Automated solution for compliance monitoring

Following the publication in 2006 of the Stoke Mandeville Report – Investigation into outbreaks of Clostridium difficile at Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust1 – many NHS organisations needed to be able to provide assurance to their Trust boards that they had suitable infection control systems and processes in place. Many NHS organisations also began the task of seeking solutions to the labour intensive, time consuming process of manually collecting various clinical audit data on numerous national and local standards, including the then, Healthcare Commission Standards, Clinical Negligence Scheme for Trusts and Department of Health – Essence of Care Benchmarks. In 2007, the corporate nursing department within Guy’s & St Thomas’ NHS Foundation Trust set out to find a process and system which would enable the organisation to measure and monitor its compliance and assurance against a variety of published guidelines, local and national standards, while also being able to gauge the standard of care delivery, infection control practices within the clinical ward and department areas and also the standard of cleanliness within the clinical environments. Guy’s & St Thomas’ NHS Foundation Trust was the first NHS organisation to partner with Synbiotix and pioneered the development of a suite of highly intuitive, electronic clinical audit tools for Infection Control Practices and a Clinical Standards Toolkit for measuring, monitoring and reporting compliance against a whole range of local and national standards. With the participation, engagement and support from all levels of staff from ward to board, successful implementation of these tools was achieved within a relatively short space of time. As a result of the pioneering work achieved, not only are the clinical audit solutions being used across all the wards and used by all ward staff on a daily basis to capture data and evidence across a number of clinical subject areas, but the achievements gained have enabled both Guy’s and St Thomas’ NHS Foundation Trust and Synbiotix to share and disseminate these developments across the wider NHS and private sector. Synbiotix has continued to work with the Trust, developing new solutions to meet its growing and changing needs to demonstrate performance and compliance against mandatory and statutory standards. Synbiotix consists of a team of business, medical and clinical professionals focused on delivering software solutions, project management and clinical consultancy services to health and social care organisations. As well as offering IT solutions, the company provides clinical consultancy services to support the implementation of transformational change in the delivery of health services, helping organisations align national strategy and health community services to organisational objectives and business priorities. In 2008, Belinda Regan, the deputy chief nurse from Guy’s & St Thomas’ was seconded to the position of interim deputy chief nurse at Maidstone and Tunbridge Wells NHS Trust (MTW), to support and assist the interim board of directors with their restructuring and action planning, following the publication of the Healthcare Commission report into the outbreak of C. difficile at MTW, in October 2007.2 The report highlighted a series of problems at the Trust, one of which was the lack of useful data to assure the Trust Board of the standards of care delivered. Following a scoping and mapping exercise of the existing compliance systems and processes in place at the Trust, Belinda Regan invited Synbiotix to assist and support the Trust to ensure that its compliance and clinical quality audits were aligned to national strategies and to maximise productivity and efficiency across the Trust.

Audits implemented

Over a period of two years, a number of clinical quality, governance and infection control audits have been implemented at the Trust and a number of new audit and compliance tools have been developed in partnership with MTW. The audits implemented at MTW cover the areas of infection control, clinical quality and patient experience. “We are also currently looking at implementing further modules, including a simple auditing tool for tissue viability and to monitor acuity and dependency, a module which has been developed by Synbiotix in association with a London Hospital,” said the chief nurse at MTW, Flo Panel-Coates. Ms Panel-Coates went on to explain how the Trust has developed its existing modules with Synbiotix to ensure that they meet their exact requirements. “We wanted an auditing system that was more locally focused than, for example, some other off the shelf packages, which could not offer us any great depth of detail or flexibility to adapt and change. We also wanted a system that could give us real-time local patient feedback and that asked some of the same questions as the National Patient Survey. This has allowed individual wards and departments to take responsibility for their own findings and actions”. With the focus of healthcare delivery now being centered on “High Quality Care for All”3 patient feedback is now one of the national metrics used for all Quality Accounts and CQUIN reports. Synbiotix, working in partnership with healthcare organisations, have developed an electronic survey and reporting system, designed to address the challenges associated with capturing, analysing and reporting survey feedback in real-time. The Synbiotix Healthcare Survey Reporting system is designed to accommodate any number of surveys that an organisation may wish to undertake. Data is captured at the point of service delivery and the responses are immediately analysed and published into the clinical area and organisational dashboard, negating the need for additional time being spent by clinical or audit staff compiling reports. “The information for our local patient feedback is collected by our volunteers using PC tablets,” said Ms Panel-Coates. “We felt that if a member of the clinical team went to a patient with the questions they may feel more obliged to give a better satisfaction rating than they otherwise would. We want the information to be as independent as possible. We have also produced a paper copy of the survey for patients who may feel uncomfortable using electronic technology. Although this then needs to be inputted onto the system we did not want to miss out on any valuable feedback from patients who are not best suited to using the PC tablets. “In our 2010 National In Patient Survey the Trust experienced a dip in patient satisfaction levels, compared with previous surveys. Although we were concerned about the lower patient satisfaction levels which were recorded in July 2010, we recognised this dip in our local data, which enabled us to act prior to the publication of the data but also acknowledged that we are taking the correct approach to collecting the data, as it was comparative with the national data. We understood why there was a dip… at the time we were going through a difficult quarter. We had challenging targets that had to be met, had reduced capacity and were too reliant on temporary medical and nursing staff. We also experienced unprecedented A&E activity in that month, so the satisfaction statistics were, at least, understandable.”