Tuesday, 25 February 2014

Daniel Mortimer, Director of Workforce and Strategy, on the results of our staff survey

There is much for us all to celebrate in our recent CQC Inspection report and today's staff survey results. There are common themes in each of these reports about how our staff feel about working at NUH, which includes pride and a desire and commitment to doing the best job for our patients.

Today's staff survey results signal we have a strong level of staff engagement, which is a reflection of the work we have done over many years to involve staff in all we do and the decisions we make. This distinctly different way of working involves harvesting the ideas of our staff. It started in earnest in 2009 with the launch of our hospital-wide transformation programme Better for You, and has gone from strength to strength ever since. It is pleasing that the vast majority of our staff feel able to contribute to improvements in their own areas of work which lead to a better experience for our patients and staff.

As with patient surveys, we never look at our staff survey results in isolation. It is important we look at all feedback we receive from our staff throughout the year to get a 360 degree perspective of what our staff truly think of working at NUH. This helps us to celebrate what we do well, and identify where we need to do better based on direct feedback from our staff. To get a broader insight into staff experience at NUH, over the coming months we will be launching the staff version of the 'friends and family' test, asking our colleagues whether they would recommend our hospitals to their friends and family. We ask our inpatients,  Emergency Department and maternity patients the same question to get a view of our patients' experience. Combining  our patient and staff results will be all the more powerful and give us an even greater insight into how we can continue to improve standards of care for those we serve.

We will also be completing an audit of our values and behaviours. This will involve asking our staff and external stakeholders whom we work closely with for their views on how we do when it comes to living the NUH values. This feedback, which will come from holding a mirror up to the organisation, will also help inform our future work to improve our culture, or the way we do things.

What the CQC Report and these staff survey results demonstrate is we are moving in the right direction. We are a continuously improving organisation. We know this from the feedback we receive from or patients and staff and our  year-on-year safety and quality improvements. We have a track record of learning from mistakes and when things don't go to plan. We listen to feedback from our patients, local community and staff. We put things right when we fallen short. Each of these characteristics are hallmarks of the way we do things. It is this culture that we continue to develop year on year, for the benefit of our patients, their loved ones, carers and staff.  

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Thursday, 20 February 2014

Elaine Berry, midwife and infection control matron, on her path into research

I never thought I would end up in research.

I always saw myself as a ‘real’ midwife - being out there with the women. But I kept thinking that it didn’t seem right that there were so many women coming back into hospital with an infected caesarean section (CS) wound.

Like most people on the frontline, it felt as though a lot of the time we were fire-fighting and there wasn’t much time to be proactive. But I took a chance, wrote a proposal and went to talk to the managers about looking into the CS infections. They saw the benefit of doing this and agreed.

Once I started researching this area, I had even more questions than I had started with. And that was where it began. I wanted to be able to answer some of these questions and answer them from the perspective of someone on the frontline who knew the reality of the situation.

I did a four month clinical academic careers internship to see if combining research activity and clinical practice was for me, and I loved the experience.

As I write this, I’m halfway through a Masters in Health Research. I know that everything I’m learning will be used to improve women’s care and experience, and help midwives do the right thing for them. 

A clinical academic career isn’t for everyone. But if you have a passion to investigate and change things that matter in your area of practice and are willing to work for it, this could be the path for you too. 

Tuesday, 11 February 2014

Charmaine Buss, specialist nurse for organ donation at Nottingham University Hospitals NHS Trust

I wish to begin this column by thanking everyone that has supported the Nottingham University Hospitals ‘Be a Hero’ campaign, which launched on January 1 2013.

As I am sure many of you do, I use the end of the year as an opportunity for reflection and celebration of everything that I have done, and consider what I’d like to achieve for the year ahead. The one success that I am immensely proud of in 2013 is the response to the campaign, which asked people to consider whether they would like to help other people after they die through the gift of organ donation.
Back in January, I hoped the programme would be successful, but I did not anticipate how well it would be received.

Between January 1 and December 31, 33 people have saved and transformed the lives of 71 people, and thousands more have signed up to the  NHS Organ Donor Register. I am so pleased for the recipients of these transplants, and hope that they were able to enjoy Christmas with their loved ones without the restrictions that chronic illness may have imposed upon their lives.

However, I also take time to think about the families of the 33 people that gave such an amazing gift and hope they are able to take comfort from knowing what a difference their loved one has made to so many lives.

Despite this amazing success, there are 170 people in the East Midlands awaiting an organ transplant. I wish them well in 2014 and hope that they receive the transplants they so desperately need.

2014 is a special year for NUH as it marks the 40th anniversary of the first organ transplant being carried out here. In that time, more than 1700 people have received a kidney and in 2013, more than 100 such operations were carried out.

We would like this figure to continue to rise and to do that we need more people to tell their loved ones about their organ donation decision and to sign up to the register.

The New Year is a time for happiness and celebrations, and traditionally a time where many people spend time with families, friends and loved ones. Whilst organ donation seems like a difficult subject to talk about, especially perhaps at this time, I do urge people to take this opportunity to talk about your wishes. This discussion now will not be anywhere near as difficult as it would be for your family to have to make the decision themselves should the worst happen. If you believe in organ donation and do not tell your family, there is a real chance that we will not be able to fulfil your wishes, as many families say no to donation when a person’s wish is not known to them.

