Quality Strategy 2024-2027
Foreword from the Chair and Chief Executive
It is a pleasure to welcome you to our first ever Quality Strategy, which sets out our ambition and priorities to deliver high quality care over the next three years.
Our strategy has been developed against a challenging backdrop which requires innovation, creativity and a focus on improvement on a daily basis. The financial issues and capacity issues will not be resolved quickly, but our aim is to provide services that are clinically effective, safe, well-led, responsive to service user needs, and offer a positive experience.
This strategy was developed through extensive engagement; conversations with hundreds of staff from right across the organisation who expressed what we need to do to continuously improve. We also spoke with service users, carers, and other partners and have included what they told us matters to them.
We believe this strategy provides a roadmap helping support and guide all our work towards a unified ambition and sustained improvement. We aim to use it as the foundation to inspire our staff to innovate, excel and seize opportunities to improve over the next 3 years.
At the heart of everything we do is our vision: We provide compassionate care with our community, in our community.
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| Anne O’Reilly
Chair |
Jennifer Welsh
Chief Executive |
Introduction
The Northern Trust provides a range of health and social care services to an approximate population of 479,000 in Northern Ireland’s largest geographical trust, covering an area of 1,733 square miles. The Trust employs approximately 15,000 people across a range of medical, health and social care disciplines. With an annual spend of approximately £1 billion, the Northern Trust delivers services from over 150 facilities which includes two acute hospitals, a mental health hospital, local community hospitals, health centres, social services and a significant network of community services.
Quality management approach
We have been exploring how the principles of Quality Management Systems can help us continually improve as an organisation. We are incorporating this learning at various levels through the organisation. These questions are guiding principles for us as we plan and deliver services:
- Vision (quality planning): what do we need to do well?
- Data (quality control): how do we know we are doing it well?
- Improvement (quality improvement): how do we do it better?
- Outcomes: how do we know it has made a difference?
How we developed our Quality Strategy
At Northern Trust we have a strong belief that delivering high quality care is grounded in collaboration and truly understanding our communities. This strategy was co-designed with a range of key stakeholders as listed in Appendix 1 at the end of this document.
Strategy design milestones
December 2023 – March 2024
- Series of stakeholder engagements
March 2024
- Quality Strategy Design Staff Survey launched
April 2024
- Analysis of feedback received
- Engaged with over 600 key stakeholders
- Initial findings shared with Trust board
May – June 2024
- Design of draft Quality Strategy
July – August 2024
- Follow up engagement with stakeholders on draft Quality Strategy
September 2024
- Final Quality Strategy approved
- Quality Strategy launched
Developing our ambition for Quality
What matters to our staff:
- Civility and psychological safety is so important
- Staff experience results in good patient experience
- Care we would want for our own families
- Person centred care
- Improving, always innovating and constantly learning
- Patient safety needs to be at the heart of everything we do
- Be open and honest
- Ensure staffing levels are efficient
- Reduce waiting times
- Culture – involving all bands of staff in quality
- Encouraging staff to input into ideas for improving services
- Time to innovate
- Listening to patients and what they are saying about the care they receive
- Involve service users more in service design
- Safer care delivering by caring, compassionate staff
- We need to be valued and experience satisfaction
- We need to reduce silo working – it’s much more valuable to look at joint outcomes
- Treat the whole person rather than silos
- Learn from other organisations
- Civility and psychological safety is so important
What matters to service users:
- Talk to the people receiving service
- We need meaningful involvement
- Feeling like I and my family matter
- Must be an easier way to do things
- Services are still in silos, teams do not talk to each other
- It is really difficult to get hold of the right person to speak to about my concerns
- Offer support and empathy
- Communication is key, the very basics of being able to speak to someone
- More recognition needed for carers
- Listen to what service users are telling you
- More services in rural areas
- Care should be individually tailored
- Being seen promptly by someone who is knowledgeable and cares
- Communicate better and make information more accesible
- Just be honest at all levels of care
- Being treated with respect and dignity
- Do the simple things well
- Admit and apologise when care falls below acceptable standards
Our strategic priorities for 2024 to 2027
Our Quality Strategy map provides a high-level overview of how we will realise our ambition. It describes how we aim to deliver safe, high quality and compassionate care.
It outlines what we will do focusing on the strategic priorities identified by our key stakeholders. We will do this by organising ourselves to effectively execute the strategy.
All of this is underpinned by key enablers which will help us deliver our priorities. Some of these enablers are what we are currently doing in the organisation.
And importantly, looking towards the future, we describe what success will look like and how we will measure the improvement in outcomes delivered for service users.
Figure 1: Quality Strategy road map
Strategic priority 1:
Our patients and service users will be at the heart of service design, development and evaluation
Why have we prioritised this?
Staff told us they want to ‘make service users feel valued and heard’, ‘set clear expectations’ and ‘involve service users and staff in all decisions around service delivery’. There was a clear sense that we need to do better at designing services around service user needs rather than what makes sense to the organisation.
What can help us?
We will use feedback from service users, carers and families to better inform and shape service delivery using a range of tools like Care Opinion.
