Cleveland Clinic London Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

This was the first assessment of this service. We rated this key question good.

This meant leaders and the culture they created led to the delivery of high-quality care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff knew what the values and strategy was for the service and were proud of the service they delivered. Staff were encouraged to raise concerns, however minor and had confidence they would be reviewed and responded to. This resulted in a transparent and open culture and staff told us they felt supported by their managers.

The service shared information from ward staff to senior leaders through daily huddles. During the onsite assessment we attended a huddle and found all staff were encouraged to participate, learning was shared, and staff achievements were celebrated. Meetings were structured to align to the vision and strategy and staff were encouraged to say what they had achieved in line with these values, meeting minutes we saw reflected this approach.

Regular leadership rounding took place where a value would be the theme and addressed with patients and staff. This involved up to 25 leaders who were spread throughout the hospital visiting different areas at the same time. The most recent rounding theme was on the value of empathy, this was explored using set questions to staff and patients. This meant leaders received feedback directly and could hear what staff and patients felt.

Several staff we spoke with told us they noticed a difference in the culture at the hospital when they started work. The service was described as welcoming and patient focussed, where people were encouraged to speak up and whistle blow. We were told the service highlighted things to improve and received support from senior leaders to do so.

Staff told us there was good working relationships and multidisciplinary team working, this meant they did not feel like they were looking after patients by themselves.

The service had a clear management structure with clear lines of responsibility and accountability. There were four surgical institutes, and each had their own leadership who were responsible for their own scheduling. Each institute fed into the medical executive committee which met monthly. They were responsible for carrying out appraisals and reviewing professional standards and conduct ensuring medical staff had the appropriate skills and knowledge to practice. The responsible officer, whose responsibilities included evaluating doctors’ fitness to practice, attended the committee which was chaired by the medical director.

The director of nursing for acute and ambulatory care also had oversight of surgery. There were clear nursing leadership structures in theatres, wards and recovery. Wards were led by the nurse in charge who was supported by a multidisciplinary team, for instance, clinical nurse specialists. Staff we spoke with told us they felt supported by leaders, and this was important to them to enable them to carry out their role

The provider had policies in place to make sure leaders had the experience and capability to carry out their roles. The Fit and Proper Persons policy detailed requirements for staff and the responsibilities to ensure all senior managers met the conditions. The board received annual assurance from HR that all appropriate checks had been carried out and staff met the requirements. This meant only suitably qualified and appropriate staff were employed.

The provider had a freedom to speak up policy and whistle blowing policy to support and encourage staff to use the systems in place to raise concerns. The policies we reviewed were in date and referenced national guidance. The freedom to speak up policy detailed several ways staff could access support including external bodies.

There were four fully trained freedom to speak up guardians (FTSUGs) with a dedicated email address for staff to contact them. They represented a range of services including theatres. There was a speak up function within the online incident reporting system for staff to report concerns anonymously.

FTSUGs were promoted through posters displayed in the care givers lounge. The provider conducted a freedom to speak up roadshow to promote the importance of speaking up to staff.

The FTSUGs reported to the quarter quality and safety board, maintaining the confidentiality of staff. Executives told us a theme had emerged over a process with HR, the team worked collaboratively to address these concerns and issues whilst maintaining the anonymity of staff.

Staff were able to provide an example of when concerns raised to the FTSUGs had been taken seriously and action was taken to investigate the issues raised. This meant staff felt confident their concerns would be listened to.

Policies and procedures were regularly reviewed through an equality impact assessment (EIA). An assessment was embedded within each policy and revisited during every policy review. Staff were required to complete an action plan and escalate any potential discriminatory impact of the policy as part of the assessment. If new guidance or information emerged that could impact equality, diversity and inclusion, the provider took immediate action to review and update all policies affected immediately. This helped address any disparities and ensure that the needs of staff from protected or marginalised groups were consistently considered.

The provider promoted an inclusive and fair culture through initiatives and processes. Staff surveys were a key tool in monitoring how different groups, particularly those with protected characteristics under the Equality Act, felt about the workplace environment.

>

The provider took several measures to prevent and address bullying and harassment. Freedom to speak up guardians were introduced to help encourage staff to raise concerns. Senior managers provided an example when staff had raised concerns which resulted in a thorough review being carried out supported by the HR team. Staff were interviewed and team building exercises were introduced to improve relationships. This demonstrated managers listen to staff and took action.

