The Yorkshire Clinic & Lodge · The Yorkshire Clinic is a private hospital situated in the grounds of Cottingley Hall in Bingley, West Yorkshire. The hospital offers care to patients

The Yorkshire Clinic & Lodge

Quality Account 2018/19

Contents

Introduction Page

Welcome to Ramsay Health Care UK

Introduction to our Quality Account

PART 1 – STATEMENT ON QUALITY

1.1 Statement from the Hospital Director

1.2 Hospital accountability statement

PART 2

2.1 Priorities for Improvement

2.1.1 Review of clinical priorities 2018/19 (looking back)

2.1.2 Clinical Priorities for 2019/20 (looking forward)

2.2 Mandatory statements relating to the quality of NHS services

provided

2.2.1 Review of Services

2.2.2 Participation in Clinical Audit

2.2.3 Participation in Research

2.2.4 Goals agreed with Commissioners

2.2.5 Statement from the Care Quality Commission

2.2.6 Statement on Data Quality

2.2.7 Stakeholders views on 2018/19 Quality Accounts

PART 3 – REVIEW OF QUALITY PERFORMANCE

3.1 The Core Quality Account indicators

3.2 Patient Safety

3.3 Clinical Effectiveness

3.4 Patient Experience

3.5 Our Achievements

3.6 Hospital Case Study

Appendix 1 – Services Covered by this Quality Account

Appendix 2 – Clinical Audits

Appendix 3- JAG Accreditation.

Jan Matin Head of Clinical Services (Matron) -June 2019

Welcome to Ramsay Health Care UK

The Yorkshire Clinic Hospital is part of the Ramsay Health Care Group

The Ramsay Health Care Group was established in 1964 and has grown to

become a global hospital group operating over 100 hospitals and day surgery

facilities across Australia, the United Kingdom, Indonesia and France. Within the

UK, Ramsay Health Care is one of the leading providers of independent hospital

services in England, with a network of 31 acute hospitals.

We are also the largest private provider of surgical and diagnostics services to

the NHS in the UK. Through a variety of National and local contracts we deliver

1,000s of NHS patient episodes of care each month working seamlessly with

other healthcare providers in the locality including GPs and Clinical

Commissioning Groups.

Statement from Dr. Andrew Jones, Chief Executive Officer, Ramsay Health Care UK “The delivery of high quality patient care and outcomes remains the highest priority to Ramsay Health Care. Our clinical staff and Consultants are critical in ensuring we achieve this across the whole organisation and we remain committed to delivering superior quality care throughout our hospitals, for every patient, every day. As a clinician I have always believed that our values and transparency are the most important elements to the delivery of safe, high quality, efficient and timely care. Ramsay Health Care’s slogan ‘People Caring for People’ was developed over 25 years ago and has become synonymous with Ramsay Health Care and the way it operates its business. We recognise that we operate in an industry where ‘care’ is not just a value statement, but a critical part of the way we must go about our daily operations in order to meet the expectations of our customers – our patients and our staff. Everyone across our organisation is responsible for the delivery of clinical excellence and our organisational culture ensures that the patient remains at the centre of everything we do. At Ramsay we recognise that our people, staff and doctors, are the key to our success and our teamwork is a critical part of meeting the expectations of our patients. Whilst we have an excellent record in delivering quality patient care and managing risks, the company continues to focus on global and UK improvements that will keep it at the forefront of health care delivery, such as our global work on speaking up for safety, research collaborations and outcome measurements.


I am very proud of Ramsay Health Care’s reputation in the delivery of safe and quality care. It gives us pleasure to share our results with you.” Dr Andrew Jones Chief Executive Officer Ramsay Health Care UK


Introduction to our Quality Account

This Quality Account is The Yorkshire Clinic’s annual report to the public and

other stakeholders about the quality of the services we provide. It presents our

achievements in terms of clinical excellence, effectiveness, safety, patient

experience and demonstrates that our managers, clinicians and staff are all

committed to providing continuous, evidence based, quality care to those people

we treat. It also shows that we regularly scrutinise every service we provide with a

view to improving it and ensuring that our patients’ treatment outcomes are the

best they can be. It provides a balanced view of what we are good at and what

we need to improve.

Our first Quality Account in 2010 was developed by the Corporate Office, it

summarised and reviewed quality activities across every hospital and treatment

centre within Ramsay Health Care UK. It was recognised that this didn’t provide

enough in depth information for the public and Commissioners about the quality

of services within each individual hospital, and how this relates to the local

community it serves. Subsequently each site within the Ramsay Group now

develops its own Quality Account, which includes some Group wide initiatives, but

also describes the many excellent local achievements and quality plans that we

would like to share.


Part 1 1.1 Statement on Quality from the Hospital Director

Debbie Craven, Hospital Director, The Yorkshire Clinic “The Yorkshire Clinic appreciates that you can choose your healthcare provider and therefore is consistently committed to offering the highest quality of care and clinical outcomes for our patients” Our Vision is to be the leading Healthcare Provider where clinical excellence, safety, care and quality are at the heart of everything we do, whilst growing our business and profitability. This Quality Account by The Yorkshire Clinic has been produced to demonstrate our continued commitment to measuring and acting on feedback from all our patients and customers about their experience, with the intention to continually learn and improve on all aspects of the services we provide. We are aware that patients can be anxious about coming into hospital and understand that providing reassurance is very important to you the patient and your family. This starts with patient safety, which is always our highest priority. To this end we continually review our clinical care standards, outcomes and feedback via audit, observation and through regular open analytical reviews encouraging a ‘no blame’ approach, which helps promote a healthy learning culture. In addition we recruit, induct and train our team to enable the delivery of the highest standards in all aspects of clinical and customer care. This approach extends to family and visitors in ensuring they are made to feel welcome at The Yorkshire Clinic. The Yorkshire Clinic is committed to ensuring that patients are kept fully informed about their treatment, which is also a significant factor associated with improving treatment outcomes. We involve our patients in treatment decisions at the earliest stage so that the options and benefits are fully discussed before patients consent to treatment. Our medical and clinical teams recognise the importance of devoting time to preparing patients for surgery, which not only reduces risk but also improves patient understanding and confidence, reduces anxiety, improves rates of recovery and shortens lengths of hospital stay. Our care extends to the post discharge period, where we offer post discharge support and guidance 24 hours a day to provide you with ongoing reassurance. Whilst patient feedback and involvement is extremely important to us, we also rely heavily on other measures of safety and clinical effectiveness which we use to satisfy ourselves that treatment is evidence-based and delivered by appropriately qualified and experienced doctors, nurses and other key healthcare professionals; examples of these are detailed in this Quality Account.


The Yorkshire Clinic is accustomed to the disciplines of regulatory and contractual requirements to assure Healthcare Commissioners of our clinical performance, and to report complaints as well as serious incidents to Regulators and Commissioners. We also maintain a Risk Register and systematically review specific actions to achieve risk reduction. The Yorkshire Clinic’s ‘Friends and Family’ patient satisfaction scores continually achieve over 99% for ‘would recommend to others’. This is consistent with other local private hospitals and is higher than that of our local NHS Trust Hospitals. By analysing the results throughout the year, we constantly seek ways to further improve the patient experience. We achieve this through our regular Customer Feedback Forums and our planned Patient Focus Groups. All of the above is supported and driven by our Clinical Strategy which is summarised below.


1.2 Hospital Accountability Statement

To the best of my knowledge, as requested by the regulations governing the

publication of this document, the information in this report is accurate.

