Quality at Ramsay Health Care UK
Ramsay Health Care UK are committed to sharing our
progressive achievements from one year to the next. As a long
standing and major provider of healthcare services across the
world, Ramsay has a very strong track record as a safe and
responsible healthcare provider and we are proud to share our
results.
Delivering clinical excellence depends on everyone in the
organisation. It is not about reliance on one person or a small
group of people to be responsible and accountable for our
performance.
Across Ramsay we nurture the teamwork and professionalism on
which excellence in clinical practice depends. We value our people
and with every year we set our targets higher, working on every
aspect of our service to bring a continuing stream of improvements
into our facilities and services.
There are inherent risks associated with being a patient in the
health care system and it is the professional and legal
responsibility of all health professionals and health organisations
to ensure that every effort is made to reduce the likelihood and
consequence of an adverse event or outcome associated with
treatment of a patient.
Patient safety
We are a progressive organisation and focussed on stretching our
performance every year and in all performance respects, and
certainly in regards to our track record for patient safety.
Risks to patient safety come to light through a number of routes
including routine audit, complaints, litigation, adverse incident
reporting and raising concerns but more routinely from tracking
trends in performance indicators.
Infection prevention and control
Ramsay has a very low rate of hospital acquired infection and
has had no reported MRSA Bacteraemia in the past 3 years.
Fig 1. Infections as a
percentage of admissions
We comply with mandatory reporting of all Alert organisms
including MRSA Bacteraemia and Clostridium Difficile infections
with a programme to reduce incidents year on year.
Ramsay participates in mandatory surveillance of surgical site
infections for orthopaedic joint surgery and these are also
monitored.
Infection Prevention and Control management is very active in
Ramsay. An annual strategy is developed by a high level Infection
Prevention and Control (IPC) Committee and group policy is revised
and re-deployed every two years. Our IPC programmes are designed to
bring about improvements in performance and in practice year on
year.
A network of specialist nurses and infection control link nurses
operate across the Ramsay organisation to support good clinical
practice.
Programmes and activities within Ramsay
include:
- Deployment of standard operating procedures, such as hygiene
and cleaning procedures, antibiotic prescribing, patient screening
protocols (covering medical history and laboratory testing)
- Reporting includes Surgical Site Infection surveillance and
Hospital Acquired Infection data reporting to the Health protection
Agency
- Auditing tracks not only practice compliance as set out in
policy / procedures but also tracks risk associated with hand
hygiene, peripheral and central venous line / infusions
- Education of staff operates on a number of different levels –
foundation courses for clinical and non-clinical staff, for new
starters, as refresher training, as advanced training. Trainers are
NHS professionals – specialists practising at consultant
level.
- Patient education is developed in parallel to promote good
patient hygiene and to improve understanding of hospital acquired
infection. This includes leaflets and website information
- Patients are invited to comment through patient experience
surveys and state perception of standards of cleanliness and staff
hygiene behaviours.
- Ramsay have deployed the PEAT tool to monitor environmental
standards and use the NPSA website to trend performance / identify
areas for improvement
Ramsay has signed up to the National Patient Safety Agency NPSA
Clean Hands Campaign where posters and information to staff,
patients and visitors encourage and promotes hand hygiene. Hand
hygiene practice is audited by observation and also by patient
satisfaction survey.
Since 2008 we have also delivered a multi-million pound
investment in new disinfection, decontamination and sterilisation
facilities to process and track surgical instrumentation to meet
national decontamination standards.
Good infection control practice is also considered at the Ramsay
National Procurement Committee in determining procurement
strategies. This is an illustration of integrated governance;
experiences are shared through joint working of multi-disciplinary
teams in our key management committees which is essential in areas
such as infection prevention and control.
Ramsay has systematically implemented patient safety initiatives
as part of a programme of targeted risk management across the
organisation.
Examples of year on year patient safety initiatives
include:
Patient centred pre-operative assessment revised and implemented
with training support – delivered in 2008
- Preventing wrong site surgery by adopting Safer Surgery
Checklist in 2009
- Transfusion training for all clinical staff in line with NPSA
guidance – delivered in 2009
Safety in the workplace
Safety hazards in hospitals are diverse ranging from the risk of
slip, trip or fall to incidents around sharps and needles. As a
result, ensuring our staff have high awareness of safety has been a
foundation for our overall risk management programme and this
awareness then naturally extends to safeguarding patient
safety.
Our record in workplace safety as illustrated by Group Accidents
per 1000 Admissions demonstrates the results of safety training and
local safety initiatives.
