Leading nursing teams to improve outcomes
Anthony Fitzgerald has been appointed as the first Matron of Nuffield Health at St Bartholomew’s. So, what is his vision for delivering safe, high quality care & how does he plan to lead the nursing teams to ensure the best possible patient outcomes?
Nuffield Health has partnered with Bart’s Health NHS Trust, leasing the former pathology and residential staff quarters buildings, to provide the only independent hospital in the City of London. Nuffield Health at St Bartholomew’s Hospital, will include 55 individual en-suite rooms, four of the most advanced digital operating theatres, seven specialist intensive care beds, a full diagnostic imaging suite, an oncology day unit and 28 consultation rooms. As the new hospital will be on the campus of St Bartholomew’s Hospital, the second largest heart hospital in Europe, the patient mix and services offered will be cardiac focused but will also cater for a full range of medical services.
Anthony Fitzgerald has been appointed as the first Matron for the new hospital, with responsibility for leading nursing care across cardiology, cardiac surgery, oncology and orthopaedics – the key clinical specialisms at the hospital. He joins Nuffield Health at St Bartholomew’s Hospital from Schoen Clinic where he was chief nurse. He has previously worked for the Harley Street Clinic as well as being a clinical advisor for the Care Quality Commission. The Clinical Services Journal spoke to Anthony about his new role, his vision for patient-centred nursing care at Nuffield Health at St Bartholomew’s and asked him ‘what will set this hospital apart from others?’
Q. What attracted you to the role?
A. My background has always been nursing and cardiac nursing is my absolute passion. St Bartholomew’s Hospital is the second largest heart centre in Europe with world leading consultants and treatment and Nuffield Health is the UK’s largest healthcare charity; there are no shareholders. This is what encouraged me to join, but I also think it will encourage others. The combination of Nuffield Health and St Bart’s is an absolute once in a lifetime opportunity.
The goal is to build a healthier nation, to keep people healthy, get them better and keep them well. I’m really excited to be able to be able to bring together the best of Nuffield Health and the best of St Bartholomew’s hospital for private patients in the city of London. My role is that of a very ‘traditional Matron’, I’m responsible for the wellbeing of the nurse and clinician workforce who will deliver outstanding care to our patients.
Q. How important is the relationship between Bart’s Health NHS Trust and Nuffield Health – what can be shared between both organisations?
A. Bart’s Health NHS Trust is an internationally renowned centre of excellence for cardiac care. If you have a heart condition, it’s the number one place to go to because of the standards of clinical and patient care, so we are very proud to be working with Bart’s Health NHS Trust. Our new hospital is next to St Bartholomew’s Hospital and our aim is to be the number one independent cardiac hospital. We are committed to enhancing the fantastic reputation, history and expertise that Bart’s Health NHS Trust already has. However, our new hospital is operationally independent from Bart’s Health NHS Trust and staffed by Nuffield Health employees.
Q. What does Nuffield Health’s ‘connected’ single pathway mean for patients?
A. The goal is to use our unique connected healthcare approach to offer our patients a complete pathway. This means the patient starts their journey with Nuffield Health and they stay with Nuffield Health until they are better again. When the patient has the first signs and symptoms of cardiac disease, they will see one of our GPs in one of our fitness and wellbeing centres or health clinics; they will have their diagnostic tests with Nuffield Health and, if they need to go on to have treatment, they will meet one of our cardiac nurse specialists, who will stay with the patient thoughout their cardiac journey. Patients are admitted into the Nuffield Health at St Bartholomew’s hospital, where they have their surgery using state-of-the-art equipment, to enable the best outcome
Once their episode of care is finished, they go on to have their cardiac rehabilitation with Nuffield Health. There is a real gap in the independent sector in terms of cardiac rehabilitation. Often, if you have cardiac surgery, you are then referred to another provider or on to the NHS to have cardiac rehabilitation
Where there is this gap, outcomes can be affected as there is a very long waiting list. This is a really important time to get patients well again and it requires a multidisciplinary approach.
Once the patient is discharged from hospital, they will come back to Nuffield Health’s fitness and wellbeing centre in neighbouring Barbican or any other location across the UK; they will have an exercise programme with a physiotherapist, which is personalised and designed to build up their cardiovascular fitness – this lasts 6-8 weeks, depending on how quickly the patient responds.
