Three Shires Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The service planned care to meet the needs of people using a clinically focused, research-based approach to developing treatment that demonstrably improved outcomes. Staff took account of patients’ individual needs, made it easy for them to give feedback, and acted on this. People could access the service when they needed it, and staff worked closely with NHS providers to manager waiting lists. The complementary range of clinical specialties available made multidisciplinary, holistic care pathways available on a seamless basis

This service scored 86 (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 monitored patient-centred care through the FFT. In the previous 12 months patients rated the service highly, with an average satisfaction rate of 97%. This was better than the national average of 94%.

Staff established detailed histories of patients to help them provide personalised care to meet each person’s treatment goals. For example, we observed a patient discussing their athletic history with the surgeon, who explored how they could safely return to such activities after surgery.

Quality improvement programmes led to improved care for patients. For example, staff consistently spoke with each patient 48 hours after discharge to check on their recovery. The team contributed to a national audit programme in this measure and extended the focus on person-centred care with a new personalised approach to shift handovers on wards.

Staff used a person-centred approach to coordinate care for patients with mental health needs, including those with a history of self-harm and recently diagnosed conditions. In such cases, consultants liaised with the patient’s GP and mental health team to risk-assess planned treatment.

Staff valued each patient’s social history and needs as part of their approach to person-centred care. We saw the theatre team discussed this during pre-operative briefings to give each member of the team an understanding of why the patient was undergoing surgery and the results they were hoping for. The ward team used this information during post-operative care to support recovery.

Theatre teams discussed the planned procedure with each patient just before they were sedated. They explained the feeling of being sedated and helped the patient understand key aspects of the procedure, including intubation. This had a calming effect on patients, who told us the clear information provided by staff made them feel included in the process

Patients rated catering, housekeeping, and facilities in addition to clinical services, highly in the FFT. In the previous 12 months, 94% of patients rated the services as excellent or very good. Patients noted the continuity of care, from first contact to post-discharge follow-up as a key aspect of their positive experience.

The service had undertaken a project to reduce same day cancellations by addressing causes. The pre-operative assessment team saw all patients ahead of surgery and the provider contacted patients with appointment and pre-surgical preparation reminders. The team had trialled a new staggered admissions system and changed logistics for consultants to reduce cancellations. This reflected the team’s inquisitive, exploratory approach to resolving barriers to challenges.

The service implemented an improvement programme for pre-operative care, including recruiting new clinical leads. The anaesthetist had experience working with theatres, enabling continuity of care between teams at each stage of treatment. The project improved the timeliness of reviews and led to flexible clinic times.

Staff used twice-daily handovers on the wards to review the needs of each patient. This included progress towards their planned discharge and a multidisciplinary discussion of each patient’s social needs and post-operative observations.

Staff acted on the increased clinical needs of patients to develop multidisciplinary working processes that supported more efficient communication, such as direct communication between physiotherapists and consultants. This streamlined care and made changes to treatment more efficient by reducing the need for administrative steps between teams. The physiotherapy team equipped the rehabilitation gym with new equipment to reflect the needs of patients in wheelchairs to help them transfer independently.

The dementia lead worked with staff to coordinate care and ensure patients had appropriate community and home support after discharge.

Staff provided appropriate, accurate and up-to-date information in formats that we tailor to individual needs.

We observed a post-operative consultant ward round during our site assessment. Consultants gave patients time to ask questions and explore their concerns, checked pain management, and explained the next steps in each individual’s treatment plan. Consultants explained to each patient what happened during their surgery and whether it had gone to plan.

Staff provided patients with detailed post-operative information before they left the hospital. This included a visual guide on managing wounds. For example, they provided generic photographs of infected wounds and told patients what to do if their operation site looked like any of the images.

Staff provided patients with information in a format they could understand at key stages of treatment. For example, a member of the pharmacy team gave each patient information on their post-operative medicines management during the pre-assessment process.

Physiotherapists met patients during the pre-assessment process and planned rehabilitation using a joint approach based on the individual’s own goals and future plans. They showed patients generic videos of pre-operative and post-operative mobility of patients who had undergone similar surgical procedures as a strategy to help patients understand more about their planned treatment.

Patients knew how to access their health and care records electronically and by requesting paper copies. During the consent process, patients decided which

personal information could be shared with other people, including their family and GP.

The provider supplied consumer rights information to patients who paid for their own treatment, including in relation to contracts and charges.

