4.2 hqa making it happen - progress - nhs highland€¦ · governance standard and the staff...

Highland NHS Board13 August 2013

Item 4.2

THE HIGHLAND QUALITY APPROACH – MAKING IT HAPPEN – PROGRESS TO DATE

Report by Linda Kirkland, Director of Quality Improvement

The Board is asked to:

Note the update of work in progress.

1. Executive Summary

In April and June 2013, the Board received formal Board papers on the next steps for the HighlandQuality Approach and;

Agreed the final visual representation of the Strategic Framework and its use and

circulation.

Endorsed the requirement to make a step change on our improvement journey to fully

embed the Highland Quality Approach.

Agreed the priority areas for Rapid Process Improvement Workshops and other quality

improvement in 2013/14.

Approved In April and noted in June the recruitment to the post of Director of Quality

Improvement.

Note the plan to utilise existing resource of £968K available in 2013/14 n a more focused

way and to approve the funding of £278K of additional resource for 2013/14.

Heard about the content and format for Lean Leader Training.

Noted the next steps to be taken in relation to the development of a Physicians/Staff

Compact.

This paper is an update on progress since June and details of next steps to be taken.

2. The Highland Quality Approach – Making it Happen

The 3 areas encompassed within the Highland Quality approach of Leadership and Culture (who),Focus and Delivery (what) and Improvement Methodology (how) have all been progressed sinceApril and a programme for implementation is underway.

2.1 Leadership and Culture (Who)

The NHS Highland Quality Hub is beginning to emerge and a number of staff are now activelyengaged in supporting on a variety of quality improvement initiatives and projects.

The establishment of the Hub and the Quality Improvement Work plan is detailed in the attachedImplementation Plan (Quality and Efficiency Funding Allocations 2013/2014). Recruitment to thepost of Senior Quality Improvement Lead (SPSP) is complete and Maryanne Gillies is confirmed inpost. The Senior Quality Improvement Lead (Lean) is being advertised at present.

The Quality Hub is jointly led by the Director of Quality Improvement, Linda Kirkland, Consultant inPublic Health, Dr Cameron Stark and Board Medical Director, Dr Ian Bashford.

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2.1.1 Values and Value Based Behaviour

One of the strategies within the strategic framework (see below) is “Care” (we create a caringexperience) and this is also one of the values. Care and compassion has been the subject ofrecent reports such as Francis on the Mid Staffordshire Foundation Trust. NHS Highland like allother boards faces the challenge of how we ensure we deliver the strategy and live our values andbehave in a caring and compassionate manner

The methodology developed for customer care of creating team values, observing behaviours,reflecting back to the team on how their behaviours align with their values has been very powerfulin those team who have taken this forward. However much needs to be done in the share andspread of this across NHS Highland. It is becoming clear that this is one part of the “culturechange bundle” but it cannot be seen in isolation. The Older People and Acute Care (OPAC) workis taking forward a number of initiatives including addressing Care and Compassion as values andstrategies as laid down in the Strategic Framework. This together with the Person Centredcollaborative, the Staff Governance Standard, the Staff Experience work stream and the “GiveRespect, Get Respect” all need to be aligned with this work and this will be a key work stream forthe coming year

2.1.2 NHS Highland Quality Improvement Fellows

The learning we have gained from other organisations such as Virginia Mason has shown thatClinical leadership in its widest sense is crucial to the success of quality improvement. It is veryimportant that staff are engaged in quality improvement work and that we nurture staff who can

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lead quality improvement work, and influence views. We propose to have four NHS HighlandQuality Improvement Fellowships. These posts will be for two days a week for between one andtwo years depending on individual preference and circumstance. In the first instance we plan toappoint clinical staff to these posts because most quality improvement work is currently focused onclinical services, but extending the posts to cover non-clinical staff in due course may beappropriate.

The Fellowships will be advertised and subject to competitive appointment procedures. The postswill include:

Training as a certified Lean Leader

An appropriate training budget to allow book purchases and relevant site visits

The opportunity to contribute to, and then lead improvement projects within NHS Highland

Playing a key role in the development of a physician compact (see below).

Publishing their work where appropriate, and to present work at relevant conferences and

meetings.

All posts will be secondments, and both the applicant and their manager will be expected tocommit to leading work on quality within their own service once their Fellowship is complete.

2.1.3 Physician Compact

Doctors play a key role in the delivery of health care. Work on high performing health careorganisations in the United States has found that one of the common features of organisations thatdelivery high quality services are the existence of physician compacts. These are agreementsstate what doctors can expect of the organisation in which they work, and what expectations theorganisation has of them.

