Questions for Quality in healthcare

The Francis Inquiry report highlights a number of areas in which the NHS must learn to do things differently. One of the key strands of organisational learning is individual learning. Reflective practice is a powerful tool to facilitate learning and here are 20 questions for self-reflection.

The questions in brackets relate to a negative culture that’s indicative of poor standards of care. The numbers in brackets refer to the relevant paragraph of Francis Inquiry 2013 Exec Summary. As you read each question identify recent specific examples. For any questions that you struggle to answer then it’s suggested that you challenge yourself to ensure that patients and safety are more at the forefront of your mind. It is hoped these questions will be useful for you in identifying good practice that can be shared within your Trust and in the wider NHS.

How have I engaged with front line staff in contributing to a safer, committed, compassionate and caring service? When did I last use these kinds of words in discussions with my team/colleagues/staff (para 41)
In the emails I wrote yesterday – how many times did words such as ‘patient’, ‘safety’, ‘care’, ‘clinical’ appear and how many times did the words such as ‘financial’, ‘savings’, ‘cost’ , ‘budget overspend’. What do I notice about what’s important?
When did I last raise a patient safety concern regarding the implications of a decision or new process? What was the outcome of raising the concern? (71)
When a mistake is made or things go wrong do I think about ‘how?’ (rather than ‘who?’) Do I identify the processes or training that need to be implemented to prevent the mistake happening again? (Or is my first thought to consider which HR policy/procedure to apply? How relates to learning from mistakes, who relates to blame for mistakes) (108)
When I last had a concern about patient safety did I speak out? What did I do to ensure that my concern was addressed? (1.1)
When a patient safety concern was brought to my attention how did I react? Did I investigate to understand the significance of the concern? (Or did I assume it was a one-off or not important or think patient has been discharged so no longer an issue?) (1.6)
Do I feel I’m supported in providing a critical analysis of the areas I’m responsible for? (Or do I feel pressured into promoting an overly positive picture of what’s going on in my area?) (1.7)
When did I last feel a strong sense of collective responsibility for ensuring quality care is delivered for all our patients? (1.8)
When did I last sit down with a patient to listen to their complaint/concern and understand from them what needs to be done differently to improve their patient experience? When did I last read patient complaint letters? When did I last change a process to minimise the possibility of a complaint that had happened in another service area happening in my area? (1.9)
How robust are the governance procedures in my area? (1.10)
Am I clear about the minimum staffing levels in my area? Who is responsible for tracking staffing levels and quickly addressing staff shortages when they fall below minimum? (1.13) (Or is there pressure to delay filling shortages because of budget pressures?)
How do I know that the staff in my area are receiving appropriate training to ensure quality patient care? How do I know that staff are keeping up to date with continuing professional development? (1.43) (Or is training repeatedly cancelled/delayed to save money?)
How frequently do I walk around patient areas and observe how patients are being treated? How frequently do I smile and take opportunities to interact with patients as I’m walking around the hospital? How approachable am I as I walk around the hospital? (1.70) (Or do I look straight ahead and walk fast because I’m very busy and need to be on time for a meeting?)
Do I involve clinical staff in decision-making? (1.109)
How frequently do I consider processes/policies/decisions from the patient perspective? Do I have examples of when processes/policies/decisions are changed after considering them from the patient perspective (1.110)
How do I support front line staff to deliver compassionate, quality patient care? (1.118)
When have I invited a peer review or ‘critical friend’ analysis of my area in order to share good practice? (1.184)
Looking back over my time in the NHS is there anything, with the benefit of hindsight, that I might have done differently to ensure the minimum standards of patient care? (68)
What 3 priorities will I take forwards from this reflection?
What will I do today to move these priorities forwards?