There were effective governance arrangements to manage performance and risk. The executive team were strategic leads and met weekly and quarterly as the Quality and Safety Board. The monthly integrated governance committee was attended by all leaders and department leads which meant there was oversight at all levels.

The nursing executive committee met weekly and was attended by the chief nursing officer and directors of nursing. Discussions included, organisational and team risks, training compliance and celebrations. The nursing leadership met monthly and discussed quality and safety with frontline managers.

Subcommittees, such as the mortality and morbidity committee and physician conduct committee, fed into the medical executive committee, giving executive oversight.

The quality metrics dashboard covered indicators of surgery quality. For instance, timings and late starts, surgical site infection rates, average length of stay and theatre utilisation. Statistics were broken down by each of the surgical institutes which allowed each one to review their performance. Each surgical institute had their own governance structure and monitored quality issues such as post operative infection rates and outcomes. A weekly forum met to discuss patients returned to theatre. Themes and trends of surgeons could be identified to see if improvements could be made or share good practice. Peer reviews meant different opinions of a procedure could be explored.

Daily safety huddles gave staff the opportunity to meet and share learning. There were three levels of meeting, ward, departmental and organisational, meaning information could be shared from ward staff to senior leaders and back.

The provider had a risk register where identified risks were rated. Each risk had a named owner and clearly showed the action taken to mitigate risks. This meant there was an oversight of risk.

The provider had a scheduled audit programme which detailed the frequency of audits, and which committee was responsible for reviewing the data. Therefore, quality could be monitored and action taken to address non-compliance.

There was a positive working culture that enabled effective multidisciplinary team working within theatres, post anesthetic care unit and surgical wards.A named nurse remained attached to the patient throughout their journey and after discharge.

The service worked well with other providers when patients were being discharged from their care. The patient records had a GP connect function where GPs could access the discharge plan and look at scans and other information regarding ongoing treatment and connect to the surgeon if required. The service liaised with other specialists, such as stoma care support meaning the patient had a seamless transfer of care.

The service could refer patients to community teams via the NHS and we were given examples of staff sourcing private companies to carry out community health checks to follow up intravenous antibiotic monitoring prior to retuning to surgery.

The service carried out procedures on behalf of the NHS when contracted to do so. In line with the requirements of NHS contracts, the provider had implemented a new incident investigating framework, so they were in line with NHS providers.

The hospital was working with a university and NHS providers to offer training for students and provide leadership training to doctors. This helped improve access to training and give those outside the hospital a chance to experience a different healthcare setting and access to specialists in their field. Senior managers told us they were committed to improving healthcare across the wider community.

The provider was a member of PHIN and worked with partners to make sure patients could access independent information about care providers and doctors to inform their choice of care provider.

The service had a strong focus on continuous learning, innovation and improvement across the organisation. Staff actively contribute to safe, effective practice and research.

The new patient incident framework was being embedded by the surgical teams and training was provided to staff. The theatre manager told us it was a proactive approach which included staff huddles to look at the facts of an incident and receive feedback quickly. We observed posters in theatre areas sharing learning from incidents and national safety standards for invasive procedures and we saw a ‘pause for gauze’ poster, reminding staff of the importance counting equipment used in surgery. We saw QR codes displayed for staff to use to submit ideas for improvement.

The service used new technology to improve care for patients. For example, laser lead extraction for pacemakers had been introduced using new specialised technology. This is a minimally invasive procedure meaning it improved patients’ recovery time.

The theatres and peri-operative areas were awarded a gold award in the providers department of distinction awards which meant these areas were seen to have high standards of care in the way they operated, for example, completing documentation to a high standard helping to keep patients safe.

Research and professional development were encouraged for all staff. The nursing institute shared governance had oversight of quality improvement and research projects. The provider was participating in the Pathway to Excellence programme which is globally recognised as enabling nursing excellence. The service engaged with higher educational institutes fostering an exchange of knowledge to enhance research, quality and impact to be at the front on innovation. The surgical service was expanding its development of robotic assisted surgical programs which included specialities such as urology and thoracic surgeries.

The provider was the first private hospital in the UK to achieve electronic medical record adoption model (EMRAM) level and 6 and level 7 awarded by the Healthcare information and management systems society (HIMSS). This technology measured clinical outcomes, patient engagement and clinician use to strengthen performance by using data to make informed decisions.