How will we do it?
- We will listen to service user and carer needs to shape service design:
We commit to using Northern Trust Involvement and Engagement groups to shape service design. We will develop a toolkit for staff to use to gain insights into what matters to our service users. - We will implement a shared decision making model for clinicians:
Shared decision-making means clinicians and service users work together to reach a decision about treatment that best suits the service user. - We will communicate openly and honestly:
We will communicate with transparency especially when things have gone wrong or when resources are limited.
“Co-designing the advanced cancer toolkit with patients has meant people are getting the right information and support at any stage from diagnosis on.”
Alison Craig, Macmillan Specialist Palliative Care Service Improvement Facilitator and Helen McGarvey, Service User
“Patient and service user involvement is key to understanding what matters to people, and how we can respond most effectively to that in the best way possible.”
Thelma Dillion, Chair of the Engagement Advisory Board
Strategic priority 2:
We will strive to make services safer, to improve outcomes and for service users to have a positive experience of the services they receive
Why have we prioritised this?
We know that people wait too long for the care they need. We know we need to get the fundamentals of care right and that people should get the same standard of good care no matter where they are treated. Staff told us that care should be based on individual needs. They felt they we need to do more to address health inequalities. They want to make services safer for service users and to improve outcomes and experience.
What can help us?
The Trust Reform and QI programmes have lots of projects supporting the modernisation of how our assessment, diagnostic and treatment services are delivered.
The Trust Learning for Improvement Group is developing a wider organisational approach to learning. We will improve how we look at all the information we have across the organisation about things which go wrong, as well as successes, in order to build a robust learning approach.
How will we do it?
- Work to ensure we deliver the right care in the right place at the right time:
We will do everything we can within the resources we have to improve on people having to wait on the services they need, using new technology, modernising services where we can in order to improve. - We will develop Trust-wide strategic improvement priorities
Through our organisational learning we will identify a number of strategic Improvement priorities each year. - We will develop a Quality Management System to share good practice and reduce risk:
We have been learning from how other organisations share safety information across the organisation. We will develop a robust, reliable and timely Quality Management System approach across our Divisions and teams identifying risks and issues, and demonstrating all the actions being taken to address this. We will implement a structure for reporting this from ward/department and Division to Trust Board. - Scope use of ‘live’ patient experience measures:
We will learn about how to gather live patient stories and experiences as they are happening in order to address issues with care.
Strategic priority 3:
Our patients and service users will experience smooth transitions between services through improved co-ordination and communication
Why have we prioritised this?
Service user representatives described the challenges people have in navigating their health care when it is provided by multiple services. Staff told us that there are too many ‘silos’ and too much duplication. They said that we need more collaboration and we need to hear the views of everyone.
What can help us?
- We will share the good practice that already exists across our networks
- Implementation of the new encompass system.
How will we do it?
- Adapt new ways of working to how we deliver care:
We will support teams to use the new encompass system and the My Care app to link services together with the sharing of information that improves patient care. - Join up professional protocols and guidelines through networks:
We will build on clinical networks to improve patient pathways, working with other agencies and signposting to services that will support people. We will identify priority areas for improvement by looking at incidents and complaints where poor communication between services has been an issue. - Improve access to information which empowers service users:
We will work with service users to develop online information that is easy to access and will support self-management of long term conditions.
“What our school loves about this team is that you are all experts in your own field…if we have a question about behaviour, language, OT, Physio, you will have sound workable advice that we can implement in our classes and most importantly benefit our children.”
School Special Needs Coordinator
Strategic priority 4:
We will be creative and innovative in our approach to continuously improve services
Why have we prioritised this?
Service users and staff told us improving services means being proactive and consistently working to make outcomes and experiences better. Staff told us to do this they need time to think and innovate. They said that leaders need to listen to our ideas to improve, gather learning and have networks to be able to share good practice across the entire organisation.
What can help us?
Staff trained in Quality Improvement who have the knowledge and skills to lead improvements. HSCQI network to support and share innovation and good practice. Local networks established to share learning and good practice.
How will we do it?
There are a number of ways we will innovate in order to improve services including:
- Time to be actively involved in improvement:
The development of a Quality Improvement Network will provide increased scale and reach, enhance knowledge exchange, support innovation and develop a community of likeminded improvers. - Everyone having skills to improve:
We will develop an organisational Quality Improvement capability framework and training prospectus with a diverse offer to support staff build confidence, knowledge and skills in improvement. - Recognising good practice, innovation, learning and scaling and spreading locally:
We will recognise the good practice of staff through development of a Quality Improvement recognition toolkit.
“The QI network is a community of individuals who are passionate about and trained in QI skills, who come together to share ideas for improvement. It is a great opportunity for service and corporate QI leads to use our collective QI knowledge and experience to help improve outcomes for both staff and patients.”
Jaclyn Crowe, Assistant Director of Organisational Development, Workforce Governance and Analytics and QI Divisional Lead
“QI training has enabled me to support multi-professional teams and projects, improving the services we provide, to deliver best practice and improve outcomes.”
