Salford Royal NHS foundation trust, which runs Salford Hope hospital, is an inspiring story of how a health service organisation can improve.
This article titled “Salford Royal’s flight to safety” was written by SA Mathieson, for theguardian.com on Wednesday 9th March 2011 09.01 UTCRecent years have seen increasing public concern about the safety of NHS hospitals, focusing on hygiene and infections such as MRSA. But according to chief executive David Dalton, Salford Royal foundation trust‘s focus on patient safety was inspired by US hospitals’ work on harm reduction. “We discovered this hospital harmed 850 patients a month, 10,000 a year,” he says, from the likes of patients falling, suffering pressure ulcers or not receiving the right medication at the right time. “And we were better than most.”
In 2008, the trust – better known by the name of its main hospital, Salford Hope – set out an ambition to become the safest hospital in the NHS. It is now has the seventh lowest mortality rate of any acute hospital, putting it in the best tenth. Dalton rattles off statistics: it has reduced infections by 70%, pressure ulcers by 50%, falls by 40%, as well as better performance on specific medical conditions. “We were clear on the targets we were going to pursue,” he says. “We’re now refreshing the strategy.”
One method used for this is ‘safety walkrounds’, a weekly event in which board members visits wards. The previous day, Dalton had visited two areas, selected at random – in this case the transport department and a hospital ward, where he met the nursing staff. He says that many of best ideas for improving safety have come from staff. They are encouraged to come up with ideas, break them down into components and test them over a period to see what works. Results are then studied by senior clinical staff and if the ideas work they can be introduced across the trust.
For example, the trust’s success in reducing patient falls has been partly down introducing checks on patients’ hospital footwear and asking if they needed help getting out of bed. “At the heart of the improvement we’ve been pursuing here is the very deep involvement that staff have had, in what you might think of as small ideas,” says Dalton. “These are very often small changes, like the footwear.”
Another counterintuitive change involved one ward abandoning automated blood pressure measurement equipment, in favour of staff going back to inflating arm cuffs by hand. “When nurses went back to being alongside a patient, they were doing other things as well,” Dalton explains: carrying out the process by hand caused them to observe the patient, including for warning signs of cardiac arrest. That change is now being emulated across the country, he says.
The trust has been aiming to increase safety, not save money. However, Dalton says that staff are also helping on financial efficiency, by coming up with ways to smooth patient activity, increasing the use of facilities such as theatres and cutting the need for short term contract staff.
Another simple idea is to lead to a significant change: from 1 April, senior staff including Dalton and his management colleagues will work on some weekend days. The aim is to have the hospital running at a constant rate, rather than slowing down for Saturday and Sunday.
Dalton points out that patients admitted on Fridays have the longest average length of stay, and says the move is aimed at reducing this. “I think it will cost more, slightly, but if you’ve got senior decision makers available for longer periods of the day and the week, they are making decisions at the best possible time for the patient, and length of stay can reduce as a consequence,” he says.
Dalton has known Mike Burrows of NHS Salford for over a decade. “We’ve got a relationship that’s based on respect and trust, and that permeates our organisations,” he says. “It’s different to what you would find in a lot of localities.” This is reflected in his expressed willingness to reduce the size of the hospital if the primary care trust wants to commission less work from Salford Royal, as long as the hospital trust can reduce its costs at the same rate.
The executive offices overlook a construction site: the trust is part-way through a reconstruction project, funded by a £200m private finance initiative deal with Balfour Beatty and Consort Healthcare. The offices are in the already completed Mayo building, named after the chemist William Worrall Mayo, who founded the US not-for-profit Mayo Clinic, now one of the world’s most presitgious healthcare providers.
While web surfing for possible names, Dalton says he realised that Mayo was born in Eccles, part of Salford. The choice of name carries an obvious implication: the NHS can learn from the US, as with Salford Royal’s conversion to reducing harm to patients – but everyone can learn from what comes out of Salford.
Profile of Salford Royal foundation trust
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