Debbie Craven

Hospital Director The Yorkshire Clinic Ramsay Health Care UK This report has been reviewed and approved by: Mr Mark Steward – Medical Advisory Committee (MAC Chair) Mr Richard Grogan - Clinical Governance Committee Chair Helen Hirst- Chief Officer- NHS Airedale, Wharfedale and Craven CCG Bradford City CCG and Bradford District CCG


Welcome to The Yorkshire Clinic

The Yorkshire Clinic is a private hospital situated in the grounds of Cottingley Hall in Bingley, West Yorkshire. The hospital offers care to patients with private medical insurance, patients who wish to fund their own treatments and patients referred through the NHS Patient Choice Scheme. The hospital has 56 beds and 12 ambulatory bays. Facilities include five operating theatres, endoscopy unit, angiography suite, physiotherapy, pharmacy, central sterile service department (CSSD), radiology and out-patient diagnostic facilities. The Lodge is a separate building but is still part of the hospital, it has one theatre, consulting and treatment rooms and is the dedicated Ophthalmology Centre. The facility is registered with the Care Quality Commission to provide care and treatment for adults, age 18yrs and over for diagnostic and screening procedures, surgical procedures, treatment of disease, medical disorders and sports injury. The hospital provides a full range of high quality services, these include, outpatient consultation, pre-assessment, outpatient procedures, investigations / diagnostics, surgery and follow up care. On-site diagnostic and screening facilities include radiology (ultrasound, general x-ray, fluoroscopy, digital mammography), static MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) scanners, pathology, angiography suite, echocardiography, ECG (Electrocardiogram) testing and Ophthalmic diagnostic imaging for treatment of patients with Wet AMD (Age-related Macular Degeneration). Other on-site support facilities include a Registered Pharmacy and services supported by Resident Medical Officer (RMO) on site 24hours, 7 days a week. The Yorkshire Clinic is registered as a satellite unit to Seacroft Hospital (Genesis) in Leeds to provide a part of the fertile treatment pathway. The Yorkshire Clinic provides direct Endoscopy (Gastroscopy) services to support prompt investigations. During the last 12 months the hospital has treated 16,655 patients, 87.4% of which were treated under the care of the NHS. The Yorkshire Clinic has 378 members of staff with a split of 142 non-clinical staff and 236 clinical staff. We have 177 Consultants who work at The Yorkshire Clinic through approved Practising Privileges. We offer a range of services which include General Surgery, Oncology, Gynaecology, Bariatric Surgery, Urology, Cardiology, Pain Management, Gastroenterology, Cosmetics and Plastic Surgery, Orthopaedic, Dermatology and Medical. Nursing and Medical Care at The Yorkshire Clinic On admission all our patients are allocated a ‘named nurse’, the role of the


named nurse is to provide coordinated care, support and treatment which is personalised to meet individual patient needs. The named nurse approach enables our patients to identify one nurse who is specifically and consistently responsible for their overall nursing care. In 1992 the Department of Health issued the Patients’ Charter in which the requirement for all inpatients to have a designated ‘named nurse’ was specifically mentioned. More recently the Francis report investigation into Mid Staffordshire NHS Foundation Trust (2013) highlighted the advantages of having such a system in place but took the requirement further by stating that a ‘named nurse’ needs to be designated for each shift, this is the model used at The Yorkshire Clinic. This was welcomed by the Royal College of Nursing who believe the ‘named nurse’ model provides a useful way to organise work around the needs of the patient (RCN 2014). Care and treatment provided at The Yorkshire Clinic is Consultant led. We have a RMO who supports the Consultants and together with the nursing team provides round the clock medical support to all our patients. The hospital has built excellent working relationships with our local Commissioner, Bradford Teaching Hospitals Foundation Trust, Leeds Teaching Hospital NHS Trust and Airedale Foundation Trust in order to deliver a joint approach to patient care delivery across the patient economy. Our GP Liaison Officer provides links to local General Practitioners to ensure that their needs and expectations are managed and through these links, referral processes are developed in order to streamline processes. The GP Liaison Officer’s key role is to engage with local healthcare professionals within the community to ensure they are fully aware of the services offered at The Yorkshire Clinic, have access to any information that can assist General Practitioners and medical staff when referring into a Secondary Care Provider. Part of the GP Liaison’s role is to coordinate the post graduate programme which runs on a monthly basis and covers a range of topics from orthopaedic surgery to cardiology. The Yorkshire Clinic also works with charities within the local community, hosting events in their support. Last year we supported The Miscarriage Association and Sick Children’s trust and raised £3406.80. The Yorkshire Clinic has chosen to support LS29 and Marie Curie Hospice Bradford in 2019, selected again through nominations from staff, discussed at the Staff Engagement Committee.


Part 2 2.1 Quality Priorities for 2019/2020

Plan for 2019/20

On an annual cycle, The Yorkshire Clinic develops an operational plan to set objectives for the year ahead. We have a clear commitment to our private patients as well as working in partnership with the NHS ensuring that those services commissioned to us, result in safe, quality treatment for all NHS patients whilst they are in our care. We constantly strive to improve clinical safety and standards by a systematic process of governance including audit and feedback from all those experiencing our services. To meet these aims, our hospital strategies are driven by our commitment to ensure that quality is at the heart of everything we do. As a leading Independent Healthcare Provider we aim to continuously improve quality, safety and patient experience. Our strategy priorities are determined by the hospital’s Senior Management Team and our people (Department Heads and their teams) taking into account patient feedback, audit results, National guidance, and recommendations from various local and National Hospital Committees which represent all professional and management levels. Most importantly, we believe our priorities must drive patient safety, clinical effectiveness and improve the experience of all people visiting our hospital. The public inquiry at Mid Staffordshire NHS Foundation Trust is a stark reminder that patients must come first with care delivered by compassionate and dedicated staff. At The Yorkshire Clinic the patient experience is at the heart of everything we do within the hospital. We want to know what matters to our patients, their relatives and carers so we can enhance the quality of our services. Our vision is to be the Leading Healthcare Provider where clinical excellence, safety, care and quality are at the heart of everything we do, whilst growing our business and profitability. Our Quality Improvement Programme focuses on three domains: patient experience, patient safety and the clinical effectiveness of care and treatment. Our Quality Account seeks to provide accurate, timely, meaningful and comparable measures to allow our partners to assess our success in delivering our vision. People are at the centre of how we ensure we operate safely – all united in a common purpose to achieve zero avoidable harm. To support our employees to achieve this goal, we have mandatory systems and processes across The Yorkshire Clinic to protect and care for all of our patients, members and our own people.


Priorities for improvement

2.1.1 A review of past clinical priorities 2018/19 In 2018/2019 we directed our strategy using the Care Quality Commissions five key domains:

Safe.

Effective.

Caring.

Responsive.

Well led. Under each domain we said we would provide clear objectives, to demonstrate our commitment to quality improvement and by employing these objectives we would evidence Safe, Effective, Responsive, and Well Led Care.

Under SAFE:

Patient Hydration – ‘Fluid balance during elective surgery- getting it right’.

The Yorkshire Clinic recognised that improvement was required in monitoring patient’s fluid balance especially in patients who have had surgery. Our Patient Journey audit and Medical Records audit scores reflected the need for improvement in this key area of ‘patient safety’.

We have:

Completed a full review of NICE Guidance CG174 ‘Intravenous Fluid Therapy

in Adults in Hospital’ May 2017, and actions have been taken to meet

compliance to the key recommendations below:

o Principles and protocols for intravenous fluid therapy.

o Assessment and monitoring.

o Resuscitation.

o Routine maintenance.

o Training and education.

The Key recommendations were reviewed by our ‘Fluid Champion’ (named

Pharmacist) and an ‘Intravenous Fluid Management’ training programme was

formulated to include all the above key recommendations. This is attended by

Registered Nurses (RGNs), Operating Department Practitioners (ODPs) and

RMOs.

The training programme covers:

Physiology of fluid and electrolyte balance in patients with normal

physiology and during illness.

Assessing patients' fluid and electrolyte needs (the 5 Rs: Resuscitation,

Routine maintenance, Replacement, Redistribution and Reassessment).

https://www.nice.org.uk/guidance/cg174/chapter/Key-priorities-for-implementation#principles-and-protocols-for-intravenous-fluid-therapyhttps://www.nice.org.uk/guidance/cg174/chapter/Key-priorities-for-implementation#assessment-and-monitoringhttps://www.nice.org.uk/guidance/cg174/chapter/Key-priorities-for-implementation#resuscitationhttps://www.nice.org.uk/guidance/cg174/chapter/Key-priorities-for-implementation#routine-maintenancehttps://www.nice.org.uk/guidance/cg174/chapter/Key-priorities-for-implementation#training-and-education


Assessing the risks, benefits and harms of IV fluids.

Prescribing and administering IV fluids.

Monitoring the patient response.

Evaluating and documenting changes and taking appropriate action as

required.

Recognising, assessing and preventing consequences of mismanaged IV

fluid therapy, including:

Pulmonary oedema.

Peripheral oedema.

Volume depletion and shock.

In addition the algorithm below is displayed in key clinical areas to support

clinicians to make the right decisions when prescribing fluids for patients; this

focuses on review of patients’ fluid balance. They review each patient’s fluid

balance chart and ensure input and output is carefully monitored to enable safe

care planning.

2hourly contact rounds: Our ward RGNs and HCAs review all patients every 2

hours as part of the ‘patient contact rounds’. Here they ensure patients have

drinks to hand and are hydrated.

