SP702USING QUALITY IMPROVEMENT METHODOLOGY TO IMPROVE STAFF ENGAGEMENT AND QUALITY OF CARE IN SALFORD ROYAL HAEMODIALYSIS NETWORK

Abstract

Introduction and Aims: There is clear evidence from the NHS staff survey of acute trusts of an association between staff engagement and hard indicators such as employee health, sick absence rates, patient satisfaction and survival. Institutions, departments and teams who aspire to offer excellence in care must also therefore pay attention to staff culture. In 2010 our network embarked on an ambitious quality improvement (QI) programme to improve the care of our dialysis patients. During the first two phases of the programme we worked on attainment of clinical standards in dialysis care and reducing infection rates. For phase 3 stakeholder input highlighted the imperative to work on improving the culture, development and engagement of staff in our dialysis units. Methods: Using the NHS Staff Survey, we performed a baseline survey of staff experience across our haemodialysis units in May 2013. Baseline data (58% returns) showed that the HD network was underperforming in comparison with the rest of the trust, which had the highest staff engagement and satisfaction scores in the UK. An Expert Faculty of clinicians, managers, academics and patients reviewed research evidence and local performance and agreed a framework for improvement with an aim of matching the staff engagement scores in the top-performing trust in the UK in one year. The Staff Culture Collaborative QI project launched in October 2013 using an IHI Collaborative methodology, with an executive sponsor. Unit QI teams (typically 3-5 staff) developed and tested ideas for change to bring about improvements to working practices, with input from a QI facilitator. Changes were tested using the model for improvement and plan-do-study-act (PDSA) cycles. Supporting methods included process mapping, flow mapping, surveys and coaching. Results: QI teams from 3 units tested changes using the Staff Culture framework for improvement as a guide. Key areas have included: multiple improvements to communication (regular structured unit team meetings, social networking, newsletters, “coffee with” sessions with senior management, a new HD unit manager network meeting, reorganisation of nursing roles with a more inclusive approach, focus on work processes such as coordinator's role, rostering, 'productive ward' issues, effective safety briefing, reliability of tasks, restructure of dialysis times and transport to improve patient flow. Learning and development including micro-teaching (small group “shop floor” sessions) to increase learning opportunities, training of nurses with managerial responsibilities in people management and leadership, a 12 month group “Leadership Coaching for Managers” programme, morale and team-building activities including staff and family days out, themed multi-cultural and multi-faith events, staff awards and personal feedback cards. Repeat measures using the 9 NHS staff survey questions relating to engagement have shown we achieved our aim of matching the top trust in the UK for staff engagement. Conclusions: Although we had begun to demonstrate improvements in some clinical indicators in our HD QI programme, staffing culture, morale and performance were an Achilles heel for our network. Staff themselves identified this as a key area for improvement. Using a quality improvement framework has empowered frontline staff to generate and test ideas to improve their working practices and environment accompanied by 'executive' permission to change. If this can be sustained going forwards, the research evidence clearly suggests that this will impact on improved patient outcomes.