Fig 2. Adverse events per thousand admissions
Effective and ongoing communication of key safety messages is
important in healthcare. Multiple updates relating to drugs and
equipment are published every month and we ensure these reach all
our teams in a timely way via a Ramsay Central Alert System. Safety
alerts, medicine / device recalls and new and revised policies are
cascaded electronically to keep each General Manager up to date
with safety issues.
Cleanliness and hospital hygiene
Assessments of safe healthcare environments also include Patient
Environment Assessment Team (PEAT) audits. These assessments
include rating of privacy and dignity, food and food service,
access issues such as signage, bathroom / toilet environments and
overall cleanliness. Ramsay scores are improving in these
assessments and reflect the investment in our facilities. Plans are
in place for further phased investment programme to deliver
refurbishments and improvements. These will also support our
infection prevention programmes to ensure the fabric of our
facilities is optimum for cleaning.
Fig 3. Overall cleanliness scores from PEAT
assessments
Clinical effectiveness
Every Ramsay hospital has a clinical effectiveness team and
committee that meet regularly through the year to monitor quality
and effectiveness of care. Clinical incidents, patient and staff
feedback are systematically reviewed to determine any trend that
requires further analysis or investigation. More importantly,
recommendations for action and improvement are presented to
hospital management and medical advisory committees to ensure
results are visible and tied into actions required by the
organisation as a whole.
Return to theatre
Ramsay is treating significantly higher numbers of patients
every year as our services grow. The majority of our patients
undergo planned surgical procedures and so monitoring numbers of
patients that require a return to theatre for supplementary
treatment is an important measure. Every surgical intervention
carries a risk of complication so some incidence of returns to
theatre is normal. The value of the measurement is to detect trends
that emerge in relation to a specific operation or specific
surgical team. Ramsay’s rate of return is very low consistent with
our track record of successful clinical outcomes.
Fig 4. Percentage returns to theatre by year
Readmission to hospital
Monitoring rates of readmission to hospital is another valuable
measure of clinical effectiveness. As with return to theatre, any
emerging trend with specific surgical operation or surgical team in
common may identify contributory factors to be addressed. Ramsay
rates of readmission remain very low and this, in part, is due to
sound clinical practice ensuring patients are not discharged home
too early after treatment and are independently mobile, not in
severe pain etc.
Fig 5. Percentage readmissions by year
Patient experience
Patient satisfaction scores for overall quality show the
majority of patients feel they receive excellent quality of care
and service in Ramsay facilities. To record a satisfaction index
over 90%, a very high proportion of Ramsay’s patients have scored 9
or 10 out of 10 for their satisfaction with all the requirements.
This is underlined by comparing Ramsay’s Satisfaction Index against
those achieved by other organisations across all sectors of the UK
economy where the full range of customer satisfaction is 50% to 95%
with the median just below 80%. Ramsay, rated against over 200
service companies in the public and private sector, has
consistently been in the top 2-3% of UK organisations in its
ability to satisfy customers.
Fig 6. Patient satisfaction index of over 90% means Ramsay rates in
the top 2-3% of organisations
Where specific questions are put to patients, 98% of patients
would recommend Ramsay and the same proportion of patients are
entirely satisfied with the overall care they received.
Fig 7. Adverse events per thousand admissions
Patient satisfaction with treatment and care from Ramsay medical
staff and nurses is high and consistent scores have been
achieved.
Fig 8. Patient satisfaction with nurses and doctors consistently
high
3.1 Patient Reported Outcome Scores PROMS
Average reductions in disability scores over post-operative
period
Hip replacement surgery and Knee replacement surgery Ramsay uses
a number of patient reported procedure specific surveys and has
been working with patients to collect their responses for over four
years since 2006. Currently we collect data about outcomes in joint
replacement surgery and cataract surgery. The incremental
improvements are benchmarked against published data and Ramsay
outcomes have out-performed these.
Oxford Hip and Knee Questionnaires are used. These are research
based validated tools measuring disability – the higher the score
the higher the disability. The patient completes the questionnaire
before replacement surgery and at a follow up examination and then
again at one year following surgery.
Hip replacement
Fig 9. Oxford Hip Scores - Past 3 years show consistent improvement
at follow up (the lower the score the better the
outcome).
Knee replacement
Fig 10. Oxford Knee Scores - Past 3 years show consistent
improvement at follow up(the lower the score the better the
outcome).
Further information
Clinical
governance