31st May 2017
Dr Brian Robson MBChB, FRCGP, MPH, DRCOG
Medical Director Health Foundation / IHI Quality Improvement Fellow
CULTURE, CULTURE EVERYWHERE ...
• Great opportunity for collaboration• Building relationships
2556 miles
“ Working together means that you should never worry alone.”
‘COLLECTIVE IMPACT’
Maureen Bisognano
THANK YOU NEW BRUNSWICK ...BRIAN, LULU AND ROSE ....
.... AND EDDIE’S WIVES!
800-565-7421
CULTURE ....
800-565-7421 If you'd like to feel just right, laugh and have some fun,Meet some friendly people, and get some fishin’ done,You can dial Prince Edward Isle, and it won't cost you none,For information, on vacation, phone the land of fun...
Eight Double Zero, Five Six Five, Seven Four Two One
That's the magic number, free for everyone,Phone today, and sail away, to the Island in the sun...
Eight Double Zero, Five Six Five, Seven Four Two One
Golf the courses, play the horses, nothin's out of reach,Fishing for the tuna, or bathing at the beach,
Make this call the best of all for Prince Edward Island fun,Eight Double Zero, Five Six Five, Seven Four Two OneEight Double Zero, Five Six Five, Seven Four Two One
by Stompin’ Tom Connors
CULTURE ? LEADERSHIP? PSYCHOLOGICAL SAFETY?
“ Good morning,I am your captain and I
would like to explain why we are so delayed and what is going to happen next ...”
Captain, KLM flight 691
Glasgow, 29th May 2017
MANY THINGS IN COMMON
http://www.curling.ca
40% in PEI !
WELL DONE CANADA !
SO WE HAVE SOME DIFFERENCES ...
Scotland Canada
Population 5,373,000 35, 959, 927
Size 80,077 km2 9.985 million km2
Population Density 67 / km2 4 / km2
With a land mass of 80,077 km2
Scotland could fit within Lake Superior (82,100 km2)
‘HEALTH’ SPEND
http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/health-care-spending-compared
14
• 5.37 million population• £13 billion H&SC budget• 14 territorial boards• Special boards
‐ NHS Education for Scotland‐ NHS National Services Scotland‐ Scottish Ambulance Service‐ Golden Jubilee Foundation‐ NHS Health Scotland‐ State Hospital‐ NHS 24
• Moving to integrated health & social care• Public Body – Healthcare Improvement
Scotland
WHAT WE DO
Death Certification Review Service
SCOTLAND’S QUALITY JOURNEY
‘This is not the end. It is not even the beginning of the end,
but it is, perhaps, the end of the beginning.’
Sir Winston Churchill
AGNES’ STORY
QUALITY IMPROVEMENT IS MESSY
Swensen S, Pugh M, McMullan C, Kabcenell A. High‐Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013. (Available at ihi.org)
http://www.ihi.org/resources/pages/ihiwhitepapers/highimpactleadership
1. Create Vision& Build Will
We have had 5 decades of clinical audit and 10 years
of clinical governance. The future will focus on
patient safety and reducing harm.
Prof Sir Graham Teasdale
NATIONAL COMMITMENT TO QUALITY
http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf Scottish Government, May 2010
3 Quality Ambitions• Safe care• Effective care• Person-centred
care
Convening the co‐producers
Celebrating success
Young Academy of Scotland: Influencing Policy
Dr Catherine Calderwood Chief Medical Officer for Scotland,obstetrician and gynaecologist
http://www.gov.scot/Publications/2016/01/3745/downloads
People felt most energised by the
potential to positively influence culture
through more shared decision
making...http://www.gov.scot/Publications/2017/02/3336”
“
2. Develop Capability
“...everyone in healthcare really has
two jobs when they come to work every
day: to do their work and to improve it.”
What is ‘‘quality improvement’’ and how can it transform healthcare?Batalden,P; Davidoff.F Qual Saf Health Care. 2007 February; 16(1): 2–3
Subject Matter Knowledge
Subject Matter Knowledge: Specialist knowledge and skills required to be a good clinician
Profound Knowledge: The interaction of the theories of systems, variation, epistemology and psychology.
Profound Knowledge
Improvement
EARLY SUPPORT
NEW TOOLS ...
Improvement Science Leadership for Improvement
IHI Improvement Advisor Waves
Quality Improvement Fellowship
IntroductoryKnowledge
AdvancedKnowledge
AdvancedKnowledge
Improvement Capacity Building:Scotland’s Approach
Scottish Improvement Leader (ScIL)
Impr Science in Action
Boards on Board
Improvement Collaboratives
QUALITY & SAFETY FELLOWS (COHORTS 1-9)
189Quality &
Safety Fellows
118Medics
61NMAHPs
9Pharmacists
1Dentist
125 28 13 11 10 1 1Scotland N Ireland Ireland Denmark Norway England Wales
“I have realised that there is a greater world out there. I want to be a credible clinician improving care:
this is my professional future”SPSP Fellow, 2014
“Pursuing change without the leadership of clinicians is extremely hazardous.”
