3 4 5 6 9 Results of Elections What is a Getting to More than just Working together to for Governors Foundation Trust? Know You doctors and nurses make a difference to patients. The free members’ newsletter of Sheffield Teaching Hospitals NHS Foundation Trust INSIDE SUMMER 2013 ISSUE 29 Good HEALTH Learning from the tragedy at Mid Staffordshire Hospital Over the last year you will have read about the tragic events at Mid Staffordshire Hospital which led to the death of up to 1200 patients between 2005 and 2009. Since then the Francis Report report to review our systems has examined what went wrong and processes. For example at that hospital and why the after the National Quality Board care patients received was not published their draft guidance as we would all expect. This called ‘Quality in the new health month we have also heard system’, we carried out a ‘True about the review by the NHS for us’ review to ensure we had Medical Director Sir Bruce robust systems in place particularly Keogh which showed that 14 to give us early warning of other Hospital Trusts had higher potential quality of care issues. than expected death rates and • Death (mortality) rates at Mid needed improvement action. I Staffordshire Hospital were found am pleased to say that here in to be high. In contrast our Trust Sheffield our clinical outcomes has had consistently lower than and patient satisfaction levels average mortality rates for a are very good thanks to the number of years. Mortality rates continued hard work and are regularly monitored and we expertise of our staff who work have an alert system in place if in the City’s adult hospitals and there is an unexpected variance out in the community. from the expected figures. This enables quick investigation and However, quite understandably action to address any problems. what happened at Mid Staffordshire Recently surgical outcomes for a Hospital and other Hospitals should number of operations were made be a concern to us all and the public and all of our surgeons information in this article I hope were within the expected will give you reassurance about mortality range, despite operating Sheffield Teaching Hospital NHS on some of the sickest patients. Foundation Trust’s performance in the areas which matter most to our • Our clinical outcomes for many patients and their families. procedures are amongst the best in the NHS and our infection rates • We have not waited until are also the publication of the Francis Continued on page 2 +GH SUMMER 2013 2 Trust welcomes the publication of surgeon’s mortality rates Sheffield Teaching Hospitals will emerge in the coming months. The Summary Hospital-level Mortality clinical outcomes, Dr Throssell other less experienced surgeons Indicator (SHMI) is recognised as the also believes the publication of may have felt unable to do. There has welcomed the national All vascular, endocrine, thyroid, best indicator of the overall quality any data must be reported very may also be patients who are very publication of surgeon’s cardiac surgeons and orthopaedic of care an organisation provides. carefully and in a way which the mortality rates and other surgeons (hip and knee) working sick and therefore the risk of an We have had consistently lower public can easily understand. clinical outcomes. in Sheffield Teaching Hospitals had operation is greater than if the than average mortality rates for death rates which fall within the “The data collected must of patient was healthy. The information is being published a number of years. The national on the NHS Choices website for the expected range or are better than course be accurate, but reporting Sheffield Teaching Hospital NHS average is calculated at 1 and that data isn’t so straightforward first time to show patients how well the national average. Foundation Trust is a centre of Sheffield Teaching Hospitals Trust is because the figures also need to consultants across England perform. Dr David Throssell, Medical Director, below this at 0.9. Mortality rates are excellence for many operations Patients can see the number of reflect the level of risk involved, said that the publication of the data regularly monitored and we have and that’s different for each patient and procedures and attracts times a surgeon has carried out a will be beneficial for both patients an alert system in place if there is patients from across the UK. As a procedure, their mortality rates and as well as each procedure. Mortality and healthcare staff. an unexpected variance from the rates for an individual surgeon are consequence, a higher percentage whether or not they are performing expected figures. This enables quick of more complex surgery is within the expected range. “We very much welcome the affected by the particular mix of investigation and action to address performed, very often on some opportunity to be open about our patients who they treat, and so any problems. We are constantly The new national performance performance and provide patients the figures published must be risk of the sickest patients. This can looking at where we can further reports have identified many of with more information. Patients adjusted. Data which has not been affect the raw performance data Sheffield surgeons are among improve patient safety and outcomes should be able to see how individual risk adjusted should not be used to compared with other hospitals the very best in the country and we monitor a range of indicators doctors are performing. That compare individual surgeons as it which perform more routine with mortality rates below the such as readmission rates, and could give a misleading picture. principle has been agreed for many operations on patients who have national average. length of stay in hospital to ensure years and has been successfully less risk of complications. Risk we are aware of any issues as early For example, after careful Vascular, hip and knee, thyroid, implemented in cardiac surgery. consideration and assessment of adjusted data is important given this as possible. endocrine and cardiac surgery have Indeed Sheffield was one of the the patient, some highly skilled scenario because it allows patients been the first to be published this first Trusts to publish outcomes for However, whilst welcoming surgeons may be prepared to to compare hospitals on a like for week. Details on other specialities cardiac surgery as long ago as 2005. the increased transparency of undertake an operation, which like basis.” Continued from page 1 • We have been implementing ‘Intentional rounding’ across considered very low for a Trust our hospital wards. This is of our size. We are constantly where, every few hours, nurses looking at where we can further on each ward, carry out a ward improve patient safety and round to check every patient is outcomes and we monitor a comfortable, has a drink offered range of indicators such as to them, is not hungry or in readmission to hospital rates, pain and asked if they need to and the length of stay in hospital visit the toilet. This is part of to ensure we are aware of any the focus we have on ensuring issues as early as possible. fundamental care needs are • Nurse staffing levels. Nurse met. Each month we also ask a staffing levels are under continual random sample of patients on scrutiny and are formally a number of wards if they feel reviewed every 6 months by the they have had their essential Chief Nurse. The review is based care needs met. We then use on the level of care patients on this patient feedback to make each ward are likely to need any improvements necessary. which informs the staffing and Nurse Directors working from patients, carers and staff are independently elected • We proactively seek out numbers and skill mix and on and the same feedback led and are patient, staff or patient feedback to inform alongside Managers and being a daily basis; control is given to actively involved in decision to the development of our public representatives. Matrons to ensure wards are where we need to make making at a strategic level as PROUD values: The Board of Directors and optimally staffed. We always improvements or indeed to well as at the front line of service Governors Council receive have a higher ratio of trained recognise where services are • Patients first delivery. Every month the Board performance reports, clinical nurses to support workers on good. We have a number of • Respectful updates and undertake visits each ward. A report is provided ways patients can give their of Directors has a clinical update to front line services and wards to the Board of Directors annually views and have also introduced from a department to hear • Ownership every month to ensure they which also considers care the Friends and Family test, about the challenges as well • Unity have a clear understanding of outcomes on each ward. where patients are asked if they as opportunities that particular • Deliver the issues facing staff would recommend a ward or services face. And finally if the • All of our support workers and patients. department to their relatives or Chief Nurse or Medical Director • A new annual appraisal undertake an established friends. This feedback along with expresses a view that a decision process is being implemented While this is a reflection of our comprehensive training complaints and survey results is or action would be unsafe, which includes values and on-going commitment to provide programme over a number fed back to wards/departments then their opinion overrides behaviours as well as job safe, good quality care for patients, of months called ‘Prepared so that improvements can be anything else.