The documents are social contracts that make values explicit, rather than a legally enforceablecontract. They are, however, helpful to doctors in deciding if the values are those of anorganisation in which they would be willing to work, and to the wider organisation in makingexpectations and support requirements for doctors clear.

Discussion with staff side representatives indicates that frameworks including the StaffGovernance Standard and the Staff Experience work has the potential to deliver this for other staff.General Practitioners are subject to different contractual arrangements, but may be interested inthe content of a compact with hospital doctors.

At the present time hospital doctors are engaged in hospital management in many ways, includingthe department and Clinical Directorate structure. This reflects a view of leadership as beingconcentrated in particular posts. Department heads and Clinical Directors have an important role,but recent work suggests that clinical leadership is a more diffuse function, and that staff at manylevels can provide leadership in their role. Doctors are in a powerful position to do this, and sowider engagement of doctors in quality improvement work is particularly important.

Advice from other areas which have created Physician Compacts is that the process of developingthe compact provides much of the value. It must be inclusive, measured and methodical. Methodsin other services have included large group meetings; working groups, focus groups, andengagement and other dissemination methods that feed developing work back to the larger body ofdoctors.

We will seek the advice of the Associate Medical Directors on the best methods of initialengagement with their medical colleagues. The methods agreed will then depend on the feedbackfrom the wider group of employed doctors. Experience in other areas indicated that the process ofagreeing a compact can take some considerable time. It is important, however, that all doctors feelthat they have had a chance to be involved and for their views to be heard.

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2.2 Focus and Delivery (What)

Appendix 1 & 2 is a draft plan which has been submitted to Scottish Government Quality andEfficiency support team as a bid for our funding for 2013/14, Appendix 1 represents a high levelwork plan for the coming year and embraces the Quality Improvement work being undertakenusing all of the methodologies (Lean/SPSP/Productive series). Appendix 2 is the timetable ofRapid Process Improvement Work streams planned for this year. The plan is work in process andis evolving, the attached being a snapshot in time, however the plan will be updated and can befound on the intranet here http://intranet.nhsh.scot.nhs.uk/HQA/Focus/Pages/Default.aspx (qualityand efficiency strategy)

2.3 Methodology (How)

NHS Highland uses the model for improvement as the framework to guide improvement work.(See below) It is important that we do not lose the integrity of any of the quality improvementmethodology; however it is also important that we have a common language and reportingmechanism. This is a key part of the evolving and emerging Highland Quality ImprovementSystem.

What are wetrying to

accomplish?

How will weknow that achange is

improvement?

What changescan we make

that will result inimprovement?

Plan

DoStudy

Act

http://intranet.nhsh.scot.nhs.uk/HQA/Focus/Pages/Default.aspx

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Scottish Patient Safety Programme (SPSP) has been operational within NHS Highland for anumber of years. The programme has been overseen by local Operational SPSP Meetings andBoard wide Leadership Group which meets monthly. The Leadership Group chaired by the BoardMedical Director reviews performance and guides continuous improvement. Latterly the group hasevolved to embrace the additional aspects of SPSP (maternity, paediatric, neonatal, mental healthand primary care) and to the guidance of the share and spread of the improvement model.

The governance of Productive Series and the Lean work is not as well developed. The ProductiveSeries reports through the Nursing, Midwifery and AHP Directorate and the Lean work through aseries of Report Outs in the Operational Units and Corporate Services.

It is timely with the creation of the Quality Improvement Directorate to review this and learn fromthe success of the SPSP Leadership Group. It is therefore proposed to establish the HighlandQuality Approach Leadership Group which will oversee and provide governance across all of theQuality Improvement Work.

As part of this work the HQA Charter database is being further developed to enable run charts tobe produced on an ongoing basis and this will be a major method in reporting progress

3. Share and Spread

The Director General, Derek Feeley and Clinical Director, Jason Leitch for NHS Scotland visitedNHS Highland in mid July. The opportunity was taken to display both to them and to each otherexamples of the Quality Improvement work underway in NHS Highland and in partnership with TheHighland Council. In the morning there was an impressive breadth and spread of posters includingDementia Champions, Older Peoples care, Values and Value based Behaviour, Preventativespend and Scottish Patient Safety Programme. They then visited the RNI Hospital, York DayHospital and Mackenzie Day Centre to see and hear at first hand, the different approach beingtaken to improve services for patients and clients.