Protected Meal times: HCAs and RGNs support patients through meal times

ensuring that all their nutritional needs are met. All non-emergency activity is

stopped to ensure patients can eat in comfort and are not disturbed.

Fluid Champions: We have identified an RGN on the ward and ODP in theatre

who are fluid champions, their role is to continually monitor patients’ fluid

management and provide on the job training for staff.

Daily Ward Rounds: Ward Sister / Ward Manager complete a daily ward round.

Staff Training and Education:

o Understanding the physiology of fluid and electrolyte balance in patients with normal physiology and during illness.

o Below is the algorithm which is displayed in all clinical departments.

Training Programme:

Acute Kidney Injury (AKI) and Fluid Balance training

programme: We have formulated a Yorkshire Clinic training

programme which provides all our ward and theatre RGNs, ODPs

and HCAs with training on AKI and fluid balance. The Training uses

the resources provided by the NHS ‘Think Kidney Campaign’ to

improve the care of people at risk of, or with, acute kidney injury and

provides practical training on correctly completing a fluid balance.

Under EFFECTIVE: We said “we will build a skilled knowledgeable workforce”.

We recognise high quality, compassionate care is about people, we want the right

staff, with the right skills, in the right place at the right time. At The Yorkshire

Clinic we pledged to play our part in securing the staffing capacity and capability

required to provide ‘outstanding’ care to our patients.

We have achieved our vision in securing the staffing capacity and capability

required to provide ‘outstanding’ care to our patients.

We have a staffing tool based on the NICE Guideline (SG1): Safe Staffing for

Nursing in Adult In-patient Wards in Acute Hospitals (2014) to ensure

patients dependency is accounted for when making a decision about nurse

patient ratio.

Ward senior nurses determine nursing staff requirements to ensure safe patient

care.

Below is how we developed and implemented the Safe Staffing Tool.

1. Nominated a senior ward nurse to undertake some research on current staffing tools in use.

2. NICE Guidelines (SG1): Safe Staffing for Nursing in Adult In-patient Wards in Acute Hospitals (2014) provided an accurate reflection of our hospital acuity.

3. Developed a training package for staff to ensure they understood the tool, and why we needed this to ensure our staffing levels met the needs of our patients.

4. Presented the tool to the Hospital Director and Care Quality Commission engagement lead.

5. The tool is now used daily and a copy is sent to the hospital Matron. It provides assurance that every aspect of patient care has been considered to ensure staffing levels meet the needs of the patients.


The tool is based on scores allocated to patient care tasks (derived from NICE

Guidance, SG1).

Patient Type Patient Score Nursing Hours Required

Routine 0 0 (empty)

Routine 1 1.5

Intermediate 2 2.5

Complex 3 3.5

1:1 4 12.5

Example: If a Registered nurse is working 7.5 hours, patients allocated to her will

be based on the hours of care they require. The number of hours of care for her

patient workload will not be more than 7.5 hours. She may have 5 routine patients

requiring 1.5 nursing hours.

We have identified specialties where our patient numbers are small and invested

in people, training and equipment to ensure patients in these specialities receive

high standard of care provided by skilled, knowledgeable staff.

Medical Services: We have recruited a Ward sister who has 16 years’

experience in Medical Nursing. (HT)

Key aspects of the role: - CPAP/BIPAP training for staff. - Develop staff knowledge and skills in caring for medical patients. - Ensure pathways and protocols are available to support safe care

of medical patients. - Developed links with other professionals to support medical

services (Community respiratory nurse).


- Ensure equipment is available to support the safe care of patients, and staff trained to use the equipment.

- Medical Operational Policy which outlines the patient’s journey.

Oncology (Chemotherapy): We have a chemotherapy lead nurse who has

completed a post graduate certificate in Chemotherapy. Our lead nurse is part of

the Ramsay Chemotherapy Quality Group. This group is aimed at ensuring

improvement of standards and sharing of good practice for chemotherapy

services. The group have formulated polices and protocols to ensure safe care

delivery for patients having chemotherapy in our hospitals. We also have a

pharmacist who is part of this group and supports the lead nurse in safe

prescribing, ordering, handling and administration of chemotherapy drugs. We

have appointed a senior chemotherapy nurse who has over 15 years’ experience

in chemotherapy nursing and supports the lead nurse in ensuring we deliver high

quality care which is evidenced based. All our chemotherapy patients are cared

for by chemotherapy trained nursing staff from the start of their journey with us

until discharge.

Bariatric Services: We have a lead nurse who has undertaken additional

training to enhance her knowledge in caring for bariatric patients. Our

bariatric patients are pre-assessed by the bariatric lead nurse to ensure they are

optimised for their surgery - this may result in referral to anaesthetic services. All

patients are seen by a dietician. We have developed a Bariatric care pathway

which supports nurses caring for patients as it outlines their journey- what must

be completed and when. We have completed a self-assessment tool to ensure

we meet compliance to NCEPOD: Bariatric Surgery- Too Lean a Service and

BOMSS (British Obesity & Metabolic Surgery Society) Guidelines.

All patients are followed up by our Bariatric lead nurse at 7 days post discharge, 1

month, 6 months, 1 year and at 2 years in line with NCEPOD guidelines.

We have lead Consultants who support quality governance ensuring patients care

is safe and effective, they are supported by clinical leads who take responsibility

for the following:

Infection Prevention and Control Lead Nurse who ensures actions in our

2018-19 Infection Prevention and Control Annual Plan are completed, these

evidence compliance with requirements of the ‘Health and Social Care Act 2008 –

Code of Practice for Health and Adult Social Care on the Prevention and Control

of Infections’, related guidance and ‘Care Quality Commission Standard Outcome

8 – Regulation 12- Cleanliness and Infection Control’.

Resuscitation Lead who ensures we meet guidance set by the Resuscitation

Council (UK) and we have safe systems, polices, processes and protocols which

enable us to care for patients where their condition may deteriorate. This includes

http://www.bomss.org.uk/


(but not limited to) training (Basic Life Support, Intermediate Life Support,

Advanced Life Support, Acute Illness Management, Transfer), Audit, equipment

review and training.

Clinical Training Lead who develops training programmes and delivers training

for the clinical team. Where complaints, incidents, audits identify that direct

improvements are required in patient care or pathways our clinical training lead

will undertake a review and formulate a training programme to enhance learning

and ensure staff are informed of best practice. The following training programmes

developed in 2018:

- Healthcare Assistant Roles and Responsibilities. - Care Pathways. - Fluid Balance. - NEWS 2. - Acute Kidney Injury. - How to Use the NICE Safe Staffing tool. - Sepsis.

Blood Transfusion Lead who ensures our blood storage, ordering and

administration processes are in line with MHRA regulations. Our lead is

supported by a Consultant Haematologist who ensures we follow maximum blood

ordering schedules; our staff are trained on blood products, prescribing, storage,

administration and that we have a clear massive haemorrhage policy which is

tested.

Occupational Health Lead who ensures all staff wellbeing is supported from up

to date vaccinations to monitoring the skin (hands) of clinical staffs including staff

education about the importance of flu vaccinations. 93% of our staff received a flu

vaccination in 2018.

Pain Management Lead is our Pharmacy Manager he advises clinical staff

including Consultants about pain management. In 2019 he is developing a pain

ladder to support clinicians in the day to day pain management of post-surgical

procedures.

Under RESPONSIVE We said “We would introduce a Patient Diary to capture patient feedback throughout their journey with us.”

We Have:

Introduced the patient diary which was first approved by our patient focus

group members to ensure it met the needs of the patient.

Our Patient Diary:

Starts from the time a Consultant decides to provide treatment to the patient at The Yorkshire Clinic.


Has a section where patients can record key dates that they need to remember.

Has sections where the patient will make interaction, and explains what they can expect (Pre-assessment, Physiotherapy, Radiology).

Outlines the patient journey, and as the patient goes through that part of the journey they can use the diary to support them in communicating with staff.

The diary is used as a starting point for discussion, nurses engage daily with patients and carers to help manage expectations, it empowers patients to discuss their care and challenge anything that they feel may have been overlooked.

The aim of the diary:

Start at the point of the patient receiving their out-patient consultation right through, pre-assessment, admission and discharge.

Improve communication and encourage patient involvement in their care. Involve all the teams and departments the patient contacts. Involve patients’ families and friends (we value their feedback). Produce a full schedule of planned interventions, such as diagnostics,

operative procedure, meal times, ward rounds, medication rounds and physiotherapy, for a patient’s stay.