The importance and challenge of clinical leadership. The Kings Fund. 2013
http://www.kingsfund.org.uk/sites/files/kf/field/field_document/don‐berwick‐the‐importance‐and‐challenge‐of‐clinical‐leadership.pdf
Don Berwick
ENGAGING CLINICIANS – OUR APPROACH
http://www.healthcareimprovementscotland.org/previous_resources/policy_and_strategy/clinical_engagement_strategy.aspx
http://www.healthcareimprovementscotland.org/our_work/clinical_engagement/qi_connect.aspx
May
201
7
QI Connect: our reach
organisations
572
@HISQIConnect
OUR GLOBAL REACH
LEARNING TOGETHER..... AGAIN ... AND AGAIN...
http://www.healthcareimprovementscotland.org/our_work/clinical_engagement/qi_connect.aspx
@HISQIConnect
Don NormanThe Design Lab
University of California25 May
Stephen SwensenMayo Clinic
2 May
QI CONNECT 2017: INNOVATION & INTEGRATION
Emmanuel GobillotGlobal Author & Speaker
4 April
Anna RothContra Costa Regional
Medical Center27 July
Bill LucasUniversity of Winchester
28 September
Chris HamThe Kings Fund
26 January
Jaideep PrabhuCambridge Judge Business School
21 February
Sally MagnusonPlaylist for LifeNovember (TBC)
Brené BrownResearcher &
Storyteller31 August
Tom MarshburnNASA
26 October
http://www.healthcareimprovementscotland.org/our_work/clinical_engagement/qi_connect.asp
3.Deliver Results
Our change theory
A clear and stretch goalA methodPredictive, iterative testing
RELENTLESS MEASUREMENT
“In God we trust… All others bring data.”
W. Edwards Deming
0.6
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1.0
1.1
1.2
Oct
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200
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4Ja
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Apr
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NHSScotland Hospital Standardised Mortality Ratio
October 2006 to December 2015
0102030405060708090100
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0S
ep-0
5
Dec
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Mar
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Jun-
06
Sep
-06
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-07
Jun-
07
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% V
AP
Prev
entio
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ndle
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VAP
Rat
e / 1
000
Vent
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ys
NHS FV ICU VAP incidence/% VAP Preventon bundle compliance Sept 05 - Dec 12
NHS Greater Glasgow & Clyde PICUVAP Rate per 1000 Ventilation Days
Jan 2013 – Sep 2015
NHS Forth Valley Pressure Ulcer CountNovember 2010 – May 2015
Total Falls Rate for 7 Scottish BoardsJanuary 2014 – June 2015
NHS Scotland
Shaping the Future
The what&
the how
http://www.scottishpatientsafetyprogramme.scot.nhs.uk/Media/Docs/20160613%20SPSP90DayProcessFinalReport%20v%203%200.pdf
http://www.scottishpatientsafetyprogramme.scot.nhs.uk/Media/Docs/20160613%20SPSP90DayProcessFinalReport%20v%203%200.pdf
•Deterioration•Medicines•‘system enablers’
•measures• transitions•context, culture, relationships
•Acute kidney injury•Emergency laparotomy...
SEPSIS 6 60
http://www.scottishpatientsafetyprogramme.scot.nhs.uk/Media/Docs/Acute%20Adult%20Care/sepsis%20VTE%20evaluation%20short%20report%20‐%20FINAL‐%202015‐06‐29%20(2).pdf
DATA ON EVERY WARD .... IN PUBLIC !
Courtesy of Malcolm Daniel
BEHIND THE DATA
LET’S STAND UP
Via @docandrewmurray
4.Engage Across Boundaries
Strategic Direction of Change
Improving Population Health
Health and social care
http://ihub.scot
5.Shape Culture
SMART ISN’T ENOUGH
https://www.amazon.co.uk/d/Books/Checklist-Manifesto-How-Things-Right-Atul-Gawande/1846683149
“... using a checklist requires [doctors] to embrace different values from ones we’ve had, like
humility, discipline, team.”
BEHIND THE TOOLS...
Safety Climate Survey Results
Much of the value of these types of surveys lies in raising the profile of patient safety and
promoting conversations, .... that’s when the improvements come through
The Health Foundation, 2011
ELAINE’S STORY
TEAM BRIEFINGS ...
“I now consider the safety brief to be every bit as important to the safety of our patients as what I do as a surgeon during the operation...”
“ ....I don’t know why theatre teams are allowed not to do a morning brief .... I wouldn’t operate without it !”
Surgeon
CHANGING THE CULTURE...
NHSScotland Surgical Safety Briefings
Royal Hospital for Sick Children, YorkhillPICU Total Delayed Discharges (+ 4 hrs)
Hospital Huddle started 7th Jan 2013
….over 1,700 leadership walkrounds have been conducted in Scotland.
Since 2008…….
Patients are and feel safe,Staff feel and are safe
#mhimprove
‘We don’t really call it SPSP, that’s just what we do......’
#mhimprove
ARE YOU....
6. Driven by Persons & Community
78
“The patient experience will define the future of the NHS in Scotland”
Paul Gray Director General and CEO NHS Scotland
ARE YOU SIGNED UP ?
http://www.whatmatterstoyou.scot
Swensen S, Pugh M, McMullan C, Kabcenell A. High‐Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013. (Available at ihi.org)
http://www.ihi.org/resources/pages/ihiwhitepapers/highimpactleadership
[email protected]@brobson3
Thank You