Our aim for the initial phase of the programme is:
“to collaboratively produce and test a roadmap by 2018 to enable Salford to become the safest health and social care system.”
Leaders previously identified “heat” in the system between clinicians as a result of friction when patients move between primary and secondary care. This is having an impact on safety and quality of care received by patients.
We undertook a listening exercise to target efforts on the areas of greatest importance to clinicians.
Know the problem
Clinicians and managers from primary and secondary care were brought together to map current processes, consider ideal states, and develop an action plan to reach an improved future.
Problem solving workshops tackled specific issues, collaboratively developing new ideas.
All of this was done with the patient in mind.
Focus on Safer Handover has enabled primary and secondary care clinicians to:
• Understand the process of handover, identify waste and blockages
• Share learning
• Built the will to change
• Refined focus on priority actions
Innovations and improvements identified will now be tested and scaled up in Salford.
Lessons from working at the interface between primary and secondary care clinicians, will be used to improve new priority interfaces, for example, between secondary and mental health and secondary care and care homes.
Care homes have previously lacked investment using improvement methodologies.
Care homes are a significant component of the Salford health economy – this programme has highlighted that to successfully reduce falls and medication errors we need to work together.
Focus on... care homes
This programme has increased capability and confidence amongst participating care homes.
Learning from this has created a baseline to inform development of future work, ensuring resources are effectively targeted.
9 care homes from across Salford joined together to improve harm free care for their residents. This programme was structured using the “Breakthrough Series Collaborative” model, sharing learning from other improvement projects and outstanding care homes.
Click here to learn from the PROSPER project
Click here to learn from Vida Hall care home
Participants in the collaborative have been keen to share ideas and learning, and organise themselves as a collective to access training.
Mary and Michael are both residents at Thornton Lodge Care Home. They both require the use of walking aids, but were identified not to use them often. Carers decided to test “pimp my Zimmer” to encourage frequent fallers to identify and use their walking aids more often.
Since having their Zimmer frames pimped, Mary has not had a single fall. Michael has fallen twice, but less frequently than he was before.
“This lady wouldn’t walk at all before we did this, it’s improving her mobility and her family love it because she’s up and about” – clinical lead nurse
In some care homes primary school children were invited in to decorate the Zimmer frames, increasing interaction between age groups.
We will be led by care homes in delivering a “community of practice” to improve safety in priority areas. The focus of this programme will be on:
• Building capability
• Developing innovative ideas
• Sharing best practice
Care Homes Community
A number of key themes emerged from a scoping report to review what information used as ‘safety data’ in Salford.
• Using the MMS Framework to structure discussions about safety has surfaced many examples of data sources that might not be traditionally considered safety related
• All sectors were fairly robust in use of ‘past harm’ data
• Some examples of data being used for prediction and prevention were identified, however this is the exception
• There is a difference between how sectors use and understand data
• We found limited examples of how data, information and knowledge is shared between organisations within Salford.
Click here to open the Scoping report
We have built a dashboard to collect and display safety information for the whole of Salford, however we do not yet have an identified structure or capacity for this to be regularly reviewed and discussed with representatives from across the whole health economy.
Are we getting safer?
Delivery of a year-long leadership development programme to:
• Inspire leaders to think differently about safety
• Enhanced leadership skills, building cross organisational relationships
• Use the MMS Framework to influence delivery and development of Safer Salford
Using the latest thinking
We are building cross-system understanding of how information is used in Salford, how different health and care settings think about safety.
This is an ongoing conversation.
What will you do differently as a result of this programme?
“Use the learning to introduce safety without barriers”
“Continue to contribute to the wider system governance and safety thinking”
This programme has led to the development of new projects, or new ways of thinking about projects, to improve safety in Salford:
• Development of an integrated medicines safety strategy in Salford
• Using public health data as a predictive tool to support whole health economy decision making
• Developing a new measure of safety related to continuity of care as new models of care are tested and implemented
• Considering new measures of safety as part of move to neighbourhood model in primary care
• Using 5 domains to inform development of stroke pathway (holistic view of whole pathway)
• Use Failure Modes Effects Analysis to inform a new crisis care pathway (Salford Urgent Care Team)
• Look at safety of handovers between care homes and secondary care – gain a fuller picture of what’s happening
New focus on safety
Test out an annual forum to share learning from safety activity in cross-system setting. The content of this forum will be responsive to learning from the improvement work streams, transformation plans and regular review of safety information.
A restructured “Safer Salford Board” will supplement this annual event with quarterly meetings to share and identify emerging safety issues and themes.
Facilitated discussion about safety culture in primary care by testing a number of potential tools in 9 GP practices.
We heard that capacity within primary care is low, time is better be invested by surfacing and responding to strategic safety themes. Effort should focus on championing safety behaviours and sharing learning.
What is our culture?
Captured and shared medication(s) safety initiatives underway in Salford:
• 9 case studies
• 12 initiatives identified
Click here to open the Medications report
Developed evidenced recommendations based on experience in Salford to inform emerging Integrated Medicines Safety Strategy.
In the wake of the Francis and Berwick Reports, the Measurement and Monitoring of Safety (MMS) Framework proposes that assessing safety by what has happened in the past does not allow us to know how safe our care is today or will be in the future.
In 2014, The Making Safety Visible programme brought together Executive and Board level representatives from across Greater Manchester to consider the use of the five domains of the MMS Framework.
Salford CCG, Salford Royal NHS Foundation Trust and Salford City Council made a commitment to establish a safety programme to focus on cross-system issues highlighted during this programme: “communications, medicines and handover”.
Making Safety Visible
Click here to open the MMS Framework report
Click here to read more about Making Safety Visible and access Salford’s case study
Initial involvement was based on those who had participated in the Making Safety Visible programme. Additional representatives were added to a Programme Board in response to the changing landscape of health and care in Salford and Greater Manchester.
Responding to feedback, additional resources have been provided and existing resource reallocated to support delivery of priority projects. Changes to work programme include:
Addition of Safer Medicines workstream
Funding for Medicines Safety Pharmacist and trial of Pharmacists in Care Home setting
Optimising patient experience of transition from primary to secondary care (and vice versa)
Curtailment of testing of culture surveys in primary care
Residents and patients
Over 250,000 people live in Salford, which means millions of healthcare interactions every year.
The involvement of and impact on residents and patients in Salford is crucial to the development of this programme.
We asked “what does a safe service look like to you” at the CCG Citizen Engagement Panel:
“equality across the neighbourhoods”
“we need to construct a package of care with the patient and their family that meets their needs”
“information is transferred from one area to another in a timely way”
“medication is explained to people using their communication style”
Rapid cycle evaluation throughout delivery of the programme, incorporating feedback from partners and participants, has informed development of the next steps from the programme.
Click on the next steps of the roadmap to find out where we will be focusing next…
“Salford will be safest health and care system” as measured by:
• Continued improvements to safety in care homes
• Cross-system safety forum
• Safer handover measures
"Salford will be the safest health and social care economy in the UK by 2022"
Safer Care Homes
Click a stop on the Safer Salford roadmap to find out how we're progressing our goal