Annual integrated report 2011

Clinical governance report: UK

GHG works within a robust clinical governance framework, which covers hospital and site activity in relation to standard-setting, implementation and monitoring. The framework is overseen by national and local clinical governance boards and medical advisory committees.

Setting standards

Our standards are based on:

  • Regulatory standards set by the Care Quality Commission (CQC) (England), Healthcare Inspectorate Wales and Health Improvement Scotland;
  • Evidence-based practice, which is underpinned by appropriately referenced policies and procedures;
  • National guidelines, which are assessed for applicability and communicated to our hospitals for implementation through wellestablished communication structures;
  • Information security and governance. GHG continues to hold ISO 27001 accreditation (Information Security) which ensures that patient and other data are managed securely at all times; and
  • Other relevant legislation and contractual obligations for example, with the Department of Health for provision of care to NHS patients.

Implementing the clinical governance framework

Maintaining the highest standards of clinical governance is dependent on the consultants and staff who deliver care to our patients.

We have implemented measures to attract and retain the correctly skilled staff. The needs of individual staff members are identified through appraisals, personal development plans and training needs analyses. These are used to plan and provide relevant training in a number of key skills. During the year under review, we doubled the number of mandatory training modules through our online learning system from 68 480 in 2010 to 117 402.

In nursing, the focus has been on updating and improving skills. Hospital infection and control reviews and training took place at 57 sites, while 37 sites held hospital transfusion link practitioner education days. Pathways are now in place in nearly all our hospitals and retraining needs have been identified. Labour management reviews took place to review skills, competencies and development paths, and best practice forums were held in paediatrics, pathways, oncology, risk assessment, endoscopy, critical care and tissue viability.

Consultants are granted and retain practicing privileges based on their ability to provide a standard of excellence in their particular specialty. GHG has carried out a significant amount of work to enable us to support the revalidation process to commence in 2012.

All activities and working environments are assessed for risk and scored to ensure that any actions required to reduce risk are prioritised. We continue to populate the corporate risk register, which provides regular information to help improve risk management. We also continue to develop our services and prioritise capital expenditure to ensure our hospitals are able to provide the prescribed standards of care.

Monitoring performance and outcomes

There has been ongoing focus on robust reporting of all incidents, near misses and outcomes, to ensure availability of information on effective clinical governance. Additional external reporting requirements are in place for GHG’s principal regulator, the CQC, the Health Protection Agency and insurers. There has also been progress on the Hellenic project, which is a sector-wide quality indicator reporting project that will provide the opportunity for independent providers to report as a sector and benchmark against each other and the NHS. Our performance monitoring covers the key areas of safety, effectiveness and patient experience.

Safety: Infection prevention and control

This focus area is led by the GHG Head of Infection Prevention and Control in liaison with the link nurses in individual BMI hospitals. Due to media coverage of hospital acquired infections, one of the most frequently asked questions from patients is: “How likely is it that I will get an infection in one of your hospitals?” Two infection rates published by the Health Protection Agency are MRSA bacteraemias and Clostridium difficile, and these results help us to reassure patients that due to effective pre-admission assessment and the high standard of clinical care delivered during and after their surgery, the risk is significantly lower than in the NHS.

Errors in administering medication have also decreased. This improvement can be largely attributed to continued training of BMI Healthcare staff and better reporting protocols.


As medical technology and clinical quality continue to advance, the average length of stay for BMI Hospital patients gets shorter. All surgery carries a risk of complications and these may result in an unplanned return to theatre. The decline in total number of unplanned returns to theatre is indicative of fewer complications.

The rate of unplanned readmission to BMI Hospitals within 31 days due to clinical complication has remained low.

Patient Reported Outcomes (PROMS)

All NHS patients who have undergone hip and knee replacements, varicose vein surgery and inguinal hernia repair are given the opportunity to complete pre- and post-operative questionnaires. This provides data on the health gain achieved by the surgery. For the current reporting period the patients treated by BMI demonstrated health gain above the average for England.

Patient experience

We continually monitor our performance by asking patients to complete a patient satisfaction questionnaire. Patient satisfaction surveys are administered by an independent third party and there has been a steady focus on increasing the response rate. Each hospital analyses the monthly reports they receive, and implements appropriate action to address any dissatisfaction or low-scoring areas.

In the 12 months ending 30 September 2011, nearly 66 000 patients completed the questionnaire, telling us about our inpatient and day-case service. We are pleased to report that our rating for overall quality of care (good, very good and excellent) has increased from 98.5% in 2009 to 99.1% in 2011. The percentage of patients who said that they would recommend BMI Healthcare has also increased, from 98.1% in 2009 to 99.1% in 2011.

Infection rates
(April 2010 - March 2011)
  Unplanned return to theatre
(October 2010 - September 2011)
  Unplanned readmissions within 31 days
(October 2010 - September 2011)
Rate per bed days   Rate per 100 theatre cases   Rate per 100 discharges  


Patient satisfaction
Patient satisfaction

Overall patient satisfaction

A particular area of focus over the last 12 months has been the way patients are discharged from hospital. Other focus areas include nursing care, accommodation and catering, all of which are reflected in the results of our patient satisfaction survey. Our consultants continue to be rated very highly.

Patient safety

In line with the aims of our clinical governance framework we have worked on a number of initiatives during the year. These include:

  • Venous thromboembolism (VTE) prevention: Our policy and risk assessment has been reviewed in line with the latest national guidance and we have been preparing to achieve VTE Exemplar status. The Department of Health will carry out an accreditation visit at the end of November 2011. This requires BMI to prove that all patients have been risk assessed for VTE and that appropriate prophylaxis has been considered, or that there are recorded reasons for the clinical decision to deviate from policy.
  • Reduction in number of patient falls: Preventing patient falls remains a challenge as patients are all accommodated in single rooms and are not within our staff’s sight at all times. A falls multidisciplinary working group contributed to the completion of a new falls risk assessment, with explicit actions for high risk patients. This was implemented in the latter part of the year and we anticipate improvements in the coming year.
  • High dependency patients: Acuity of patients has increased in a number of hospitals. Training programmes have been conducted to equip all clinical staff to meet the needs of this group of high-acuity patients. These range from healthcare assistance training to recognising and ensuring that the deteriorating patient is treated appropriately, in a timely way and with the skills required for the care of high-dependency patients. This has provided a good base for ensuring more of our hospitals are able to provide this level of care.

Review of monitoring outcomes

Reports are generated as part of our monitoring activity, and these are analysed and reviewed by a multidisciplinary Clinical Governance Committee. This body assesses whether remedial actions taken are appropriate and sufficient. These reports are then provided to the Medical Advisory Committee for final review and action where this requires the involvement of consultants.

Corporate level reports are reviewed monthly by the GHG Governance Board, chaired by the Group Medical Director. Other members include the Group Clinical Governance Director, Group Director of Nursing and Clinical Services, Group Director of Imaging, Group Chief Pharmacist and Lead Physiotherapist. Hospital performance is benchmarked, trends are analysed and action taken is ratified to ensure that there is business-wide learning to minimise risk of recurrence.

Looking ahead

  • Achieve of VTE exemplar status.
  • Up-scale staff competencies and infrastructure to fully support increase in high-acuity services.
  • Progress the Hellenic project to successful completion of Phase 1, involving the reporting and benchmarking of some key indicators against NHS and other independent sector providers.
  • Expand collection of PROMS data for hip and knee replacements to all patients.