Colleague Involvement at Salford Royal NHS Foundation Trust
For the last four years, Salford Royal NHS Foundation Trust has delivered amongst the safest services in the Country for its patients whilst also achieving the highest employee engagement scores in the NHS. These achievements were capped by the recent CQC Inspection establishing the Trust as only the second in the country to achieve an 'Outstanding' rating. The only other Trust to achieve this rating is Frimley Park, which also has amongst the best engagement scores in the NHS.
A corner stone of our success has been the 2008 launch of a Quality Improvement Strategy which was aimed at reducing harm and mortality. At the heart of all this work has been the desire to make fundamental improvements in the quality of care for all patients at Salford Royal and the delivery of these improvements has focussed on working with our teams at the front line of care, using established Quality Improvement Methodology to safely test, evaluate and implement changes. We use several Quality Improvement Methodologies such as The Institute for Healthcare Improvement's Breakthrough Series Collaborative Model, lean methods and tools and Microsystems coaching.
The feedback from our people about how involved they feel in change within the Trust is amongst the highest in the NHS and the results of this model of deep colleague engagement has produced significant results, which has taken the Trust from amongst the poorest performers 12 years ago to now being amongst the 10% safest places to be treated in the NHS, seen a 90% reduction in clostridium difficile and a 51% reduction in cardiac arrests and results in 90% of patients rating their care to be very good or excellent.
This hasn't all just come about through engagement – there had to be a focus to all this work, which stemmed from a big and bold objective set by the Trust Board, which was to become the 'safest place in the NHS'. At the time of setting this goal in 2008, it seemed like an over ambitious one, especially considering the performance at that time. The progress however since this bold objective has been significant and shows what you can do with a big, memorable goal (all our colleagues can easily remember the goal and understand the day to day part they can play in this) and then a method of truly involving and trusting front line colleagues to make the right changes.
A proven ability to involve colleagues of all levels in the pursuit of excellence
As discussed above, at the core of the methodologies used by Salford Royal is the engagement of front line teams in the development of solutions to the problems that face them. During quality improvement projects of all kinds, teams are taught the 'Model for Improvement' and 'Plan Do Study Act', these methodologies are fundamental in empowering all levels of colleagues to make changes in their areas in the pursuit of improving quality and safety.
To complement this approach, we have throughout all three of our Quality Improvement Strategies had a commitment to developing our workforce at all levels. As part of our capability building we provide colleagues with training opportunities to develop quality improvement capability, this includes:
A suite of modules which cover the basics of many aspects of quality improvement including:
The Model for Improvement
Managing Improvement Projects
Reliable Care
Measurement for Improvement
Clinical Quality Academy
A comprehensive deep-dive into improvement methods and techniques
A 12 month programme offered to clinician led teams
Bespoke quality improvement training as requested by divisions, wards and departments to support local quality agenda
Implementation of Clinical Microsystems Coaching on a rolling programme
A patient-centric approach
At the centre of Quality Improvement at Salford Royal is the patient, they are the reason that we want to improve care, whether it is reducing harm and mortality or making care more reliable, ultimately the outcome is: how does this affect the patient. Since the first strategy we have also involved patients in Quality Improvement projects where appropriate, inviting them to be part of project steering groups and learning sessions so that they can help us to understand how the changes we want to make will affect them. We have also had a comprehensive programme of collecting patient stories. The purpose of these stories is to set a tone of patient centeredness and to put the patient at the centre of any decision making.
Finally, in January 2013 Salford Royal launched a project aimed directly at improving patient, family and carer experience. This project has been designed to deliver what matters most to our patients and is part of our wider Patient Experience Strategy. A fundamental element of this Patient Experience Strategy has been the development of Always Events. These are an Institute for Healthcare Improvement Methodology taking the concept of Never Events – i.e., things that should never happen in a health care environment and flipping them around. Always Events are something that our patients should always expect to receive when they come into our Trust. The Trust Always Events were developed through focus groups with our patients and their families.
We firmly believe that our significant engagement levels have only come about following the whole organisation rallying around a single, memorable cause- to become the safest place in the NHS - and our commitment to support all colleagues in making improvements, not matter how big or small, to ensure that everyone feels able to contribute to this cause.
Paul Renshaw is Executive Director of Organisational Development and Corporate Affairs at the Salford Royal NHS Foundation Trust.
Updated: 22nd February, 2018
Author: Meghan Grant