Case study 8 - Cygnet Health Care

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You can download our case study for Cygnet Health Care. (pdf)

Introduction

Cygnet Health Care was established in 1988 and is one of the UK’s largest independent providers of mental health and social care pathways. Cygnet operates 17 hospital units – as well as two registered nursing homes - with more than 730 beds. It is fine-tuning its existing systems to ensure all its doctors have access to the supporting information they need to revalidate.

Challenges

Cygnet is responsible for helping around 80 doctors with their revalidation – many of whom work entirely in the independent sector. A large number of these doctors are not employed by Cygnet directly, but have practising privileges instead in one or more of their hospital units. On top of this, around 40 doctors have practising privileges in Cygnet hospital units but spend the majority of their time employed within the NHS.

Both groups of doctors will need to have ‘whole practice’ appraisals to revalidate. The challenges for Cygnet have been to provide its NHS-employed doctors with supporting information they can use for their appraisal by another organisation, and to be aware of the whole practice portfolios of the independent doctors it is responsible for appraising and making revalidation recommendations about.

As Vicky McNally, Cygnet’s Corporate Governance Director, explains: ‘Many things have changed since we started talking about how we plan to approach revalidation, including the provider landscape. Now there is an increased recognition that the independent sector has a valuable role to play in providing supporting information for whole practice appraisal, and there is an increased willingness within the NHS to work closely with us to gain access to that information.’

Ensuring that meaningful and collectible supporting information is being recorded for every doctor in every Cygnet hospital unit is a complex endeavour.

Robert Kehoe, Cygnet’s Medical Director and Responsible Officer, says: ‘I need the medical director and hospital manager of each hospital unit to be my eyes and ears, and also ensure that the relevant supporting information for every doctor is being collected on a regular basis. It’s my job to make certain that senior managers are aware of their responsibilities.’

Action

In order to ensure that every doctor in every hospital unit is aware of what revalidation is, how it will affect them, and what they are required to do to prepare for it, Cygnet has arranged a series of regional revalidation roadshows which are travelling across the country until November 2012.

These roadshows are open to all doctors that utilise Cygnet’s services, and are also a perfect platform for Responsible Officer Robert Kehoe to explain to medical directors and hospital managers what is expected of them.

As Robert explains: ‘Each medical director and hospital manager is responsible for managing their unit’s appraisal and supporting evidence collection.’

‘At the regional roadshows I am able to explain that a lot of the information required for revalidation is already being collected by Cygnet in order to complete the minimum mental health dataset, and it is really a matter of slightly reformatting the way we collect this data to ensure it can be used as supporting information for individual doctors.’

Vicky McNally elaborates: ‘We are constantly thinking ‘is there a way that we can use the information we already collect to support the revalidation process and enable doctors to demonstrate outcomes and performance’? It’s right up there on our agenda.’

Cygnet has developed a bespoke database of key information which ensures supporting information is easily available for doctors. A whole raft of information, including risk and incident logs, is recorded electronically on an individual basis so it can be used by doctors as evidence for their appraisal and revalidation.

This means Cygnet’s doctors have access to good quality supporting information in a format that is easily accessible and reviewable whenever it’s required.

Robert is also organising for eighteen colleagues to be trained by an external trainer in up-to-date appraisal methods to ensure there are plenty of appraisers available to the doctors revalidating with Cygnet.

Results and benefits

Since working through the NHS Revalidation Support Team’s Organisational Readiness Self Assessment (ORSA) tool, Cygnet has seen a huge improvement in the number of doctors receiving quality regular appraisal. The organisation believes this has given a ‘sharper focus’ to performance related activity, and a standardised medical appraisal policy is currently being rolled out across the organisation.

Vicky believes that the process of developing a framework for whole practice appraisal has strengthened communication channels within Cygnet, but also between independent providers and the NHS. Cygnet has also found the support of the NHS Revalidation Support Team invaluable and has helped them link with various providers to work through the challenges of revalidation together.

Robert echoes this, and maintains that there is something to be said for the way in which preparing for revalidation has strengthened communication channels within Cygnet. At the regional roadshows, Robert and Vicky will personally meet all medical directors from across the country face to face – facilitating closer working relationships and ultimately enhancing organisational standards.

The roadshows themselves also reassure Cygnet doctors that they are fully supported, and help to bring part time employees closer to the organisation.

Key findings

• Cygnet has developed closer relationships with the NHS to ensure its doctors can have whole practice appraisals. Cygnet believes this enhanced integration has the potential to improve the provision of patient care in the future.
• Cygnet found it was already collecting clinical data that doctors could use as supporting information for appraisal and revalidation, but the data needed to be reformatted. As part of its revalidation project, it has developed its own database which captures supporting information for individual doctors.
• The process of preparing for revalidation has helped Cygnet to improve its management systems, strengthening relationships and communications within the organisation and between its hospital units.