Darent Valley Hospital - DGT - Quality Strategy

Dartford and Gravesham NHS Trust

Quality Strategy Providing outstanding care which is skilled, trusted and kind, every time

Care with compassion

Respect & dignity

Striving to excel

Professional standards

2020 - 2025

Working together

Foreword

We are excited to introduce our Quality Strategy: free from harm with thoughtfulness, skill and respect to guide the Trust over the next five years. We have progressed significantly over the past five years, evidenced by our achievement of our ‘Good’ rating by the CQC in 2019. Our alliance relationship with Guy’s and St. Thomas’ has brought new training and development opportunities for our staff and has supported us in the adoption of the Nightingale programme. Our ward accreditation has been rolled out to 21 wards, 15 of which have been accredited. Although improvement in the quality of our services will result in staff being more joyous at work, better engagement with our partners, improved efficiency and adoption of digital technologies, the Quality Strategy primarily supports the delivery of two of the Trust strategic priorities for the next five years: ‘Journey to Outstanding’ and ‘Continuous Quality Improvement’. Our Quality Strategy focuses on five priorities, which are instrumental in their delivery, and these are: • Positive patient experience: Enriching the experience of our patients and their families • Harm-free care: Protecting our patients, by reducing the proportion of clinical incidents that cause harm • Effective care: Improving clinical outcomes for our patients by providing the best evidence- based care, every time • A culture of excellence: Providing our staff with the best skills, training and education to deliver high standards of professional practice • Reduce mortality: Achieve position in 10% of NHS organisations with the lowest risk adjusted mortality This quality strategy progresses us on our journey to Outstanding. We will provide clinical care that is free from harm and we will provide that care with thoughtfulness, skill and respect. The quality strategy is the framework through which improvements in the services we offer to patients can be focused and measured for the planning, implementation, evaluation and reporting of quality services. Although we know that we deliver good care, and that overall on most indicators we are comparable to similar National Health Service organisations, we are not content with just being good, we want to be outstanding; we want our patients

and their families to receive care and experience that is outstanding, and we want our staff to feel valued and committed to ensuring they provide personalised, comprehensive and effective care. We are committed to ensuring that the voice and experience of our staff, patients and communities is used to drive improvements across our services. This Quality Strategy is set in a challenging time; We know that we continue to find it hard to recruit clinical staff at all levels and skill sets, and we are seeing an increase in infection rates and the acuity of our patients. We are not alone in these challenges; services out of the hospital setting are also hard-pushed to deliver the care they would like to. We are committed to working collaboratively with our partners to improve the overall population health. We are also exploring how best we protect our patients and staff from COVID-19 whilst ensuring that care is accessible, safe and that our patients remain connected and supported by their loved ones whilst in hospital. We are embracing digital solutions and working closely with our local community to make considered changes to the care we provide. We will be closely monitoring the delivery of the strategy at our monthly Quality & Safety Committee which reports to our Trust Board. The papers and minutes of these, as well as our strategies for 2020-2025, can be found on the Dartford and Gravesham Trust website. We will also continue to publish our annual Quality Account, also available on our website.

Siobhan Callanan Chief Nurse

Steve Wilmshurst Non-Executive Director,

Chair of Quality & Safety Committee

Contents

Executive summary

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Introduction

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Context a. Partnership working and population health management b. Services with focused strategies / programmes Quality priorities a. Delivering the strategic objectives through our quality priorities: journey to Outstanding b. Delivering the strategic objectives through our quality priorities: continuous quality improvement c. Positive patient experience d. Harm-free care e. Effective care f. A culture of excellence g. Reduced mortality

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8-9

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12 13 14 15 16-17 19-21 22-26 27-28 18

Delivering the Quality Strategy a. Continuous quality improvement b. Patient and staff engagement c. Governance

Appendix Reporting and communicating the Quality Strategy

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Executive summary

Our vision: Providing outstanding care which is skilled, trusted and kind, every time

Quality Priorities:

Positive Patient Experience Enriching the experience of our patients and their families. • Involving patients, families and carers in designing and improving care • Listening to feedback • Staff feel services provide the best quality care • Improving care for children and young Harm Free Care Protecting our patients, by reducing the proportion of clinical incidents that cause harm. • Effective systems and processes to deliver harm free care • Patient safety culture through learning and adopting best practice Effective Care Improving clinical outcomes for our patients by providing the best evidence based care, every time • Care is provided in the right place at the right time • Improve clinical effectiveness through learning

A Culture of Excellence Providing our staff with the best skills, training and education to deliver high standards of professional practice. • Clinical supervision, education and training to develop staff’s skills in providing outstanding care • Safe, sustainable, productive staffing to provide effective care Reduce Mortality Attain performance to be in the upper quartile of organisations with the lowest risk adjusted mortality rates. • Continuously strive for the lowest mortality rates

