Winner: Cambridge University Hospitals foundation trust
A comprehensive drive for transformation meant our winner slashed MRSA bacteraemias and waiting times and raised day of surgery admissions
This trust has set itself five priorities to drive through an organisational transformation that it hopes will raise standards from what is already a very high baseline. They are:
improving the patient experience;
improving care and safety;
ensuring clinical excellence and effectiveness;
valuing staff and partners;
striving for innovation in everything.
The foundation trust has made leadership - and the part this plays in challenging, motivating and exploring more effective ways of delivering care - central to this transformation. It is an approach that looks for staff to understand their responsibility for upholding the organisation's values (to be kind, safe and excellent) while challenging practices that are of no benefit to patients.
Leadership is being embedded at all levels of the Cambridge trust through the development of a unique leadership academy. Over 200 staff have taken part so far, working on projects directly related to patient care that take leadership to the bedside.
Now staff also recognise their part in the ownership of the challenges the trust has been facing. This shared responsibility for standards has played an important part in work on at least one of Cambridge's priorities: improving patient care and safety.
During 2007-08 there were 41 MRSA bacteraemias - a 49 per cent improvement on the previous year. The trust has also launched the first central venous access service in the country, with a dedicated theatre suite and inpatient and outpatient services supporting safe line insertion.
Work to ensure clinical excellence and effectiveness is encouraging better use of resources, shortening patient pathways, driving up operational performance and improving quality of patient care. This has seen the day of surgery admission rate increase from 34.5 per cent to 56 per cent, reduced elective and non-elective spells from 4.3 to 3.9 days and 6.0 to 5.9 days respectively, and freed up 60 beds, used to help further hospital efficiencies.
Reconfigured medical services have seen Cambridge's alert status fall from predominantly red/black to predominantly green. Improvements include a focused acute medical service in the emergency department where consultants at the door triage patients, referring them back to GPs as appropriate, and the introduction of an acute elderly care assessment ward.
Reduced waiting times ensure 91.5 per cent of admitted patients receive treatment within 18 weeks from GP referral. By working with primary care trust and social care partners, Cambridge has been helping delayed transfers of care reduce from 25-30 in April 2007 to 5-10 in February 2008.
It was evidence of an impressive depth of change that persuaded the judging panel of the strength of the Cambridge entry. Judges also made particular note of the move to outcomes and values, the linkage of values with patient and staff satisfaction measures and how innovations from staff had been implemented across the organisation.
Highly Commended: Christie Hospital foundation trust
The Christie Hospital's vision for its first year as a foundation trust was to treat more patients, increase life expectation and quality and improve standards of care.
To drive those strategic plans, the specialist tertiary cancer unit undertook a rigorous programme of information gathering and planning and set itself three key objectives: improving clinical outcomes; developing chemotherapy and radiotherapy services; and undertaking world-class research.
Key achievements in 2007-08 included consistently achieving the 62-day target for cancer waiting times, doubling chemotherapy day care capacity, being the first UK hospital to be invited to join the Organisation of European Cancer Institutes, and the installation of a new surgical robot. Services are consistently ranked excellent or good by over 90 per cent of patients.
Significantly, the Manchester trust has also been able to make the move from a historical recurrent financial deficit to a recurrent surplus, achieving a Monitor financial risk rating of four (capped) and Monitor risk ratings for quality of care and mandatory services of green. A pilot project for service line management has helped clinicians see the patient pathway differently and develop opportunities for improving care and reducing costs.
A new£35m treatment centre (opening in 2010) will provide the trust with the largest early clinical trials units in the world.
Finalist: Luton and Dunstable Hospital foundation trust
To achieve its ambitions for further transformation over the next three years, Luton and Dunstable has put a "road map" framework for implementation in place. This has four key strands: leading the NHS in patient safety; improving the patient and staff experience of care; ensuring the hospital is fit for 21st century healthcare; improving delivery and devolving autonomy to strategic business units.
Luton and Dunstable aspires to lead on patient safety. Its accelerating patient safety programme aims to ensure every area of the hospital has an improvement team to drive safety and quality. In addition, a number of consultants and other clinical staff work as directorate safety leads which together form the Patient Safety Committee.
A two-year development programme for 100 of the trust leaders is supporting the build of capacity and capability behind the transformational change.
There have been real gains in the reduction of harm. Mortality rates have gone from 11 per cent worse than the national average to 10 per cent better and cardiac arrests have been reduced by 50 per cent.
Innovative work to develop a new model for emergency care balances patient safety, experience and efficiency. As part of the redesign, work was undertaken with patients attending accident and emergency, to understand their experience. They participated in a video, were observed and interviewed.
Finalist: Royal Bournemouth and Christchurch Hospitals foundation trust
Royal Bournemouth and Christchurch measures its progress against its strategic vision, Putting Patient First, while striving to deliver the best quality healthcare, through seven strategic goals. These range from patient-centred care to partnership working, each with a series of actions and metrics for success, tracked quarterly and shaping the annual plan and budget.
The strategy has been developed through extensive stakeholder engagement to produce the vision and the detail and has been highlighted as an example of good practice by the Foundation Trust Network.
There is evidence of people development throughout, with leadership at all levels and a culture of respect. Good partnership working with NHS and other organisations has helped to improve and develop intermediate and palliative care services, which in turn have delivered multi-million-pound savings for reinvestment in community services.
Examples of service development include: a dedicated hip and knee replacement centre with total pathways redesign; improved outcomes; and producing the best length of stay in the country.
Of the acute trusts in the Healthcare Commission's comparison indicators for 2007-08, Royal Bournemouth and Christchurch is rated as second best for MRSA incidence per 1,000 bed days and third best for 30-day mortality rate.
Finalist: Salford Royal foundation trust
The goal of Salford Royal's quality improvement programme, which aims to reduce mortality by eliminating avoidable harm within three years, is to become a "transformed" organisation, in which every member understands their role in delivering clinical quality and works towards that goal every day.
It is what the trust describes as part three of a bigger improvement process that began back in 2002. Within the space of a few years, Salford Royal moved from one-star to three-star status, achieving the highest NHS Litigation Authority standards of safety for both acute and maternity services.
Extensive consultation with patients and staff in 2006 guided the trust's thinking for further service improvement. Stakeholders described three key components of the healthcare they wanted to see improved: safety, cleanliness and personalised care.
Providing this to every patient, every time became Salford's mission. In 2006-07 the trust was awarded the highest standards in the Healthcare Commission assessment.
Now the trust is embarked on a whole-systems approach, paying equal attention to what it sees as four key quality drivers: culture change; clinical processes; measurement; and workforce capability. The trust is placing an emphasis on understanding its systems in greater detail and using small tests of change to build momentum.