Collaborating for Quality NHS SCOTLAND'S QUALITY IMPROVEMENT HUB A New Partnership for Improvement

Jane Murkin Associate Director of Improvement

Outline the design and development of NHS Scotland's Quality Improvement Hub

Context of healthcare today and its relationship with quality improvement

Consider the application of improvement science and methodologies in relation to knowledge management

• Roles and functions

• Coordination and integration

• Infrastructure – local and national

• Identify opportunities to test and implement new and different ways of working

An opportunity to identify and participate in designing and shaping the future state

SESSION AIMS

CARE IS NOT SAFE – INSTITUTE OF MEDICINE REPORT

“Between the care we have and the care we could have, lies not a gap, but a chasm”

ADVERSE EVENTS IN HOSPITAL

• 3.7% Harvard 1991• 16.6% Australia 1995• 10.8% London 2001 50% PREVENTABLE

3 million bed days in UK£1 billion per annum in UK

• Acute hospitals 9.5% - HAI(July 2007 HPS)• Pre work SPSP• SPSP Data – what are we learning in relation to harm

GLOBAL TRIGGER TOOL REVIEWS

3 Exemplar Hospitals (900 notes)

40 Bed rural Hospital (300 notes)

10 Hospital Research Project (240 notes)

7 Hospital System (3000 notes)

Multi-state Tertiary System (2000 notes)

Events/1000 Days

83 90 NA 119 86

Events/100 admissions

45 40 37 41 38

Admissions with adverse events

32% 30% 30% 29% 30%

A MAJOR STUDY OF RELIABILITY IN AMERICAN HEALTH CARE…

• McGlynn, et al: The quality of health care delivered to adults in the United States. NEJM 2003; 348: 2635-2645 (June 26, 2003)– 439 indicators of clinical quality of care– 30 acute and chronic conditions– Medical records for 6712 patients– Participants had received 54.9% of scientifically indicated

care (Acute: 53.5%; Chronic 56.1%; Preventative 54.9%)

• Conclusion: The Defect Rate in technical quality of American health care is approximately

• 45%

HOW SAFE ARE CLINICAL SYSTEMS?

Primary research into the reliability of systems within 7 NHS organisations and ideas for improvement

( Health Foundation May 2010)

Reliability in healthcare – This is not simply a matter of putting in place proper guidelines and expecting practitioners to follow them. It involves identifying in advance the points at which those mistakes can happen, the different elements that contribute to those mistakes and the systems that practitioners should follow in order to ensure pt safety

CONVERTING RESEARCH TO CARE

Publication

Bibliographic databases

Submission

Reviews, guidelines, textbook

Negative results

variable

0.3 year

6. 0 - 13.0 years50%

46%

18%

35%

0.6 year

0.5 year

9.3 years

Dickersin, 1987

Koren, 1989

Balas, 1995

Poynard, 1985

Kumar, 1992

Kumar, 1992

Poyer, 1982

Antman, 1992

Negative results

Lack of numbers

Expertopinion

Inconsistentindexing

17:14

Original research

Acceptance

Patient Care

Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yrbk of Med Informatics 2000; 65-70

17 years to apply 14% of research knowledgeto patient care!

MID STAFFORDSHIRE REPORT

Remember…

The Improvement Guide, API, 2009.

A MODEL FOR LEARNING AND

CHANGE

When you combine the 3 questions with the…

…the Model for Improvement.

PDSA cycle, you get…

Develop the Quality Improvement Hub, reflecting a new partnership for improvement between NHS National Services Scotland (NSS), NHS Quality improvement Scotland (QIS), NHS Heath Scotland, NHS National Education for Scotland (NES), and the Scottish Government Health Directorates Improvement and Support Team (IST).

Scottish Government, May 2010

QI Hub – What is it all about?

• Collaboration between NES, NHSHS, NHS QIS, NSS, IST and SGHD

• A coherent and cohesive national approach to supporting QI

• Maximising resources – the whole is greater than the sum of its parts

• Brokering access to resources and support to realise ‘world class’ ambitions of the H/C Quality Strategy

The QI Hub aims to bring improvement science into everyday work and language of NHS staff and to support demonstrable improvement in patient care through quality improvement activity.

