Here is a guest blog from Dr Richard Hixson, describing the rapid implementation of excellence reporting in his trust – County Durham and Darlington NHS Trust.
Excellence Reporting; conception, implementation and experience.
Working as a Deputy Medical Director in Patient Safety was eye opening and rewarding but at times confusing. We focussed on the incidents, the actions and learning but however we dressed it up, it always felt as though we couldn’t shake the negative. An averted incident could only be reported as a near-miss and there was simply no mechanism to understand how somebody’s positive actions had prevented harm from occurring. The machine that processed incidents responded rapidly whilst individuals cited in patient experience documents remained blissfully unaware of the praise they were receiving. We simply had an imbalance in our processes.
Wrapped up in the world of Serious Incidents, complaints and mortality, I was totally unaware of concepts such as ‘Safety 2’ and ‘Learning from Excellence’. I repeatedly expressed frustration, tagging a slide onto every presentation I gave stating we needed a smaller stick, a bigger carrot, a focus on learning from the positives and a mechanism to recognise the good stuff. One stairwell rant was overhead by a dietician, Jennie Winnard who was aware of the work taking place in BCH. We therefore decided to team up and pay the Executive Body a visit. Our vision was presented in June 2016 and we were immediately challenged with creating a fully functional excellence reporting platform for the largest trust in the Northeast of England. We had just over 2 months to deliver over the summer holidays working to a budget of £0.00.
Utilising our Patient Safety colleagues and Ulysses, the company behind Safeguard, we succeeded in creating a module that sat alongside incident reporting and whilst being similar in aesthetics was much, much simpler to complete. Due to the time pressure, there was little fanfare accompanying the September 1st launch as we relied upon simple communications: emails, trust bulletins, screen savers and word-of-mouth. We sat back and waited to see whether anyone else ‘got it’ eager to see how our initiative was received by colleagues.
Fast forward 16 months and the results can only be described as staggering. In the first year alone, 1131 reports were filed naming 1634 members of staff with 75% for ‘going the extra mile’ and ‘team work/peer support’. Summaries were being provided to Care Groups and integrated into governance meetings, bulletins ran short stories on ‘the good stuff’ whilst surveys revealed recipients felt more positive about themselves, their colleagues, their job and even the Trust for weeks or months after receiving a report.
What started as a pure ICT portal has now extended to ‘ER cards’ which can be used for staff such as domestics who do not access email. Even without re-marketing, excellence reporting continues to gather pace with increasing numbers of reports filed every week. Positivity is addictive with recipients looking out for and recognising the excellence in others which simply manifests as high-quality care being provided by ‘ordinary staff’ who feel they are ‘just doing their job’.
As one of our recipients reported – “Of all the changes in the Trust, the little addition of excellence reporting has made a tangible difference to the working lives of many. Most of us, including me would not like to tell the world how good we are at what we do. Excellence should be perceived by others. Excellence in patient care should remain our motto and inspiration”.
On reflection, it just seems so obvious that this is just what the staff and Trust needed. I just cannot believe it took us so long to appreciate and implement.
Richard Hixson, Consultant in Anaesthesia and Critical Care.
County Durham and Darlington NHS Foundation Trust.