Scottish Patient Safety Programme:  lessons learnt in Scotland 

Professor Jason LeitchClinical Director

The Quality Unit, Scottish Government 

@jasonleitch

• 5 million people• £12 billion• 14 Health Boards• 8 Support Boards• Integrated delivery• Moving towards social care integration

Public FinancesFall in Government expenditure

Scotland’s approach

Aims:To deliver the highest quality healthcare services to the people of Scotland 

For NHSScotland to be recognised as world‐leading in the quality of healthcare it provides

2020 Vision/Quality Ambitions

“Safe, effective and person‐centred care 

which supports people to live as long as possible at home or in a homely 

setting.”

Implementing at scale….can it be done?

Execution

Ideas

Will

Our change theory

A clear and stretch goalA methodPredictive, iterative testing

How Do We View Our Measures?

Improvem

ent

Judgement

Research

Judgement Research

Improvement

Performance

AimsTo Further Improve the Safety of People in Acute Adult 

Healthcare1. Reduce Harm95% of people in acute adult health care free from harms in the Scottish Patient Safety Index by 2015: 

Cardiac ArrestCatheter Acquired Urinary Tract InfectionsPressure UlcersFalls

2. Reduce Hospital Associated MortalityReduce HSMR by 20% by 2015.

Don Berwick 

• Get goals• Get bold• Get together• Get a model (and stick with it)

• Get patients and families

• Get the facts• Get to the field• Get a clock• Get the numbers• Get the stories

How has the frontline done it?

NHSScotland Surgical Safety Briefings

NHSScotland Surgical Mortality

Scottish ICUs Averaged Bundle Reliabilityand VAP Rate/1000 ventilator days

60%

70%

80%

90%

100%

Oct-07

Apr-08

Oct-08

Apr-09

Oct-09

Apr-10

Oct-10

Apr-11

Oct-11

Apr-12

Oct-12

Apr-13

Oct-13

Apr-14

Oct-14

0

5

10

15

20

25

Average VAP Bundle Reliability

Average VAP rate/1000ventilator daysMedian for 2008

Better

Better

60%

70%

80%

90%

100%

Oct-07

Apr-08

Oct-08

Apr-09

Oct-09

Apr-10

Oct-10

Apr-11

Oct-11

Apr-12

Oct-12

Apr-13

Oct-13

Apr-14

Oct-14

0

5

10

15

20

25

Average VAP Bundle Reliability

Average VAP rate/1000ventilator daysMedian for 2008

Better

Better

60%

70%

80%

90%

100%

Jul-0

7

Jul-0

8

Jul-0

9

Jul-1

0

Jul-1

1

Jul-1

2

Jul-1

3

Jul-1

4

0

1

2

3

4

5

Average Central Line InsertionBundle Reliability

Average Central line BloodStream Infection/1000 linedaysMedian in 2008

Better

Better

60%

70%

80%

90%

100%

Jul-0

7

Jul-0

8

Jul-0

9

Jul-1

0

Jul-1

1

Jul-1

2

Jul-1

3

Jul-1

4

0

1

2

3

4

5

Average Central Line InsertionBundle Reliability

Average Central line BloodStream Infection/1000 linedaysMedian in 2008

Better

Better

Scottish ICUs Average Central Line Insertion Bundle& Central Line Related Blood Stream Infection rate 

/1000 days

Hospital Standardised Mortality Ratio Scotland: 2006 to Sep 2013

Kendra

7 year old Severe autism

Kendra

@jasonleitch