Luton and BedfordshireQuality Improvement

LaunchJoin the online discussion and tweet your thoughts or ideas using the hashtag #QIConfFollow us on @ELFT_QI

• Fire Exits• Tea-break• Lunch• Slido

House-keeping

Welcome

John WilkinsDeputy CEO & Managing Director

for Bedfordshire and Luton

Dr. Richard EvansDeputy Medical Director

What’s coming up this morning?

All about

Let’s join the conference in East London

Back to Bedfordshire

What is QI?

Dr Zelpha KittlerClinical Director, Bedfordshire

Institute of Medicine, Crossing the Quality Chasm: A New Health

System for the 21st Century, 2001

What is Quality?

Why does Quality matter?

Our core purpose for existing

Of greatest importance to our patients, carers, staff, GPs and all our stakeholders

Poor quality costs

Provides a clear long-term focus – guiding decision-making, investment, organisation

Where do we want to get to?

Working in partnership with patients and carers to continuously improve

Empowering front-line staff to innovate and improve the care we

provide

Systematic ways of implementing change

and monitoring progress

Improve quality improvement capability

in our organisation

Continuous quality

improvement

Where do we want to get to?

How do we do QI?

A listening and learning organisation

Empowering staff to drive improvement

Increasing transparency and

openness

Re-balancing quality control, assurance and

improvement

Patients, carers and families at the heart of all

we do

The Culture we want to nurture

How are we planning to develop QI across

Luton & Bedfordshire?

Dr Farid JabbarClinical Director, Luton

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67.8

51.1

UCL

LCL

Incidents resulting in physical violence (Trust-wide, excluding Luton and Bedfordshire) - C Chart

No.

of Inc

iden

ts

TRUST WIDE VIOLENCE REDUCTION

25% reduction

AIM:To provide the highest

quality mental

health and community

care in England by

2020

Build the will

Build improvement

capability

Alignment

QI Projects

1. Launch event & roadshows2. Microsite3. Using the power of narrative4. Celebrate successes5. Network of champions / ambassadors6. Learning events

1. Initial assessment of alignment & capability2. Recruiting central QI team3. Online training4. Face-to-face training5. Follow-up coaching on projects6. Develop in-house training for 2016 onwards

1. Align all projects with improvement aims2. Align team / service goals with improvement aims3. Align all corporate and support systems4. Patient and carer involvement in all improvement

work5. Embed improvement within management structures

Reducing Harm by 30% every year1. Reduce harm from inpatient violence2. Reduce harm from falls3. Reduce harm from pressure ulcers4. Reduce harm from medication errors5. Reduce harm from restraints

Right care, right place, right time1. Improving patient and carer experience2. Reliable delivery of evidence-based care3. Reducing delays and inefficiencies in the system4. Improving access to care at the right location

How do we drive improvement?

Culture change – from managing performance to supporting quality improvement

Leadership

Invest in our people - provide our staff with the skills and space to make improvements

Innovate - Small-scale change led by front-line staff with short cycles of change to keep momentum

Spread what works

How do we align QI projects to the overall Aims?

The Tennis Ball Game

Break out Exercise

At your table: How many people are at your table?

6, 7, 8, 9 or 10

Assign a time keeper

Assign a number to each of the other people at your table, starting with the number 1 and continuing until you run out of people

Break out Exercise

Your current process involves tossing a tennis ball from person to person, following the sequence provided on the next slide

Practise your process one time

Time keeper - please time how long the team takes to complete the process (in seconds)

6 people

7 people8 people

9 people

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5

Break out Exercise

Team Aim: To reduce the time taken for every person to touch the ballCome up with change ideas and try them out

Rules: • The initial sequence as provided must be adhered to• You may only test one change idea at a time• You have 4 minutes to test out different change ideas

to achieve your aim

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7 people8 people

9 people

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Knew your aim and worked together to…• Think of a few different ways of doing it• Tested out the approaches• And you learned…

What worked well and perhaps what didn’t too!

You’ve just done some PDSAs!

