Mid-Staffordshire Foundation Trust Research Articles

Introduction of a new ward round approach in a cardiothoracic critical care unit.

Francis (2013) described inconsistent ward rounds and failures to conduct ward rounds properly as contributing factors to the poor care seen at the Mid Staffordshire Foundation Trust. He suggested that the absence of a nurse at the bedside had clear consequences for communication, ward round efficiency and patient safety. He recommended that nurses should be actively involved in ward rounds and linked this to high quality patient care. To share an experience of introducing a ward round checklist, a bedside nurse verbal summary and the development of standard operating procedure for Ward Rounds in cardiothoracic critical care unit to improve patient safety and care. Semi structured interviews of six registered nurses. A questionnaire to 69 registered nurses. An electronic questionnaire sent to 23 members of the MDT. An observational audit of seven ward rounds reviewing 69 patients. 97% of nurses agreed that verbal summarizing had improved clarity and 90% felt that it had improved patient care. 87% of the MDT respondents stated that they had noticed an improvement in the attendance of the bedside nurse at the ward round review. The ward round checklist reduced omissions. Communication with patients during ward rounds was an area which needed to be improved. The introduction of a new ward round approach and audit of its practice has enabled an improvement in the quality of patient care by: Giving more opportunity for the nurse to participate and feel part of the ward round. Reduction of omissions through the use of a ward round checklist. Improved clarity among the MDT by the use of bedside nurse verbal summarizing of the plan of care. Nurses' full participation in ward rounds is essential to ensure effective communication and enhance patient safety.

Inspection as a driver for quality improvement

Following publication in 2013 of the report by Robert Francis QC into care at the Mid Staffordshire Foundation Trust, the Care Quality Commission (CQC) has introduced a new and radically different approach to hospital inspection. This involves much larger teams (typically 30 or more people) including clinicians, experts by experience and CQC staff. Eight core services are assessed against five key questions (domains): Are services safe? Effective? Caring? Responsive to patients' needs? Well led? Each domain of each core service is rated on a four point scale: Outstanding, Good, Requires Improvement or Inadequate. To date 65 (40%) of the 160 acute trusts in England have been inspected, the aim being to inspect all trusts by December 2015. The most important single finding is the huge variation in quality of care that the inspection teams have identified within the NHS. Informal feedback suggests that the new approach to inspection represents a significant improvement on previous CQC inspections, though further improvement is imperative.

Medicine of the Person: a charter for change following the Mid – Staffordshire Francis enquiry.

The findings of the Mid-Staffordshire Foundation Trust UK Inquiry, chaired by Robert Francis QC and its 290 recommendations for change in the culture of healthcare delivery are a stunning indictment of a management system that had lost the capacity to care for the patient [1]. Here, the healthcare had become unmoored from the core NHS values to care for patients and had become devoid of compassion, driven by top-down management system of secrecy and dishonesty, characterized by an almost total failure to listen to patients, families and carers.

Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire

Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be ‘all changed, changed utterly’. Today,...

The NHS White Paper: licence for radical cultural reform of the NHS?

The NHS White Paper: licence for radical cultural reform of the NHS?

Betrayed by targets

Like many people, until the media frenzy that surrounded the Francis Report (2010) and the action of the Care Quality Commission (CQC), I was totally unaware of the detail of the scandal that had unfolded in Mid Staffordshire Foundation Trust. This area of middle England, surrounded by beautiful countryside, is typical of many parts of the UK. But the pursuit of foundation status, the drive to meet targets and the resultant ‘appalling’ standards of care are alleged to have led to 400-1200 deaths in three years (ibid). Can this be a typical town in middle England? If it was a war-torn nation we would be shocked and sickened.