcare is likely to focus on
whether there is a lack of comparable quality data, thus impairing effective decision-making by
patients. BMI Healthcare is committed to producing high quality group and hospital-level data
that allows patients and referring clinicians to compare different facilities and make informed
choices and we are keen that the Hellenic project, which is working across the private
healthcare sector, is able to generate standardised quality measures and indicators for private
providers as soon as possible. Patients and clinicians deserve - and need - access to
standardised information and whilst there are some very useful initiatives, such as that
published by the National Joint Registry, a national scheme to help patients make informed
choices of providers is essential. We will over the coming year therefore be increasing our
financial commitment to Hellenic to play our part in enabling this.
In the last financial year BMI invested almost £44m to improve and extend our clinical services,
improve hospital infrastructure and enable better business processes, as part of a continuing
commitment to improve quality of facilities and services. These include major upgrades in some
of our hospital’s theatre complexes, ongoing upgrades in our MRI and CT scanners and the
start of work to replace our existing patient administration system.
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We believe that all providers of health services should strive to deliver the best quality –
assessed across the domains of patient safety; procedural effectiveness; and patient
experience. It is crucial that patients and clinicians should have easy access to this information
in order to make informed choices about where and how they want to be treated.
I am proud of the progress shown in BMI’s Quality Accounts. The information available has
been reviewed by the Clinical Governance Board and I declare that as far as I am aware the
information contained in these is accurate. I am fully aware of all of the hard work by our staff
that lies behind the improvements reflected in the numbers shown. I pass my thanks to all staff
for their involvement in this.
Stephen Collier, Chief Executive Officer
BMI The Harbour Hospital in Poole,
Dorset is part of BMI Healthcare, Britain's
leading provider of independent healthcare
with a nationwide network of hospitals &
clinics. The Hospital has 37 beds with all
rooms offering the privacy and comfort of
en-suite facilities, broadband, TV and
telephone. The hospital has three theatres,
including an endoscopy suite and high
dependency rooms.
1. Regulatory landscape
BMI Healthcare are registered as a provider with the Care Quality Commission (CQC) under the
Health & Social Care Act 2008. BMI Harbour Hospital is registered as a location for the following
regulated services:-
• Treatment of disease, disorder and injury
• Surgical procedures
• Diagnostic and screening
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The focus is on healthcare outcomes rather than process and the key requirement is to provide
evidence of these and not just to produce the “policy”. The Group Quality & Risk Team
continues to provide guidance and support to ensure compliance with all regulatory standards.
Six-monthly unannounced provider visits to all sites help us to monitor performance and to
address any issues.
The CQC have not had cause to take any enforcement action against Harbour Hospital and the
hospital has not been the subject of any special reviews or investigations. The CQC carried out
an unannounced inspection on 15 th December 2012 and found the hospital to be compliant with
all standards assessed. .
Standards of treating people with respect and involving them in their care
Standards of providing care, treatment & support which meets people's needs
Standards of caring for people safely & protecting them from harm
Standards of staffing
Standards of management
2. Governance
BMI Harbour Hospital has a local framework through which clinical effectiveness, clinical
incidents and clinical quality is monitored and analysed. Where appropriate, action is taken to
continuously improve the quality of care. This is through the work of a multidisciplinary group
and the Medical Advisory Committee.
At corporate level the Clinical Governance Board has an overview and ensures that there is
corporate learning and quality improvement.
There has been ongoing focus on robust reporting of all incidents, near misses and outcomes,
to ensure availability of information for effective clinical governance with implementation of
appropriate actions to prevent recurrences in order to improve quality and safety for patients,
visitors and staff.
There are external reporting requirements for CQC, Health Protection Agency, PCTs and
Insurers. There has also been ongoing progress on the Hellenic project, which is a sector wide
quality indicator reporting project which will provide the opportunity for independent providers to
report as a sector and to benchmark against each other and the NHS in a number of key
indicators of quality. Submission processes have been fine-tuned and the focus now is on
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ensuring consistent quality of the data. We continue to report under the domains of safety,
effectiveness and patient experience
3. Safety
3.1 Infection prevention and control
The focus on infection prevention and control continues under
the leadership of the Group Head of Infection Prevention and
Control, in liaison with the link nurse in BMI Harbour Hospital.
