Learn how Wirral initially ensured their services were supported, protected while maintaining their high level of quality during the first outbreak wave and how they are now enabling the restoration of services in a COVID-19 safe and quality compliant manner.
"..it’s a valuable tool thats helping us to identify themes and potentially barriers to restoration."
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So good morning everyone. It's great to be here (albeit virtually) to be able to talk to you about our governance framework and how we're increasing our assurance using our state system. And it's been really great to hear from Cody and Yvonne about how others are using InPhase in a similar way to us and how they are seeing very similar benefits.
So, as Andrew said my name is Emma Carvel and I am Therapy Quality Lead for Wirral Community NHS Health and Care Foundation Trust. I'm a children's language therapist by background and I worked clinically as a team leader until two years ago and I became really involved in the improvement journey of our organisation. So, I am here today with my colleague Jane, who's going to co-present the second part of our presentation this morning. I'll just briefly hand over to you Jane so that you can introduce yourself as well.
Hi, I'm Jane Marshall I'm the Lead Commissioner for the Community Care market for Wirral Council, but working in integrated commissioning arrangements with Wirral CCG, so commission the Community Care markets on behalf of both organisations.
Thanks Jane. So, the first part of this morning's presentation is going to focus on Wirral Community Trust implementation of states. And the second part is going describe how over the past three months, the system has translated across to Wirral Care Homes and a collaborative venture between ourselves and the local authority. So just a little bit of background really to our organisation, and so we provide health and social care to Wirral and parts of Cheshire, we operate over four divisions with over 1800 employees.
Following a CQC inspection in March 2018, the trust identified an opportunity to develop a stronger governance framework. So we saw this as an opportunity to have one system that could act as a repository for all standards relating to regulation quality and assurance and in November 2018, we procured the tools from InPhase, and we gave it the bespoke name of SAFE, which as you can see stands for "Standards Assurance Framework Excellence". By giving it our own name, we feel it's given us ownership of the system and it represents some of the really unique qualities that SAFE now has for going back, you know.
We had a very clear vision to improve our standards, so not just for our regulators CQC, but of course for our patients and for our community. We recognised that staff engagement was crucial in a successful change management and we saw faith implementation as very much an opportunity to have a positive impact upon the culture of our organisation. So in collaboration with our developer and InPhase, we built our SAFE system over December 2018. In January, 2019, we trained over 130 members of staff and we went live at the start of February. So really, very similar to what Cody was saying - it's very, very rapid implementation and InPhase were very responsive to that.
SAFE consists of a number of modules and they can be seen on this slide, which shows the login homepage. So as you can see on the top menu, the modules includes a number of regular inspections and these are things that are completed by team leaders on a monthly basis and they include a medicines management inspection and Information Governance inspection and a team leader checklist. So there are a set of expected standards with key messages relating to each area that the team leaders will rate, they are aligned or not.
We also have a procedural document tracker and this enables us to track when policies, standard operating procedures and patient group directions are due to expire, and to alert the author to review and progress down the approval route.
The nice update and tracking module alerts us to nice updates, we can then assess that guidance replicability and services can review and add evidence of compliance.
Our "CAS-Alert" module allows us to monitor central alerts coming through, to ensure that we can respond to them in a timely way.
We also have the CQC module and that consists of a CQC self-assessment that you've seen in an earlier presentation that's completed on a quarterly basis by services. And this enables them to upload evidence for the CQC domains and the key lines of inquiry, to show that we're safe, caring, responsive, effective and well led. We've implemented a divisional peer review of evidence which provides that additional layer of assurance of the strength of the evidence. So we've now got evidence over, I think it's six and a half thousand key lines of inquiry across the organisation, which is something that we do celebrate on a regular basis. We are an integrated health and social care organisation and our Adult Social Care module of social worker standards framework and the Care Act framework to allow teams to align themselves and to the standards and provide evidence of this.
Okay. So I'll hand hygiene essential steps audit has been built on to SAFE. So we have around well over 1,100 members of staff who are required to complete this every quarter. The staff complete either a self-audit or a peer audit and historically there were a number of systems that we use to recall hand hygiene, including electronic case notes and paperwork documents. What this meant really provided a challenge, because it meant that compliance was really difficult to track. But now we have one system, the tool allows us to monitor completion and compliance at a number of different levels.
And again, this is really to echo what Yvonne and Cody have talked about already in their presentations, but for me, one of the most exciting parts of SAFE and InPhase oversight is the dashboards for reporting. Because what we have, is we have a lot of data going in and our dashboards, provide a very, very visual and user-friendly, colourful way of seeing that data. And what we know is that we can see completion rates across a number of things. So looking at our next inspections and also compliance, and that can be viewed and broken down at a number of organisational levels. So we're getting assurance at a service level, a divisional level, and a trust-wide level and we use our systems for meetings and committees. And again, to echo what the others have said, it’s around that live reporting of data which is so valuable. The minute data goes in, the system is updated live. So it's fantastic that progress can be very clearly tracked over time.
Okay, so the next slide is an example of our hands hygiene dashboard. So what you can see here in the middle, is that for the first quarter of this year, we achieved (and this is the demo quarter) but achieved a completion rates of 93%, and as I said the completion and compliance are two separate things. So we have a compliance of the 93% of stuff, but completed their hand hygiene audit, we have a high compliance with 100%. We've also got the facility to look up the peer review element. So we would be expecting staff to complete at least one peer review over an annual period of time. What we can see from the start of this year, with so far around 40% of staff we've done that. By the end of this year, we'll be aiming to about 90%, perhaps.
