HEALTHCARE DELIVERY
We can then respond to any safety issues accordingly. Our philosophy means that everybody has a voice. Things will go wrong in healthcare, but the right response is not to brush it under the carpet, or to say it was a one-off.We systematically evaluate incidents and work out how to put it right as an organisation.” Nuffield’s approach is improving
patient care and its clinical quality indicators are among the best. For example, it has achieved very low rates of venous thromboembolism (VTE), at just 0.02% for the past 10 months. While these rates are low compared to the national average, Nuffield is not content to rest on its laurels, and the organisation is striving to further improve on this figure. Dr Jones explained that Nuffield assigns each patient a nursing care pathway following assessment of VTE risk. All incidents of VTE are evaluated and, if necessary, the pathway improved, while taking into account new practices and making processes clearer, if required. This approach is also used in dealing
with adverse incidents. “How you handle significant incidents really defines excellence,” said Dr Jones. “As medical director, that is what I concentrate on. Every incident that happens needs to be reported openly. In fact, we take it very seriously when there is a failure to report such incidents.” Nuffield experiences between 25 and
50 serious incidents during a quarter. In 2010, 167 incidents were recorded and in 2011 there was a significant reduction to 122 incidents. Not all serious incidents relate to patients, as the statistics also include incidences such as not having the correct instruments available to perform the operation. The proportion of incidents related to overall activity runs at 1%, which compares favourably to the national average of 7%. “We are very proud of our data,” said Dr Jones. The figures are freely available in
Nuffield’s Annual Quality Report. “We are very open about what we get right but also about what we get wrong. You have to be open about major mishaps – to demonstrate what you have learnt from them and what you are going to do to improve.”
Safe surgery Nuffield was an early signatory to the World Health Organization’s safe surgery initiative in 2008. Checklists and a culture of safe surgery are embedded into Nuffield’s core clinical pathways. Again, openness is key and everyone from porters to theatre technicians are encouraged to report near misses, so that the whole organisation can learn from it.
MARCH 2012
‘We are very open about what we get right but also about what we get wrong.’
Nuffield carries out over a third of a
million procedures each year. The number of incidences of incorrect procedure or an injection in the wrong place averages five patients per year. “We have not, during my time as medical director, performed an incorrect major operation,” said Dr Jones, “but near misses make you think hard about the team, the hospital, the approach and what can be done better.” Dr Jones is keen to point out that
Nuffield hospitals do not cherry-pick ‘simple’ surgery cases, although they will only admit patients that they are able treat safely, to achieve the best outcomes: “If we are not cut out to do it, we will not attempt it. However, we carry out neurosurgery, cardiac surgery, liver and pancreatic surgery, as well as surgery on weight-loss patients that is often considered ‘too high risk’ by some NHS hospitals.”
Infection control Nuffield Health places infection control as its number one priority. It is a strong believer in matrons and the organisation has always placed matrons in charge of clinical care in hospitals and infection control is top of their remit. “We have an
Dr Andrew Jones.
end-to-end strategy to cover every aspect of infection control to make sure we get it right,” said Dr Jones. Nuffield always screens for MRSA for
major procedures. The matron is in charge of cleaning and Nuffield assembled a working group of housekeepers to write the cleaning manual. “They are the experts and they are very proud of their housekeeping standards,” said Dr Jones. Nuffield audits all infection control
approaches to make sure that it is following best practice and sets a very high target of 95% compliance. Procedures include hand washing and the wearing of gloves for procedures on patients. The statistics speak for themselves.
SSI incidences from hip replacement operations are 0.14% following surgery,
Nuffield Health: a charitable concern
Nuffield Health charitable objectives are ‘to advance, promote and maintain health and healthcare of all descriptions and to prevent, relieve and cure sickness and ill health of every kind’. To fulfil its charitable aims, Nuffield provides services to help people get healthy and stay healthy, to understand and manage their personal health risks, and to get timely diagnosis and treatment for any problems which arise. Nuffield Health aims to make a
financial surplus each year which is re-invested to improve services for patients. Most of Nuffield’s income comes from charges for the services it provides. Sometimes fees are charged directly to the beneficiary, for example with membership of a Fitness & Wellbeing Centre or for self-pay treatments in hospital, but often fees are paid or subsidised by insurance companies, employers or the NHS. Nuffield Health was founded in 1957
(originally as the Nursing Homes Charitable Trust) with money donated by the major provident associations of the time, and several of its hospitals were founded with the help of donations from the local community. Lord Nuffield acted as guarantor to a loan which helped the Trust get started and later lent it his name, but he was not an original benefactor. For the first 30 years or so Nuffield
had a fundraising department and actively sought donations, but that was wound up in the early 1990s as it became clear that the rising costs of modern medicine were too expensive to be met in this way and the organisation moved to recovering the full cost of services through fees. Today it has 31 hospitals (with 1,345
beds and 111 theatres), runs 51 fitness and wellbeing centres, has five medical centres and over 200 on-site workplace fitness and wellbeing contracts with employers.
THE CLINICAL SERVICES JOURNAL 51
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