By implementing patient diaries with patient views, the team aims to have a positive impact on improving the patient experience and service productivity. We will see the patient journey from the patient’s perspective which will enable us to improve our patient pathways. We believe this is how we will achieve ‘Outstanding’ in the care and services we offer.

Under CARING We said “We would develop Ward Customer Care Standards that set out what our customers can expect during their stay.” The standards will aim to set the course for all ward staff about what is expected from them to enable a seamless patient journey.

Taking care of patients is what healthcare is all about. It may be hard for some

people to think of patients as customers, but they definitely are. Their choice in

choosing us to provide their healthcare keeps our hospitals running. At The

Yorkshire Clinic we see our ‘patients’ as ‘customers’ and within this objective we

aim to improve our patients experience through developing ward based customer

care standards and providing our staff with ‘customer care training’.


We Have:

1. Delivered Customer Care training (face to face) to 94% our hospitals clinical and non-clinical staff.

Customer Care Training 2018-2019 Agenda

Time (hrs) Agenda Presented by:-

09:00 -10:00 Achieving Customer Excellence the Ramsay

Way

Matron

10:00 Break

10:15 -10:45 Difference between providing a good experience vs. providing a good service. (DVD) How do get from Good to Great?

- Questions

Group

10:45 - 11:00 10 Point Pledge Matron

11:00 - 11:30 When we get it wrong

- Seven Steps to Good Complaints Management

Matron

11:30 - 12:00 Group work Patient complaints:

- What are the customer care issues /complaints?

- What would your response be to the patient?

Group

12:00 - 12:30 Start Stop Continue You are a key person (hand-out)

Group

2. The Ward Customer Care Standards developed to reflect the patient journey.

Standard 1: Admission to Ward by Administration Staff. The customer will be received from main reception and escorted to their allocated room, which will be comfortable and clean. The customer will be orientated to their room and will be provided with facilities advertised in the hospital patient information literature. Standard 2: Admission to Ward by Nursing Staff. The customer will be admitted, assessed and prepared for theatre / procedure in a safe, courteous and efficient manner. Clinical aspects of the admission process will be completed to the highest standard by competent, skilled staff with expert knowledge enabling safe, effective and efficient care. Standard 3: In-Patient Stay. The customer will be provided with excellent clinical care, which is ‘person centred’, using a multidisciplinary approach the care


provided will be seamless. Confident, competent and professional clinical staff will deliver the care. Care delivered will be safe, effective, responsive and well led. Standard 4: Telephone enquiry to ward (external and internal); answering machines / voicemail. The customer will receive prompt, courteous and accurate information delivered in a pleasant and efficient manner.

Standard 5: Catering. The customer will receive an efficient service by courteous and professional staff. The food and drink presentation will be excellent, meeting the nutritional needs of each individual customer.

Standard 6: Patient Transfer from Ward to Theatre. The patient will be transferred to theatre in a comfortable, controlled and safe manner, maintaining dignity and aiming to reduce patient anxiety. Standard 7: Patient Transfer from Recovery to Ward. The customer will be transferred from the recovery area to the ward in a comfortable, controlled and safe manner, maintaining the patient’s dignity. Standard 8: Discharge. The customer will be discharged from the ward when clinically ready and medically fit, in a controlled, organised and safe manner. Standard 9: Patient room and Ward Environment. The ward rooms and ward environment will be clean tidy and fully equipped to ensure the customers’ comfort and facility needs are met. (Personalisation: It’s the ‘little touches’ that really help in making people feel at home).

Under WELL LED

We Said “We would focus on Staff Engagement”. Our front line staff will play key

roles in improving patient care and new innovations of safe care will be celebrated.

Services will be delivered with the full participation of those who use them, staff and

external partners as equal partners.

We Have:

Set up a Staff Engagement Committee led by our Hospital Director, this committee consists of clinical and non-clinical staff from all departments. The committee discuss key items where decisions about care, services, and pathways need to be made. We believe our frontline staff have the answers to how best improve patients pathways and staff wellbeing. The committee decide the month end magic reward for all the hospital staff. (This is to thank our staff every month for their hard work and commitment). This has included:

- 10 minute staff massages. - Krispy cream doughnut for all staff. - Hot chocolate and marsh mellow stands.

Leading the Ramsay Way Workshops. Our Senior Leadership Team (Hospital Director, Matron and Operations Manager) have led workshops


for all the hospital staff to refresh and re-invigorate the Ramsay Values. The Workshops consisted of reviewing the Six Ramsay Values, what does it mean to us and how can we use these values to lead our day to day practices. Staff feedback from the workshops was very positive as they felt it provided them with opportunity to re-engage with our Ramsay values and reminded them that we are truly ‘People Caring for People’. We can use the Ramsay Values to lead.

Our Values will be driven by the Ramsay Way. We will bring to life the Ramsay Way in all we do. Caring: We are caring, progressive, enjoy our work and use a positive spirt to

succeed.

Pride: We take pride in our achievements and actively seek new ways of doing

things better.

Value People: We value integrity, credibility and respect for the individual.

Positive Outcomes: We build constructive relationships to achieve positive

outcomes for all.

Working Together: We believe that success comes through recognising and

encouraging the value of people and teams.

Sustainability: We aim to grow our business while maintaining sustainable levels of

profitability, providing a basis for stakeholder loyalty.

1. Ensure all staff are stakeholders in developing the hospital strategy.

In 2018 we have developed 3 strategies where our staff from front line to senior leaders have supported their development and objectives within the following.

- 3 Year Clinical Strategy. - Patient Experience Strategy. - Dementia Strategy.


2. Staff Survey on Leadership and Culture. We formulated a staff survey in April 2019 which is now in circulation for staff to complete. The survey aims to identify the current culture and leadership at The Yorkshire Clinic. Following collation and analysis of the survey we will ensure we have a ‘You said we did’ project to ensure our teams can see that we will take action from their feedback.

3. The Ramsay Academy has provided many leadership courses for staff at

all levels including: - Project Management. - Management induction. - Making quality appointments. - PDR & Induction. - Courageous Conversations. - Leading a Effective Team - Aspiring Leaders Programme - Master of Business Administration (MBA)

We have conducted internal training sessions centred on ‘compassionate leadership’ and emotional intelligence. Compassionate leadership - Example of compassion provided by some of our leaders: “Compassion for me is the healthcare assistant I saw who stayed for an hour after her shift had ended, holding the hand of an elderly lady who was in distress and talking to her lovingly and caringly, until she was calm again”. Compassionate leadership is more than just being a compassionate individual and caring for a colleague who is in pain. A compassionate leader, as well as being a compassionate person, encourages compassion and caring in the wider organisation. A compassionate leader encourages employees to talk about their problems and to provide support for one another. Compassionate leadership is about a) being a compassionate person and b) trying to create a culture whereby seeking or providing help to alleviate a sufferer’s pain is not just acceptable but is seen as the norm. - This is what our training is centred on. Emotional Intelligence: Emotional intelligence or EI is the ability to understand and manage your own emotions, and those of the people around you. People with a high degree of emotional intelligence know what they're feeling, what their emotions mean, and how these emotions can affect other people. For leaders, having emotional intelligence is essential for success. After all, who

is more likely to succeed – a leader who shouts at his team when they are under

stress, or a leader who stays in control, and calmly assesses the situation?

There are five key elements to EI:

1. Self-awareness.

2. Self-regulation.

3. Motivation.


4. Empathy.

5. Social skills.

The more that a leader manages each of these areas the higher their emotional

intelligence.

Patient Safety:

Our plan: Ensure our staff feel they can confidently ‘Stand up for Patient Safety’. Ramsay UK implemented the ‘Speaking Up For Safety’ (SUFS) Programme in 2018. The Speaking Up For Safety programme was aimed at helping us:

Achieve culture change by increasing the ease and motivation for all staff to feel safe to ‘speak up for safety’.

Develop insights and skills to respectfully raise issues with colleagues when concerned about a patient’s safety.

At The Yorkshire Clinic our Clinical Training Lead and Assistant Matron have undergone training provided by the Cognitive Institute to deliver SUFS training to all our staff which will:

• Ensure staff understand this is not a stand-alone or short term initiative; as a programme driving culture change it is a long term commitment

• Encourage all staff to speak up in the moment, however when they are unable or it was not effective, to report this to a manager and the organisation will speak up on their behalf.