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Trust Strategy Summary

Introduction

Dartford and Gravesham NHS Trust (DGT) provides a comprehensive range of acute services to a population of 400,000 across Dartford, Gravesham and Swanley, as well as Bexley. Services are provided across two main hospital sites, Darent Valley which provides elective and emergency care and Queen Mary’s, our planned care centre. DGT’s workforce is a committed family of highly skilled, caring, and compassionate staff comprising of over 3,400 individuals from a variety of professional and technical backgrounds, as well as over 170 volunteers that provide invaluable support to the overall patient experience. Our teams are continually striving to improve the quality of the care we provide, the safety and effectiveness of our services and the experience of our patients and their carers. This map shows the population that we serve and the hospital sites that we primarily operate from. We also provide outreach services to a wide range of places in the community including GP practices, community hospitals, care homes and patient homes. Our population is rapidly growing with local developments such as Ebbsfleet Garden City, a Healthy New Town. The population is set to grow by 35,000 within five years and by 55,000 within 10 years. Our strategies for 2020-2025, have been developed in the context of this exceptional population growth, as well as the demographics of the population we serve. The demographics across Dartford, Gravesham and Swanley and Bexley are similar with pockets of high levels of deprivation, a range of ethnicities and languages spoken and a population with a high proportion of both younger and older people.

Performance against our 2019/20 Quality Priorities • Patient Safety: Our priority to reduce MRSA and gram-negative bacteraemias was achieved. We focused on learning from falls, pressure ulcers and medication errors; based on our performance, both falls and pressure ulcers will remain priorities. Progress towards providing 7 day services was also prioritised. Whilst significant progress was made on consultant reviews, consultant-led interventions and diagnostics, greater investment is required to achieve a 14 hour consultant review standard. • Patient Experience: Our patient and public engagement plan launched resulting in improvements in the feedback received from patients. In particular, there was a focus on focused engagement with those with learning disabilities and recording these on our patient administrationsystemtoimprovecommunication and care across services for those patients. New pathways were developed for children and young people’s epilepsy and sickle cell services to support their transition from children’s services to adult services, and work continues to finalise the sickle cell pathway. • Clinical Effectiveness: The Trust successfully reduced mortality for those with fractured neck of femurs through the development of a frailty team. As a proposed hyper acute stroke unit in Kent & Medway, the Trust will continue to focus on improving the quality of the stroke service. The implementation of the Better Births strategy began in 2019 and will continue to be a focus for the Trust in partnership with the Kent & Medway Maternity Network. Our Quality Strategy sits at the heart of all other Trust strategies and it outlines our five quality priorities, with the overall aim to improve patient safety, experience and the effectiveness of the care we provide, enabling us to become an

Outstanding organisation: • Positive patient experience • Harm-free care • Effective care • A culture of excellence • Reducing mortality

These priorities are supported by a culture of continuous improvement, a robust governance systemand a diverse patient and staff engagement plan.

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Trust Strategy Summary

Context

Partnership working and population health management Partnership working supports and drives quality improvement. Working with our partners through clinical networks, locally, regionally, nationally and internationally, the Dartford, Gravesham and Swanley Integrated Care Partnership (ICP) and the Kent and Medway (as well as the South East London) Integrated Care System (ICS) supports us to share skills, experience, and expertise in addition to making the best use of scarce resources. We are committed to sharing our learning and successes with other organisations so that they can improve the quality of care they provide. We are committed to learning from others, and will actively seek to understand the quality improvements taking place both in and outside of the NHS, and adopt their successes localising aspects where required. We believe that a fundamental part of delivering high quality is ensuring that our patients receive the most appropriate care, in the most appropriate place, and by the most appropriate professional. Evidence has shown that, for most of our patients, the best place for them is in the place that they call home (their ‘best bed’). We are therefore committed to ensuring that our patients

only access our hospital for acute care and also supporting them to get back to their ‘best bed’ as soon as possible.; in order to achieve this, we are working together with our local communities, partnering and collaborating within the systems that we operate in, to redesign pathways across Primary, Community, Mental Health and Secondary care. We know that by working together, we can remove fragmentation and ensure that pathways and systems are aligned and well-coordinated. We believe that this can make a difference between ‘good’ and ‘outstanding’ care. Further details of proposed pathway improvements across our system can be found in the Clinical Strategy. Population health management The ICP is committed to improving the health of the population we serve. To do this, it will be driven by population health management data to proactively engage with individuals in their health and wellbeing care plan, empowering them to better understand how to manage their condition as well as when, how and where to seek help when needed. This will result in more targeted interventions to prevent ill-health, improve the quality of care (in particular the effectiveness of interventions and patient experience) and improve outcomes. • Coordinated care for those with the most complex needs • A new model of coordinated inpatient care • Rapid discharges of re-integration into community based care • Scaled up and enhanced primary and community care teams • Multi-disciplinary teams for complex service users • Integrated access to specialist advice and treatment • Ongoing care in the community, enabled by technology • Building business intelligence systems and share care record • Tailoring services based on population segmentation • Better population health through community engagement • Supporting self-care and patient activation • Linking people to community assets and services • Proactive approach • Joined-up crisis response services • Integrated access to unplanned, urgent and emergency care services Integrated Care Partnership Care Model