The service was compliant with the Accessible Information Standard for printed and digital information. The team had worked with a national specialist organisation for blindness to supplement digital media with accompanying audio descriptions. They extended this to health education and patient feedback material.

Staff made it easy for people to share feedback and ideas or raise complaints about their care, treatment and support.

A marketing officer joined the daily hospital huddle to update colleagues on recent public reviews made by patients. This helped staff to maintain a broad understanding of hospital performance and consider any improvements possible by the team. At the time of our assessment the hospital had a 98% satisfaction rate measured by patients’ public ratings.

Staff worked within the provider’s complaints policy and displayed details about how to complain in key patient areas and on the website. The provider was a member of the Independent Sector Complaints Adjudication Service (ISCAS) and signposted patients in the event they were unable to resolve the complaint. In the previous 12 months, surgery services received 11 formal complaints, which was 13% of the total received. In each case the quality and risk manager discussed details with the complainant, carried out an investigation, and coordinated a resolution.

The service was in the process of establishing a patient participation group (PPG), made up of former patients, to help assess services and drive future changes. The model had seen early success, with the experiences of a patient using the physiotherapy gym contributing to the installation of a new access ramp.

Staff made sure that everyone can access the care, support and treatment they need when they need it.

People who were anxious or worried about their treatment, rated staff particularly highly. In the previous 12 months, over 99% of patients said their consultant had shown them understanding when assessing their needs and 98% felt they had sufficient time with their consultant.

The provider designed services to be accessible and timely for people who were likely to have difficulty accessing care and staff were trained to remove barriers. For example, the team offered remote care when this was safe and appropriate, and made sure patients could communicate in the most convenient way for them.

While treatment cancellation was rare, staff considered patient’s access needs when rebooking.

Patients had equal access to care, treatment, and support because the provider

complied with legal equality and human rights requirements, including avoiding

discrimination, considering the needs of people with different protected

characteristics, and making reasonable adjustments. The physiotherapy team had made particularly detailed adjustments to treatment plans to support access.

All areas of the service were accessible step-free, and staff provided digital access to consultation and care where this was appropriate. The service operated an on-call out of hours contact number staffed by a clinician for patients recently discharged.

The provider had a comprehensive equality, diversity, and inclusion programme that enabled staff to identify and address discrimination and inequality that could

disadvantage different groups of people in accessing care.

Results from the FFT in the previous 12 months reflected consistently positive feedback about their experience and outcomes. For example, 98% of patients said they felt ready to be discharged and over 99% said there was always someone to speak with.

Staff used a range of quality assurance projects to benchmark care and identify opportunities for improvement. Recent projects included effective discharge, acute kidney injury, and fluid balance. A project manager in each department supported staff with auditing and shared results across the provider’s network as evidence of good practice in patient outcomes.

Staff established an estimated length of stay at the point of admission and used post-operative multidisciplinary reviews to plan a safe date of discharge. The team were flexible in this an approach and extended stays where patents needed more intensive recovery care.

Staff used strategies such as a patient hour and a 4-part quality system to drive equitable patient outcomes. This included focused time to spend with patients to support their holistic wellbeing and planning activities that led to good outcomes.

The service provided care for private and NHS patients. Staff provided care equitably regardless of how it was financed.

The service had reduced length of stay in line with new approaches to surgery and recovery. In the previous 12 months, 95% of patients had returned home within 24hours of their procedure. Staff used the national ‘getting it right first time’ model to consistently achieve this goal provided it was safe for the patient.

Staff had good awareness of the health inequalities faced in the region and understood how these contributed to poorer health outcomes amongst some groups. They considered each patient’s physical, mental, emotional, and social needs and were trained to identify and address barriers linked to protected characteristics under the Equality Act. Such work reflected embedded, inclusive policies that supported equitable outcomes.

There was a sustained focus on keeping up with demands and adapting the service in line with changes in population health trends and themes. Staff understood many patients experienced anxiety about their conditions and post-operative recovery and worked with them to establish long-term goals.

Post-operative rehabilitation took place for up to 9 months and staff empowered patients to build healthy lives that made the most of their surgical procedures. Staff worked together to support patients with flexible appointments and joint working. For example, as patients returned to work and their personal commitments, staff understood pressures on their time, which could make it difficult for them to attend frequent appointments. As a result, teams worked together during scheduling, such as arranging a wound nurse appointment and a rehabilitation appointment back-to-back.