MOD004054 Healthcare Environment
Introduction
Figure 1: KCH Foundation Trust
Source: (From web)
Brief history
King’s College of London was founded on 14 August 1829, by Royal Charter King George IV. It includes St Thomas’s Hospital Medical School, one of the oldest medical schools in Britain, with a history of medical teaching and has a prolonged history in surgery that traced back to at least 1561.
The premises of king’s College Hospital and Foundation Trust, particularly the Standard Campus, includes many historic buildings, many listed at various grades. The construction was completed in 1828 to the riverside of the frontage of Somerset House. The site was divided into two parts, one is the Strand Campus and the other one is Macadam Building. The Maughan Library is situated within the Chancery Lane Conservation Area.
Activities
King’s College Hospital NHS Foundation Trust is well known for its internationally recognized and its best services and care. These include several acute diseases such as liver diseases and transplantation, neurological sciences, diabetes, cardiac services (Heart failure, Blockages, angioplasty), oncology, hematology, and fetal medicine.
King’s College Hospital NHS Foundation Trust is the major designated trauma center for the people across South East London. It takes care of acute heart diseases as well as hyperacute stroke, neurological diseases, and cancer.
King’s is the pioneer of medical research and innovation in various fields in surgeries, medicine, cancer treatment. The hospital takes care of several leading clinical control, units, and research centers, such as the Clinical age research unit, the HIV research center, and Harris Birthright Centre, Developments have recently begun a new leading-edge Hematology Institute.
King’s Commercial Service Limited is the company aims to supervise some crucial commercial operation on the behalf of the trust. It is constituted to expand income diversify commercial activities both in the UK and overseas.
There are currently three outpatient clinics open in the UAE, one in Abu Dhabi and one in Dubai. In early 2019 a full-scale inpatient hospital opened in Dubai. The company operates a successful international recruitment business covering nurses and doctors for both King’s and other healthcare organizations. In 2018/19 the recruitment team bought in 780 nurses into the UK and 329 into the Kings supporting nurse vacancy rate.
SWOT Analysis and its Role
It stands for Strength, weaknesses, Opportunities, and Threats. It is a useful tool used for analyzing aforesaid four categories. It helps to construct what is good for an organization and express what is lacking, to minimize risk, and to maximize productivity. It enables us to take advantage which leads towards success.
It has various roles in many aspects. It has the potential to build strength, boost up weaker sections, wiped out threats, and making opportunities.
SWOT analysis matrix
| Strength
2018/2019 was the challenging year for the trust as the trust regained control over financial recovery and improvements. They control over the financial improvement plants and manage the cover impact on financial pressure,
The expenditure was included in some significant areas including construction of the CCU, reorganization of the emergency department at Denmark Hill, electronic patient monitoring, device upgrade, added new types of equipment, and many more.
To ensure the meet of patient demands, the trust continued to invest in building infrastructure provide quality health services.
The trust had already started to provide essential health services in various aspects such as acute heart diseases, acute liver diseases, neuroscience, oncology, ophthalmology, etc.
King’s College Hospital also working with other NHS and independent sector providers to provide supplementary capacity in surgery and orthopedics to reduce the negative impact on patients. The number of breaches reduced gradually from 457 breaches which were reported in August to 192 breaches which were reported for the end of March 2019.
In the Denmark Hill site, additional virtual clinic capacity has been deployed which has resulted in providing telemedicine and virtual consultation to over 300 patients on daily basis and reductions in the patient tracker list size.
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Weakness
Kings College of Hospital has the highest level of bed occupancy on its sites at Denmark Hill and PRUH throughout 2018/2019, which restricted them to respond during peak times at their expected level,
During 2018/2019, trust struggled to maintain at various divisions and demanded to improve the quality of health services for access to standard emergency services, elective, and diagnostic care. The increased number of elderly patients who attending emergency services are facing great problems. This put additional pressure on the authority and need wider capacity within the trust across beds, outdoor patient service, and diagnostic center.
