Quality Improvement, Testing and Real Life Improvement
Professor Jason Leitch National Clinical Director
Healthcare Quality
Scottish Government
@jasonleitch
“Strong evidence for an innovation is necessary but not
sufficient to result in its adoption”
Mark Freeman, 2012, The International Journal of
Management Education
“Prosperity, fairness and
participation"
Wealthier & Fairer
Smarter
Healthier Safer & Stronger
Greener
Public Finances Fall in Government expenditure
Projected % change in age structure of Scotland’s population: 2010-2035
27% of people in Glasgow have a
degree or professional qualification
27% of people in Glasgow have no
qualifications at all
Implementing at scale…. can it be done?
Execution
Ideas
Will
“By what method?... only the method
counts”
W Edwards Deming
DESIGN DESIGN DESIGN DESIGN APPROVE
Conference Room
Real World
The Typical Approach…
IMPLEMENT
DESIGN
TEST & MODIFY
TEST & MODIFY
APPROVE IF NECESSARY
Conference Room
Real World TEST &
MODIFY
The Quality Improvement Approach
START TO IMPLEMENT
Our change theory
A clear and stretch goal
A method
Predictive, iterative testing
‘This model is not magic, but it is probably the most useful single
framework I have encountered in twenty years of my own work on
quality improvement’
Dr Donald M. Berwick Former Administrator of the Centres for Medicare &
Medicaid Services Professor of Paediatrics and Health Care Policy
at the Harvard Medical School
The Model for Improvement
NHSScotland Surgical Safety Briefings
NHSScotland Surgical Mortality
NHSScotland Hospital Standardised Mortality Ratio
October 2006 to March 2015
General Medical Services
Pharmacy
Community Nursing
Dentistry
% Sepsis Six: < 1 hour
Sepsis: % Antibiotics < 1 hour
% 30 day Mortality of ICD 10 A40/A41
Percentage of children seen by panel within 12 weeks of recommendation
Barshare Primary East Ayrshire
Outcome Measure - Percentage time spent in class per week
(aggregated for all 4 pupils)
Daily Average Instructional Time
2012
18 classrooms 2013
63 classrooms 2014
80 classrooms
Increase in average score between initial evaluation and
final evaluation
The first choice we make each and
every day is, "Will we act upon life, or will we merely be
acted upon?"
Stephen Covey
Circle of Influence
Circle of Concern
Stephen Covey: The 7 Habits of Highly Effective People (1989)