Interview: Teach the right things. Achieve the right outcomes.

Barnsley NHS Trust Head of Nursing Quality Gavin Portier and Patient Safety Learning Founder and Chair Jonathan Hazan sit down to discuss how positive messaging and learning around patient safety produces positive outcomes.

Questions: Jonathan Hazan
Answers: Gavin Portier

How was your Quality Improvement programme being conducted (and how was Perfect Ward being used) before you took on your role as Head Nursing Quality at Barnsley?

In 2016, Barnsley Hospital introduced Perfect Ward as a digital assurance tool for monitoring the quality and safety of clinical areas across the Trust. However, there was little staff engagement in the quality improvement process. Though audits were being completed, there was no process around highlighting issues or sharing good practice.

In 2018, the Trust invested in the Head of Nursing Quality post. The purpose was to build and lead a governance structure and maintain oversight of the Perfect Ward audits. It provided assurance to the board that findings from reports were acted on and learning was shared. By creating a governance process, teams became empowered to create positive change based on Perfect Ward findings. However, findings were used as a measurement of quality and safety as opposed to being a tool for improving quality and safety.

What inspired you to change it and what changes did you make?

One of our main concerns were the occurrences of hospital-acquired pressure ulcers, which remains a constant challenge for acute health care services. The root cause analysis (RCA) investigations continued to find recurrent lapses in care. These resulted in hospital-acquired pressure ulcers. The actions from RCA investigations repeatedly recommended staff training and spot checks by ward leads and matrons.

The problem with this approach is that training requires staff to be taken from the clinical area for classroom-based learning. Senior staff would then be busy with the auditing process. However, senior nurses have a wealth of clinical experience, and their skills and time are better used in role-modelling the correct delivery of care.

The measurement of quality and safety of care is often by detecting and measuring harm from lapses in care. This negative approach tends to find only more negatives. It never addresses the real cause of patient harm due to lapses in care. The cause being, incorrect care. However, if you teach and do the right things, you’ll achieve the right outcomes.

By sharing results organisation-wide, frontline staff were enabled to take action and create change. Repeat issues were addressed urgently and teams began to share best practice.

How did you communicate changes to staff and to managers and what were their initial reactions?

To start, we developed a Tissue Viability Nursing (TVN) team to lead audits, as well as use Perfect Ward for education and assurance tool. The Trust Clinical Nurse Specialist would list all the care interventions that contributed to the prevention of hospital-acquired pressure ulcers. The list of interventions was cross-referenced with all care standards and guidelines from the national TVN network. The Trust also reviewed RCA investigations findings to ensure that previous issues were identified. These were then pulled into the quality assurance framework where the TVN team could audit, assess and measure teams’ compliance on delivering all these interventions.

The ethos of this approach again is, focus on doing the right things and it will lead to the right outcomes. The focus is to ensure that the care delivered is of the highest quality and all possible lapses in care are identified before the pressure ulcer occurs, rather than wait for patient harm.

Did you find some areas were more resistant to change than others?

The teams, notably the senior nurses on wards welcomed this approach as this released them from audits and spot checks. Having the TVN team perform the Perfect Ward audits ensured the assessments were undertaken independently and that clinical experts are assessing the standard and quality of care. Matrons and ward lead nurses were moved towards role-modelling the best care practices to junior staff and students. This put clinical leadership back by the patients’ bedside.

What was the impact of the change to a more positive approach? Has staff wellbeing improved?

We’ve changed our culture around improvement. We’ve shifted from avoidance and instead, we teach staff and teams to focus on what to do (and how to do it well) as opposed to focusing on negatives. We are able to use our assessment process as an educational tool. By distributing findings transparently across teams, staff can see their actions improve the standards of care and safety.

Have you seen an improvement in patient safety?

The Trust has completed eight months of using this approach and the Perfect Ward Pressure Ulcer Prevention Audit is able to identify the areas of care teams which are strong and where support and coaching are needed. Before, this richness of information was not been available, and it was difficult to provide targeted training to teams. Having a digital quality assurance framework shows us exactly what interventions are not meeting the required standard. This allows for the TVN team to design bespoke training sessions for these teams in the clinical area, rather than in a classroom away from the ward.

The evidence shows standards of care are improving. We are identifying lapses in care more quickly and efficiently. We are able to predict and prevent them, resulting in a reduction of hospital-acquired ulcers.

-End-

To learn more about quality assurance and governance at Barnsley NHS Trust, please contact tomi@perfectward.com

Bios:

Gavin Portier

Gavin is the Head of Nursing Quality at Barnsley NHS Trust. He has a clinical background in critical care and has held nursing leadership positions roles including Registered Manager and Clinical Lead for Complex Enhanced Dementia, Service Manager for Community CAMHS, and Head of Quality Compliance & Assurance.

Jonathan Hazan

Since retiring as chief executive of Datix in 2016, Jonathan has worked with a number of successful healthcare and IT businesses. He founded the charity Patient Safety Learning, which he chairs and is a trustee of AvMA. Jonathan is an advisor to Perfect Ward and chairs Hotel Radio, a music live-streaming company.