CHEC - Kings Norton

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• 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 and wider communities. 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 is the first assessment for this service. This key question has been rated Good. This meant that the service was consistently managed well. Leaders and the culture they created assured 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.

The service had a shared vision, strategy and culture. The vision was to make healthcare services more readily available and accessible in local communities, by offering patients greater choice, flexibility and reduced waiting times. Their values included caring, passionate, togetherness, listening and focus. Staff understood these values and embodied these to deliver good patient care. Care was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff were aware of the vision and strategy for the local clinic. They knew of the challenges and flexibility of the service. Senior managers were able to describe the challenges of providing the service but felt that the staff were aligned with the needs of the service and were flexible in delivering a service wherever this may be. This was demonstrated by supporting sister sites during times when this clinic was quieter. The service had a positive culture as staff described feeling listened to and supported. Staff felt free to raise any issues knowing that their opinion would be valued.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. The clinic manager had fulfilled a number of roles within the service on their way to clinic manager. This gave them an understanding of the service and the challenges staff face at times. It also enabled them to be empathetic with staff. The clinic manager ensured that most decisions that could impact the staff were discussed with staff so that they felt part of the team with some control over their working lives. Leadership development opportunities were available for staff who wanted this development.

There was a national lead for endoscopy who was well known to staff working at the site. They provided further training and support to staff. The lead had extensive training in the area of endoscopy, having attended training at a nationally recognised centre.

The service fostered a positive culture where people felt they could speak up and their voice would be heard. There was a company wide freedom to speak up guardian and a champion who worked in the education team. Freedom to speak up opportunities were advertised in the staff room. Staff were aware of this process but felt well supported by their clinic manager and would raise any issues with them without fear. They were confident that they could contact the clinic manager at any time through a text message if they were not on site. Staff felt that they were included in the development of the service.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff felt that they would be able to apply to work flexibly should they need to. Within the team there were staff who worked across sites. Where transportation was an issue for these staff this was provided. The staff were reflected of the population that they served and as such the manager felt that they understood the communities they worked within.

The service had clear responsibilities, roles, systems of accountability and good governance. There were governance meetings at a local, regional and national level to share the learning across the organisation. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There was a clear framework of what must be discussed at a clinic, team or regional and national level in meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. Flash alerts were created following incident investigation to share learning across the provider. Monthly team meetings included presentations from the overarching Clinical Governance Steering Group. These kept staff informed on issues within the wider organisation and let them monitor the clinics performance.

Staff at clinic level could escalate concerns when required. These concerns matched those on the clinic’s risk register and included issues such as brakes not being applied to workstations, and full bin bags being removed in a timely manner. All risks on the clinic risk register were appropriately scored in line with their policy. The highest scoring risk was around the transfer of patients on and off the operating bed. The service decided to assess patients prior to admission to reduce the risk.

While information systems were generally electronic, the provider had applied limits to the amounts of data individuals could see. For example, the clinic manager and region operations manager could only see parts of the HR system. Staff in the clinic area did not have access to this area of the IT systems. However, the clinic manager and senior managers had access to the areas which they needed to assess performance both individually and at a clinic level.

Staff were aware of the impact of their service on the planet and sought to utilise reusable equipment wherever possible. Where single use items were used these were packed individually and only opened when necessary. The staff also separated waste into recycling and other waste in both the procedure rooms and in the staff areas. The service used electric vehicles to transport staff and patients and in other areas as much as possible. Recycled paper was used in the clinic.

The clinical lead for endoscopy services ensured that all staff working in this specialism were kept informed of developments in the service. They worked with the teams across the country to monitor performance, develop staff and ensure that improvements in the service were identified.

The service understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. They engaged with the local integrated care boards and NHS trusts. This included the review of performance and quality indicators. The clinic manager was available to patients, their families and carers should they wished to raise any issues. Information was shared with the referrer to ensure seamless care. The clinic and senior managers were aware of performance and sought to address deficits and understand other markets within the healthcare system.

The clinic worked with several partnerships, some of which were managed centrally. Meetings were held with all partners to ensure that parties had the opportunity to raise any issues to improve services experienced by the patient. These partnerships included suppliers of equipment such as lens suppliers, pathology services and sterilisation services.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged staff to look for ways of improving the experience, outcomes and quality of life for people. They actively contributed to safe, effective practice and research. Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. Patients were encouraged to offer suggestions for improvements through a suggestion box at the main reception. Suggestions could also be taken on the patient satisfaction survey using the tablet.

There was a notice board in the main waiting area which included a ‘you said we did’ element where staff wrote about what they had done with patients’ comments. There was also an area to note key performance indicators which then had a section highlighting “our promise”; this area was utilised to inform patients what the team were doing about the indicators. For example, the clinic was showing 95% for infection prevention and control. In the ‘Our Promise’ section was written, “Training plan in place for hand hygiene and re-audit monthly”.

Staff could suggest ideas for improvements to the service and felt these were acted upon. There were a number of quality improvement methods in place and staff knew how to apply these and were knowledgeable about the projects relevant to the clinic. An example of this is the amendments made by senior staff and the clinic staff to the checklists. Staff felt that their comments were taken on board and an updated checklist had been piloted. Staff participated in audits and understood these were to improve practice and patient experience.