Nurses help spark improvements to trust placed in special measures by Care Quality Commission

Nurse-led innovation has been credited with helping turn around a struggling NHS trust in only 18 months

Nurse-led innovation has been credited with helping turn around a struggling NHS trust in only 18 months

Princess Alexandra Hospital
The Princess Alexandra Hospital NHS Trust has its own quality improvement faculty to support
and encourage staff to implement ideas. Picture: Alamy

The Princess Alexandra Hospital NHS Trust in Harlow, Essex, was moved out of special measures last week after health watchdog the Care Quality Commission (CQC) found significant improvements on a recent inspection.

In an October 2016 CQC report, the trust was rated as inadequate overall, and received inadequate or requires improvement ratings in four out of the five domains of whether services are safe, effective, caring, responsive and well-led.

Following a new inspection in December, three domains are good, and two require improvement, leading to an overall rating of requires improvement.

Shortages of staff still a problem

A concerted improvement programme has led to the trust now being one of the best in the country for cancer waiting times, maternity services, end of life and dementia services, infection control, falls, pressure ulcers and delayed transfers of care.

The CQC agreed that while improvements had been made, there is more progress needed, including shortages of staff in a number of services. Rates of mandatory training and appraisals must also be increased.

Chief nurse and deputy chief executive Nancy Fontaine said that nurses have been driving improvements at the trust. More than one third of staff have been on leadership programmes and there is a large cohort of nurses and midwives on doctoral programmes.

Support and encouragement

The trust has its own quality improvement faculty to support and encourage staff to implement ideas that will benefit services.

‘We teach staff our methodology, help with project management and support them so that the small nugget of an idea becomes a reality,’ Professor Fontaine says.

Among the previous criticisms was that some services had a closed culture and some of the relationships between staff, especially doctors and nurses, were fractured. The CQC said there was an ‘apparent disconnect’ between board and ward level.

The trust responded by trying to foster a more open culture, bringing the staff together and asking them which changes should be made. 

Change in culture

Professor Fontaine said: ‘The culture has changed. Our staff have told the CQC that they feel involved. There is no medical hierarchy now, and the nurses have the power. Nurses have led the quality, culture and staff experience improvement.’

CQC’s chief inspector of hospitals Ted Baker said: ‘Our inspectors found a dedicated staff at the trust who had worked hard to ensure improvements were made. However, this trust has to ensure it continues and consolidates this work and makes further changes so that people receive the care they should be able to expect.’

New approach means babies are often discharged at 9am instead of 10pm

Nurse-led discharge for babies from the neonatal unit was one area of outstanding practice highlighted by the Care Quality Commission at The Princess Alexandra Hospital NHS Trust in Harlow, Essex.

Neonatal unit manager Janelle Gardner says the new approach was suggested by staff frustrated at seeing babies discharged at 10pm because doctors were too busy to complete paperwork.

Babies now often leave the ward at 9am because unregistered nursery nurses or other nurses have filled in the necessary documents for low risk patients.

Ms Gardner has undertaken a leadership programme and ran staff days to improve teamwork and communication. Band 7 nurses have been given more leadership responsibility, team meetings were introduced and study days provided for staff.

‘Understanding where the problems are and being able to put things in place has given staff back ownership and made them feel involved and engaged with the service,’ Ms Gardner says.  ‘Making sure that we address safety is the priority of everything we do.’


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