National Quality Improvement Working Group
Chief Medical Officer's staff engagement event,

'Our NHS, Our Future - Improving Quality'

7th February 2008 at the QEII Conference Centre, Westminster



As part of Lord Darzi's Review a series of visits had taken place during the week identifying excellence and providing an insight into how things work, visits were made to the highly rated Stroke Services at St Thomas' Hospital, a Primary Care surgery in Dorset, a Mental Health Outreach service working across social care sectors, a Cardiac Unit in Middlesborough, and a children's service in Bristol in Paedatric Oncology.


St Thomas' has a dedicated acute and rehabilitation stroke unit, consisting of both acute and rehabilitation beds. It is staffed by a multidisciplinary team of doctors, nurses and therapists. 


The unit makes the best use of technology to aid speedy treatment and diagnosis of a patient's condition. This unit has also benefited from the fact that those that have worked on the stroke unit have done so for quite an number of years and the experienced gained has greatly benefited those patients treated in this unit.


On visiting this unit I saw a very strong ethos of team work in allowing the staff to develop their skills that have been built up over the years. The team in the unit has also developed a strong working relationship not only with the Accident and Emergency Department in the hospital, but more over they have an extremely close working relationship with the emergency crews and Ambulance Trust that serve the hospital. This is critical in identifying and giving the correct treatment as quickly as possible to the patient after suffering a stroke.


From visiting this unit at the hospital, and from talking to the patients that have been treated by the team there, you do feel that the people who work in the stroke unit are always striving to improve the way they deliver the care to their patients.


The stroke team also provide a 24/7 thrombolysis service, made possible, in part, through the innovative use of telemedicine.  This enables the stroke team to assess patients in Accident and Emergency (A&E) outside of normal working hours.


The telemedicine system is critical for the stroke unit in that it allows the Consultant Doctors to be able to examine the patient very quickly whilst they are in A&E but also even more critical, is that this examination is performed within the very narrow time frame that is so critical for the speedy diagnosis and correct treatment for the patient so that it aides there recovery. The advantage of this system is that the Consultant can view the patient no matter where they are or at whatever time this may be so that no time is lost in the process of treatment.


The telemedicine system could be used for all other treatments especially in emergency situations where the speed of treatment is so critical. On reflection the system would be of great advantage in the Ambulances where paramedics could have a link with the A&E's so that those doctors in the hospitals could give advice in those situations.


It was clear from this visit and from feedback from those who had visited the other healthcare facilities that there were a relatively small number of things that were needed to achieve quality of care.  One of those is the use of data and the sharing of this data so that Clinicians can better treat those who come to them. The sharing of this data quickly and taking this approach throughout the NHS would benefit the patient enormously.


St Thomas' uses a web-based system (called ASSET) which allows hospitals to compare the services they offer to those provided by other trusts of the same size and patient mix and see where they could make improvements.


Clinicians we saw, see the use of data scientifically in the sharing of this data, not just as a management tool because management wants to do it or that it should be done. Having those that treat the patient taking ownership makes it important. One of the ways that they have taken this on board is through the weekly meetings that all the staff attend in their units, so that they can see what has gone well and what has not. Items for discussions at these meetings have been such things like the number of falls patients have had, the number of infections, pressure sores, but more importantly what they could do reduce them. This is using tools such as Human Performance techniques to improve the quality of care of their patients along with Performance Management tools.


One of the main contentions was that doctors did not want to be involved at first because of the measures of being measured and observed that things could be done better. The engagement of junior doctors was critical in the management of change for the benefit of the patient.


Discharge and long term rehabilitation have improved tremendously in St Thomas, and has impacted in the length of stays for patients in the hospital.  Stroke care has become very much a specialist service, and the management team has given fantastic support. Having the Heads of departments on board was another critical factor, but the more significantly having Senior nurses, developed acute services has allowed nurses to have driven quality - barriers of conventional hierarchy have been removed.


The question is how to replicate this across the country to the wider treatment of patients within the NHS. Clinical leadership is the key and how you transform that, measuring and improving to reduce MRSA C-diff infections and that targets should mean something, having clinicians taking part in decisions is a must.


Quality is a universal system therefore there is a need for a Matrix of quality. If we have a Matrix of quality, this can be adapted for the different trusts throughout the country and the staff will take control and adapt this for their own environment and to their own particular hospital - the environment maybe different - but striving for continual improvement in quality is the same for the patient - that is the goal for the review.


Derek Butler
MRSA Action UK

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For more information contact Derek Butler


Telephone: 07762 741114