On behalf of all the donor team in Nottingham, I wish you a happy and healthy New Year.

Thursday, 6 February 2014

Peter Homa, Chief Executive, Inspection report confirms our patients can be proud of their local hospitals.

Our inspection report confirms our patients and the people of Nottingham can be proud of their local hospitals. Our patients can have confidence in the quality of care being delivered at both Queen’s Medical Centre and Nottingham City Hospital.

The Care Quality Commission, the health and social care regulator, has judged that our services are safe, caring, effective, responsive and well-led.

The CQC said they observed many examples of compassionate care during their inspection. They found our staff to be hard working, caring and committed. They said many of our staff spoke with passion about their work and were proud of what they did. Patients are safe in our care.

I feel both proud and privileged to work at NUH with such talented and committed colleagues. Our patients (and the CQC) have praised the care we provide and the healthy, open culture we have developed at our hospitals. Patient safety and the delivery of good quality care are at the centre of all we do. This report shows we’re making good progress. I readily acknowledge that we do not always get things right. Where this happens, we always work hard to put things right and learn from this to avoid the same things happening again.

We were disappointed that CQC judged NUH as ‘high risk’ when they announced the inspection in spring 2013. I appreciate the distress this caused colleagues, patients and relatives and the disappointment of our staff, and we have communicated that to CQC.  The current more considered CQC view is that NUH is not ‘high risk’ and rather overall NUH is a ‘good trust.’

Our hospitals were among the first group of NHS trusts to be inspected under the CQC’s new inspection regime. The CQC inspection team now includes practicing doctors, nurses, managers, patients and other healthcare professionals. Our inspection team comprised over 60 inspectors. 

Professor Sir Mike Richards, the Chief Inspector of Hospitals, spent time at our hospitals during the inspection and was part of this important process. The inspection had both announced and unannounced elements to it and was more wide-ranging than anything we have experienced previously.

We always welcome scrutiny. It enables us to learn how we can further improve patient care. This is a consistent hallmark of NUH. I have to admit, NUH being judged ‘high risk’ was a low point in my career. Even allowing for all of the complexities and imperfections that come with running one of the country’s largest acute teaching trusts, this was a description of NUH I didn’t recognise. This is because I know most of our 14,000 staff and their commitment to providing excellent patient care often in challenging circumstances.

We saw the inspection as a valuable way to further improve our patient care. We have been able to influence the CQC’s evolving inspection model which will undoubtedly improve the quality and safety of NHS care across the country. We are using the CQC feedback to build on the extensive work already underway across our hospitals to improve the quality of care and patient safety. We have a strong track record for good clinical outcomes, improving safety year-on-year and are recognised as an organisation that is committed to continuous improvement.

The report shows us that we have much to be proud of and I hope reassures our patients and local community that they can have much confidence in the quality of care being delivered at NUH.

As a Trust committed to making continuous quality improvements, we work hard to learn from feedback we receive from patients and partner organisations. We can always do better. The inspection identified two areas which need quicker improvement, including attendance at mandatory training and accelerating our medical equipment maintenance programme. We are giving each of these areas very close attention and also addressing a number of other areas the CQC has advised we can do a better job for our patients, their relatives and carers.

We welcome all feedback, as it supplements that we receive from patients throughout the year from a range of sources, including complaints, surveys and serious incidents which occur in our hospitals.

The new-look inspections are, I believe, a big step in the right direction and one which will continue to improve standards of care for patients, which is what we are each here to do, regardless of our role.

Tuesday, 4 February 2014

Heather Bailey, clinical development nurse in the neonatal unit at City Hospital, on Kangaroo Care

Having your first cuddle with your baby is one of the most emotional moments in any parents’ life, but for some it does not always come as soon as they had hoped.

For babies that are born early or with other complications it is often not possible for their mum or dad to hold them for several days, or sometimes even weeks.

But this does not necessarily have to be the case.

This year Nottingham University Hospitals Charity paid for my colleague Judith Stephenson and I to travel to a hospital in Uppsala, Sweden to watch how neonatal nurses there work. Premature babies have a much higher survival rate in their country and we wanted to find out why. In particular, we were looking at how they use something called ‘Kangaroo Care’.

The concept originated in Colombia, where hospitals could not afford equipment like incubators. It involves the baby being placed on a parent’s bare chest wearing only a nappy for long periods of time. Babies stay there for as long as possible – sometimes up to 14 hours - and research has shown it helps to regulate their temperature, improves their oxygen levels and stabilises their heart rate. It also helps with breast-feeding as it improves the mum’s production of milk.

In the UK and Europe we are fortunate to have so much advanced technology that it is often easy to become over-reliant on it. Kangaroo Care is one of the most basic forms of care possible, yet hospitals here do not use it as much as they could. There is a fear that ill babies should not be taken out of incubators but it is possible to use this method on some of the tiniest babies, even if they still need feeding tubes and ventilation.

One of the scariest things for new parents who have premature babies is the lack of control, but Kangaroo Care puts them back in the driving seat. Who better to help improve the health of a new baby than the mums and dads themselves?

Following our visit we have introduced more training for staff at NUH about Kangaroo Care and have produced official guidelines for them to refer to. We are also looking in to getting some special shirts developed for mums to wear, which help to free up their hands while they have their babies on them and preserve their dignity.

We still have a long way to go before the method is as accepted in the UK as it is in Sweden, but the benefits cannot be underestimated.