• Ensure staff can see how the programme is part of the Ramsay Way and aligns with core values.

• Work with their team so that the ‘Speaking Up’ message is alive every day. 90% of our staff have completed the ‘Speaking Up For Safety’ (SUFS) training Programme.

2.1.2 Clinical Priorities for 2019/20 Welcome to our Quality Account for 2018-19. In this section we will describe our clinical development plans and ambitions over the next year. We will demonstrate our commitment to providing the highest possible standards of clinical quality, and show how we are listening to our patients, staff and partners, and how we will work with them to deliver services that are relevant to the people who use them. Our Vision As the leading Independent Healthcare Provider, here at The Yorkshire Clinic we make a positive difference in the lives of our patients by providing compassionate high quality care that is customer focused. We will go that ‘extra mile’ to provide person centred care and ensure our staff are equipped with


knowledge and skills, enabling them to deliver safe, effective care that is responsive, caring and well led.

Our Vision is to be the Leading Healthcare Provider where Clinical Excellence, Safety, Care and Quality are at the Heart of everything we do whilst growing our business and profitability. These Five Key domains will direct what we want to achieve in 2019/2020:

Safe.

Effective.

Caring.

Responsive.

Well led. Under each domain we will provide clear objectives, which demonstrate our commitment to quality improvement and how we will achieve these objectives. Evidence and best practice will underpin all our objectives. Having patients and staff (our people) at the heart of everything we do, our strategic objectives and our values will determine our quality vision for the next year.

Under Safe we will focus on: Infection Prevention – Preventing Surgical Site Infections: Focus on reducing the risk of surgical site infection by ensuring full compliance to the Surgical Site Care Bundle and NICE Guidance NG125 published in April 2019: ‘Surgical Site Infections - Prevention and Treatment’. The Yorkshire Clinic is proud of its Infection Prevention and Control Standards, quality governance around this key patient safety objective enables us to ensure our patients are not at risk of acquiring infections during their stay with us. However as stated in the World Health Organisation - Preventing Surgical Site Infection (2015)- Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance. In low and middle-income countries, 11% of patients who undergo surgery are infected in the process. It is imperative that healthcare organisations identify measures aimed at keeping patients safe during surgery. New guidelines and evidence must be utilised to prevent surgical site infections. Our goal at The Yorkshire Clinic is to ensure we are continuously improving and using current best practice and research which will give our patients confidence that they can receive care and treatment at The Yorkshire Clinic without fear of acquiring an infection. To do this we will: Ensure full compliance to the Surgical Site Care Bundle (High Impact

Intervention 4).


The Health Act 2008 Code of Practice for Prevention and Control of Healthcare

Associated Infections (2015) states that ‘Effective prevention and control of

Healthcare Associated Infections has to be embedded into everyday practice and

applied consistently by everyone,’ and that NHS organisations must audit key

policies and procedures for infection prevention and control. In 2013, the EPIC3

group noted that ‘standard infection control precautions need to be applied by all

healthcare practitioners to the care of all patients. Every clinician has the potential

to significantly reduce the risk of infection to their patients by ensuring that they

consistently comply with evidence based practice and guidelines every time they

undertake a clinical procedure. The High Impact Interventions (HII) are a means

to provide compliance assurance. HIIs in this document relate to those key

clinical procedures which can increase the risk of infection if not performed

appropriately. They have been developed to provide a simple way of highlighting

the critical elements of a particular procedure, the key actions required and a

means of demonstrating reliability using compliance measurement. The purpose

of the HII is to minimise unwarranted variation in practice by providing a way of

identifying where compliance needs to be increased and a measure of how often

all elements are performed for a given procedure. The HII tool is also the means

by which results can be quickly fed back to staff and actions can be agreed and

implemented.

High Impact Intervention Care bundle to prevent surgical site infection:

This high impact intervention is based on WHO and NICE guidelines. The risk of

infection reduces when all elements within the clinical process are performed

every time and for every patient. The risk of infection increases when one of more

actions of a care process are excluded fddor not performed.

Aim to reduce the incidence and consequences of surgical site infection

(SSI) through:

Screening and decolonisation.

Preoperative showering.

Hair removal.

Skin preparation.

Prophylactic antibiotics.

Normothermia.

Incise drapes.

Glucose control.

Surgical dressing.

Hand hygiene. The aim of the care bundle, as set out in this high impact intervention (HII), is to

ensure appropriate and high quality patient care. Regular auditing of the care

bundle actions will support cycles of review and continuous improvement in care

settings.


Ensure the NICE Guidance NG125 published in April 2019: Surgical Site

Infections - Prevention and Treatment. Recommendations are implemented

in practice.

The guideline includes new and updated recommendations on:

Nasal decolonisation before surgery.

Antiseptic skin preparation during surgery.

Antiseptics and antibiotics before wound closure.

Methods of wound closure.

Information for patients and carers (what happens before surgery, what

happens during surgery, what happens after surgery).

Treating surgical site infection and specialist wound care services.

Under Effective we will focus on:

Patient Experience - We will develop a patient experience strategy with this

vision at the core “The heart of our success as an organisation is the

involvement of our patients, their relatives, carers and the community to give

them the best experience of care possible”.

Goodrich and Cornwall (2008) set out the case for the reason it is necessary to

have a clear strategy for improving patient experience, both in terms of clinical

outcomes and the success of the organisation.

Improving patient experience makes good sense for patients because:

The reduction of anxiety and fear can speed the healing process and shorten

a patient’s length of stay.

The provision of information reduces post-operative complications.

Good communication / information that enables people to self-manage their

illnesses more effectively.

Effective communication improves treatment and medications compliance.

Improving patient experience makes good business sense because:

Patients are increasingly using the internet to rate their experience, which

affects organisational reputations.

The Care Quality Commission has a clear focus on the experience of patients

who have used or are currently using our services.

The White Paper, ‘Equity and Excellence: Liberating the NHS’ (Department of

Health 2010) highlights the central aim of putting patients and the public first, to

offer greater choice and control. This includes shared decision making,

underpinned by the principle ‘nothing about me without me’.

https://www.nice.org.uk/guidance/ng125/chapter/Recommendations#nasal-decolonisationhttps://www.nice.org.uk/guidance/ng125/chapter/Recommendations#antiseptic-skin-preparationhttps://www.nice.org.uk/guidance/ng125/chapter/Recommendations#antiseptics-and-antibiotics-before-wound-closurehttps://www.nice.org.uk/guidance/ng125/chapter/Recommendations#closure-methodshttps://www.nice.org.uk/guidance/ng125/chapter/Recommendations#information-for-patients-and-carershttps://www.nice.org.uk/guidance/ng125/chapter/Recommendations#preoperative-phasehttps://www.nice.org.uk/guidance/ng125/chapter/Recommendations#intraoperative-phasehttps://www.nice.org.uk/guidance/ng125/chapter/Recommendations#intraoperative-phasehttps://www.nice.org.uk/guidance/ng125/chapter/Recommendations#postoperative-phasehttps://www.nice.org.uk/guidance/ng125/chapter/Recommendations#antibiotic-treatment-of-surgical-site-infection-and-treatment-failurehttps://www.nice.org.uk/guidance/ng125/chapter/Recommendations#specialist-wound-care-services


In 2012, NICE (National Institute for Clinical Excellence) released patient

experience guidance and a standard; enabling trusts to self-assess against a

range of patient experience measures and work towards improving. Follow this

link to view the standard: http://www.nice.org.uk/guidance/QS15 .

The Francis Public Inquiry (2013) investigated the events that led to patient harm

and unnecessary deaths at Mid Staffordshire NHS Foundation Trust. The

Government response detailed in ‘Hard Truths’ (2013) included actions for

improving patient experience arising from the public inquiry and a further six

commissioned independent reviews, including the Berwick Report (2013) and the

Keogh Mortality review (2013). These reviews made clear recommendations for

healthcare providers that patient feedback was essential. Recommendations

included:

Preventing and detecting problems early; this includes using diverse

means to gather patient feedback and taking appropriate action. Ensuring

that the complaints process is more robust and that complaints are heard

at Trust Board, published and action taken to improve services.

Results and analysis of patient feedback needs to be made available to

CCGs, regulators and the public, in as near ‘real time’ as possible and

actions taken promptly. Ensuring that Friends and Family Tests (FFT)

results are published for every ward within a maximum timescale of five

weeks, and having systems to comply with ‘Duty of Candour’.

