Excellence reporting at Chelsea and Westminster Hospital (#2490)

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Idea Description
Overview of Innovation:
Define:
Excellence Reporting in ChelWest…and Beyond

Discover:
Following a difficult few months in London, with four major incidents in a short space of time, we felt that our staff needed some morale-boosting. This project seemed like the perfect solution. It provided a platform for formal positive feedback, rather than our previous system that encouraged only ubiquitous negative feedback through error-identifying incident reporting.

We created a simple system, allowing colleagues to submit Excellence Reports via online or paper forms. We used a short explainer video (see https://vimeo.com/209937486) and posters to tell people about the project. And then we got started.

And this project worked. In the first month we received 30 excellence reports, and in the second month we received 40. We distributed the reports, as well as sharing themes and anonymous quotes with the department as a whole.

Dream:
In a year’s time, our Excellence Reporting project will be rolled out across the hospital and the Trust. Chelsea and Westminster ED will have demonstrated increased staff morale and overall well-being due to this project. We will have published our initial results In a peer-reviewed journal.

Excellence Reporting will be part of the governance structure of the hospital. We will encourage every clinical governance half day to have Excellence Reports presented. Additionally we will run appreciative inquiry workshops


Design:
We have an Excellence Reporting team in the Emergency Department and the project has already expanded to the Medical Team, with the Executive Unit of the Trust interested in broadening this project further. Our Emergency Department team is a champion of Excellence Reporting and will lead the development throughout the hospital.

Our initial challenges were in implementing the project and encouraging staff to submit reports. We led by example, and the Excellence Reporting team submitted reports ourselves initially to help spread the word; other people started to follow.

We are focusing on developing the analytics and automating the online process to generate excellence reports and data analysis. Currently this is done manually by the Excellence Reporting team.

Destiny:
We have presented this project at internal department, hospital, and trust-wide meetings. This project has also been presented abroad (in Australia) and widely across social media. Other hospitals have asked to use our resources, such as the explainer video for their own departments.
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Overview of Innovation:
Discover

At Charles Gairdner Hospital in Perth, Western Australia it was noted that less than 7% of medical staff had ever reported a clinical incident. The second most common reason cited by doctors for not reporting was the negative connotations or consequences associated with reporting incidents. With the aim of redressing this balance it was decided to pilot a system of excellence reporting (ER).

The Medical Assessment Unit (MAU) was chosen as a pilot site and 3 methods of reporting were implemented, intially a paper form and e-mail automatic reply form in October 2016, followed by an online form via the hospital intranet. All staff groups are able to submit reports.

In September 2016, prior to commencing ER, we undertook a survey looking at staff morale and perceptions of learning. We received 74 reponses (74/149), a 50% response rate. 46% of respondants agreed or strongly agreed that there was more focus on failures than achievements on the MAU compared to 31% of respondants who disagreed or stongly disagreed with this statement.

51% of respondants perceived they learned best from reflecting on their own mistakes and incidents, 46% from studying good practice and only 3% felt they learned best from studying others mistakes or incidents.

From October 2016 to May 2017 27 excellence reports were submitted.

Dream/Design:

There have been several challenges associated with this project. The team initially leading the project were not MAU staff members so educating staff and keeping the reporting momentum going was difficult. Involving an MAU medical registrar and one of the nurses as ER champions and excellent communications support from the MAU ward clerk, has gone some way to addressing this.

Destiny:

Learning from excellence is currently being shared at the monthly ward meetings which have been renamed Morbidity, Mortality and Excellence meetings. The MAU nurse champion has created a communication board on the ward dedicated to ER which includes anonymised quotes from submitted reports.

We are currently repeating the staff survey a year after introduction of ER with the hope that staff appreciation via ER has led to an improvement in staff morale. We also plan to look at the rate of incident reporting by MAU staff in October 2017 compared to October 2016 to guage whether the measures implemented to redress the balance between reporting of errors and episodes of excellence has gone any way to decreasing the negative connotations around incident reporting. 
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Overview of Innovation:

HEFT provides maternity services across 3 sites and has a birth rate of approx 10500 births per year. Following the Care Quality Commission’s inspection of HEFT in 2014 the Head of Midwifery commissioned an Internal Quality Review, reviewers identified that there was an issue with low staff morale and motivation, it was also noted that retention of staff and high sickness levels were adding to the low staff morale. Following the reported success of LfE at Birmingham Children’s hospital a team of senior midwives at HEFT decided to implement LfE within Maternity.
The ‘quick start up guide to LfE was adopted and with buy-in from the senior midwifery leadership team and the trust safety and governance lead an implementation date was set.
The LfE project lead met with staff from other departments who had already implemented LfE to share resources and to discuss any barriers encountered.
The team opted to use a quick, simple and easy to use paper reporting system.
The launch was well advertised in and around the maternity unit. Each ward area was assigned an LfE notice board and LfE was launched officially.
LfE updates are regularly presented at a variety of forums within maternity. Information, trends and themes are fed back to all staff.
The LfE initiative has been very well received in maternity, staff appear genuinely grateful to have a system of reporting when things go well in addition to reporting clinical incidents. There appears to be a shift in the culture of the organisation and how safety is managed. LfE cannot take all the credit for this however as the maternity governance system has recently been restructured and risk is now owned by the clinical leads in each area and not by an overarching maternity governance team. It is felt that the arrival of LfE has complimented these changes within the service.
Hopes for the future:
Governance and risk to take the project forward and expand across all areas of the trust
Implementation of an online reporting system that can generate emails to the reporters automatically and notify the team when a report is submitted.
Clinical area's to have a named member of staff as LfE lead, which will be trained in Appreciative Inquiry and will hold regular AI conversations to discuss the reports submitted.
For key learning from LfE reports to be identified and implemented in a timely and efficient manner.
For an improvement in the quality of information submitted on reports, with greater detail about what was specifically excellent.
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