Highest

Ongoing care needs

Urgent care needs

Whole population

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Trust Strategy Summary

Context

Services with focus quality strategies and programmes Paediatric Services Our vision for paediatric services is to have a ‘safe and trusted paediatric and transition service’. The Long Term Plan set out clear ambition for improving the quality of services for children and young people, particularly as they transition to adult services. Children and young people are seen in a variety of areas across the Trust and it is important that we make sure that, wherever they are seen, the care and environment is appropriate for them and their families. We have therefore recently set up a Children and Young People's Board to: • D evelop and lead the implementation of a Children and Young People Strategy across the Trust • E nsure staff are supported to provide the best possible care to our children and young people, through supervision, leadership and education • E nsure the Trust responds appropriately and in a timely manner to advice, guidance and recommendations from regulators and external bodies • A ct as the ‘guardians of quality services’ for children and young people across the Trust, including safeguarding • D evelop partnerships across the Integrated Care Partnership in DGS and Bexley to better facilitate pathways for children’s care.

Over the next five years we want to ensure that children and young people, along with their families and carers, are welcomed, receive outstanding care and an experience appropriate to their age and developmental needs in every area of the Trust. Our children’s services have excellent links with the Evelina, through the GST Healthcare Alliance, which we will continue to foster over the next five years. The Children's Board will report directly into the Trust Board. Maternity Services – Maternity Transformation Programme The aim of this programme is to deliver the Better Births Strategy (2016). We are committed to delivering the 10 parts of the programme, and are working collaboratively with partners across Kent and Medway ICS to do so. We deliver over 4,800 births each year to mothers across Dartford, Gravesham, Swanley, Bexley and increasingly into Essex. The maternity services vision is to be the ‘best maternity service in Kent and Medway also serving Bexley and Essex’.

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Trust Strategy Summary

Quality priorities

Our vision: Providing outstanding care which is skilled, trusted and kind, every time

Our Strategic Priorities delivered through the the Quality Strategy Journey to Outstanding Ensuring patients receive outstanding clinical care, are kept free from harm and are treated with thoughtfulness, skill and respect. Continuous quality improvement To be a learning and improving culture, using continuous improvement to discover, create and innovate. Our Quality Priorities are delivered through: • a culture of continuous improvement; • listening and involving our patients, • patients’ families and our staff; • and, a system of shared governance. These have been developed considering: • performance against our quality priorities for 2019-2020; • our 2019 CQC inspection feedback; • Better Births Strategy; • National Patient Safety Strategy; • patient and staff feedback; • COVID-19 experience and learning;

Enriching the experience of our patients and their families. Positive patient experience Protecting our patients by reducing the proportion of clinical incidents that cause harm. Harm-free care Improving clinical outcomes for our patients by providing the best evidence-based care, every time. Effective care Providing our staff with the best skills, training and education to deliver high standards of professional practice. A culture of excellence Attain performance to be in the upper quartile of organisations with the lowest risk adjusted mortality rates. Reduced mortality

• our ICP and ICS plans; • Learning from Deaths; • and, our Trust Strategy for 2020-25.

For further information on our performance against quality metrics, see our 2019/20 Quality Report.

Our values:

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Trust Strategy Summary

Quality priorities

Delivering the strategic objectives through our quality priorities: Journey to Outstanding The Trust’s strategic objectives Journey to Outstanding and Continuous Quality Improvement, have a series of outcomes that the quality priorities align to, and seek to, deliver. This page focuses on the strategic objective Journey to Outstanding. Strategic objective: Journey to Outstanding Ensuring patients receive outstanding clinical care, are kept free from harm and are treated with thoughtfulness, skill and respect Strategic objective outcomes:

1. Our patients will only access our hospital for acute care and we will support them back to their ‘best bed’, the one that they call ‘home’, as soon as possible Quality priorities: • Positive patient experience • Effective care

2. Our patients will have confidence in the effectiveness and safety of the care they receive in our hospital, comparable to, or better than, any elsewhere Quality priorities: • Positive patient experience • Effective care • Harm-free care • Reduce mortality 4. The care and services we provide will be of the best possible quality, based in evidence and supported by appropriate resource(s) Quality priorities: • Positive patient experience • Effective care • Harm-free care • A culture of excellence