Building on sound foundations

• Improvement work to date• Global ‘Improvement Movement’ (SPSP)• Bringing coherence to implementation and

improvement support methodology(NHS Healthcare Improvement Scotland /QEST)

• Drawing on NES’ developing educational infrastructure for QI

• Measurement for Improvement (NSS/ISD)

WE ARE NOT ALONE …

The NHS Scotland Quality Improvement Hub works in partnership by providing a coordinated national resource to care teams and organisations.

Facilitating:• Implementation support – flexible and responsive• Education and learning about QI – Accessible and relevant• Measurement of QI which is meaningful• Facilitating QI networks for NHS staff

Underpinned by creativity and innovation

Shaped and designed by NHS Scotland

Progress to date

• The Quality Improvement Hub –”Delivering to improve” – April 2010

• Our approach – Partnership, initiation, shaping the development, set up, action planning, execution plan, launch, go live and implementation

• Stakeholder consultation – May 2010• Stakeholder event – Shaping the development – June 2010• Formulation of work programme aligned to Quality strategy

and national priorities• Regional events – Developing the community ,Improvement

Directory• Ongoing stakeholder engagement – Board visits - learning• Proof of concept testing March – June 2011• An improvement approach

MAKING IT HAPPEN....

• Coordinating centre - Elliott House• Small core team – Exec Leadership, Associate Director,

Improvement Advisor, Data Systems Manager – link to ISD, Business Manager, Project support

• Evidence into Practice Portal – virtual communities• Building a Community of Improvement Practitioners

(Directory)• Planned and ‘bespoke’ programmes• Prioritisation process – levels 1 - 5

BROKERING SUPPORT FROM NHS SCOTLAND STAFF

Proof of concept work –

• Supporting the development of a Mortality Reduction Improvement Plan,

• Building capacity and capability for QI,

• Patient safety in Primary Care,

• National Audit work

Testing a brokerage model with boards

Directory of Improvement Practitioners

Developing our workforce

So many opportunities and so much potential

THE CHALLENGE

• Complex healthcare systems• Competing priorities• Initiative overload • Project weary staff• Project failure rate• In some NHS Boards same staff – multiple hats• History of a target culture• Policy/politics• Our resources are limited – people being the greatest• How can we achieve more and maximise the potential?

“NHS SCOTLAND HAS UNDERTAKEN A BOLD, COMPREHENSIVE, AND SCIENTIFICALLY GROUNDED PROGRAMME TO IMPROVE PATIENT SAFETY.  THE DEDICATION OF NHS LEADERSHIP AT ALL LEVELS TO THIS ENDEAVOR IS APPARENT TO ME, AND BODES WELL FOR SUCCESS.  IN ITS SCALE AND AMBITION, THE SCOTTISH PATIENT SAFETY PROGRAMME MARKS SCOTLAND AS LEADER – SECOND TO NO NATION ON EARTH – IN ITS COMMITMENT TO  REDUCING HARM TO PATIENTS DRAMATICALLY AND CONTINUALLY.”

DON BERWICK JUNE 2008

WHAT WILL IT TAKE TO IMPROVE QUALITY AND SAFETY?• Winning the hearts and minds of the staff• Focusing on improvement not targets• Leadership • Integration • Making it daily work • Creating infrastructure• Creating capability and capacity• Measurement that has meaning• Understanding context and culture• Momentum

CREATIVE THINKING

• Creativity implies having thoughts that are outside the normal pattern.

• What can you do to have “new” thoughts?• How do we “provoke” new thinking?• What can we test and implement• How do we learn ourway into a new world• How much and by when?

What's our collective aim?

Integrating and aligning knowledge management expertise and resources to support local and national quality improvement activities and implementation of our quality strategy

"We cant change the human condition, but we can change the conditions under which humans work"

James Reason

• The power of words