Cleveland Clinic London Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. The service constantly asked people for feedback, which was persistently positive and achieved the provider’s expected standards. Such standards were furthered by the team’s internal audit system and care ethos that focused on patient centred, compassionate care.

This service scored 80 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Kindness and compassion were embedded in all aspects of care. For example, above and beyond the care delivered by outpatients’ staff, the patient safety team operated safety frameworks within the ethos of compassionate, connected care. They focused on ensuring patient safety whilst supporting staff in a culture of no blame that promoted learning.

Staff understood factors that could cause anxiety and worry amongst patients. They used effective communication strategies to provide support, including time and space to ask questions.

Patients rated the care and compassion provided by staff highly. Staff asked patients for feedback throughout their treatment to maintain a continuous understanding of their experience. In the previous 12 months, 96% of patients rated their overall experience as excellent or good, 96% rated nursing care as excellent or good, and 97% rated consultant care as excellent or good. These results were reported at provider level and reflected care feedback across all 3 outpatient locations.

The front desk team provided patients with a private waiting area if they preferred to be away from others. This team recognised when patients were in distress, and they were proactive in providing comfort and dignified support. This was standard practice across the provider’s outpatient locations, and we saw it in practice at this site.

We saw staff treat patients as individuals during all their interactions. During a cast removal, the orthopaedic specialist nurse discussed the process with the patient and explained what they were doing and why. They anticipated the patient’s concerns and needs and adapted their communication and approach to the individual. This was repeated throughout our inspection and staff at all levels had an inherent understanding of how to meet each person’s needs. This was reflected in patient feedback, in which 94% of patients said the care team were always responsive. This result was reported at provider level and reflected care feedback across all 3 outpatient locations.

Equality, diversity and human rights training was mandatory for all staff and enabled the team to address needs and requests in relation to culture, religion, and personal preferences. The ethos of the service was person-centred and staff demonstrably placed patients at the centre of their work.

Patients spoke highly of access and coordinated care in the service. Patients we spoke with noted how their health outcomes were better because of the independence and choice they had in choosing appropriate clinicians and outpatient services for their care.

Staff delivered care within an overarching privacy and dignity policy that guided them in ensuring patients had choice and as much control as possible in care decisions. This extended beyond flexible appointment times and meant patients could choose how the service could meet their needs relating to culture, religion, and personal identity.

Staff respected each patient’s individual choice and adapted care and treatment to meet protected characteristics, culture, religion, and personal preferences within safety guidance.

Staff were trained as chaperones and proactively offered this service to patients for minor surgery treatments and where they assessed the patient as anxious or in need of additional support.

The electronic patient records system, shared across all sites, included a flagging feature to alert staff to additional needs at the first point of contact when patients presented for an appointment. For example, reception staff could identify quickly if the patient was known to have safeguarding, language, or chaperone needs. They also used this system to identify if a patient’s previous behaviour meant they could only be seen with 2 members of staff, or a particular gender of staff, for the team’s safety. This was a common process staff were trained to follow across all 3 outpatient services. We saw the process in practice when a member of the reception team identified a patient was struggling to communicate in a busy environment. They discreetly suggested they move to a quieter area to talk and check in for their appointment. The patient was visibly calmed and pleased by this.

As patients could self-refer to a clinical speciality, consultants did not always have extensive medical history information for each individual. They assessed this on an individual basis and ensured care and treatment requests were clinically indicated and appropriate for the patient’s desired outcome and health needs.

All staff undertook cultural awareness education sessions that covered all aspects of how to understand and meet patients’ needs. The provider had a spiritual care service that supported patients, families, and staff regardless of faith.

While the provider did not offer a dedicated mental health service on an outpatient basis, psychologists were based in acute medicine and provided support in the event a patient presented with urgent needs.

The service had introduced boxes in reception areas containing a communication book with useful images and advice in an easy read format. Boxes also contained activities to reduce anxiety, such as jigsaws, colouring books, and soft mittens for ‘twiddling’.

Staff wellbeing was at the core of the provider’s values and included a multidimensional wellbeing support system in which leaders were upskilled to understand the psychology of day-to-day staff wellbeing. The provider facilitated psychological safety and empowered all staff to give candid, constructive feedback.

The provider had increased the number of trained mental health first aiders (MHFAs) four-fold since the programme was introduced, reflecting need. MHFAs undertook an intensive training programme led by a clinical psychologist to be certified as practitioners by an external body.

Staff told us working relationships were underpinned by mutual respect and they felt the department, and provider, were positive places to work. The outpatient department had a high turnover of patients, with clinical care provided by dozens of consultants supported by nurses. The senior team recognised the need to ensure a collaborative working environment and assured this through systems such as the physician conduct committee.

Clinical educators worked with clinical nurse specialists across all sites to develop the outpatient nurse role and enable nurses to pursue more advanced specialties. This was in recognition that nurses in the department primarily worked as support for consultants and may not have the same development opportunities as inpatient colleagues.

Results from the most recent annual staff survey were positive overall and staff reported feeling empowered, supported by leaders, and said they felt a sense of belonging to the provider. Senior staff implemented action plans, based on exploratory discussions with staff, to address areas for improvement. This included in staffing levels and support for new staff during their probationary period.

Staff were a key focus of the provider’s vision and values, which included empowering staff to be accountable for their performance and achievements and to be innovative and inclusive in their work.