• Introduction to the KSS Academic Health Science Network (AHSN) and Quality & Patient Safety Collaborative (QPSC)
• QI Capability
• Peer Support
• PDSA – Tennis balls
• Model for Improvement
• Life Platform
• Communities of Practice
• Patients as Partners for Improvement
• Improvers Network
• Q
• Measurement for Improvement •
Presentation covers:
What support is there?
• Breakthrough series – support with the QI methodology available to increase QI capability (this is the first of 4 sessions and QI will be drip fed through).
• This session is the introduction to QI capability building
• 492 joined the Improvers Network
• Bronze QI training (on-line training)
• LIFE Platform
• Networking events
• Peer Support
• Q
Can improving safety culture improve outcomes for patients?
Touching tennis ball An introduction to PDSA
Tennis Ball
• Aim is for every person on the table to touch each ball with both hands in the quickest time.
• You can only touch 1 ball at a time!
• DOCUMENT your Theories, Predictions, Results
Please choose individuals:
• 1. Note taker
To fill out your sheet
• 2. Timekeeper
Need a watch with a second hand (or phone)
Making a Prediction
• What is your theory? –What process will you use to improve time?
• What do you think will happen? –What is your prediction about time?
• Think ahead to future tests –….and how they might be shaped by the current small test.
Getting the Most out of the Exercise
• This exercise is designed to teach how to perform a test of change.
• During the simulations, observe – the conversations that occur
– the generation of ideas
– any disagreements
– the team dynamics
– the interactions between individuals.
• Think about what is happening and how it might apply in a clinical setting.
Reflection
Take a moment to reflect on your own work. What will you incorporate from this session into your plans?
Why study Quality Improvement?
• Based on Institute for Healthcare Improvement (IHI) Model for Improvement
What is a Driver Diagram?
Aim: What, how much and by when? (Me, Size smaller/1 stone lighter - by summer holiday!)
What to measure?
Outcome Measures The impact/result of the work you are trying to achieve – (my final weight/dress size)Mortality Process Measures Are the processes performing as planned ?– (eating less/exercising more)Use of NEWS Balancing Measures Are the changes designed to improve causing new problems? (am I starving myself and fainting/feeling ill?) Staffing workload shifted? (outreach excess calls) Use a balanced set of measures for all improvement efforts.
Reflections from the ball exercise and PDSA cycles?
We are great at planning and doing – but sometimes the study and act are missing! This should be quick easy small tests of change – don’t invest too long in each PDSA Seek Usefulness Not Perfection Aim – if you knew the best time at the start of the exercise– would your original aim/time have been different?
Why start small?
• Experience tells us that not all situations are the same
• One standardised process will not work for all
• Design a process to deliver reliable care for a group that is easiest to work with
• Learn from that group and spread to others
Why Some Improvement Efforts Fail?
• We do not get to the root of the problem • We do not understand human factors and engineer
systems to deal with the human condition • We do not simplify • We add steps to the processes that result in increased
work and complexity • We do not engage everyone at the right time
• Goal posts change
What is the LIFE platform?
• Bespoke QI platform developed by SW AHSN
• Based on IHI model for improvement
• Allows for collaborative learning
• Covers all aspects of project development
– Driver diagrams
– PDSA cycles
– SPC charts
• Project library / Resources section
• Asset mapping capability
How can we use it?
• Free to all healthcare workers in KSS
• Register through site https://life.seedata.co.uk/login/signup/
• User guide– look in resources in LIFE
Why have we got it?
• Increase visibility of improvement
• Improve collaborative working
• Improvers network
• Tracking of collaborative improvement
CoP – Mortality and Serious Incidents
• Communities of Practice are groups of people who share a concern or passion for something they do and learn how to do it better as they voluntarily interact regularly……
Myron Rogers
CoP – Mortality and Serious Incidents
What we care
about DOMAIN
What and how we do things
together about it
PRACTICE
Who cares about it
COMMUNITY
CoP – Mortality and Serious Incidents
• Our ambition for the CoP:
• Building relationships between organisations to improve reviews and so enrich learning for safer care.