The day was a great success and it led to discussion about how NHS Highland could be positionedto support NHS Scotland in some of the training and development in Quality Improvement and topossible collaboration with the Institute of Health Improvement in Boston. Support for thechallenge to share and spread improvement has been offered both by the visitors (Jason andDerek) and by NHS Highland. All of this will be key areas for development over the coming year.

4. Continuous Learning

The Board is aware and has supported the approach taken of visiting and collaborating with a widerange of organisations who have had a successful impact of change and quality improvement tohelp learn from test our approach to large scale redesign. This work has also been important tohighlight areas where we are further ahead in our thinking, strategy and implementation. Wecontinue to seek learning from those at the forefront of quality. Our partnership with VirginiaMason Medical Centre in Seattle and Tees, Esk and Wear Valley NHS foundation Trust have beenreported on many occasions to the Board. We are now in discussions with South CentralFoundation in Alaska and are exploring the model they have developed of “Nuka” which boils downto some basic ideas. The relationships are key to healthcare, that patient care should beintegrated, there should be same day access to primary care, customer-owners are partners intheir own health care and there should be ample opportunity to offer advice and feedback. And tomake all of this happen, there should be a culture where training and retraining is valued. Nukaand the model accords very well with the Highland Quality approach, and they deliver this in a veryremote and rural area

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5. Contribution to Board Objectives

This report contributes to achieving all the specific objectives of NHS Highland through the furtherdevelopment and implementation of the Highland Quality Approach.

6. Governance Implications

Staff Governance – The Lean Methodology fully engages and empowers staff in all qualityimprovement activities. The development of a proactive programme to ensure all staff aredeveloped into new roles as appropriate will also be developed.

Patient and Public Involvement – Patients and the Public have been and will continue tobe actively engaged in quality improvement work.

Clinical Governance – The provision of safe, effective, high quality services isfundamental to delivering the Highland Quality Approach.

Financial Impact – There are no Financial implications.

7. Risk Assessment – Priorities for Quality Improvement work will link with the CorporateRisk Register.

8. Planning for Fairness – The Board Paper on the Equalities Act demonstrates howpromoting Equality is very much part of the Highland Quality Approach.

9. Engagement and CommunicationSignificant engagement and communication plans with staff regarding the Highland QualityApproach have already taken place and will continue.

Linda KirklandDirector of Quality Improvement

2 August 2013

APPENDIX 1

Quality and Efficiency Funding Allocation 2013 – 14

Quality and Efficiency Plan Returns

The NHS Highland Quality and Efficiency Plan is embedded within the Highland QualityApproach, which provides the framework for all delivery plans.

Highland Quality Approach

Since 2010, NHS Highland has been developing and fully embedding the Highland QualityApproach (HQA) as part of the NHS Highland Strategic Framework and ensuring that wetransform the way we design and deliver safe, effective and person centred services. This isan ambitious goal, but one the Board believes is critical in ensuring that quality health andsocial care services are sustainable into the future.

Changing demographics, advances in technology, increasing expectations of the people weserve, the challenging economic circumstances and the accelerated pace of change allserve to drive the need for transformational organisational change.

The key elements of our Strategic Framework are summarised in our Strategic Triangle.

1. Please provide the strategic narrative which links specific projects to an overall

Board plan for CQI capacity and capability

NHS Highland

Lead Contact;

Linda Kirkland, Director of Quality Improvement

2

The Strategic Triangle is designed to place the individual at the top, with everything else we

do supporting the person. In developing our approach we have drawn from the best learning

we could find. In particular, the key elements summarised in the Strategic Triangle are

adopted from Virginia Mason Medical Centre. The foundation of the Strategic Triangle is the

Highland Quality Approach which describes “the way we do things in Highland”

The Highland Quality Approach is based on 3 fundamentals

Culture and Leadership (who) Focus and Delivery (what) Improvement Science Methodology (how)

Funding from Quest has supported and continues to support all 3 elements of the approach

and in particular in building capacity and capability for quality improvement.

We have clear evidence to support us in determining what we need to do, how we need todo it and how we can make it happen. To achieve our goals and for every member of ourstaff to understand and live the Highland Quality Approach, we now need to refocus ourexisting resources and invest further in our infrastructure, to ensure we set ourselves up for

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success – success that can be sustained overtime and transform the way our organisationruns its business.

