The Hillingdon Hospital

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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

This was a focused follow up assessment; We assessed elements of one quality statement. We looked for evidence of accountability and good governance to manage and deliver safe treatment and care. We assessed if the breach of legal regulation in relation to governance, management sustainability had been addressed.

We found the service had made improvements. However, well led remained as requires improvement.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service did not always have clear responsibilities, roles, systems of accountability or good governance. Staff did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There were management and governance structure for the unplanned care division. This included escalation processes and reporting arrangements that provided staff at all levels with an oversight of patient safety and experience. For example, the monthly quality report included a range of quality and performance metrics such as audit results and staff insights from safety huddles.

These were reported to the monthly ED, unplanned care divisional governance meetings, at the nursing, midwifery and APH board and at the quarterly trust infection prevention and control committee (TIPCC) meeting. However, these governance arrangements failed to ensure some patients privacy and dignity was maintained. As some of the SOPs and process had recently been implemented and they were not yet embedded into practice such as the RAT and TES SOP, some data could not be provided or the impact of these changes could not be evidenced.

Learning from incidents, complaints and escalated issues was undertaken via a range of meetings and channels. This included at shift handover, during hot debriefs, at the monthly divisional quality board, via the team chat and at the safety huddle that had replaced the bed meeting. We were told that a range of staff attended the 8am safety huddle including executives, staff from the medical team, mental health colleagues and department staff. The aim was to resolve any issues from the previous night and address concerns in a timely manner. There were daily meetings that reviewed all incident reports submitted in the last 24 hours, which was attended by the governance manager and senior nurse. At this meeting the incidents were reviewed and graded. This ensured that incidents were triaged and allocated for investigation in a timely manner.

There was a weekly informal meeting that reviewed progress of investigations, identified any support required and provided an opportunity for learning. The meeting we attended demonstrated that staff were held accountable for the progress of their investigations, were able to explain the rationale for delays and were allocated specific actions as required.

There were bi-weekly meetings attended by the UEC matron and band 7 nurses that focused on service development following the last CQC inspection. This meeting tracked improvements, assisted with resolving issues that were impacting on staff implementing change and ensured staff had assurance to demonstrate that issues had been resolved.

The trust had recently relaunched monthly quality and learning forums, which were open to all staff. These sessions included learning from incidents, investigations, complaints, claims, audit, IPC and learning from deaths. These sessions fed into a monthly learning poster which was available in the department and shared via team brief. Staff we spoke with were aware of how to access this information and stated that they preferred the poster not to be displayed in the staff room, as they felt this was an area they used to take a break from work. We were told that to facilitate learning with other teams in the hospital, a range of learning opportunities included the ‘grand round’ and that a tabletop exercise had recently been completed to explore an incident, this multiteam exercise enable those present to discuss missed opportunities, what went well and what could be improved to avoid a similar incident occurring in the future.

A range of training had been developed to skill up staff to lead investigations of incidents. This included face to face incident management training, 8 modules on specific topics including serious incident review training. While this was aimed at band 6 nurses it was recognised some middle grade doctors had expressed an interest in developing their skills in this area and therefore would be invited to join the course. This approach would mean that the division had more staff trained and competent in the investigation of incidents.

After action review (AAR) facilitator training had been provided to increase the number of staff trained to lead ‘after action reviews. AAR is a method of evaluation that is used when outcomes of an activity or event, have been particularly successful or unsuccessful. It aims to capture learning from these tasks to avoid failure and promote success for the future. The AAR training attendance log provided by trust demonstrated that an ED matron and ED consultant had attended the training.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.