3. Our patients will feel respected and will experience kindness and compassion, every time Quality priorities: • Positive patient experience

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Trust Strategy Summary

Quality priorities

Delivering the strategic objectives through our quality priorities: Continuous Quality Improvement The Trust’s strategic objectives Journey to Outstanding and Continuous Quality Improvement have a series of outcomes that the quality priorities align to and seek to deliver. This page focuses on the strategic objective Continuous Quality Improvement. Strategic objective: Continuous Quality Improvement To be a learning and improving culture, using continuous improvement to discover, create and innovate Strategic objective outcomes:

1. Continuous improvement is purposely linked with the Trust’s strategic priorities Quality priorities: • A culture of excellence

2. Achieving CQC rating of outstanding Quality priorities: • Positive patient experience • Effective care • Harm-free care • Reduce mortality

3. A strong and positive culture of continuous improvement is reported across the organisation Quality priorities: • A culture of excellence

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Trust Strategy Summary

Quality priorities

Positive patient experience Enriching the experience of our patients and their families Lead: Chief Nurse Trust Group / Coordinating Committee: Patient Experience Outcomes: • Services are designed, and care delivered, in a way that involves patients, carers and families as partners in care • Staff work in services that they believe are delivering the best positive outcomes for patients, carers and families • Feedback from patients, carers and families is taken seriously and influences improvements in care • Both patient and public voice are integral in the decision making process when making changes to services or care delivery • Improving children’s and young people’s services Each of these outcomes is underpinned by a series of measures of success which evolve over the five years of this strategy. These will be monitored and reported to the Patient Experience Committee at a frequency agreed by the committee itself. See appendix for the specific measures of success for each of the five outcomes that together will deliver the quality priority, a positive patient experience. The Patient Experience committee is a sub-committee of the Quality and Safety Committee and as such, the Patient Experience committee minutes are received by the Quality and Safety committee.

Feedback from patients and staff in June 2020, based on changes in practices due to the COVID-19 pandemic, included the following recommendations to be taken forward relating to patient experience: • Continuation of the Compassionate Care Team, that facilitatedtechnologyenabledconversations with patient’s loved ones, to reduce loneliness and anxiety as a result of visitor restrictions for inpatients • Continuation of the Family Support Team, provided by the palliative care team, that provided support to the families of patients in their last days • Exploration of how to best enable patients to have greater confidentiality when liaising via telephone or video calls • Adoption of hand signs, and other ways to communicate emotions to patients, when wearing protective equipment which limits patients’ ability to “read” staff • The commitment of our community has been overwhelming. We are committed to engaging our patients, their families and carers in the design of services and pathways to improve the patient experience, and provide outstanding care as close to home as possible, which will continue to include the use of digital technology

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Trust Strategy Summary

Quality priorities

Harm-free care Protecting our patients by reducing the proportion of clinical incidents that cause harm Lead: Chief Nurse Trust Group / Coordinating Committee: Patient Safet y Outcomes: • Robust, effective systems and processes are in place to deliver harm-free care all the time • E nhance the embedding of a safety culture in the trust ensuring learning from adverse events, and compliance with national best practice Both of these outcomes is underpinned by a series of measures of success which evolve over the five years of this strategy. These will be monitored and reported to the Patient Experience Committee at a frequency agreed by the committee itself. See appendix for the specific measures of success for each of the five outcomes that together will deliver the quality priority, a positive patient experience. The Patient Experience committee is a sub-committee of the Quality and Safety Committee and as such, the Patient Experience committee minutes are received by the Quality and Safety committee.

Feedback from patients and staff in June 2020, based on changes in practices due to the COVID-19 pandemic, included the following recommendations to be taken forward relating to patient experience: • Patients attending hospital are required to wear masks and will have their temperature and symptoms checked • Seating areas have been adapted to allow for social distancing • Staff will be wearing the appropriate personal protective equipment (PPE)

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Trust Strategy Summary

Quality priorities

Effective Care Improving clinical outcomes for our patients by providing the best evidence-based care, every time Lead: Medical Director Trust Group / Coordinating Committee: Quality & Safety Committe e Outcomes: • Ensure that patients are treated in the right place at the right time • Clinical staff are supported to drive a clinically curious culture, and increase shared learning, while improving clinical effectiveness Both of these outcomes rely on effective partnership working with other health and care providers, ensuring patient-centred smooth pathways are developed based on patient feedback, best practice and clinical effectiveness. These outcomes are underpinned by a series of measures of success that evolve over the five years of the strategy. These will be monitored and reported to the Quality Committee at a frequency agreed by the committee. See appendix for the specific measures of success for both of the outcomes that together will deliver the quality priority, effective care.