At the same time, the cardiac rehabilitation nurse will go through the medication with the patient and talk through the life changes that may be required, such as managing stress and making sure they are managing their work/life balance. They spend time with a nutritional therapist, looking at diet and how this impacts recovery, as well as ongoing wellbeing and cardiovascular fitness
They also spend time with one of our psychologists talking through the changes that are sometimes difficult to make after a cardiac event. A cardiac event or cardiac surgery is lifechanging for a patient, so it is really important to have this psychological input. It also includes family members, so we support not only the physical but also the mental health component of the patient’s care. The consultant is also part of that journey so if there are any complications, they are on hand to fix these as quickly as possible.
Q. How will you ensure high quality care at the new hospital?
A. As Nuffield Health doesn’t answer to shareholders, it can reinvest its income into delivering excellence in patient care. This also means the new hospital can access the latest technologies. In terms of care excellence, another key component is the people.
Nuffield Health’s values of being ethically inclusive, flexible, responsive and aspirational will guide how we all work in the new hospital. We need to make sure that we have a nursing workforce that is highly skilled and help them to be the best version of themselves, to deliver excellent care to patients.
This means providing the nursing workforce with access to the right training and professional development, and we support this through our Nuffield Health Academy. We offer a wide range of professional skills development, through a mix of virtual classroom, online learning and face-to-face learning. This also includes leadership development – nurses need to be leaders. This gives nurses not just the clinical tools but also the leadership skills to really make a difference in delivering excellent patient care.
When our nurses go home at the end of a shift, they feel like they have made a difference to a patient’s life as well as their family. This is an important part of the healthcare experience. We want nurses to go home energised, by feeling they have made a difference, because they have the skills and support to do their job. We also need to make sure we have all the wraparound services in place, including practice educators that support the nursing team to improve their skills. They support them when things are tough or when things go wrong, and they encourage them to always think ‘how can we improve?’ This is an important part of shaping the nursing workforce.
Ultimately, our ability to provide connected healthcare services and the fact that Nuffield Health is a charity will enable us to attract the best nurses and clinicians in London. We want our nurses to come from a range of backgrounds, from the NHS and the independent sector, and to be passionate about delivering excellence to our patients. Our nurses and clinicians will have more time with patients, have opportunities to develop their careers and a good work-life balance.
In addition, it is important to ensure that we have the appropriate systems in place to monitor standards. We do this through our ward managers, sisters and charge nurses, who are on hand to monitor the standards of care being delivered and to support our nursing team to improve and deliver the best care that they can.
We also have a robust clinical governance framework to enable Nuffield Health to monitor the quality of healthcare delivery in real time and take action. If something isn’t working, we can fix it straight away. We encourage patients to tell us how we can improve and what went well, but we also encourage nurses and clinical staff to speak up if they have concerns and we act on this – we are very quick to respond. My role is to be the voice of the patient; to really listen to patients and our nursing teams, and to use what they tell me to make a difference.
Q. How will Nuffield Health ensure high standards of patient safety?
A. One of the biggest challenges I have had to deal with and investigate over the course of my career has been medication errors. In some cases, the nurse has been unable to read the prescription, leading to an error, or there have been drug interactions, so we have invested in an electronic prescribing and administration system. This has a significant benefit in terms of patient safety and mitigates some of the risks.
The technology has built-in artificial intelligence, which automates important checks for drug interactions and whether the right frequency of the medication has been prescribed, and that the right dose has been prescribed to the right patient
When nurses are administering the medication, it is performed through the electronic system, so it also has important built-in safety checks, such as the timing between medicines, prompts to check the weight of the patient for cardiac medications, and prompt to check blood pressure to ensure it is appropriate to prescribe the medication.
Nuffield Health has a very robust approach to infection prevention and control (IP&C). Within our hospitals, we have dedicated IP&C lead nurses, who are experts in their field who work closely with our clinicians, with a dedicated network of IP&C champions. Each department has an IP&C champion and we have invested in university-level training, in collaboration with De Montford University, to make sure they implement and monitor robust IP&C standards in their departments. I believe this is unique.