Ensuring accountability to develop robust processes for understanding the

experiences of patients - triangulated with other quality related information.

To use FFT as a catalyst for improvement and to use patient stories

alongside quantitative data to make the data ‘real’.

Ensuring staff are trained, motivated and understand the positive impact

that happy and engaged staff have on patient outcomes – using the NHS

staff survey and staff FFT to measure staff experience.

Our Patient Experience Strategy will focus on what our patients, family & carers want & need and we will use patient views backed by research (What

Matters to Patients?).

In our strategy we will make the following pledges to our patients and ensure we

implement these:

http://www.nice.org.uk/guidance/QS15


Introduce ourselves, and call you the name you want to be

called.

Introduce ourselves with “Hello my Name is”……..

Keep you informed, comfortable and safe at every step of

your journey with us.

Provide as many ways as we can for you to tell us about

your experience.

Strive to understand your experience and use that

understanding to improve our care and services.

Help you understand what is happening throughout your

time with us and involve you in decisions made about your

care.

Work in partnership to make improvements.

Ensure we share what has changed as a result of the feedback you give us.

Ensure we respond to complaints within the agreed timescales.

Treat you as we would wish to be treated ourselves.

Understand your needs as an individual and work together

to meet them.

Make all reasonable adjustments to the care we provide

based on your individual needs.

Empower patients to become leaders in making

improvements with us.

The Patient Experience Strategy will aim to enable and empower all staff within

our hospital to feel able to put the patient experience at the heart of everything

we do. The strategy will launch the start of our journey and cultural shift from

‘doing to’ patients, to ‘working with’ patients and carers. Our long-term aim is to

ensure that patients have a central role in all aspects of care provision, service

design, improvement and assurance processes.

Pledge

One

Pledge

Two

Pledge

Four

Pledge

Five

Pledge

Three


Under RESPONSIVE we will:

Improve people’s experience of discharge from hospital by better

coordination and planning.

Hospital discharge is a complex and challenging process for healthcare

professionals, patients and their carers; it is widely documented throughout

literature search that there are constant pressures to discharge patients from

the ward as quickly as possible, allowing little time to organise and plan the

care and support required for effective convalescence at home, or to assess

holistically the patient’s needs prior to their discharge.

Research commissioned by the Royal Voluntary Services (2014) estimated

that people aged 75 and older are more than twice as likely as those under

this age to be readmitted back to hospital if they are not given enough support

on discharge, particularly those who live alone or have long-term health

conditions.

An inquiry by Healthwatch England into discharge processes resulted in the

publication of the report ‘Safely Home: What Happens when People Leave

Hospitals and Care Settings?’ (2015) the report states that many of the people

questioned felt ‘rushed’ in their discharge home. The inquiry identified that

communication breakdown between hospitals and community care providers,

the lack of involving people in decision- making about their own care and the

failure to address the needs of patients were amongst the key causes of

ineffective discharge.

This all directs us to have clear systems and processes to ensure safe,

effective discharge which is planned and involves the patient and carer.

NICE guidance published in 2015 – ‘Transition between in-patient hospital

settings and community or care home settings for adults with Social care

needs’ provides key recommendations aimed to improve people's experience

of admission to, and discharge from, hospital by better coordination of health

and social care services.

Good practice in discharge planning has long been recognised as the

cornerstone of a successful transition of an individual from a hospital

environment to their home.

The Yorkshire Clinic aims to improve patient discharge which will in turn

provide patients with confidence about their ongoing recovery and the

transition from hospital to home will be seamless.

We will do this by:

Developing a discharge project group who will develop a standard for all nurses

and clinical practitioners to follow who are involved in patient discharge.


Implement the 10 steps of discharge planning Ready to Go – No Delays, one of the High Impact Actions (NHS Institute for Innovation and Improvement, 2009), offers a 10-step process for planning the discharge or transfer of patients.

1. Start planning before or on admission.

2. Identify whether the patient has simple or complex needs.

3. Develop a clinical management plan within 24 hours of admission.

4. Coordinate the discharge or transfer process.

5. Set an expected date of discharge within 24 hours of admission.

6. Review clinical management plan daily.

7. Involve patients and carers.

8. Plan discharges and transfer to take place over seven days.

9. Use a discharge checklist 48 hours before transfer.

10. Make decisions to discharge and transfer patients each day.

Review all aspects of ‘discharge’ in the Ramsay Patient Journey Policy (CN040)

and evidence compliance.

Develop discharge packs with all information required to meet individual

patient needs.

Staff education and training about the importance of effective discharge.

Discharge checklist to ensure both the clinical staff and the patient agree

fundamental goals prior to discharge.

Discharge lead with Champions who will support staff in ensuring patients

discharge is safe and seamless.

Under Caring we will focus on:

Improving the care and experience of people living with Dementia during

their journey at The Yorkshire Clinic.

Recognition of dementia and its effects on our society has never been

so high on the National agenda.

In 2009 the Department of Health published the National Dementia

Strategy with the aim of ‘ensuring significant improvements to

dementia services’ (DoH 2009). Objective 8 of the strategy advocated

improving the quality of care for people with dementia in general

hospitals.

In 2012 the Prime Minister’s Challenge on Dementia was launched

promising to deliver major improvements in dementia care and

research by 2015 (DoH 2012a).


In 2012 the Dementia Action Alliance, in partnership with the NHS

Institute for Innovation and Improvement launched ‘Right Care – Call to

Action’ for the improvement of care for people with dementia in

acute hospitals (DAA 2012).

The Yorkshire Clinic will develop and implement a ‘Dementia Strategy’, with

objectives that will drive our vision of becoming a truly dementia friendly hospital

that strives to consistently deliver high quality care that meets the needs and

expectations of our patients and their carers.

We will do this by:

Using the frame work based on the Royal College of Nursing (RCN)

principles for dementia care in hospitals:

Our Dementia Strategy will focus on:

Staff who are skilled and have time to care: Dementia Awareness Training for all staff:

Partnerships: Positive partnerships in care will be developed which

will ensure wellbeing, care choices and preferences are understood

and followed for people living with dementia and their carers. Views

and feedback will be actively sought and acted upon to ensure

continuous improvement in the service provision. Carers will have their

needs assessed alongside those of the patient to ensure they are


adequately supported, informed, educated and enabled to continue

with their caring role.

Assessment and early identification of dementia: Assessment to ensure

patients with Dementia are identified and an individualised care pathway

initiated at pre-assessment.

Care that is individualised: Care plans will be person centered,

responsive to individual needs and support nutrition, dignity, comfort,

continence, rehabilitation, activity and palliative care.

Environment: The Yorkshire Clinic will incorporate dementia friendly

principles into all aspects of the hospital environment. These

environments of care will enhance the patient experience and ensure

that no avoidable harm is caused and that we maximise privacy, dignity

and independent activities of living.

Good Governance: The Yorkshire Clinic will form a Dementia Strategy Delivery Group who will enable implementation and monitoring of the strategy. The group will work in collaboration with all hospital staff raising awareness and ensuring the needs of people living with Dementia and strategic priorities are met.

Under Well Led we will focus on:

Improving the quality of care provided to patients with diabetes

undergoing surgical procedures based on the NCEPOD Guidance- Highs

and Lows (A review of the quality of care provided to patients over the age of 16

who had diabetes and underwent a surgical procedure) published Dec 2018.

Diabetes is a serious, lifelong condition where blood glucose levels are too high.

There are two main types; type 1 caused by the body not being able to produce

any insulin, and therefore not able break down the glucose and type 2 where the

body does not make enough insulin, or it is not good enough.

1 The care of patients with diabetes is complex and this is particularly true of

those undergoing surgery. The care can cross numerous specialties which can

compound the issue of diabetes not being managed consistently. The recent

National Diabetes Inpatient Audit (NaDIA) showed that 18% of inpatients have

diabetes.

2 Previous work has shown that more than 15% of patients undergoing surgical

procedures are known to have diabetes.

3 Therefore it is essential that all staff are familiar with diabetes management to

ensure care of the patient’s glycemic control, along with the clinical reason for

their admission, that surgery is coordinated and appropriate.


The NCEPOD study found care could be improved in patients with diabetes

undergoing surgery. Method A: retrospective case note and questionnaire review

was undertaken in 509 patients aged 16 and over who had diabetes (type 1 or

type 2) and who underwent a surgical procedure. Key findings: The overarching

theme of the findings was that there was a lack of clinical continuity of diabetes

management across the different specialties in the perioperative pathway.