Feedback from patients and staff in June 2020 based on changes in practices due to the COVID-19 pandemic included the following recommendations to be taken forward relating to effective care: • Staff to be trained in the donning and doffing of protective equipment • Maintaining register of staff and their skill sets to allow rapid redeployment of staff in critical incidents • Technology enabled outpatient care to reduce attendance to hospital,and continue to allow patients to access care

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Trust Strategy Summary

Quality priorities

A culture of excellence Providing our staff with the best skills, training and education to deliver high standards of professional practice Lead: Chief Nurse

Trust Group / Coordinating Committee: CQi Academy, Quality Council, Quality & Safety Committee Outcomes:

• S Formalise clinical supervision process to ensure all staff have appropriate mentoring, coaching and supervision All staff have the core identified statutory and mandatory skills for their roles Staff receive appropriate education and training to ensure they have the right skills to support new models of care Safe, sustainable and productive staffing Ensure there is sufficient and sustainable staffing capacity and capability to provide safe and effective care to patients at all times A culture of excellence and investing in the skills and development of staff will improve the safety, outcomes and experience of our patients. Each of these outcomes are underpinned by a series of measures of success that will evolve over the duration of this strategy. These will be monitored and reported to the Quality & Safety Committee at a frequency agreed by the committee. See appendix for the specific measures of success for each of the five outcomes that together will deliver the quality priority, a culture of excellence. The Continuous Quality Improvement Academy and Quality Council will be established during 2020/2021, these will then report to the Trust Board and Trust Leadership Team respectively.

Feedback from patients and staff in June 2020, based on changes in practices due to the COVID-19 pandemic, included the following recommendations to be taken forward relating to a culture of excellence: • Continuation of a clinical advisory board to review recommendations and proposed changes in practices/pathways to make quick, well- informed decisions • Nursing staff to have the opportunity to rotate to other areas of the hospital to enhance their skills and to improve communication between departments/services

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Trust Strategy Summary

Quality priorities

Reduce mortality Achieve position in 10% of NHS organisations within the lowest risk adjusted mortality Lead: Medical Director Trust Group / Coordinating Committee: Patient Safety, Quality & Safety Committe e Outcome: • A ttain performance to be in the upper quartile of organisations with the lowest risk adjusted mortality rates This outcome is underpinned by the measure of success set out in the appendix. Mortality rates will be monitored and reported to the Patient Safety committee and in turn to the Quality and Safety committee at a frequency agreed by the committee.

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Trust Strategy Summary

Delivering the Quality Strategy

Continuous quality improvement • Quality culture • DGT CQi Academy • Nightingale and ward accreditation programmes Patient and staff engagement • Patient and Public Engagement Continuum • Engagement plan on a page 2019-2022 • Freedom to speak up • What the quality priorities mean to our staff

Shared governance • Developing shared governance • Quality Councils • Trust Leadership Team meeting

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Trust Strategy Summary

Delivering the Quality Strategy

Continuous Quality Improvement (CQi): To be a learning and improving culture, using continuous improvement to discover, create and innovate Quality Culture: A strong and positive culture of continuous improvement is reported across the organisation Our culture of continuous quality improvement will: • B e nurturing and learning, where staff are supported, provided with training and education and have the knowledge and skills to drive and deliver quality improvements • P roactively encourage staff to be engaged in identifying, shaping and delivering quality improvements • S hare learning and celebrate successes, rewarding our staff for their achievements • V alue the great capacity that a diverse workforce that feel and experience equality, belonging, fulfilment and inclusion provides to foster innovation and creativity This culture means that we will: • h ave a relentless focus on the needs of patients, families and staff; • use data for learning and improvement; • h ave an engaged workforce that drive improvements and find joy in their work; • a nd, continuously learn and test the changes we introduce, in a structured way, to rapidly roll out and celebrate successes. We recognise that developing this culture will take time. By 2025 we aim to be recognisably at stage 3: Culture of continuous improvement.

The three stages of Quality Improvement:

Years 1-2 Early experiences

• project-based, with an emphasis on operational improvements

Years 2-4 Making it part of early work

• linking improvement efforts with strategic goals • moving from a series of projects to daily continuous improvement

• Changing mindsets and building capabilities • Embedding Qi across all areas of the organisation Years 5-10 Culture of continuous improvement