Reducing Harm and Developing the Right Care in

Right Place at the Right TimeQI In Luton & Bedfordshire

Ishrat Love-ChowdhuryQI Lead

“…Using data, we can determine what care is working well and what needs to be improved, allowing patients, clinicians and commissioners to <see>

the quality and efficiency of care…”

Chief Data OfficerNHS England

0

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800

0%

10%

20%

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669

283

182 168133 128

89 86 80 80 6949 46 45 42 35 26 25 21 17 15 14 13 12 12 9 9 9 4 3 2 1 1 1

80%

Frequency

%Pareto Analysis Luton & Bedfordshire

incidents

Violence

or Agg

ressio

n

Absence

without le

ave

Clinica

l condition or P

hysical

Frailt

y

Treatm

ent /

Procedure

Breach of S

ecurity

Propoert

y Dam

age

Medica

tion Error

Unexpect

ed Dete

riorati

on

Health an

d Safet

y

Dange

rence

Occurre

nce

Informati

on Governan

ce

Access

or Tran

sition

Clinica

l Risk

Assessm

ent is

sue

HR / Comms /

Estat

esLeg

al

Death of S

ervice

User

Finan

cial

Psychologic

al

Acciden

t

Governan

ce

Safeg

uarding

Pressure

Ulcers

Occupati

onal Hea

lth

Investiga

tions / Te

sts

Medica

l Devi

ce / E

quipment

Neglect

Death of C

hild

Diagnosti

c issue

Domestic V

iolence

Instituitional

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600

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100%

120%

551

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9078

58 5746 44

31 26 24 23 20 20 20 17 11 11 9 8 7 5 4 2 2 2 1 1 1 1

80%

Frequency

%

Pareto Analysis Luton incidents

0

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325

127

96

6355

43 40 3831 26 23 23 22 20 19 18 17 17 15 14 12 12 11 5 4 4 1 1 1

80%

Frequency %

Pareto Analysis Bedfordshire incidents

REDUCE HARM BY 30%

EVERY YEAR

RIGHT CARE, RIGHT PLACE, RIGHT TIME

QI Work in East London on

Violence and aggression

Globe ward

Designed and developed the Safety Culture Bundle of interventions throughout 2015Used on 4 acute wards with some success on PICUsShared bundle includes:• Safety huddles• Broset Violence Checklist• Safety Crosses• Safety discussion in ward

community meetings

Tower Hamlets Violence Collaborative

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No.

of I

ncid

ents

per

100

0 O

BD

MHCOP service

Tower Hamlets collaborative

REDUCE HARM BY 30%

EVERY YEAR

RIGHT CARE, RIGHT PLACE, RIGHT TIME

QI Work in East London on

Improving Access

Newham Child and Family Consultant Service

Front Door QI Project

Driver diagram

To reduce waiting times for CFCS from 11weeks to 9 weeks

by April 2015 and improve the patient

experience of referral to CFCS as demonstrated by

increased attendance at first

appointment

Referral Processes

Define Admin process for handling referrals

Define standards from CAMHS clinicians in liaison

activity with referrers

Streamlining referral processes

Identify and use onward pathways for cases diverted

from CFCS

Demand Management

Information provided to referrers about CFCS

Checklists/ Screening tools for referrers

Awareness events

Signposting to alternative services

Limited Capacity

Increase proportion of telephone consultation time

Workload balancing

Broaden interventions Develop self help materials

Standardise liaison activity with referrers

Develop telephone screening protocol for families

Develop welcome call to families accepted to CAMHS prior to

appt

Develop library of easily accessible self-help materials

Screening checklists for GPs/referrers

Review and rationalise info sent to families

Develop knowledge about alternative services in

community / ‘secret shopper’ users.

Review and develop administrative systems for

referrals

AIM PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS

A PS D

A PS D

A PS DD S

P A

DATA

FEEDBACK

TO FRONTLINE

STAFF:

Compliance

w PVC check

D SP A

Cycle 1: Collect baseline data on current referral process

Cycle 2: Standardize triage assessment script

Cycle 4: Pilot triage (‘Front door’) service

Cycle 3: Develop self-help library and local service database

Sequence of PDSA’s – for one change idea or secondary driver

Cycle 5: Using interpreters

A PS D

A PS D

A PS DD S

P A

DATA

FEEDBACK

TO FRONTLINE

STAFF:

Compliance

w PVC check

Cycle 6: : Drop-in appointments

Cycle 7: Pilot combined DLC & ‘front door’ role

Cycle 9:Implement the full ‘front door’ service

Cycle 8: Align referral admin with ‘front door’ service

Sequence of PDSA’s – for one change idea or secondary driver

(cont.)