In previous organisations that I have worked for, there has not been this dedicated resource and specialist training provided to the nursing workforce, which really sets Nuffield Health apart in terms of patient safety. This is one of the things that I am most proud of. In all of our patient areas we also have non-slip flooring to prevent falls and we make sure that orthopaedic patient rooms are an appropriate size to enable mobilisation – even the ergonomics of the furniture have been designed to help ensure the best possible outcomes.
In fact, Nuffield Health’s nursing team have been actively involved with the design of the new hospital, working with architects and designers to optimise the environment. This is because of a policy introduced during the build of Nuffield Health’s Cambridge Hospital that opened in 2015 and subsequently became the first independent hospital in the UK to achieve an “outstanding” rating from the Care Quality Commission.
The design of any new hospital must consider the interaction between patients, clinicians and visitors, along with supplies and equipment. Listening to the nurse and clinician perspective of how best to accommodate these interactions ensures high-quality, safe care.
Q. How do you plan to ensure effective team working?
A. From day one, we will encourage team working across disciplines. Multi-disciplinary working is essential for the best outcomes and we do this really well at Nuffield Health. We have daily multi-disciplinary team (MDT) meetings and ensure our daily ward rounds are attended by our physiotherapy teams, pharmacy teams, nutritional support therapists, as well as our nursing teams, so we are encouraging our clinical teams to really collaborate.
MDTs meet before a patient has their surgery, so everyone knows about the patient, plans their care and then implements it. It is vital to avoid working in silos and to ensure the patient care experience and pathway are ‘joined up’.
We have a fairly flat hierarchical structure within our nursing teams and this is another important factor. Although I’m the director of nursing at the hospital, I use the term ‘Matron’ in my title; ‘Matron’ is that visible person who is on the ‘shop floor’, where care is being delivered, and encouraging nurses to speak up if they feel that something isn’t safe. Matron is often the one that says: “we are not starting the surgery, because the nurses feel that all elements of the safer surgery process have not been completed”.
The theatre manager reports directly to me and I make sure I am very accessible. I get changed and go into theatre and make sure I’m present for some of the ‘Time Outs’. I ask nurses: “what worries you?” I take this feedback to our quality board to enable change to happen.
Sometimes, executive level nurses can remove themselves from the clinical environment. However, by being the conduit between nurses working in the theatre environment for example, and the quality board, I can make sure any concerns are listened to and action is taken.
Q. How will Nuffield Health deal with the challenges posed by COVID-19?
A. Nuffield Health’s hospitals across the UK treated over 375,000 NHS patients during the COVID-19 pandemic. We were quick to respond and support the NHS. If we have another surge, we will be ready to step up once again. We were also very quick to implement robust IP&C measures to protect patients and staff. All of our hospital staff have access to testing, with twice weekly lateral flow testing.
This was available throughout the first waves of the pandemic and we will continue to offer and encourage this. It enables us to respond very quickly if a staff member needs to self-isolate, to protect our patients. In terms of the patient pathway, we screen patients before they come to hospital and when they come to surgery, and they are asked to selfisolate before and after surgery.
We are also asking our staff to take up the vaccine. I was very proud that, as a nurse, I was able to return to the NHS for a period of time to help with the vaccine roll-out and on ICUs. It was a unique opportunity to play my part and make a difference, but it also gave me a unique insight.
Q. How will you support the wellbeing of nurses?
A. What I heard and saw during my redeployment was that nurses were very tired; I witnessed nurses crying at the end of their shift because it was so tough. I asked them “what would make a difference?” It was having access to talk to someone, to have professional support, to give them the emotional skills to cope with being a nurse.
I have learnt from this experience so, at Nuffield Health, we ensure we give our nurses this support. At the new hospital, I will be implementing wellbeing champions. They will be very visible and will attend nursing handovers, walk the floor and spend time with the nurses to pick up the signs that staff members may be becoming tired or stressed. They are trained in ‘mental first aid’ and take preventative action to sign post nurses to a platform of emotional wellbeing support, cognitive behavioural therapy and psychologists – free of charge. They also make sure our nurses have access to Nuffield Health’s ‘MOTs’, as well as access to diet and exercise plans.
Nuffield Health provides a comprehensive benefits package to all of its employees, giving them access to its fitness and wellbeing centres free of charge. It is more than just a gym. You can also use the spa facilities to unwind at the end of a shift. I think this makes a big difference
Ultimately, we are building a healthier nurse, to make sure we retain the nursing workforce and that patients get the best possible care.