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Trust Strategy Summary

Delivering the Quality Strategy

Continuous Quality Improvement (CQi): To be a learning and improving culture, using continuous improvement to discover, create and innovate Over the next five years, we will invest in a DGT CQi Academy to provide the training, skill and knowledge required to successfully deliver quality improvements. This Academy would host and align all improvement efforts so that we can effectively and consistently measure cause and impact. We already adopt a range of improvement programmes such as LEAN methodology, the Nightingale and ward accreditation programme as well as audit-initiated improvement plans led by training doctors. DTG CQi Academy DGT CQi Academy: Methodology and Quality Management System Quality Improvement Methodology: We will be focusing on adopting a single improvement methodology for consistency and this will be the Model for Improvement. This will provide a cycle of improvement which involves problem definition and diagnosis, testing of change ideas, data collection and analysis, implementation and evaluation and a set of tools and techniques that support individuals to implement the improvements. It relies on engaging stakeholders, including patients and carers, as well as a learning culture and strong clinical and managerial leadership throughout the Trust. Our continuous improvement strategy, led by the Director of Improvement, describes in more detail the ways in which staff will be trained and supported to undertake change projects using the above frameworks. To support the successful delivery of this strategy, alongside the model for improvement methodology, we will also implement an effective quality management system using the tried and tested quality management framework that is used across the most successful health and social care organisations across the UK. Quality Management System:

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Trust Strategy Summary

Delivering the Quality Strategy

Continuous Quality Improvement (CQi): To be a learning and improving culture, using continuous improvement to discover, create and innovate Nightingale Programme The Healthcare Alliance is a collaborative model between DGT and Guys and St Thomas Hospital (GSTT) and was formed in 2018. Within the alliance, both Trusts are committed to the learning and sharing of good practice such the Nightingale Programme. The nurse-led Nightingale Programme is a quality improvement programme that was launched at Guys and St Thomas Hospital (GSTT) in May 2016; its aim is to ensure that patients receive safe, effective care delivered with the utmost kindness at all times by standardising processes on the ward, improving communication between multidisciplinary teams on the ward and involving staff and patients in decision making. The programme uses a combination of simulation training and focussed arrangements for the first, middle and last hours of shifts on the ward and standardising how staff are deployed. Although it is recognised that each ward works differently and every shift can be different, with variances in staffing levels and skill mix across the 24 hour day, the Nightingale programme seeks to minimise inconsistencies, and support staff from different professions and clinical backgrounds, to jointly work together in creating care plans for our patients. The programme also supports in improving staff satisfaction and has a positive impact on the health and wellbeing of our staff; evidence shows that this leads to the delivery of improved patient outcomes and efficiencies. In collaboration with GSTT, the Nightingale programme was successfully launched at DGT on 1st March 2019. We have focused on training and building knowledge on all of our wards. Over the next 5 years, under the guidance of the DGT CQi Academy we will be focusing on moving from this being a programme to a culture change.

Ward Accreditation Programme

Step 1: Baseline Audit

Audit gainst 152 performance indicators through observation, interviews and data collection

Step 2: Assessment Result

A weighted scoring matrix is applied across the five CQC domains to give a total score

Step 3: Accreditation

A ward is accredited as white, bronze, silver or platinum based on their total score

Step 4: Support

Action plans are developed and monitored and tools such as the Nightingale Programme are adopted

Step 5: Re-audit

The same audit is undertaken three months later and scores compared to baseline Step 6: Maintaining and Improving Accreditation Wards continuously work towards ‘platinum’ by monitoring performance against trajectories through audits and Early Warning Signs system (NEWS2)

Step 7: Review

Once ‘silver’ or ‘platinum’ has been achieved for two consecutive years, an annual review process will take place to maintain accreditation level

Step 8: Celebrating success

Through staff awards and local / national sharing of achievements

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Trust Strategy Summary

Delivering the Quality Strategy

Patient and Staff Engagement Our aspiration is to work with patients along the engagement continuum, from informing to Partnering and empowering, in order to provide the best possible experience. We believe that only by working with our patients will the best possible care and experience be achieved. Wewill create the best possible patient experience at individual, service and organisational level by: • L istening carefully and responding effectively to our patients • B eing proactive in including and managing expectations • P ersonalising care • G etting the basics right The Patient and Public Engagement Continuum In 2019, we ran a series of patient engagement workshops with our patients and partners. Based on what our patients told us, we have decided to adopt the patient and public continuum engagement framework to develop our patient engagement strategy; we think that this will enable us to effectively engage with our patients and their families in different situations, services and across different aspects of patient experience.

Informing

Providing individuals and communities with balanced and objective information to assist them in understanding problems, alternatives, opportunities and solutions. For example, co-decisionmakingwhen considering options for treatment

Consulting/Responding to Feedback

Obtaining individual and community feedback. For example, acting on frequent feedback issues, responding to complaints and asking patients for their views on a range of options for change

Engaging and Involving

Working directly with patients and communities to ensure that concerns and aspirations are consistently understood and considered. For example, setting up reference groups, partnership boards etc.