OU

TCO

ME

MEA

SURE

SImproving Access Collaborative – CAMHS Newham CFCS Front Door ServiceMarch 2016

BALA

NCI

NG

MEA

SURE

S- Baseline data

Jan-

14

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-14

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-14

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48.8

UCL

LCL

Average waiting time from referral to 1st face to face appt (NH CAMHS) - X-bar ChartA

vera

ge W

aitin

g Ti

me

/ Day

s

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144.1

UCL

LCL

No. of referrals received (NH CAMHS) - I Chart

No.

of R

efer

rals

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14Fe

b-14

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16Fe

b-16

5%

10%

15%

20%

25%

30%

35%

40%

45%

28.54%

20.58%

UCL

LCL

% of 1st face to face appt DNAs (NH CAMHS) - P Chart

DN

A /

%

REDUCE HARM BY 30%

EVERY YEAR

RIGHT CARE, RIGHT PLACE, RIGHT TIME

QI Work in East London on

Improving Physical Health

AIM:

Reduce cardiovascular

risk for all adults and children for

whom we initiate or change

psychotropic medication

Information provision

Minimum standards & checks

Pods for community settings

Assessment

Health promotion (exercise, diet, education)

Smoking cessation

Involvement in all QI areas

Monitoring

Communication between services

Improving physical health

collaborative;Driver Diagram

Overview

Leadership

Prescribing

3. Measuring and Reporting• Template development: define

scope, data, spec• Reports & dashboards

1. Equipment

2. Assessment & monitoring

3. Intervention

4. Service user & staff engagement

Infrastructure

AOS

Sapphire ward

Luton & Bedfordshire Looking at data over time…

How has QI impacted on staff?

2010 2011 2012 2013 2014 201555

60

65

70

75

80

85

90 Staff able to contribute towards improvements at work

Scor

e (%

)

2010 2011 2012 2013 2014 20153.5

3.6

3.7

3.8

3.9

4

4.1

4.2 Staff Motivation to Work

Scor

e

2010 2011 2012 2013 2014 20153.3

3.4

3.5

3.6

3.7

3.8

3.9

4

4.1 Staff job satisfaction

Scor

e

2010 2011 2012 2013 2014 20153.5

3.6

3.7

3.8

3.9

4

Overall Engagement ScoreELFT ScoreNational Median

Scor

e

Let’s hear from some of the staff and patients in East London about what kind of impact QI has made…

Tea break15mins

…Take a look at the posters on display

Running QI Projects within a supported

environment

Running a QI Project

Neil LadStaff Nurse, Onyx ward

Being a QI Coach and supporting projects

Jamie StaffordClinical Nurse Manager

Jade ward PICU

Next up for QI Luton & Beds

Ishrat Love-ChowdhuryQI Lead

Area Project

Luton To ensure Physical Health Needs & Risk Assessment are completed for all admissions

Luton To improve Patient Safety and Follow-up discharge

Bedfordshire Reducing waiting times in Bedfordshire’s East and West CMHTs

Bedfordshire Improving Outcomes

Bedfordshire Embedding a system of practice audit

Bedfordshire Provision of synchronised and high quality reporting

Other initial QI Projects

Learn more about QI April – August 2016

• General QI Roadshows• Service / Team sessions• Preparatory Workshops

All the details will be on the Microsite as more dates are confirmed www.qi.elft.nhs.uk

Date: Service:23rd March 2016 Ash Ward Away-day30th March 2016 Keats Ward Away-day25th April 2016 General QI Roadshow 127th April 2016 Coral Ward Away-day27th April 2016 Fountains Court Away-day26th May 2016 General QI Roadshow 24th July 2016 General QI Roadshow 3July 2016 Psychiatric Liaison ServicesJuly 2016 Jade Ward PICUJuly 2016 Older People’s Services July 2016 Bedfordshire All Community Services Away-day6th Sept 2016 Bedfordshire Well-being Service Away-DayEarly July 2016 CAMHS August 2016 Learning Disabilities

And we’ll be coming to meet your teams..Please check on www.qi.elft.nhs.uk for all confirmed dates and venues…

Prework Workshop9/29-10/1

Webex 110/14

Webex 211/2

Supports:• Listserve• Assignments

AP-1 AP-2Webex 3

11/30AP-3

ProjectPlanning Reliability Sustaining

Gains

Workshop

(3 days)

Webex #2Webex #1

• Faculty consults• Webex calls• Coaching calls

Webex #3 Learning Set 2 &

graduation

AP-5AP-4

The two learning sets will be focused on sharing the participants’ work on their projects and learning from each other. These sessions also will reinforce the

content from the Webex calls and the ISIA workshop.

Learning set 1

Improvement Science in Action6 Month Learning Path

Service User Input

Support around every team

Project Sponsor QI Coach

QI Forums

QI Team

www.qi.elft.nhs.uk

qi@eastlondon.nhs.uk

@ELFT_QI

Let’s re-join the conference inEast London

Back to Bedfordshire

We’re Quality Improving…”

• Lunch available• Posters• Drop-in session

Wrap up

The ELFT

Has now launched in Luton and Bedfordshire!