Okay. On the next slide, as I mentioned earlier, looks at the service breakdown. So what we can see is we can see overall location and compliance for the trust. We can then break it down to a division, and then go even further. So this is an example of our adults and community services. So we can look very clearly at any point in the quarter, to see how services are doing. We can celebrate those services that have got really, really high completion and we can offer support for those who haven’t to help them to get to that standard.
Okay, so over the past few months we've all had to work very differently. We've had to transform the way that services are delivered and adapt to new standards relating to prevention infection control and PPE. So as a result of this, we have adapted our governance framework to support services to do this safely and effectively and we've had excellent support from InPhase to do this at a very rapid pace. Our COVID-19 module comprises of code of specific nice guidance and COVID specific checklist, and a quality framework for the framework of evidence was developed as a direct result of the NHS England improvement community standard operating procedure which outlines how community service should respond to the pandemic. In terms of IPC care planning and virtual working, we translated this thought into a framework by which services could rate their alignment. And this allows very quick identification of any areas that needed more support, which also allowed us to celebrate and share best practice, (for) things that were going well.
The next slide shows just a part of the COVID-19 checklist and this was something that we implemented. Services complete this every month to provide assurance on areas such as agile working supervision, risk management and PPE. The dashboards reporting enable again completion and compliance to be seen easily across the trust, and at various levels to services, not only aligned to the standards, but they can also put comments, or they can add evidence to support this alignment - as can be seen here, where we've got the facility to answer the question, but also to add that evidence as well.
Any areas of non-alignment should have actions in place to bring about that improvement.
Okay. So moving on to the next slide. So the service restoration framework that with the National Direction and NHS faced the response and requirement to restore services. We recognise the need to support them to do it safely, whilst maintaining a focus on provision of high-quality care. We emphasise the importance of sustaining new ways of working that were going well while restoring activities that will require careful planning around PPE and social distancing.
We created a reset plan for services to complete as part of the COVID-19 module. InPhase and our developer Paul were very responsive and flexible to the ever-evolving needs of our trust and therefore our SAFE system.
So part of the reset plan can be seen from the slide, that it shows the dynamic sunbeam with segments relating to each area. So by selecting a segment, a set of prompts appear, relating to the area and that act as a prompt, or services to consider evidence alignment against the exception dashboard that we have built has enabled us to identify any areas of concern that we can immediately escalate about to division or leads, or support, we've got in place.
So we've got some of the benefits here for the system so it's around, enabling easy identification of goods and outstanding areas, and again just to echo what Yvonne, and Cody have said, it's about celebrating that good practice and it just gives you that really easy way to identify that and also a quick way of identifying areas requiring improvement. It's very user-friendly and visual and it supports the provision of safe care.
And again, it's about that visibility that transparent data and the live aspect of the system. And, yeah, so I think that's it really, so it's just onto any questions.
So we had a couple of questions come through. Start with my one, selfishly. So thinking about the restoration plans... so obviously, this week in the media we have quite a bit of news about Macbook Pro coming out, PlayStations and Xboxes, however, more importantly, aside from that, about the vaccine, and what that could mean in terms of restoring some normality back. So, how do you advocate... envisage... the kind of the restoration plans.
Kind of picking back up within the community, we first need to acknowledge that we won't be restoring services to how they used to be in many ways. So, in the here and now, the framework is supporting services to deliver care safely. Obviously within COVID restrictions because it's got those standards around social distancing, PPE and remote working, but I think we've also ensured that it's got an emphasis on ways of working and measuring outcomes. So for example for virtual consultations. In some areas, we're finding ways to be extremely effective and actually a better way of working than before. We really want to sustain this, even in a non-, you know... COVID world. And it's also a valuable tool that's helping us to identify themes and potentially barriers to restoration. So an example of that is that around group consultations and having a platform to enable us to deliver certain things, like diabetes, smart or Parkinson's education talks. So what we've done is we've used the framework, not just to highlight issues at a service level but to identify those themes that are trust-wide and look at solutions to overcome them. And as I say, it's very much about that kind of safe provision of care now, but locking in those, you know, new really beneficial ways of working going forward that we will be maintaining. Once we do with you a bit of... a little bit more normality.
I have a question. I know there's a little bit of a story here. How have you got the confidence that people are actually putting in genuine assessments or self-assessments of their own compliance and the way in which that looks as if it has made an actual impact and change in how people have behaved?
I think as I mentioned at the beginning, it was around that culture. We've definitely seen a culture shift, and within the whole organisation. We were very much, whatever information... you know... goes into the system we do put a lot of quality assurance processes in place. And that's a very, very supportive mechanism for staff. So just as an example, our peer review of the CQC standards and the self-assessment. We would... again, this was potentially before COVID, but would easily be replicated virtually. It's around services, getting together to review each other's evidence and talk about it, talk about the strength, about evidence. We talk about evidence almost on a ladder of strength of what things we can add to make it stronger, so we look at photographs audit and it's about triangulation. So what we're finding more and more is that insight that the system can give us, so that everything is telling the same story, but it's coming from a number of different sources, and we're just, you know, sort of triangulating that, just about assurance, that whether that answers the question, but.
Last question... from all of our usage of webinar... similar kind of theme to it... but how in real time or near-time on the dashboards, just kind of following on from that kind of agency attention. Okay, so they are... as soon as the information goes in, they all, it pulls through to the dashboard. Immediately, which is fantastic. Yeah. What I think is traditionally, we, you know, for our monthly meetings, we'd be pulling reports off, and often they are required to be in, you know, a few days before the meeting, and you know what I do is I use our same system live within, and I trust wide assurance meetings to show the most accurate and up-to-date picture of where we are.