Co-designing

Working in partnership with patients and communities in each aspect of the decision, including the development of alternatives and identification of the preferred solution

Partnering and Empowering

Placing decision-making in the hands of patients and communities. For example, personal health budgets

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Trust Strategy Summary

Delivering the Quality Strategy

Patient and Staff Engagement: Patient and Public Experience and Engagement Strategy 2019-2022 How will we engage people? Working with our patients and partners, we have developed a Patient Engagement Strategy with the principles of working at an individual, service and organisational level to deliver our patient experience priorities. We will create the best possible patient experience at the individual, service and organisational level by: • Listening carefully and responding effectively to our patients • Being proactive in including and managing expectations • Providing personalising care • Getting the basics right We want to offer care the is compassionate, personal, safe and respectful to all our patients and their loved ones. Our aspiration is towork with patients to provide the best possible experience. We believe that only by working with our patients will the best possible care and experience be achieved. Our vision Individuals and communities will be provided with balanced and objective information to assist them in understanding problems, alternatives, opportunities, solutions. • Feedback will be obtained and acted upon for frequent issues, e.g. asking patients views on a range of options for change • Patients will have their concerns and aspirations consistently understood and considered • Patients and communities will work in parnership with the Trust in each aspect of the decisions offered What will this mean for patients?

• We have a current Patient Engagement Strategy that expires in 2019 and needs to be 'modernised' for current healthcare transformation • We support staff who work at Darent Valley Hospital, Queen Mary's Hospital, Elm court and outreach sites to empower patients to give feedback on current pathways of care • We have conducted two formal patient experience events in 2019 in order to proactively redesign our thinking of patient engagement • Patient experience and engagement is also a theme for change in the 2019/2020 Quality Accounts that will be published on the Trust website in July 2019 • We have ongoing ability to capture positive and negative themes in feedback via a range of methods • Staff will be following the requirements of NHS Long Term Plan (2019): √ People will get more control over their own health and more personalised care √ People-centred care will be key, ideally digitally enabled when applicable √ People will be empowered and their experience of health and care will be transformed What does this mean to staff? Our current position • We will present the agreed strategy to the Patient Experience Committee and Trust Board by September 2019 • We will widely publish the new Patient and Experience and Engagement Strategy, starting in Autmn 2019 • We will ensure all staff are made aware of the new strategy by Trust wide Commmunications and staff induction/ trainingevents for 2019/2020 • We will collect data on patient experience and engagement and present our tindings monthly via Quality and Safety Committee, in the Director of Nursing's Quality report to begin in Autmn 2019 • We will conduct at least 5 patient experience/ engagment events between 2019-2022 How will measure success?

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Trust Strategy Summary

Delivering the Quality Strategy

Patient and staff engagement: Freedom to Speak Up (FTSU) The Trust has a number of Freedom to Speak Up Guardians who offer independent support and advice to staff that want to raise concerns. The guardians work with all staff to develop a more open and transparent culture. The Trust has a named Executive Director (Director of Nursing and Quality), and a Non-Executive Director for whistleblowing. • That all staff believe that DGT is an open and transparent place to work • That all staff feel empowered to 'speak up' as a matter of our core business • That the Trust Board and senior managers are committed to open communications when concerns are raised • That staff feel supported to make change Our vision • Every Trust must have a FTSU Guardian to give independent support and advice to stagg who want to raise concerns • The role was established following the report published by Sir Robert Francis, Freedom to Speak Up Review - 2015 • The National Guardian's Office supports Trusts and Guardians on all matters relating to raising concerns in health care Background • We have a lead Freedom to Speak Up Guardian and seven Freedom to Speak Up Ambassadors • We support staff who work at Darent Valley Hospital, Queen Mary's Hospital, Elm court and outreach sites • We currently see between 10-20 staff per quarter (April 2019) who have concerns about aspects of their work life • We welcome speaking up on a wide range of inssues including: patient safety, unfair treatment, inappropraite behaivours, communication difficulties and many others Our current position

• We will provide contact to staff who choose to access Guardian/Ambassadors within 3 working days • We will attend at least 5 staff induction events every year • We will provide 100% anoymised data returns to the National Guardian's Office every Quarter • We will conduct at least 5 'speaking up' toolbox talks in 2019/2020 • We will hold 6 Ambassador Forums between January/December 2019 • We will review the 'Raising Concerns Policy' as required and by August 2020 at latest • We will represent the Trust at reginal/national events at least twice a year in order to share and receive good practice • We will meet with the CEO, Chairman, Executive Direction for Whistleblowing and/ or the Non-Executive Director for Whistleblowing at least four times per year • The Guardian/Ambassadors will listen to staff tell their stories and offer practical support and advice. Ambassadors support the Guardian with profiling and referrals • The Trust will be helped with maintaining a strong culture of speaking up • The Guardian/Ambassadors will act as champions for raising concerns without fear of reprisal and will profile the benefits of speaking up • The Guardian/Ambassadors will promote effective teamwork within the Trust and between departments to support individuals raising concerns locally • The Guardian/Ambassadors will ensure that speaking up processes are continually improved • All staff will be appropriately supported when they speak up or support other staff who are speaking up What does this mean to staff? How will measure success?

