Boards on Board 27 th and 28 th January 2011

1. Boards on Board 27th and 28th January 2011

2. Housekeeping • Webstreaming • Fire Alarm at 3PM • Hotel queries, see Leanne • Still a few places left at dinner, please see Leanne • Please turn mobile phones to silent

3. TransparencyWhat's it got to do with boards? SPSP Boards on Board Event 27 January 2011 Frances M Elliot Chief Executive NHS Quality Improvement Scotland

4. Transparency Definition of transparent: allowing light to pass through so that objects behind can be easily seen; easily understood; of such a kind that the truth behind it is easily perceived; clear and unmistakeable Often described in terms of how individuals behave and organisations function e.g. with candour, integrity, honesty, ethics, clarity, full disclosure, legal compliance The aim: to allow us to deal fairly with each other and those we serve.

5. Lack of transparency Lack of transparency is often built into the very structure of an organisation For information to flow freely within an institution, followers must feel free to speak openly, and leaders must welcome such openness This allows critical information to get to the right person at the right time and for the right reason.

7. Trust Trust and transparency are always linked The unimpeded flow of information is essential for healthy relationships and for organisational health Ibsen defines “vital lies” as the operative fictions that cover a more disturbing truth in troubled families In organisations they play a role in attempting to keep embarrassing truths from surfacing.

8. Professionalism What is professionalism? The competence and skills of a practitioner Implicit accountability for one’s actions The codes governing the way professionals behave and practice, both clinically and managerially Demands an honest and open response to any criticism or complaint.

9. Stark reality While accepting that the overwhelming majority of practitioners will behave professionally, history reveals that in any group of human beings there will be those who do not Sadly, the litigious society in which we now live dictates that we must protect against this often deviant minority.

11. Medical scandals Damaging secrets often come to public attention because of whistleblowers - courageous individuals who expose their organisations’ deepest secrets, often at considerable peril to themselves Because history demonstrates the person who exposes wrongdoing suffers, usually by being shunned, demoted, fired, or otherwise punished.

12. The new transparency In everyday life we live in a globally networked society The mobile phone equipped with a camera, and CCTV, means that each of us is, more or less, always under scrutiny and on display This new, involuntary transparency recognises that there is no such thing as secrecy It calls for a new code of behaviour, one dictated by the reality that we can never assume we are alone or unaccountable for our actions.

13. Implications for boards A need to face up to the new world of transparency expected by patients, the public and politicians It will result in more information about service delivery and clinical outcomes being readily available Our challenge is to enable this new transparency by providing relevant real-time clinical outcome data for all.

15. Boards on Board This event is aimed at: increasing your understanding of your responsibilities as non-executive and executive directors together Putting the person/patient at the centre of board business Building a transparent culture in your boards Supporting you to act on what you learn from this event.

16. Boards on Board Derek Feeley Acting DG Health and Social Care Chief Executive NHSScotland

17. I’ll cover • Rationale for accelerating Boards on Board • Lessons from patient safety • Implications for Governance • Integration

18. Building from a strong base

20. The Healthcare Quality Strategy for Scotland Person-Centred- Mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision making. Clinically Effective- The most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. Safe - There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.

21. Mid Staffs • The evidence gathered by the Inquiry shows clearly that for many patients the most basic elements of care were neglected. Calls for help to use the bathroom were ignored and patients were left lying in soiled sheeting and sitting on commodes for hours, often feeling ashamed and afraid. Patients were left unwashed, at times for up to a month. Food and drinks were left out of the reach of patients and many were forced to rely on family members for help with feeding. Staff failed to make basic observations and pain relief was provided late or in some cases not at all. Patients were too often discharged before it was appropriate, only to have to be re-admitted shortly afterwards. The standards of hygiene were at times awful, with families forced to remove used bandages and dressings from public areas and clean toilets themselves for fear of catching infections. • Speaking at the publication of his final report, Robert Francis QC said: • "I heard so many stories of shocking care. These patients were not simply numbers they were husbands, wives, sons, daughters, fathers, mothers, grandparents. They were people who entered Stafford Hospital and rightly expected to be well cared for and treated. Instead, many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives."

22. Mid Staffordshire report

23. Lessons from Mid-Staffs • Care often far below an acceptable standard • Reliance on distinction between strategic and operational issues, and disclaimer of responsibility for the latter • Lack of urgency in approach to governance • A corporate focus on process at the expense of outcomes • A weak professional voice in management decisions • A lack of external and internal transparency • False reassurance from external assessments • A disregard of the significance of the mortality statistics

25. " i am so proud to be a nurse"........i just want to get back to work ....get on and  do something" LS7 participant

26. What can be achieved?

27. If I had shown you the following results in January 2008 would have believed them possible?

28. 5% reduction in HSMR

30. 73% reduction in central line infections

32. 43% reduction in ventilator associated pneumonia

34. 72% reduction in critical care c.diff

36. 14% increase in ward hand hygiene

38. 58% decrease in ward c.diff

40. 23% increase in peri-op briefings

42. 15% increase in on-time antibiotics

44. Future Developments • Paediatrics • Primary care • Mental health • Heart failure • Pressure ulcers • VTE

45. Why should it be easier in January 2010 than it was in January 2008? • Workforce • SPSP fellows • Improvement advisors • Programme managers • Infection control teams • Established walkaround system • More non-exec involvement • Higher profile of quality and safety at boards

46. Highest Performing Boards • See extranet data regularly • Discuss HSMR and question executive team about it • Receive reports on extent of harm in hospital and see a plan to reduce it • Board members on walkarounds • Have safety and quality as first board agenda item • Use staff and patient feedback

47. 15% reduction in mortality • Completeness and coverage • Improvement advisor training • Boards on board • Leadership attention • HSMR • Tempo • Data • Resource SPSP board teams

50. Governance in NHSScotland