The Challenge
Maintaining patient safety and quality is a top priority for all NHS Boards. As regulatory reform and the NHS transformational savings programmes progress, the expectations around delivery of safe, high quality care become increasingly critical. Implementing reform whilst maintaining and also increasing PSQ intensifies the leadership challenge faced by NHS Boards.
Boards often require additional support to identify and assure of current compliance status across a number of regulatory requirements, or to ensure achievement of regulatory compliance in very short periods of time. This process can be very labour intensive, requiring significant experience, expertise and a high level of focus and input from teams and individuals who are currently focusing on other organisational priorities.
The implications of failing to address PSQ challenges in a timely manner are well known following the Mid Staffs enquiry and other very public examples of failure. Despite this Trusts continue to be challenged by this agenda and are found wanting by regulators.
In short, failure to meet the requirements of the Health and Social Care Act places patients and the public in danger. There are a raft of penalties that are applied to Trusts, which include financial penalties but equally important is the very real risk of major reputational damage for not only for organisations but for those individuals who may be held to account.
The Francis Report places additional requirements on Trusts, identifying key warning signs for gaps in patient safety and quality as:
How can IMD support you?
Trusts that have already utilised the IMD approach to PSQ report that they now have a clear picture and understanding of their PSQ status. They have valuable external verification of this status and a complete picture of the level of compliance across a range of PSQ requirements, outcomes and regulations. As a direct result, they have a bespoke action plan to move the Trust forward to the desired state of 100% compliance.
Finally, looking to embed the approach within their organisation, our clients have a plan to move them to a planned proactive and sustainable agenda rather than reacting to a range of external requirements.
What IMD does
Our focus at IMD is to ensure that we work together with you and your teams to co-design work programmes so as to ensure local ownership and to implement sustainable change.
We provide an experienced senior team who have the skills, expertise and a wide understanding of working and delivering the PSQ agenda. We ‘map and gap’ the current level of PSQ compliance at different levels across your Trust and identify interventions to enable you to improve your compliance and close the gaps, taking into account a triangulation of policies, processes and practice.
Policies
We’re experienced enough to provide tailored on-going support and coaching to the key Directors and Managers as required in order to embed this approach for long-term success.
How we do it
Whatever stage your organisation has reached we tailor our approach and interventions to suit you, the client. We don’t use ‘off the shelf’ packages, we believe in working in partnership with you and adapting to match your distinct needs. For instance, if you already have a clear understanding of your compliance gaps, we can support you with developing bespoke interventions to enable you to close these gaps and with testing out compliance in practice on the front line. In addition, the approach we take is not only for use at an organisational level, we can also modify it for operational level use, for instance, undertaking pharmacy reviews and theatre or service reviews.
The broad approach we use is to:
- Map the broader PSQ compliance status of the Trust that triangulates across to CQC, NHSLA and other compliance frameworks such as CPA, HTA and Health and Safety.
- Identify the gaps in compliance and the priorities for action that should form the basis for organisational objectives in the following year.
- Identify further actions and interventions that are necessary to move the PSQ agenda from a reactive to a proactive one.
The work involves a triangulation of:
- A desktop review of Board papers, relevant Board committee papers and PSQ meeting papers, plus all available recent PSQ compliance reports. We review the documentation against relevant standards and produce a provisional perspective on the compliance status of the Trust.
- We then work with you to test out and to confirm and challenge our findings. From this, we agree areas to be further tested out at the front line.
- This front line testing involves walking round the Trust and testing out compliance in practice. We don’t do this in an inspectorial way, rather we use our experience of working within NHS organisations to work with your own staff in a supportive and developmental way, enabling them to see the connections between the questions we ask and what this means for them in their everyday practice – therefore helping to embed this as a sustainable approach at all levels through the organisation, not just at Board level.
This approach enables us to present a map of organisational compliance and demonstrate where the gaps are. This can then be used to support the Trust to plan its future priorities and objectives, thereby having an externally validated and internally owned proactive PSQ Strategy and the ability to monitor progress and compliance on-going.
Why choose IMD?
We are passionate about patient safety and quality and recognise how important it is to weave it through all of our work in health care. We don’t support a ‘tick box’ approach – we strive to achieve sustainable solutions for you.
In addition to the resource implications of trying to focus on this internally, there are several key benefits to using IMD:
Providing you with assurance
If you are an aspirant foundation trust, a desktop review of compliance will provide you the assurance you need in your application to Monitor.
If you are unsure or concerned, or if you simply want assurance on the current PSQ status of your organisation, we can help you by mapping your current state of compliance, identifying and recommending how to close gaps in compliance in the context of maintaining the balance of PSQ, Operations and Finance:
Closing your compliance gaps
If you know that you have compliance gaps, we can help you to identify the extent of those gaps and develop a plan to achieve compliance, in partnership with you.
If regulators have placed compliance conditions on your organisation, we can support you to achieve compliance.
Managing your reputation
Finally, we work with you to ensure that you, and IMD, gain a reputation for ensuring PSQ is at the heart of our organisations and everything we do, vastly reducing the risk to you and your organisation of major reputational damage as a result of patient harm.
What our clients say
High-level Governance Review for Liverpool Community Health NHS Trust:
“Thank you for your support and input in reviewing our overall Governance structures, and the alignment with our IBP and Strategy. Your flexibility in providing the input we required in such a tight time frame was greatly appreciated. Our staff and senior management team have indicated that they were very happy with the approach you took, and the timely and efficient manner in which you undertook the task. The outputs you provided were also returned in a very timely fashion, and were clear, concise, and constructive; you clearly had an understanding of what we required, and the experience to be able to rapidly analyse and filter the large amount of information provided. This was a very brief piece of work, and I hope we do get the opportunity to work with you and IMD again in the future.”
Medicines and Pharmacy Management Expertise, Liverpool Women’s NHS Foundation Trust:
“Following a CQC visit in February 2012 IMD were commissioned to provide some expertise in Management of Medicines and Pharmacy Management. IMD supplied an experienced Consultant with a pharmacy qualification and who had worked at a senior level in the NHS. The work was conducted at pace, thoroughly, fairly and with a universal belief in the integrity of the work produced. This has focused the organisation to commit to a number of tasks and objectives with a renewed confidence.
The outcomes have been impressive:
Medicines Management Committee has been revitalised with renewed enthusiasm to challenge poor performance in relation to medicines management and to hold members of the committee to account for actions
A thorough Serious Untoward Incident review unearthed fundamental flaws with the roll out of key policies and changes in practice. These have now been corrected.
Senior staff benefited from performance coaching
Thus, governance arrangements, key pharmacy staff engagement, systems and processes have all been enhanced is a remarkably short period of time.
The IMD Consultant worked in a constructive and supportive way with the team, enabling others to do better, empowering people to deliver stronger, safer services. The IMD Consultant had outstanding interpersonal skills, commanding immediate respect and confidence. He was extremely skilled at influencing and managing conflict, enabling resolution.
By late July 2012 a subsequent visit from the CQC meant that the previously noted moderate concern in respect of key outcome 09 (Management of Medicines) could be removed.”
For further information, please contact Julie Burgess, Senior Consultant, via email at