Cancer patients which increase 11% during 2018/2019 put additional pressure on the trust due to lack of quality health check and analysis, the patient has to wait two weeks to know their reports, and the first treatment started after 62 days.
In the Denmark Hill site, additional virtual clinic capacity has been deployed which has resulted in providing telemedicine and virtual consultation to over 300 patients daily and reductions in the patient tracker list size.
It is important to fact that KCH Trust left a negative impact on the environment and recognized as to operate a sustainable and efficient organization. |
| Opportunities
In the 2018/2019 financial year, trust drew down £145.7m of interim revenue and capital support loans. £134.8m represented cash support against the Trust 2018/2019 deficit, with the remaining £10.9m designated as approved funding against 2017/18 capital projects which were carried forward for completing in the current financial year.
To provide additional support, Trust has worked with Hunter Consulting in the mid of the year to provide the ECR program.
The Focus of this work is to achieve sustainable development and provide the best medical services. This year, the Trust has produced energy through non-conventional ways like offshore wind generation, cleaner grid electricity, and reduce the use of coal energy. So that carbon emission related to emergency consumption was reduced by 8% or 2493 tonnes. CO2 emission has been reduced to 10% in 2015 compared to produced in 2007. Under Climate Change Act (2009), The Trust has targeted to achieve a 34% reduction of carbon emission by 2020 and an 80% reduction in 2040.
The 2019 annual report, published by the Sustainable Development Unit (SDU), NHS Improvement, and the Healthcare Financial Management Association (HFMA) was recognized KCH Trust for excellent sustainability and received a certificate for excellence. The organization can demonstrate how they maintain a commitment to environmental, social, and financial sustainability and it is regarded as a fundamental way.
As a result of various initiatives and innovation, waste management has significantly improved over the past 12 months. Approximately 9% of total waste production has decreased by recycling, reuse. The Trust has set up a plan to achieve and increase the recycling process from 36% to 75% by 2020, which higher than the current rate.
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Threats
It is a significant challenge among the London Trusts as well as King’s, on both its Denmark Hill and PRUH sites to achieve the Emergency Care Standard (ECS). Lack of patient flow and unavailability of services in some aspects preventing any positive impact on performance improvement.
The most emerging service at the Trust is the patient transport service. Between 2018 to 2019 the number of patient individual services has been increased from 5,500 per month to 18,600., since 2011. This increased service harms the environment due to a negative impact on the air quality index by extending the number of vehicle services.
Increased demand for energy consumption leads to an increased cost of energy. It is estimated that the total of cost energy is £6,016,761. The cost of gas increases by approximately 8% and the cost of electricity increases by approximately 17%. In 2018-2019 the gas energy consumption reach nearly 15%.
The Trust started to make prioritized and continues to monitor the infection-related healthcare association. Between 2016-2017 their sex cases were recognized which were antibiotic-resistant Staphylococcus Aureus at Denmark Hill and one case at PRUH.
Between 2018-2019 the cases of antibiotic resistance cases have been increased, 80 cases were recognized across the trust. Which was higher than the Department of Health and Social Care comprising 71 cases but lower than the previous year.
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Strength
King’s College Hospital provides essential health care and fully managed services across nine diagnostic and treatment facilities. Those include elderly critical care, cardiac department, liver foundation, endoscopy, renal dialysis, children’s critical care, and dental. King’s College Hospital provides consumables, implants, and devices and maintains these facilities and services during clinical procedures.
Trust continues the work to achieve standard treatment performance within a short period. It works with the authorities and governing body for developing and improving over 52-week breaches. This plan enables outdoor patient and theatre productivity to maximize the use of daily case indoor and outdoor patient clinic in a week. They use some additional providers for delivering to meet weekend capacity for outdoor patients and day-case theatres, especially for Ophthalmology, Dermatology, and Endoscopy provision.
NHS and other autonomous bodies allowing to provide pieces of equipment for surgery and acute orthopedics to reduce the number of patient flow during the first half of the year.
