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Using a big conversation to improve care quality

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A local health community held a “big conversation” on how to ensure care is high quality.

Recently a number of reports have highlighted poor nursing care. This leaves me, as a nurse leader, questioning a number of areas within our profession and healthcare system. There is no one simple answer to resolving all the issues that have contributed to such failures. The start is to open up and listen to patients and frontline staff. We are starting a journey to shape nursing care across Derbyshire based on core values. As part of this, NHS Derbyshire Cluster health community held a Big Conversation on Care, supported by the East Midlands Leadership Academy, to discuss this issue and how it affects patient experience.

Seventy delegates came from settings including care homes, hospitals, mental health and learning disabilities units, and clinical commissioning groups. Leadership was shared between all directors of nursing in the Derbyshire cluster.

The debate was opened by independent adviser Elizabeth Fradd, who discussed balancing professional and corporate responsibilities to deliver best practice.

Delegates worked in groups to debate three key questions:

  • What are we getting right?
  • When and how are we letting patients and carers down?
  • What is needed and how will we know we are delivering good-quality care consistently?

Five key themes were drawn from the conversations and are outlined below.

Sharing practice

This was not limited to “best practice” - there was also a desire to understand each other’s services better and move towards working more collaboratively to improve care. As one delegate noted, we need change “across the whole system” and to acknowledge the role of patients in this.

Improving communication

Many delegates wanted more open and honest discussions with colleagues and patients because no one is expert in everything and, as one noted, to develop an “NHS speak” - a common language of understanding each other’s practices.

Integrated, seamless 24-hour care

There was a call for 24/7 care and a more seamless service, and to improve the culture. Delegates recognised integration required more opportunities to share ideas and experiences with other staff and services.

Patients first - getting the basics right

Elizabeth Fradd said we needed to “find the person inside the patient” and put the patient first. Getting the basics right was key. There is a need to focus on all users, but especially on older people, those with learning disabilities and those who are vulnerable.

Training, valuing and motivating staff

It was suggested that Derbyshire could become a “beacon of excellent patient care”. Staff needed space to create, be innovative but also to fail. Leadership and role modelling is needed at all levels.


The Collaboration for Leadership in Applied Health Research and Care (CLAHRC) compiled a report on the day, in which it noted: “The overriding result was one of inspiration through being heard, having honest, genuine and open dialogue and positively engaging with like-minded people. The event gave many the confidence to try to take things forward and influence others, and there was a sense of the event being an opportunity that gave hope for the future.”

The next step is to set up a “nursing cabinet” - a stakeholder board that will oversee work to improve “care through the patients’ eyes”. This will involve health professionals, academics, voluntary organisations and patient groups. Box 1 outlines key actions taken as a result of the event. The report on the day’s findings is available on the trust website.

Box 1. What delegates said and actions taken

Patients need integrated seamless care

Action taken
  • We are reviewing how the health system works, particularly in unscheduled care
  • Work on improving care for patients with dementia has been the focus in commissioning this year, with training and support for staff

Create a learning and sharing environment

Action taken
  • Directors of nursing are exploring technology to support learning across the health system
  • A follow-up event in May will provide another opportunity to hear about issues and successes

Give professionals space for innovation

Action taken
  • Directors of nursing are commissioning a unique leadership programme focused on “dignity and care” and innovation in nursing

Communicate board to ward

Action taken
  • The report is currently being discussed at all NHS boards and foundation trusts

Maggie Boyd is executive director clinical quality NHS Derbyshire Cluster.

  • This article has been double-blind peer reviewed
  • Click here for a print-friendly PDF of this article


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Readers' comments (1)

  • I'm presently doing an essay on what makes a good nurse reflecting on my first practice placement on an endoscopy unit. I found staff backbiting, the senior sister and lead specialist nurse were far too superior to smile let alone greet you when you greet them, not once in 7 wks was I worthy enough to be acknowledged by them. My mentor was an english girl who didn't like my south african friendliness, nor my accent, took snippets of conversation we had had and told others causing a tension for me and that I spent to much time with pts. even though I'm trying to develop skills. My take-over mentor was lovely from Bulgaria and said if I wasn't so friendly it would be better for me. How sad I thought that these people are like this! The basics are definitely missing in modern nursing

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