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Trust Strategy Summary

Delivering the Quality Strategy

Patient and Staff Engagement: What do our quality priorities mean to you? We have engaged with our staff to understand what the quality priorities mean to both them and the care they provide to our patients.

Effective care

• Training on patient centred care • Improve communication between departments • Improve communication between staff roles and grades • Review and consolidate nursing documentation • Improve discharge lounge processes to release nurses time • Introduce 7 day services across the Trust • Auditing working practices and policies against latest guidance • Review service need and demand • Take part in local and national audits • Work in partnership with centres of excellence • Undertake more simulation based education • Use simulation training to look at latent threats and team management • Culture of all-year training as a priority • Active engagement with education • Introduce ergonomists to identify latent threats, offer solutions in the design of systems and processes and design threats out A culture of excellence

Positive patient experience

• Continuously monitoring patient feedback • Use feedback to improve care • Create a safe space for difficult/confidential conversations • Accessible Parkinson’s service • Reduce time patients wait in Outpatients for their appointments • Friends and family test on iPads to obtain feedback more quickly • Improve pain management • Develop patient experience training including

family centred care, communication, empathetic and compassionate care

Harm-free care

• Training on enabling professionalism • Harm free care training to include human factors, understanding systems and processes • Tailor harm free care training for different patient groups / care needs • Staff to keep up to date with guidance and practices change in line • Zero tolerance to pressure ulcers, focus on prevention and management • Team building to reduce harm level

/ put safeguards in place • Review dementia service

Reduce mortality

• Supporting patients in their homes to avoid hospital admissions • Development of a deteriorating patient programme to include training on NEWS and

PEWS and emphasise escalation • Increase ALERT/HDU training

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Trust Strategy Summary

Delivering the Quality Strategy

Governance Whilst it is important to have an open and transparent organisational culture, maintaining confidentiality and the security of patient information is extremely important. The Trust has the following measures in place to protect patient’s data: • T he Trust has a Caldicot Guardian, the Medical Director, who is responsible for protecting the confidentiality of people’s health and care information and making sure that it is used properly. • A ll Freedom of Information Requests are responded to within the agreed timeframes and are reviewed by the governance team (and, when appropriate, the Caldicott Guardian) to ensure that only appropriate data and information is shared and never patient identifiable data. • W e have information sharing agreements in place with all of our partner organisations, and share encrypted patient information through agreed systems and secure connections to enable clinical decisions to be made. • T he Trust is also committed to remaining compliant with General Data Protection Regulation (GDPR). Duty of Candour means that NHS organisations have a legal duty to inform and apologise to patients if mistakes have been made in the delivery of their care or treatment, or where moderate or severe harm has been caused. The Trust’s clinical governance team support staff in informing and apologising to patients, making sure that we always follow the CQC advice and Regulation 20 requirements. We try our best to get things right, but sometimes mistakes happen. When they do, it is vitally important to put things right as soon as possible, and to ensure that the same mistakes do not happen again. Receiving compliments and complaints is important for ensuring good quality healthcare – helping us to find out more about what we are getting right, and what we can improve. Duty of Candour, Complaints and Compliments

We have a Patient Advice and Liaison (PALS) team that offer advice and support to patients and their relatives; they seek to resolve day-to- day problems, address concerns that patients or visitors have about their visit to the hospital and advise on who to contact for help on a variety of issues. All of our complaints are processed in line with the Local Authority, Social Services and NHS (Complaints) Regulations 2009. The ‘National Patient Safety Strategy: safer culture, safer systems, safer patients’ (2019) sets the direction for the NHS to improve the insight into patient safety, through data and the involvement of patients and staff, to deliver sustainable improvement to patients’ safety. Taking this forward, we aim to better understand what is happening in our services by recording and analysing data, to give us greater insight into why something is not working as effectively as it should be, and to inform decision making on what improvements can be made. In doing so, we will continue to use the National Patient SafetyThermometer and will be adopting the Patient Safety Incident Response Framework, when published in 2021. We also continue to focus on consent, five steps to safer surgery, National Safety Standards for Invasive Procedures, Getting it Right First Time and our infection prevention and control measures. Each Trust Board member has an ‘adopted’ clinical and non-clinical area to support meaningful ‘Ward to Board’ relationships and dialogue. This supports an open and transparent culture and makes sure our Board regularly sees the quality of the clinical care we provide. Patient Safety Learning from our mistakes; complaints; patient visitors and staff experiences; as well as data, is vital to driving a continuous quality improvement culture and delivering changes that are noticeable to our patients, visitors and staff on a daily basis. We will increase our focus on reviewing the impact of our action plans developed in response to times when care has not been outstanding. Learning

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Trust Strategy Summary