Absence of joint ownership of the diabetes management and multiple guidelines

targeted at specific specialties, rather than a joint multidisciplinary approach,

meant that the diabetes management of the patient was falling between gaps in

the surgical pathway.

The Yorkshire Clinic is situated in Bradford and serves healthcare for this

population. Bradford has the UK’s highest prevalence of diabetes, with more than

one in 10 people (10.4%) in the West Yorkshire city diagnosed with the condition.

The National average is 6.6%.

The Yorkshire Clinic will implement the recommendations made within the

NCEPOD quality improvement study with the aim to improve the care for

patients with diabetes undergoing surgery.

The Recommendations below will be actioned through the Yorkshire Clinic

‘Clinical Effectiveness Group’ led by the Clinical Education lead.

1. Write and implement a standard and policy for the multidisciplinary

management of patients with diabetes who require surgery.

2. Appoint a clinical lead for perioperative diabetes care in hospitals

where surgical services are provided.

This person will be responsible for developing policies and

processes to:

a. Ensure diabetes management is optimised for surgery.

b. Ensure patients with diabetes are prioritised on the operating list,

including the co-ordination of emergency surgery*

c. Identify when involvement of the diabetes multidisciplinary team,

including diabetes specialist nurse, is required.

d. Ensure high-risk patients are identified, such as those with type 1

diabetes.

e. Identify patients with poor diabetes control who may need pre-

operative optimisation.

f. Audit cases of prolonged starvation.

g. Ensure high quality discharge planning.

3. Use a standardised referral process for elective surgery to ensure

appropriate assessment and optimisation of diabetes. This should

include:


a. Satisfactory HbA1c levels within 3 months of referral.

b. Control of co-morbidities.

c. A list of all current medications.

d. The patient’s body mass index (BMI).

e. Estimated glomerular filtration rate (eGFR)

f. Perioperative risk rating.

4. Ensure that patients with diabetes undergoing surgery are closely

monitored and their glucose levels managed accordingly. Glucose

monitoring should be included:

a. At sign-in and sign-out stages of the surgical safety checklist (e.g.

WHO safety checklist).

b. In anaesthetic charts

c. In theatre recovery

d. In early warning scoring systems

e. System markers and alerts should be used to raise awareness of

glucose levels, e.g. tagging of electronic medical records, use of a

patient passport or unique stickers in paper based case notes.

5. Ensure a safe handover of patients with diabetes from theatre

recovery to ward, this should be documented in the case notes and

include:

a. Medications given in theatre.

b. Glucose level on leaving the recovery area.

c. Glucose level on arriving into the ward.

d. Ongoing management of diabetes, especially VRIII.

e. Criteria for contacting the diabetes team.

6. Develop a pre-operative assessment clinic policy and standards for

the management of patients with diabetes. These should be

developed by the lead anaesthetist and the clinical lead for

perioperative diabetes management, and include:

a. Identification of high-risk patients, such as those with poorly controlled

or type 1 diabetes.

b. Optimisation for surgery.

c. Criteria for involvement of the diabetes multidisciplinary team.

7. Ensure that patients with diabetes attending a preoperative

assessment clinic prior to elective surgery have:

a. Access to the diabetes multidisciplinary team, including diabetes

specialist nurse input.

b. Written instructions regarding their diabetes management plan prior to

surgery.

8. A clinical lead for day surgery should be in place in all hospitals

providing day surgery services. This lead, along with the clinical lead

for perioperative diabetes management should be responsible for

ensuring that patients with diabetes are considered for day surgery,


where appropriate. Policies should be developed to ensure patients with

diabetes have equity of access to day surgery.

9. Cancellation of elective surgery in patients with diabetes should be

avoided, particularly for known clinical reasons. Cancellation rates

should be audited locally and the results acted upon.

10. Develop and implement referral criteria for surgical in patients with

diabetes to:

a. Diabetes specialist nurses.

b. Dietitians.

c. Pharmacists.

d. Other diabetes multidisciplinary team members as required.

11. Record and monitor the time at which a patient begins fasting (for

surgery or clinical reasons). If a patient misses more than one meal,

their care should be escalated to the responsible medical team as this

indicates prolonged starvation.

12. Prioritise patients with diabetes on the operating list to avoid

prolonged starvation.

13. Provide patients with diabetes with education and information

about their diabetes management at discharge from hospital as

part of the discharge planning process.

2.2 Mandatory Statements The following section contains the mandatory statements common to all Quality

Accounts as required by the regulations set out by the Department of Health.

2.2.1 Review of Services During 2018/19 The Yorkshire Clinic provided and / or subcontracted 34 NHS services which include:

Adult ENT NHS Clinic.

Adult Gastroscopy Upper GI NHS Clinic.

Adult Gastroscopy Lower GI NHS Clinic.

Adult Diagnostic Endoscopy, Flexi Sigmoidoscopy & Colonoscopy NHS Clinic.

Adult Gynaecology NHS Clinic.

Adult Hysteroscopy & Heavy Menstrual Bleeding Clinic.

Adult Hernia Surgery NHS Clinic.

Adult Laparoscopic Hernia Repair NHS Clinic.

Adult Gall Bladder Surgery NHS Clinic.


Adult Colorectal Surgery NHS Clinic.

Adult Lumps & Bumps NHS Clinic.

Adult Minor Plastics Lumps & Bumps NHS Clinic.

Adult Hip NHS Clinic.

Adult Hip Revision Surgery NHS Clinic.

Adult Knee Ligament / Acruciate Ligament (ACL) NHS Clinic.

Adult Knee NHS Clinic.

Adult Hand & Wrist NHS Clinic.

Adult Elbow NHS Clinic.

Adult Shoulder NHS Clinic.

Adult Foot & Ankle NHS Clinic.

Adult Urology NHS Clinic.

Adult One Stop, No Needle, No Scalpel, No Suture, Vasectomy NHS Clinic.

Adult Vasectomy NHS Clinic.

Adult Male Incontinence NHS Clinic.

Adult Prostate NHS Clinic.

Adult Pain Management NHS Clinic.

Adult Cataract Surgery NHS Clinic.

Adult YAG NHS Clinic.

Direct Access Gastroscopy NHS Clinic.

Direct Access Nerve Conduction Studies NHS Clinic.

Adult Neurology NHS Clinic.

One Stop No Needle, No Scalpel, No Suture Vasectomy NHS Clinic.

Adult Sleep Studies NHS Clinic.

Adult Minor Breast Surgery NHS Clinic.

The Yorkshire Clinic has reviewed all the data available to them on the quality of

care in all 34 of these NHS services.

Ramsay uses a balanced scorecard approach to give an overview of audit results

across the critical areas of patient care. The indicators on the Ramsay scorecard

are reviewed each quarter of every year by the hospitals senior managers

together with Regional and Corporate Senior Managers and Directors. The

balanced scorecard approach has been an extremely successful tool in helping

us benchmark against other hospitals and identifying key areas for improvement.

In the period for 2018/19, the indicators on the scorecard which affect patient

safety and quality were as detailed below:


Human Resources

Data April 2018- March 2019

Staff Cost % Net Revenue - 25%

HCA Hours as % of Total Nursing - 45%

Agency Cost as % of Total Staff Cost - 1%

Ward Hours PPD - 4.04

% Lost Time - 24%

Mandatory training:

Mandatory training occurs twice a month (1x clinical, 1x non-clinical) and includes

the following workshops:

Infection Control.

Fire & Medical Gasses (Clinical).

Data Protection.

BLS & AED (Clinical).

Manual Handling.

Prevent.

Food safety.

Safeguarding.

Radiation protection.

Riskman. Current compliance - 1st May 2019 mandatory training is 94%.

2014/2015 2015/16 2016/17 2017/18 2018/19

Total Health Care Assistants – whole time equivalent (WTE)

36.30 39.48 43.74 45.73 50.40

Total Registered Nurses (WTE) 53.17 49.89 53.62 52.32 60.76

Total WTE Nursing (RN & HCA) 89.47 89.37 97.36 98.05 111.16

HCA hours as a % of Total Nursing Hours

40.50 44.17 44.90 45.40 45.00

Rolling Sickness Absence 3.66 3.74 4.39 3.98 4.71

Rolling Employee Turnover 20.20 17.70 13.40 15.30 16.10

Number of Significant Staff Injuries 0

(RIDDOR reportable)

0

(RIDDOR

reportable)

0

(RIDDOR

reportable)

2

(RIDDOR

reportable)

0

(RIDDOR

reportable)


Additional training is available throughout the year through the Ramsay academy including the following:

PDR & Induction training.

