Quality – International | Life Healthcare

Quality – International
We made significant developments in our international business from a clinical governance and quality reporting perspective. Our newly developed Group clinical quality and governance framework provided the foundation for the initiation of a number of clinical governance and quality integration projects across the various country teams.

OUR 2019 PRIORITIES		OUR PROGRESS

Further investment in governance and internal audit functions		Completed a new practicing privileges framework, which includes all new General Data Protection Regulation (GDPR) provisions, and new contracts finalised with all reporting radiologists Established an outsourced internal audit function across territories Achieved International Organisation for Standardisation (ISO) reaccreditation in Italy without any major non-compliance

Comprehensive preparation of hospital units in Scanmed for Minister of Health accreditation		The Warsaw Primary Health Care Outpatient Clinic was re-accredited by the Minister of Health

Preparing for the annual external audit of the ISO 9001:2015 QMS and the information security management system PN-EN ISO/IEC 27001:2017-06		Scanmed retained its certification in terms of ISO 9001: 2015 – quality management system (QMS), and received ISO 27001:2015 re-accreditation

Implementation of an electronic system for processes monitoring and measuring		Scanmed continued with both paper and IT patient hospital records while an electronic solution was identified and subsequently implemented

Implement Life Healthcare Group clinical quality and governance framework		The Life Healthcare Group clinical quality and governance framework provided the foundation for the initiation of a number of clinical governance and quality integration projects, and was driven by the country teams, which included: Locally appropriate clinical governance structures, processes, roles and responsibilities Clear lines of responsibility and accountability for the overall quality of clinical care Adverse incident reporting and shared learning Patient experience monitoring Harmonisation of quality metrics and reports, including integrated measurement and information systems Identifying improvement priorities and benchmarks

OUR 2020 PRIORITIES

Focusing on the quality of patient records within the patient management system to reduce the number of duplicate records
Consistent focus on customer service training programmes for patient-facing employees to further improve customer experience
Address and integrate new legislative requirements into all policies and processes
Review the clinical governance committee structure in line with the Group framework
Develop and implement standardised mechanisms to evaluate the quality of freelance staff, including doctors and technicians
Introduce a standard format for radiologist reports
Prepare for the re-accreditation of the Sport Klinika in Žory, as well as the Blachownia Hospital and St. Raphael Hospital
Implement a standardised patient experience survey and improving response rates

Alliance Medical

We are committed to providing our patients with high-quality services. Following the introduction of the Group clinical quality and governance framework, various workstreams were initiated across the Alliance Medical business. These included:

Streamlined and integrated committee structures
Effective performance frameworks and monitoring processes
Specific key performance indicators (KPIs), which are regularly reviewed and reported on, including:
- Safety
- Patient experience
- Effectiveness and clinical outcomes
- Efficiency
- Health and safety
- Regulatory compliance

Alliance Medical's quality and risk teams monitor various input, process and outcome metrics and report on these against internal and contractual benchmarks. All metrics are included in monthly quality reports, which are presented to the individual country management teams and unit managers who are, in turn, tasked to address areas of poor performance.

During the year in the UK business, we explored the implementation of DoseWatch, a holistic, enterprise-wide dose management solution that tracks and manages radiation and contrast exposure to patients. We completed a pilot programme, which demonstrated the project's aims and confirmed that imaging modalities in both static and mobile sites could be validated and integrated into the software.

We also initiated the implementation of HL7 clinical system integration for direct access to prior images and reports from the local NHS trusts.

We made significant progress towards the implementation of a radioisotope auto-dispenser system across our high-volume PET-CT units, which will significantly reduce the radiation dose exposure of our employees. Our due diligence and pilot programmes identified the fully automatic Trasis Unidose dispensing system. All new site designs include the structural support and physical space for the Trasis Unidose machines and four existing sites have been identified for installations.

QMS processes and accreditation underpin many of the clinical governance, quality and patient experience policies, processes and procedures within the Group. In the UK, Alliance Medical achieved the Royal College of Radiologists and College of Radiographers' Quality Standard for Imaging (formerly the Imaging Services Accreditation Standards) accreditation. The standard was developed to support diagnostic imaging services to make continuous improvements and to ensure that patients consistently receive high-quality services delivered by competent staff working in safe environments. Significantly, Alliance Medical is the first multi-site provider organisation in the UK to achieve this. The Care Quality Commission (CQC) continues to inspect all Alliance Medical services in the UK, with 97% of services being rated as good. Furthermore, in the UK, Alliance Medical is also accredited in terms of ISO 27001:2013 – IT, NHS Digital Data Security and Protection Toolkit and Investors in People.

In Italy, we implemented the ISO 9001:2015 risk matrix for central functions, which focuses on HR and procurement, and integrated the central quality system for new acquisitions. We also achieved ISO 2001:2015 re-accreditation without any major non-compliances.

The restructuring of the quality department in Ireland, as well as the appointment of a Head of Patient Safety and Quality in April 2019, was pivotal to the business. The appointment of a full-time senior management team resource allows for a specific focus on and improvement of our QMS, and in 2020 we will improve our QMS in line with Group, statutory, and national accreditation requirements. While we are accredited in terms of the Caspe Health Knowledge Systems (CHKS), a project team has been constituted in preparation for the new accreditation criteria. We were also accredited in terms of ISO 2001:2015.