Catherine McGovern, Senior Lead Nurse for Nursing and Midwifery
Strategic priority 5:
We will enable staff to deliver safe, high quality care
Why have we prioritised this?
There was overwhelming feedback from staff that resolving some of our workforce issues and gaps is key in order to improve the quality of services we deliver. Safe staffing levels, better communication and staff feeling valued were strong themes in the conversations had during our engagement process.
What can help us?
Our People and Culture Plan 2023 – 26 is the vehicle through which we will realise our commitments ensuring Team North is “more than a workplace”.
How will we do it?
- Nurturing our people: ensuring our staff feel safe, well and valued:
We will promote, support and respond to staff wellbeing and inclusion needs, at both an individual and team level. We will continue to promote and embed an open, just and learning culture where everyone feels safe and empowered to speak up, learn from errors and improve services. - Enabling our talent: helping staff to develop and grow:
We will ensure all staff have access to development opportunities, with a focus on digital competence and confidence. We will develop stronger teams and enhance leadership capability at all levels. - Building our teams: ensuring the workforce is ready now and for the future:
We will develop innovative recruitment practices and campaigns across local, national and international labour markets. We will build career pathways and implement new roles to meet the current and future needs of our community.
“Working for the Trust has always made me proud to be part of the team who looks after the patients. Our Department is very much like a wee family. We all help each other out and our workplace is a happy wee place.”
Anita Rembiasz, Catering Production Supervisor
What will success look like?
We will assess success and progress towards realising the strategy using the following measures.
Priority 1
- Our patient satisfaction measures will improve on current baselines.
- The number of compliments will increase and complaints will decrease.
- We will have more service users involved in service design and evaluation.
Priority 2
- We will use patient outcome measures across a range of services to show us how we are improving.
- We will monitor our patient experience measures to tell us if patients are satisfied with our services and how we need to improve.
Priority 3
- We will widely implement the My Care portal in order to improve coordination and communication across services.
- We will increase our clinical networks and use the Encompass system to join up care across services.
Priority 4
- We will implement a Trust Quality Improvement network and QI Capability framework.
- We will enhance the reach of Quality Improvement training and projects across the organisation.
Priority 5
- We will reduce absence and vacancy rates.
- We will increase recognition and improve staff experience scores.
“Teams within Psychology Services produce an outcomes report annually that answers 3 questions: How much do we do? How well did we do? Is anyone better off for having attended our services? We also benchmark against other services nationally. This really helps us improve the quality of treatment we offer.”
Professor Ciaran Shannon, Consultant Clinical Psychologist
Quality monitoring and assurance
Quality Strategy delivery plan
A Quality Strategy delivery plan will be developed outlining the steps necessary to achieve the specific strategic priorities, detailing the actions, timelines, and responsibilities required for successful delivery.
The plan will include clear timelines, resource allocation, and specific performance measures and metrics to ensure progress is measurable and on track.
Reporting
We will regularly review our performance in delivering this strategy by monitoring the implementation of our delivery plan, evaluating its impact, and reporting to the appropriate committees outlined. Annually, we will report the activities for the strategy delivery in an annual progress report.
Monitoring and assurance
The strategy will be monitored as part of our Integrated Governance and Assurance Framework. Actions will be reviewed via two committees within the organisation which continually monitor and review quality.
Appendices
Appendix 1: Stakeholders who participated in Quality Strategy design
- Dietician staff
- Social work staff
- Ward clerks and administration staff
- Speech and Language Therapy staff
- Nursing staff
- Support services staff
- Performance team
- Reform team
- Human Resources and Organisational Development teams
- Trade Union Representatives
- Learning Disability Families
- Engagement Advisory Board
- Disability Advisory Group
- Trust Board
- Mental Health staff
- Public Health nurses
- Community Care staff
- Medical staff
- Dementia Companions
- Home care staff
- Physiotherapist staff
- Occupational Therapy staff
- Imaging staff
- Podiatry staff
Appendix 2: Supporting strategies and plans
Internal
There are a number of strategies, frameworks and programmes of work within the Trust which inform and support implementation of the Quality Strategy.
These include:
Corporate Plan
Our Corporate Plan describes our corporate objectives from 2024/25 to 2027/28. Its vision is aligned with that described in our quality strategy: ‘We provide compassionate care with our community, in our community.’ In the objective to improve outcomes and experience for service users, it describes the development of this strategy and the associated operational plan to oversee its delivery.
People and Culture Plan
We have a dedicated People and Culture Plan to support our greatest asset our people. The plan published in 2023 sets out a range of commitments to create a positive and sustainable future for staff. It recognises that happy and engaged staff means better outcomes and experience for our population. This quality strategy complements all the commitments outlined in our People and Culture Plan.
National/external drivers
- Quality 2020
- Healthcare Improvement Scotland’s work on quality management systems
- NHS Impact
- Health Foundation reports and publications
- Evaluation of the NHS partnership with Virginia Mason institute
- HSC Strategic Outcomes Framework and System Outcomes Measures (in development)
- Follow the Northern Trust