COSHH training.

Problem solving and decision making.

Making quality appointments.

Human factors.

Allocate.

Dealing with difficult people.

Conflict resolution.

Root cause analysis.

Developing resilience.

Coaching and Mentoring.

Managing meetings.

Time management.

Negotiation skills.

Surgical First Assistant.

Courageous conversations.

DSE Training.

Train the Trainer for Intravenous Drugs and Manual Handling. Appraisal 1st May 2019 is 95%. We have seen an increase in both the number of Healthcare Assistants and Registered Nurses employed. Employee turnover has increased slightly but we have overall seen less of an increase than 16/17-17/18. Turnover is higher in the clinical areas however as before, we have a good conversion rate to bank contracts which assists with flexibility. Continued work into creating better promotional clinical opportunities and the continued focus on employee engagement should on a long-term basis help reduce staff turnover. Sickness absence has increased by 0.73%. Sickness tends to be higher in the clinical areas and we continue to use the Bradford scoring system to effectively manage this.

Patient satisfaction:

Throughout 2018-2019 we have seen an increase in our Friends and Family responses and we continue to focus on obtaining feedback from patients through this method. We consistently achieve 99-100% of our patients stating they would recommend our hospital to Friends and Family. We have also introduced a ‘We value your feedback’ card, which we give to patients, the aim of feedback through this method is to obtain some qualitative data on what our patients think of the care and services at the Yorkshire Clinic.


Below is some of the comments received from Patients in our ‘we value your feedback cards’.

Formal Complaints per 1000 Hospital Patient Days (HPD's)

The Yorkshire Clinic received 36 complaints 1st April 2018 to 31st March 2019

compared to 33 complaints in the previous year. The 36 complaints were

expressions of concern, dissatisfaction and requests for action to be taken.

Complaints received were categorised as 20 related to Customer Service and 16

related to medical treatment / clinical care and Diagnosis. All of these were

investigated thoroughly complying with CQC timeframes for response. Every

complaint received is considered very seriously and given the immediate attention

of the Hospital Director and Matron on the day it is received, following which a

thorough investigation is commenced into the concerns raised as per Ramsay

Complaints Policy.

We discuss all our complaints at our Customer Focus Group, Governance

Committee and Medical Advisory Committees to ensure appropriate action is

taken and learning can be evidenced.

There were no EMSA (Eliminating Mixed Sex Accommodation) breaches throughout 2018/19.


Significant Clinical Events ‘Never Events’ are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented. For further details please visit: https://improvement.nhs.uk/documents/2266/Never_Events_list_2018_FINAL_v5.pdf The core list of ‘never events’ includes:

Wrong site surgery.

Wrong implant / prosthesis.

Retained foreign object post procedure.

Mis-selection of strong potassium solution.

Administration of medication by the wrong route.

Overdose of insulin due to abbreviations on incorrect device.

Overdose of methotrexate for non-cancer treatment.

Overdose of midazolam during conscious sedation.

Failure to install functional collapsible shower or curtain rails.

Falls from poorly restricted windows.

Chest or neck entrapment in bed rails.

Transfusion of ABO incompatible blood components or organs..

Misplaced naso or oro-gastric tubes.

Scalding patients.

Unintended connection of a patient requiring oxygen to an air flow meter.

1st April 2018 - 31st March 2019: There has been No Never Events at The Yorkshire Clinic. Patient safety and reduction in incidents which cause patient harm has been a key focus during 2018-2019. This has been supported by the introduction of the ‘Speak up for Safety Programme’. The introduction of the National Safety Standards for Invasive Procedures (NatSSIPs) has further supported the embedding of patient safety frameworks and policies at the Yorkshire Clinic. The National Safety Standards for Invasive Procedures (NatSSIPs) aim to reduce the number of patient safety incidents related to invasive procedures in which surgical Never Events could occur. These new standards set out broad principles of safe practice and advise healthcare professionals on how they can implement best practice, such as through a series of Standardised safety checks and education and training. The standards also support hospitals to work with staff to develop and maintain their own, more detailed, local standards and encourage the sharing of best practice between organisations. The Yorkshire Clinic has fully implemented the NatSSIPs including the local standards set by Ramsay Healthcare. One of the local standards which is key to ensuring patient safety is the List Safety Officer (LSO) Role:

https://improvement.nhs.uk/documents/2266/Never_Events_list_2018_FINAL_v5.pdfhttps://www.england.nhs.uk/patientsafety/never-events/natssips/https://www.england.nhs.uk/patientsafety/never-events/natssips/


Patient safety during the performance of invasive procedures is dependent upon adequate preparation, the accurate scheduling of procedures and the management of procedure lists. This standard supports procedure teams in ensuring that lists accurately reflect the plans for patients and the procedures they are scheduled to undergo. Each procedure team should have an identified team member responsible for collating relevant briefing and debriefing documentation e.g. reviewing action logs and sharing information with local governance and management systems on a regular basis. (NatSSIP’s September 2015).

2.2.2 Participation in clinical audit During 1st April 2018 to 31st March 2019, three National clinical audits covered NHS services provided at The Yorkshire Clinic. The National clinical audits that The Yorkshire Clinic participated in, and for which data collection was completed during 1st April 2018 to 31st March 2019, are listed below alongside the number of cases submitted for each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry.

Name of Audit Participation

(NA, No, Yes)

% cases

submitted

Comments

National Joint Registry (NJR) – Per

patient

YES 95% None.

JAG Census – Quarterly YES 100% All requirements met

fully.

Elective surgery (National PROMs Programme) Hips Knees Cataracts

YES

NA

NHS Safety Thermometer YES 100% None.

Medicines Safety Thermometer YES 100% None.

SSI – Surgical Site Surveillance

Hip and Knee Arthroplasty (30 day

post-surgery wound surveillance

programme)

YES

100% None.


All the above audit reports are discussed at the local Clinical Governance committee meetings to ensure no trends are developing and outliers are highlighted. National Audits The National clinical audits list we intend to undertake within the period 1st April 2019 to 31st March 2020 is as follows:

Name of Audit / Clinical Outcome Review Programme

National Joint Registry (NJR) – Per patient.

NHS Safety Thermometer.

Elective surgery (National PROMs Programme).

JAG Census – Quarterly.

SSI – Surgical Site Surveillance – Quarterly.

National Bariatric Surgery Registry (NBSR).

National Ophthalmology Audit.

Local Audits

The Yorkshire Clinic participates in the Ramsay Corporate Audit Programme (the schedule can be found in Appendix 2). The audit topic and schedule is set centrally by Ramsay Health Clinical Governance Committee to allow greater opportunity for benchmarking. Additionally The Yorkshire Clinic also carries out a number of local clinical audits all of which go through the Clinical Governance Committee where actions are taken to improve the quality of the healthcare provided: Summary of some of the local clinical audits undertaken from 1st April 2018 to 31st March 2019:

Medical Records: Initial Audit score was 96%, this was a result of the training

and focus given in 2017 to improve the quality of record keeping. We had RCN

training delivered on record keeping and the Heads of Department were tasked

with ensuring staff kept quality records to support quality care delivery.

Throughout 2018 our Medical records audit scores were >90% and we continued to action key criteria within the audit where compliance was identified as poor. Patient Journey: Initial score in April 2018 was 93%; through focused education and monitoring by the Heads of Departments all audit criteria set within the Patient Journey audit were maintained and all aspects of the patients journey policy were adhered to as this was reflected in the audit scores of 95% in each quarter of 2018.


Ward Operational: This audit provides assurance of processes and pathways on the ward which direct quality governance. Initial audit score in April 2018 was 97%, however in November 2018 we employed a new ward Manager who completed a detailed audit which showed aspects of the criteria required action, the audit score was 88%. Following completion of actions which included ensuring monthly team meetings occurred, 100% of staff completed mandatory training and appraisals; the current audit score was 92%. Availability of medical device documentation is an area where improvement is required. Physiotherapy Operational: Throughout 2017-2018 the physiotherapy operation audit has been 100%, the focus of the team is ensuring all aspects of the audit criteria are met and this can be evidenced is a result of this score. Quality Clinical Gov

Documents

The Yorkshire Clinic & Lodge · The Yorkshire Clinic is a private hospital situated in the grounds of Cottingley Hall in Bingley, West Yorkshire. The hospital offers care to patients