The introduction of new legislation, SI256 and SI30, substantially changed the regulatory requirements around radiation protection and the business continues to ensure it is prepared and able to meet these requirements. We also completed a new practicing privileges framework, which includes the new GDPR provisions.

Patients' feedback is an important tool and we measure patient satisfaction levels and complaints across all Alliance Medical geographies using the following:

Patient satisfaction rates: We are committed to providing the highest quality of service to our patients. All feedback is welcomed and is used actively to improve what we do and the way in which we do it.
The propensity to recommend our services to friends and family: This is a sensitive and comparable patient experience metric, across different healthcare services and territories.
Patient complaints: We recognise that at times, we might fail to meet patients' expectations. Patients may experience a standard of care lower than they expected and may wish to raise their concerns to help to improve our service. We are committed to listen to their concerns and provide a full and appropriate response.

In the UK, we send out electronic patient satisfaction surveys to consenting patients. The results are automatically compiled and monthly reports are produced for the quality and operational teams. Both Ireland and Italy contract independent service providers to perform the patient satisfaction surveys on our behalf and provide us with monthly reports and analysis of trends. In Italy, complaints are addressed by individual facilities and we aim to centralise this function during 2020.

Clinical quality indicator	Year-on- year trend	Target	2019	2018
UK
Patient experience (satisfied and very satisfied)		>92.5%	95.3%	94.4%
Friends and family score		>92.5%	94.9%	94.5%
Written patient complaints per 10 000 scans		4.0%	3.2%	4.4%
Escalated events per 10 000 scans		1.0%	0.9%	0.7%
CQC/IRMER incidents per 10 000 scans		0	0.1	0.1
RIDDOR reportable incidents per 10 000 scans		0	0	0.1
Clinical audit: Level 1 and 2 discretionary scores		<5%	0.05%	0.02%
IRELAND
Patient experience (satisfied and very satisfied)	n/a¹	>92.5%	98.0%	n/a¹
Friends and family score	n/a¹	>92.5%	96.5%	n/a¹
Written patient complaints per 10 000 scans	n/a¹	<5	4.2	n/a¹
ITALY
Patient experience (satisfied and very satisfied)	n/a¹	>80%	88.0%	n/a¹
Friends and family score	n/a¹	>90%	96.5%	n/a¹

¹ Comparable data not available.

POLAND

We are primarily driven to achieve optimal clinical outcomes while meeting the needs, values and preferences of individual patients.

The medical directors of our key segments are responsible for the overall clinical outcome and patient experience. During the year, Scanmed appointed a Group Medical Director and a Medical Director of Cardiology. Together, these two appointments will co-ordinate closely with the medical directors of each hospital and the various heads of quality and audit to ensure that we provide high-quality medical services to our patients.

Scanmed has a dedicated team responsible for managing internal and external audits, as well as the implementation of accreditation standards. Scanmed's QMS, which is verified by the results of cyclical internal and external audits, is certified according to the requirements of the following international standards:

ISO 2001:2015 – QMS (quality management systems)
ISO 27001:2013 – IT (information technology)
ISO 31000:2009 – Risk management

Pleasingly, our Warsaw Primary Health Care Outpatient Clinic was re-accredited by the Minister of Health, and received an excellent score of 92%. We also retained our ISO 9001:2015 QMS certification, and was re-accredited in terms of ISO 27001:2015.

Scanmed's quality and risk teams use a monitoring system, as well as process measurement, to track various input, process and outcome metrics. These results are measured against internal and contractual benchmarks. Our clinical indicators comply with the requirements set by the Minister of Health and the Centre for Quality Monitoring in Health Care.

In Scanmed's outpatient clinics, patient satisfaction surveys form part of an EU co-funded project. We conduct surveys via paper questionnaires, emails, and through our clinics' websites. In 2019, we received a patient experience (satisfied and very satisfied) score of 88.10%, with 88.11% in 2018. From 2020 onwards, we will also measure the propensity of patients to recommend our services to their friends and family.

We also conduct in-hospital patient satisfaction surveys, which are paper-based and have an extremely low response rate of less than 1%. This has been identified as an area of improvement for the year ahead.

2018 Clinical quality indicator	Cardiology units	St. Raphael Hospital	Blachownia Hospital	Sport Klinika
Readmissions (<30 days) (%)	0.80	2.71	2.21	0.51
Return to theatre (%)	0.67	0.67	0.56	0.79
Healthcare-associated infections (HAI) (%)	0.67	1.29	1.14	0.12
Pressure ulcers (%)	0.08	0.56	0.31	0.00

2019 Clinical quality indicator	Cardiology units	St. Raphael Hospital	Blachownia Hospital	Sport Klinika
Readmissions (<30 days) (%)	0.62	2.72	1.86	0.26
Return to theatre (%)	1.15	0.60	0.43	0.52
Healthcare-associated infections (HAI) (%)	0.61	0.84	0.87	0.26
Pressure ulcers (%)	0.08	0.50	0.34	0.00

We are in the process of identifying and implementing an electronic system to monitor and measure our processes. In the meantime, we continue to keep both paper and IT patient hospital records up to date.

We aim to implement unified, monthly quality reports and patient experience surveys in all our departments. Following this, we will constitute a clinical governance committee, which will establish the assurance mechanisms needed to ensure standards of care are safeguarded, and that an environment is created in which clinical excellence is continually promoted.