Em Wilkinson-Brice, chief nurse and executive director of service delivery writes:
Over the last week, Express & Echo readers will have been shocked at the stories of individual suffering, neglect and abuse that have, with the publication of the Public Inquiry report on Mid Staffs, now been thoroughly exposed. As a nurse, a senior manager in the NHS, but above all as a human being, it is impossible not to be affected by the litany of failure that was so starkly set out by the families and loved ones of those who received a level of care that was completely unacceptable. For me and for all of us responsible for delivering safe, quality care, the publication of the Francis Report has triggered a chance to pause and reflect on what now needs to be done to ensure that the NHS system does not allow this to happen again.
As Robert Francis QC says in his report, "The NHS is a service of which this country can be justly proud, offering as it does universal access to free medical care, often of the highest order. It is a service staffed by thousands of dedicated and committed staff and managers who have been shocked by what they have heard of the events surrounding the Trust".
In complex organisations, staffed by thousands of people, facing financial constraints within a system that is constantly changing, meeting the healthcare needs of everyone, is really challenging. And, even in the best run hospitals, we don't get it right all of the time. We must therefore listen to our patients and staff and work together to continuously improve our services.
I have been a nurse for 24 years and I strongly believe that, for all staff on the 'front line of care', compassion and sensitivity to the needs of patients and their loved ones is critical if we are to make patients and their families feel cared for. For that to happen each and every day, it is my responsibility as Chief Nurse at the RD&E and that of senior managers and the Board to create an environment and culture where compassionate care can flourish. That means recognising and valuing the emotional effort our staff invest in patient care, providing the time to care, and making sure the right equipment and training is available which enables staff to deliver safe, quality care. We also need to put systems in place which will identify when care is not being delivered to our expected standard and act quickly to apologise, correct, and maintain public confidence in us as an acute hospital.
Last year, we put in place a new vision to guide the work of the 2,800 nurses, midwives and allied health professionals [AHPs] providing patient care at the Royal Devon & Exeter Hospital. This programme set out an ambitious organisational wide commitment to ensure that high standards of care are applied consistently. The three year programme, which was developed by the senior leaders, seeks to capture the pride and dedication that our nurses, midwives and AHPs demonstrate on a daily basis. It also emphasises their passion to constantly improve patient care: 'good' is not good enough – we want to be the best we can possibly be for our patients, their families and carers."
The programme of work which sits beneath the Vision includes simple innovations such as ensuring good practice in one area can be rolled out and applied consistently and reliably across the hospital and making sure that individuals are held accountable. For example:
• We are rolling out Comfort Rounds where we ensure that each ward undertakes a nursing round every hour. We believe it is not acceptable for patients to rely on a call bell to request assistance. We want to pre-empt the essential needs of our patients so every patient every hour will be asked by a nurse or midwife whether they are comfortable and if there is anything they need. This regular check will address essential aspects of patient care including pain management, nutrition and hydration. We also expect this pro-active approach to reduce the incidence of patient falls and pressure ulcers.
• We have always sought to improve our services by listening to patient feedback. Now, based on a successful trial in our orthopaedic wards, we are systemically capturing patient feedback whilst patients are still in hospital and sharing this at daily team safety briefings to promptly address any issues or concerns that may arise.
• We now have anonymous staff feedback cards to pick up on themes or issues which need addressing because staff morale and satisfaction in the workplace can mirror patient satisfaction
At the heart of these initiatives - and many others besides – is the understanding that delivering safe, quality care to patients each and every time with compassion and dignity must be the main focus for our work and that, whilst targets and financial imperatives are important and have their place, they cannot and must not get in the way of good, decent and compassionate care.