Mid Staffordshire NHS foundation trust has become notorious for failing to take care of its patients. This piece looks at some of the ways it has started to make improvements, although it has a long way to go.
This article titled “How staff helped Mid Staffordshire make a clean start” was written by SA Mathieson, for theguardian.com on Wednesday 31st August 2011 08.00 UTC
From 2005 to 2009, Mid Staffordshire foundation trust showed how profoundly an NHS organisation can fail its patients.
A Healthcare Commission report from March 2009 and an independent inquiry in March 2010 condemned the trust for chasing foundation status and saving money by slashing staff levels. Patients were left unwashed, unfed and ignored for hours, and the Healthcare Commission noted mortality rates were more than 25% higher than average, equating to hundreds of unnecessary deaths over several years.
The inquiry found that staff who spoke out were ignored and may have been bullied, with others displaying a lack of compassion. At last month’s NHS Confederation conference, chairman Sir Stephen Moss said that the former board treated staff “like a boil on the bum”. Christine Lloyd Jennings, until recently the trust’s director of human resources, spoke of “a culture of fear”, with staff told not to talk to the board.
Now the trust has changed – although it stresses it has plenty of room for further improvement. Its mortality rate is now 15% below the expected number, and although the latest Care Quality Commission report in August was far from perfect, with concerns over its management of medicines and recruitment, it said that “people that use the service experienced effective, safe and appropriate care, treatment and support that met their needs and protected their rights”.
Antony Sumara, who recently stepped down as chief executive after two years turning the trust around, has attributed it to various techniques. One was to begin every monthly board meeting with a patient’s story, often in person. Another was to review every death to see if the trust could have provided better care. The board toured the hospital regularly, cleared the backlog of patient complaints and greatly simplified the trust’s goals, starting with “create a culture of caring”.
But the secret weapon was the staff, who were encouraged to become innovators. The trust’s ‘Taking patient care to the next level’ project, launched in September 2010, asked for 20 volunteers – and had 60 applicants. They were given time outside their existing jobs to produce and test ideas, and formed five project teams, working on the patient discharge process, special care baby unit, diagnostic image preparation, accident and emergency and outpatients.
The results, presented by the team members to a further NHS Confederation session, are generally simple, cheap and effective. For example, mothers in the special care baby unit had previously walked across a main corridor with towels and toiletries to another ward to have a shower, needing to be let back into the unit by staff. The project team decided to convert a staff changing room within the unit into a good quality bathroom (including a pirate rubber duck) costing £12,000 – which was donated by businesses. One result as that staff saved more than 70 hours over a three month period through no longer having to buzz parents back in.
“The new bathroom enables parents to have total privacy and dignity,” says Chris Bradshaw, one of the unit’s nurses, in a video on the work. “They can remain on the unit, knowing they are near their babies, and if we need them, we only need to knock on the door.”
The accident and emergency team focused on missing documentation, a problem exacerbated by the existence of seven forms, each with a different purpose, such as observation, drugs and fluid charts. Each time nurses realised the need for more, they had to leave patients alone for up to 14 minutes, and when patients were moved, the forms had to be collected together.
The answer was to combine the forms into one, and ruthlessly edit it from an average of 30 pages per patient admission to 12.
“Everything that they need is in the document, so they don’t need to keep running away,” says Cathy Peters, sister in emergency medicine in another video. “This is better patient care, because that 14 minutes has gone back to patient care, so we’re not walking away – and we can do the job we’ve been trained to do.”
As well as those improvements, the trust reckons that this has allowed it to earn between £200,000 and £275,000 more each year, as well as supporting the introduction of the Healthcare Resource Groups 4 (HRG4) costing system, when failing to do so would have cost it nearly £2m a year.
The other teams have made similar improvements. The outpatients team started processing bookings for more than six weeks in the future by post, so they could be processed at quieter times, and combined three desks into one ‘welcome’ desk, which removed the queues (see video).
The diagnostic imaging team dealt with the third of patients who were previously incorrectly prepared. They provided information folders for staff and leaflets for patients, and the proportion is now less than a quarter, saving around £40,000 a year for almost no outlay.
The discharge team created a checklist for staff and a patient leaflet. Piloting these on three wards saved an average of two days per patient per stay – worth £526,000 and 1,069 unnecessary bed days.
“It’s a thousand tiny things that make a difference to a patient,” said Max Western, director of the consultancy Panthea that supported the process. “Not a massive IT programme, but a shower.” He said the organisation has not been turned around as much as turned upside down, with patients top, supported by frontline staff, then the management.
Western also pointed out that the programme cost £100,000 including £25,000 on consulting – and has saved £2m. “Next time you buy a consulting programme costing £2m, you should expect £160m of benefits. Otherwise, you would be much better off trusting your staff,” he said.
Summing up, Sumara said: “If we can do more of these sorts of things at management events, where our staff tell us what to do rather than us telling them, it would be great, wouldn’t it?”
The evidence from Mid Staffordshire – including the savings recorded, a favourable assessment from Cambridge university’s Judge Business School (see video) and the enormous enthusiasm of team members in conversation afterwards – is that getting frontline staff to improve their own NHS organisations would be a great move.
Video interview with Simon Kent, programme manager of the Taking Patient Care to the Next Level project
Staff from Mid Staffordshire, including people from the project teams, Sir Stephen Moss, Julie Hendry and Simon Kent, will be online to answer your questions between 11.30am and 12.30pm on Wednesday 31 August. Click here to join the debate.
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