Due to healthcare media coverage of infections, one of the most
frequently asked question from patients is: “How likely is it that I
will get an infection in your hospital?” Two infection rates
published by the Health Protection Agency are those of MRSA
bacteraemias and Clostridium difficile, and with these results we
are able to reassure them that due to effective pre-admission
assessment and the high standard of clinical care delivered
during and after their surgery, the risk is very low.
At BMI Harbour Hospital there have been zero cases of hospital apportioned Clostridium difficile
(20 cases/100,000 bed days in NHS hospitals) over the last year and zero cases of MRSA
bacteraemias since the independent sector began to report to HPA in 2008. This is compared to
1.1 cases/100,000 bed days in NHS hospitals for the period April 2010 to December 2011
(latest data published).
Environmental cleanliness is also an important factor in infection prevention and our patients
rate the cleanliness of our facilities highly.
Care Bundles were introduced in the second half of the reporting period and monitoring results
of audit and monitoring will be reported in next year’s Quality Accounts.
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3.2 Patient Environment Action Team Assessments (PEAT) 2012
PEAT is an annual assessment of inpatient healthcare sites in England that have more than 10
beds. It is a benchmarking tool to ensure improvements are made in the non-clinical aspects of
patient care including environment, food, privacy and dignity.
The assessment results help to highlight areas for improvement and share best practice across
healthcare organisations in England.
BMI Harbour Hospital has improved their scores for Catering but the score for Environment has
decreased and will be the focus for quality improvement over the year.
BMI
Year Environment Food Privacy & Dignity
2012 Acceptable Good Good
2011 Good Acceptable Excellent
3.3 Venous Thrombo-embolism (VTE)
BMI Healthcare, has recently been awarded VTE Exemplar Centre status by the Department of
Health across its whole network of hospitals including, The Harbour Hospital. We see this as an
important initiative to further assure patient safety and care. To deliver the initiative BMI
Healthcare established a National Thrombosis Team, chaired by the Group Chief Pharmacist.
The Team had the responsibility of implementing the Venous Thrombosis Prevention Policy
which was launched alongside a new risk assessment tool, patient information leaflets,
prophylaxis (prevention) protocols, training packages and regular audits to ensure ongoing
compliance. All patients undergo an appropriate VTE risk assessment and decisions are made
on appropriate prophylaxis.
BMI Harbour Hospital reports all VTE and pulmonary embolus (PE) through the corporate
clinical incident reporting system. It is acknowledged that the challenge is receiving information
for patients who may return to their GPs or other hospitals for diagnosis and/or treatment of VTE
post discharge from the Hospital. As such we may not be made aware of them. We continue to
work with our Consultants and referrers in order to ensure that we have as much data as
possible.
BMI Harbour Hospital had and incidence of 0.02% of DVTs per 100 admissions and no reported
PEs in this reporting period.
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4. Effectiveness
4.1 Patient reported Outcomes (PROMS)
Patient Reported Outcome Measures (PROMs) are a means of collecting information on the
effectiveness of care delivered to NHS patients as perceived by the patients themselves.
PROMs is a Department of Health led programme supported by a number of key partner
organisations, including The NHS Information Centre for health and social care. Eligible
procedures are hip and knee replacement, inguinal hernia repair, varicose vein surgery for NHS
patients who consent to participate and complete questionnaires. BMI Harbour Hospital has
participated in the PROMS programme but has not carried out any hip or knee replacements,
varicose vein surgery for NHS patients.
For the current reporting period, the tables below demonstrate that the health gain between
Questionnaire 1 (pre-operative) and Questionnaire 2 (post–operative) for patients undergoing
Inguinal hernia repair is better than the average for England.
