Communicating the results of your clinical audit findings to the trust board

1. Communicating the results of your clinical audit findings to the trust board Emerald Toogood 12 February 2013

2. Content key messages you want the board to hear/ key messages the board need to hear best approach and communication medium what do you need the board to do/ what can they do

3. Context • Barts Health:15,000 employees, more than six sites, eight clinical academic groups (CAGs), one board • Quality Assurance Committee • Trust Board Sub Committee • Quarterly activity reports from the Clinical Effectiveness Unit • CAG Quality and Safety Exception Reports • Non-Executive Scrutiny • Air time: one page • Trust Board meetings • Start with a patient story • Open to the public Aim: to share plans for improvement based on quality and safety concerns

4. What do they need to know? • What matters to patients? • achieving the expected clinical outcome • consistency and continuity of advice • reassurance, pain relief and dignity Aim: to allow senior managers to provide effective scrutiny

5. Identifying key messages • Outlier investigations • Outcomes audit • What are the wider implications for the organisation? • are mortality meetings effective? • Has this happened before? • what can we say about staff experience of making improvement? • What can the board do? • commission an independent review • link to organisational development, operational, informatics strategy Aim: to keep an eye on what could go wrong next and to use the expertise of the trust’s leaders to deliver improvement

6. Why is reported practice falling short of expectation? Aim: to extend pockets of improvement to large scale change Consider reporting by theme • Poor clinical practice • Training issue/ juniors? • Delayed/missed diagnosis • Patient flow/access • Demographic • Is the service fit for the demographic in question? • Data quality, coding • Drug reaction or condition • Coders’ access to information • Low staff morale • Institute for Heathcare Improvement Safety Climate Survey (leadership, safety culture) • Dysfunctional team • Are the same issues being highlighted over and over again?

7. What evidence is there? Aim: using knowledge of other data to understand key issues • What triggered the local audit in the first place? • Does the number of serious incidents bear any relation to the number of incidents reported? • How does the number of complaints compare with the number of incidents reported? • Peer review • Trend • Routine reporting falls disproportionately in some CAGs • Integrated performance reporting

8. Integrated performance reporting With acknowledgement to the Barts Health Development Directorate Performance Support team

9. Identifying risk Aim: to operate a reliable routine reporting system which helps us to glean key messages

10. Escalating ‘inaction’ Aim: encourage leaders’ input at the frontline to resolve recommendations that seem ‘too difficult’ and boost morale; helping to make ‘my’ issue ‘our’ issue

11. Example Aim: to state how the matter will be improved and give assurance Brief analysis of the problem with reference to various data sources “The national standard is X ....the result in June 2012 was Y...A case review by an independent consultant confirms the finding. The surgeons from all three sites have met and appointed a Clinical Lead to develop working practice to report by the end of June 2013. Immediate improvements include greater use of nasogastric tubes which has been incorporated in the Enhanced Recovery Programme. In November 2012 the CQC wrote to Barts Health stating that further enquiries were not required.”

12. Tips Aim: use valuable airtime wisely • Avoid tendency to focus on issues – instead focus on the improvements required • Link to wider trust programmes • Be clear regarding accountabilities and timeframes for deliverables • Be prepared to report back on progress in three months’ time • Avoid duplication of reporting at various board-level committees • Avoid detailed appendices

13. Reporting route Aim: involve and consult the wider multidisciplinary team • Share the contents of the trust report with the team in question • Telephone call, email or local committee review • Provide feedback to staff on the comments and advice given by the board • Challenge from the board is good!

14. Recognising success Aim: to share good news in appropriate forums Trust ‘Heroes’ nominations for teams and individuals Grand Round Audit presentation days/ quality improvement groups Trust Bulletin/magazine Conferences

15. Summary Focus on the patient: what does this mean for my mum? Report plans for improvement and offer assurance Seek to improve quality in an organised way by connecting both concerns and improvements Context – how can the audit findings be applied to the wider organisation or parts of it?