• Our community:
• A community from Kent, Surrey and Sussex closely involved in mortality/SI reviews and management and committed to making a difference.
PAPfI
• We are developing this pilot training in partnership with HW East Sussex and HW Surrey, Mark Doughty, Senior Consultant, Leadership Development – The Kings Fund (and founder of the Centre for Patient Leadership) and the KSS leadership academy.
• Patients will have 4 learning sets over 1 year
• Patients aligned to QPSC projects including the deteriorating patient
Improvers Network
• 492 joined “I’m IN”
• LIFE Platform
• Networking events
• Local Chapter meetings
• Stepping stone to Q
• Communities of Practice – Mortality and Serious Incidents
• Q is an initiative connecting people who have health and care improvement expertise across the UK.
• Q is led by the Health Foundation and supported and co-funded by NHS Improvement.
• The Q community is made up of a diverse range of people including those at the front line of health and social care, patient leaders, managers, commissioners, researchers, policymakers, and others.
• Next stage – growing Q (May / June 2017)
Q is not a taught programme, but a network of support for those already knowledgeable in undertaking improvement.
Can improving safety culture improve outcomes for patients?
Measurement for Improvement Making the data work for you!
Primary Drivers Secondary Drivers
Recognition Improved
assessment and
monitoring in all care settings
Communication/safety netting Improve safety
within the healthcare
system
Management Improve timely treatment and
management of deteriorating
patients
Escalation improved
response to deteriorating patients in all
settings
1.Patients to have accurate NEWs scores whilst in inpatient and urgent care
2. NEWS calculated at emergency by community staff
3. Emergency GP referrals to have an accurate full set of observations and NEWS score ( including out of hours)
4. Care homes to use and calculate NEWS and benchmark
5. Education in all care settings re NEWs and recognising deterioration
6. Agreed escalation policies and trigger in all care settings
7. Patients with NEWS score of >5 to have a rapid assessment according to the escalation plan by an appropriate team
8. Patients with NEWS >5 to have screening for Sepsis/AKI ( Sepsis 6 within 1 hour of trigger)
9. ? Use of escalation plans – involve patients, family and carers
10. Ensure all patients have medications review
11. Use of checklist, agreed bundles, sepsis 6
12
13. Education of all staff in all care settings
14. Patients to have accurate NEWS score communicated at all referral points
15. Use of structured communication/common language
16. Patient information and discharge summaries containing adequate information/plans
Aim of the Programme
To improve the recognition, escalation,
management of the
deteriorating patient whilst
improving communication
and safety netting to
ensure improved
safety across the healthcare
system
By April 2018, use of NEWS in all
care settings ,
Reduction in transfer
to ICU within 24
hours of ED admission,
reduction in mortality,
reduction in cardiac
arrest calls, reduce LOS, ( ???? Need
to agree)
17.
18. Develop teams improvement science knowledge and capability
19. Develop dashboard and use of measurement for improvement
Improve Improvement capability and culture
Possible Measures Do these work? Are there additional measures which would be better suited to your setting? Which are your top 5 or do we need more?
Process measures Outcome measures Balancing measures
NEWS score documented Critical care admission Staff satisfaction
Accuracy of NEWs score (Proportion
accurately recorded)
Rate of inappropriate admission to
hospital
Outreach staff workloads
Proportion of high/changing NEWs that
elicit an appropriate response
Cardiac arrest (In/out hospital)
Proportion of communications including
last NEWS score
Deaths associated with coding for sepsis
Time to review -medical review/GP
discussion/paramedic review
Length of stay
Time to escalation decision OR senior
review
MET calls
Time to or proportion with documented
medication review
RRT for AKI
Time to screening tool completion
(Sepsis, AKI, delirium)
Proportion where timely and
appropriate EoL review undertaken
Measures
Type of measure:
Outcome Measures The impact/result of the work you are trying to achieve – (my final weight/dress size) Process Measures Are the processes performing as planned ?– (eating less/exercising more) Balancing Measures Are the changes designed to improve causing new problems? (am I starving myself and fainting/feeling ill?)
Things to think about:
• Not sector specific
• Important to clinicians
• Practical (can be elicited with available resources)
• Purposeful