Trust has to deliver several high-impact actions to improve performance, and it maintains its standard over 62 days, this is also part of the comprehensive action.
PRUH has created more capacity in the urology department to deliver local anesthetic template biopsies for the outpatient setting and removes the existing pressure of running services in theatres. it may unable to estimate its assets and discharge its liabilities in the normal course of business.
King’s volunteer services have a significant impact on the organizational priorities to improve patient and visitors’ experience. Volunteers have engaged with 108,660 patients and visitors and supported by giving 32,980 hours of their time.
To define the mortality rate, the Trust assessed their mortality rate by using NHS Digital summary Hospital-level Mortality Indicator (SHMI), a presently trending way to define excellent outcomes concerning morality. During the year, the ranking improved from 7th to 6th. For some fatal diseases like heart failure, heart attack, acute liver diseases, stroke, aplastic anemia, leukemia, acute kidney failure, diabetes, the mortality rate is lower than expected. 110 death out of 547 deaths which comprise 20% of the death rate were subjected to protocolized cases and cases underwent a review of the investigation. None of these were hampered or disrupted or create problems for the patient care provider.
One of the King’s defining characteristics is R&I. Patients and their families and their staff come under one umbrella, by giving them care. During the year R&I strengthening their leadership, governance, quality, and contracts teams, the board was developed in December 2018.
The accreditation program is closely linked with the application of lean philosophy and techniques. To their services most effectively and efficiently, they designed this program, it is designed the CQC domains in safe, effective, caring, responsive, and well-led.
For improving the quality of medical teams, educational supervisors and doctors are undergoing training, continuous improvement training has been provided through the programs King’s Improvements through Engagement (KITE). It is an opportunity for junior doctors, as they are provided with formal QI training. It has a wide range of specialties and has a device solution to projects informed by patient safety issues.
They also started a Value-based healthcare program (VBHC), one of the best program and award winning approach adopted between 2012 to 2015. It involves the development of a blueprint for clinical pathway improvement that considers all aspects of the pathway and delivering the value of the economy.
They also make collaborate with the other leading hospital in Europe to ensure the development of the highest level of expertise within the trust. These include the Karolinska, assistance Publique, and charity. To provide the best health care services the Trust has set up a collaboration with the European University Hospital Alliance that create pathways and measure outcomes across Europe.
For obtaining transparency and making the Trust trustworthy three more policies have been adopted by Trust such as anti-bribery policy, community engagement, equality, and human rights. They set up an audit committee and obtain a zero-tolerance policy to ensure compliance, overseen, and appropriate policies are placed towards fraud and bribery. The Trust wants to ensure that, services they have been provided meets the needy by making community engagement, so they can closely interact with the patient and their family and staff. And the most important and going concern for today is equality and human rights. Their main aims are patient safety, outcome equality, and experience. The critical part of the strategy is to create an inclusive, fair, and equal employment and care employment. It is important to have a moral, ethical, and legal duty to treat everyone fairly, equally, and without discrimination.
After upgrading the condensate system water consumption has decreased by 4% or 13,102 cubic meters since the last year.
Weaknesses
The major weakness the Trust facing is the financial issue. The majority of the Trust’s are borrowing capital loans of £139.6m and revenue/working capital loans of £514.2m. Due to the increased size of the fiscal deficit, the Trust Board carefully prepared the accounts based on being a ‘going concern’ and there are major uncertainties that may impact on the going concern.
The Trust faces several risks, after submitting the financial report by the Department of Health and family welfare, makes concern about trustability and raises a significant question about material uncertainty, that may cast a negative impact on the Trust liabilities. The statement related to financial deficit provided by the Department of Health and welfare does not mention any adjustment that proves any appropriate basis of going concerned. After raising this concern which is closely related to patient care, Trust has set up a committee, that has the provision of making and accepting any financial recovery plans, placed to the Department of Health and Family welfare and the department would support by finance.
