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| Elizabeth Bradbury, Director |
The NHS is 69 years old today and some of the achievements are staggering. For example SimonEnright shared at the recent NHS Confederation Comms conference that when the NHS launched 69 years ago there were 480k in-patient beds…..now there are just 125k! In addition life expectancy has been rising by five hours a day!.
As the birthday tributes are broadcast, I’ve paused to consider some of the changes during my 30 year NHS career and the way in which AQuA can support the NHS in 2017:
Collaborative Care Models
When newly qualified, I did some agency nursing shifts with a district nursing team in the east London docklands. I set out on foot with a map, list of patients to visit and a bag of door keys to gain access to the homes of people who couldn’t answer the door themselves.
For someone used to the high-tech, team based, specialist-on-tap world of A&E work, on the district was a culture shock! My abiding memory is the isolation and loneliness of the housebound patients and the disconnect between district nursing and other community based services.
I compare this to devolution or the neighbourhood and locality teams that are in place now, with the emphasis on partnering with patients using techniques, such as AQuA’s Shared Decision-Making programme or Wigan’s community asset based model.
AQuA’s Transformation and Integration team works closely with locality teams, on the collaborative design and implementation of new place-based care models e.g. commissions with the Wirral and Halton localities to develop accountable care.
A Systematic Focus on Quality
As a student I saw patients with truly horrendous pressure sores; hospital acquired infections were common and staff involved in incidents of patient harm were poorly supported.
Over the last decade or so we’ve seen an intensive focus on developing a system of organisational quality and shifting the quality curve to the right. Regional and national patient safety initiatives have targeted particular harms, whilst AQuA has worked with its members on campaigns such as community sepsis, restraint reduction in in-patient mental health units, and to support to the workforce with patient safety training e.g. its two- tier human factors programme.
It was a lightbulb moment for me when I saw a run chart on the wall of an US intensive care unit in the mid-2000s, showing the number of days between any patient developing a chest infection through the use of clinical care bundlesThey were trying to break their record of 300+ days.
AQuA’s Advancing Quality programme has been committed to high reliability clinical care for nearly a decade; working with hospitals, and more recently primary care, to define and embed clinical care bundles. See their results here.
We have undertaken several Well-LedReviews as part of NHS provider trusts’ corporate assurance process, enabling boards to take a proactive approach to establishing a quality culture and putting quality at the heart of all their work.
We are also working closely with NHS Improvement and member Trusts who have had a 'Requires Improvement' or 'Inadequate' CQC rating, helping them implement plans to improve the quality of care and the improvement capability of their workforce.
Building Improvement Capability
The NHS workforce has always featured in strategy and operational plans, but the language of quality and an emphasis on both doing your job to the best of your technical ability, and continuously improving how you do it (Batalden.P, 2004) were absent during my training.
AQuA’s work with its’ 70+ member organisations includes intensive workforce capability building in improvement theory and techniques e.g. customised work with the North West Ambulance Service and Wrightington Wigan and Leigh NHS Foundation Trust. Usually we work as partners building capability from foundation to expert level, and develop a plan for the member to become self-sufficient after several years of support.
System Leadership
In my early NHS career our focus was upon the success of our own organisation, often to the detriment of person-centred integrated care and the success of partner agencies. Now we see a focus on system leadership.
AQuA’s OD and practical system leadership support helps build trust and constructive relationships in multi-agency leadership teams, we also undertake extensive bespoke work with our members and their partners aligned to Sustainability and Transformation Partnership plans, e.g. recent work with the Mersey CCGs to explore alternative models of commissioning, and with the Wirral and Halton localities to lead accountable care models.
As the birthday tributes are broadcast, I’ve paused to consider some of the changes during my 30 year NHS career and the way in which AQuA can support the NHS in 2017:
Collaborative Care Models
When newly qualified, I did some agency nursing shifts with a district nursing team in the east London docklands. I set out on foot with a map, list of patients to visit and a bag of door keys to gain access to the homes of people who couldn’t answer the door themselves.
For someone used to the high-tech, team based, specialist-on-tap world of A&E work, on the district was a culture shock! My abiding memory is the isolation and loneliness of the housebound patients and the disconnect between district nursing and other community based services.
I compare this to devolution or the neighbourhood and locality teams that are in place now, with the emphasis on partnering with patients using techniques, such as AQuA’s Shared Decision-Making programme or Wigan’s community asset based model.
AQuA’s Transformation and Integration team works closely with locality teams, on the collaborative design and implementation of new place-based care models e.g. commissions with the Wirral and Halton localities to develop accountable care.
A Systematic Focus on Quality
As a student I saw patients with truly horrendous pressure sores; hospital acquired infections were common and staff involved in incidents of patient harm were poorly supported.
Over the last decade or so we’ve seen an intensive focus on developing a system of organisational quality and shifting the quality curve to the right. Regional and national patient safety initiatives have targeted particular harms, whilst AQuA has worked with its members on campaigns such as community sepsis, restraint reduction in in-patient mental health units, and to support to the workforce with patient safety training e.g. its two- tier human factors programme.
It was a lightbulb moment for me when I saw a run chart on the wall of an US intensive care unit in the mid-2000s, showing the number of days between any patient developing a chest infection through the use of clinical care bundlesThey were trying to break their record of 300+ days.
AQuA’s Advancing Quality programme has been committed to high reliability clinical care for nearly a decade; working with hospitals, and more recently primary care, to define and embed clinical care bundles. See their results here.
We have undertaken several Well-LedReviews as part of NHS provider trusts’ corporate assurance process, enabling boards to take a proactive approach to establishing a quality culture and putting quality at the heart of all their work.
We are also working closely with NHS Improvement and member Trusts who have had a 'Requires Improvement' or 'Inadequate' CQC rating, helping them implement plans to improve the quality of care and the improvement capability of their workforce.
Building Improvement Capability
The NHS workforce has always featured in strategy and operational plans, but the language of quality and an emphasis on both doing your job to the best of your technical ability, and continuously improving how you do it (Batalden.P, 2004) were absent during my training.
AQuA’s work with its’ 70+ member organisations includes intensive workforce capability building in improvement theory and techniques e.g. customised work with the North West Ambulance Service and Wrightington Wigan and Leigh NHS Foundation Trust. Usually we work as partners building capability from foundation to expert level, and develop a plan for the member to become self-sufficient after several years of support.
System Leadership
In my early NHS career our focus was upon the success of our own organisation, often to the detriment of person-centred integrated care and the success of partner agencies. Now we see a focus on system leadership.
AQuA’s OD and practical system leadership support helps build trust and constructive relationships in multi-agency leadership teams, we also undertake extensive bespoke work with our members and their partners aligned to Sustainability and Transformation Partnership plans, e.g. recent work with the Mersey CCGs to explore alternative models of commissioning, and with the Wirral and Halton localities to lead accountable care models.
You can follow all the latest on the NHS birthday celebrations on Twitter via #NHSbirthday. Feel free to share your own celebrations with us @AQuA_NHS.
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