2011/2012
Inguinal Hernia repair
Q1 Q2 Health gain (Q2 - Q1 average)
Harbour
Hospital
England
80.429 82.429 2.000
79.699 79.443 -0.256
Copyright © 2011 Re-used with the permission of The Health and Social Care Information Centre. All rights
reserved.'
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4.2 Unplanned Readmissions within 31 days and unplanned returns to theatre.
Unplanned readmissions and unplanned returns to theatre are normally due to a clinical
complication related to the original surgery. BMI Harbour Hospital has had a decrease in the
indicators over the lat year.
.
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5. Patient experience
5.1 Patient satisfaction
BMI Healthcare is committed to providing the highest levels of quality of care to all of our
patients. We continually monitor how we are performing by asking patients to complete a patient
satisfaction questionnaire. Patient satisfaction surveys are administered by an independent third
party. There has been ongoing focus on increasing the response rate to ensure that the analysis
of the data we collect provides us with reliable information on which to base our quality
improvement efforts. BMI Harbour Hospital analyses the monthly reports they receive, and
implements appropriate action to address any issues of disatisfaction or areas which have been
scored lower than others.
A project to improve on excellence has been ongoing over a number of years. The areas of
focus have been based on our patient feedback e.g. admisison and discharge processes,
nursing care and this has resulted in a year on year increase in patient satisfaction scores. The
focus for this year is Housekeeping and Catering.
There has been an increase in scores in all areas of patient satisfaction except for the
admission process and accommodation. This is evidence of the commitment and actions taken
by the hospital to continually improve patients’ experience. Admission and accommodation will
be a focus of quality improvement in the current year.
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5.2 Complaints
In addition to providing all patients with an opportunity to complete a satisfaction survey BMI
Harbour Hospital actively encourages feedback both informally and formally. Patients are
supported through a robust complaints procedure, operated over three stages:
Stage 1: Hospital resolution
Stage 2: Corporate resolution
Stage 3: Patients can refer their complaint to independent adjudication if they are not satisfied
with the outcome at the other 2 stages.
The number of complaints has reduced over the last year. Every complaint is thoroughly
investigated and the patient receives a written response. In addition every effort is made to
address the issues of concern to prevent a recurrence of any similar issues to continuously
improve the quality of care. In the reporting period, no complaints escalated to Stage 2 and all
were resolved at hospital level.
6. National Audit & Guidance
a. NCEPOD
During the Reporting Period, BMI Harbour Hospital participated in two NCEPOD studies. They
submitted a nil return for “Are we there yet”, a review of paediatric surgery as they had not had
any paediatric deaths. The report was published in October 2011 and the recommendations
have been noted.
BMI Harbour Hospital also participated in the Cardiac Arrest Procedures Study and the report is
expected to be published in June 2012.
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. National Clinical Audits
BMI Harbour Hospital was only eligible to participate in National Joint Registry audit and all joint
replacements are submitted to this.
6.3 Research
No NHS patients were recruited to take part in research.
6.4 NICE Guidance
BMI Healthcare has noted the “Patient experience in adult NHS services quality standard”
published in March 2012 and this is being mapped to policies and procedures in place to ensure
that these are being met.
7 Priorities for service development and improvement
Based on what our patients tell us and all of our monitoring activity the Board will be supporting
our focus on the following areas:-
• Ongoing engagement with NHS commissioners to enhance patient choice and service
delivery to NHS patients will be measured by agreed quality indicators
• Further develop and enhance availability of performance and quality indicators for
patients, consultants, referrers and commissioners.
• Audit compliance with Care Bundles” to ensure that these have been effectively
implemented and this will be measured by infection rates.
• Extension of collection of PROMS to include hip and knee replacement for private
patients.
• Patient satisfaction with the admission process and accommodation.
• Improvement in patient satisfaction with nursing and the discharge process.
• Improvements in the management of complaints and responses to patients with roll out
of a corporate tool kit.
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