Opportunities
Additional demand for cancer treatment has increased in recent years. All tumor groups at PRUH, with service areas in Gynaecology, Neurological Injury, and Urology all come down to 8days. Trust delivered several impacts in various aspects throughout the year, by improving performance. It has become more concerned and about the current situation and a program have been put in place to provide additional capacity in the private sector as well as making the best use of capacity across the Trust, to ensure that patient is being properly monitored.
The Trust also started a full review of all patients that have waited longer than they should have to understand whether they have come to harm as a result of their extended result. Radiology utilizes supplementary machinery such as scanners, modern medical devices which yield a result with a bit of time and reduce time consumption. PRUH and South sites have been provided with these modern instruments thus services never fall. The Trust has published several data quality reports which make concern about data quality and validation reported by RTT. To focus on the validation of patient tracker, the Trust governing body recruiting additional staff for the central validation team and divisional PTL (Patient Tracker List) users.
Threats
The Trust has not acquiescent against the 99% targets since December 2017, with the performance worsening through the year 2018 to 2019 due to capacity curtailment and demand overtakes the capacity in a couple of diagnostic test areas.
Endoscopy demand for both surveillance and diagnostic at PRUH patients has the outbursts capacity and during that time where emergency demand exceeds the available acute beds within the wards. This has a significant impact on the ability to provide endoscopy services as planned on the PRUH site.
Conclusion
Kings continue to report excellent outcomes about mortality. The latest summary assessed by using NHS Digital Summary Hospital-level Mortality Indicator (SHMI) is trending in the right direction with our Shelford ranking improved from 7th to 6th during the year.
Morality is lower than expected, or as expected for: trauma, stroke, acute myocardial infection, pneumonia, sepsis, acute kidney injury, hip fracture, endocrine surgery, bariatric surgery, nephrectomy, hip and knee replacement surgery, emergency laparotomy, and renal replacement therapy.
One of the defining characteristics of kings is research and innovation. It is important to note that Trust which provides treatments to their patients, make interaction with the patients’ family and concerned to their staff. In this year, they make significant changes within research and innovation with the considerable strengthening of the leadership, governance, quality, and contracts teams and developments of trust’s R&I strategy which was approved by the Board in December 2018.
The vision of R&I is, they developed a therapy that is cell-based, clinical, and surgical. Through the center of excellence, they rebuild an international reputation for research, industry partners, and academic networks and deliver world-class clinical research across the key clinical areas, critical care, and trauma medicine, hematology, neuroscience, liver disease, transplantation, fetal medicine, metabolic, pediatrics and end of life services.
Trust is innovating new and improved specialist treatment and innovation for the benefit of patients locally, nationally, and globally.
Recommendations
- To continue to maximize the strength the trust should be increased and facilitated volunteer roles over the trust. The volunteer has a crucial role to respond to the needs of both patients and staff, as well as they, have a positive impact on patient services, operational process, and removal threats. It should give them provision of supporting several departments including Neuroscience, Nuclear Medicines, and Therapies. This initiative both ensures that patients attend their appointments and also saves the trust money by reducing lost appointments.
- The governing body should accept and learn the innovative way as they provide the best patient care services. Innovation can generate a new model of care and medicinal services. In the case of the rapid response team, they have to separate themselves from the other part of the organization, they make concern only about emergency patients and must be provided with the best medicinal pieces of equipment.
- Rapid testing facilities and quick access report is the major part of any hospital and any related institution. They must be provided with the best testing facilities and kit, thus they can measure the authentic result and make the proper way of cure. It is also important to develop a clear quantitative measurement system and provide accurate estimates of the overall impact of the outcomes.
- A hospital must be maintained by the patient standard protocol. Hospital authorities should up to dated and train doctors and nurses on regular basis. Health care service providers should maintain clear communication with the patient’s family members. They should be given standard professional training in risk management, they have the crucial role of supporting the safety of the hospital.
- Risk prevention can be supported by increased patient awareness. If they are sufficiently informed about their medication, they can recognize the medicine they are provided with and reduce mistakes related to dosages of medication. An active relationship between consumer and health care providers are important components of a patient safety strategy.
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