The shift in emphasis away from the general nature of the allocation towards a much greater

priority and accountability for the deployment of resources to support delivery of improved

patient flow is welcomed, and in addition NHS Highland will continue to build capacity and

capability with the funding.

Strategic Context

A range of National Reports and Programmes of Work provide the strategic and policy

context for our Quality Improvement work and support the direction of travel and the

development of the Highland Quality Approach including;

1. The Scottish Government’s 20:20 Vision

The HQA aligns with the Route Map for 2020 vision and a number of the priority areas

are supported by the Quest funding (highlighted below)

2 NHS Scotland Healthcare Quality Strategy 2010

2020

Vision

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

Triple aim

Quality

Outcomes

Quality of

Care

Quality of

Care

Quality of

Care

Healthier

living

Effective

resource use

Independent

living

Services are

safe

Engaged

workforce

Positive

experiences

Priority Areas

1. Person-centred care 7. Early Years

2. Safe Care 8. Health Inequalities

3. Primary Care 9. Prevention

4. Unscheduled and Emergency Care 10. Workforce

5. Integrated Care 11. Innovation

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The Strategy identifies three Quality Ambitions – Safe, Effective and Person-CentredCare, with quality improvement and people at the heart of all that we do. The QualityStrategy builds on the significant progress made in improving healthcare over the lastfew years in terms of:

Reducing waiting times Improving access in Primary Care and for Dental treatment Healthcare and support for people with long term conditions Better outcomes for people with Cancer, Stroke, Heart Disease and Diabetes

3. The National Person-Centred Health and Care Programme.

4. Values, Behaviours & Customer Care.

5 The Francis Report 2013.

6 Performance, Improvement and Co-productionDerek Feeley, Director General Health and Social Care and Chief Executive of NHS

Scotland outlined at the 2012 NHS Scotland Event, his vision for ‘Getting to the third

curve’. The development of the Highland Quality Approach is NHS Highland’s

considered strategy and operational plan to take us through this process.

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Total funding received of £382,988.

Allocated as advised

47% Acute Flow £180,004

24% Mental Health £91,917

29% Capacity & Capability £111,016

The HQA is marbled through the NHS Highland Local Delivery Plans but the funding is

particularly supporting a number of quality improvement initiatives which in turn will support

achievement of several access targets (highlighted in key delivery risk section).

1. Deliver faster access to mental health services by delivering 26 weeks referral totreatment for specialist Child and Adolescent Mental Health Services (CAMHS) fromMarch 2013; reducing to 18 weeks by December 2014; and 18 weeks referral totreatment for Psychological Therapies from December 2014.

2. To deliver expected rates of dementia diagnosis and by 2015/16, all people newlydiagnosed with dementia will have a minimum of a year’s worth of post diagnosissupport co-ordinated by a link worker, including the building of a person-centredsupport plan.

3. Reduce the rate of emergency inpatient bed days for people aged 75 and over per1,000 population, by at least 12% between 2009/10 and 2014/15.

4. No people will wait more than 28 days to be discharged from hospital into a moreappropriate care setting, once treatment is complete from April 2013, followed by a14 day maximum wait from April 2015.

2. Please provide Information on the proposed split of the allocation between the key

priority areas, highlighting which of your key delivery risks, such as those outlined in

your LDP, this funding will support you to address. (For the mental health access

targets please cross reference to the HEAT Self-Assessment Risk Returns. For the

acute flow returns please cross reference to the relevant access targets and

standards.

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3. Proposals for the use of Quality and Efficiency Funding for 2013 / 14

Allocations area Specific

programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project

Give an outline of the

proposed approach to

internal communications,

governance and on-going

support for delivery

Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

Mental Health

(Psychological

services)

Deliver faster

access to mental

health services

by delivering 26

weeks referral to

treatment for

specialist Child

and Adolescent

Mental Health

Services

(CAMHS) from

March 2013;

reducing to 18

weeks by

December 2014;

and 18 weeks

referral to

treatment for

Psychological

Therapies from

December 2014

A small number of

patient records are

still held separately

in a standalone

database and

require to be

transferred into the

iSOFT system in

North Highland and

the Helix system in

Argyll & Bute

6 weeks of admin agency

backfill, to allow the work to

be completed in protected

time.

Mental Health Operational

Group oversees actions

which reports to Mental

Health Steering group

Waiting times access group

also oversees and reports

to Board Improvement

committee

All records will in

future be held on the

central PAS system

iSoft/Helix and

transferred to Patient

Management System

(PMS) later in the

year

LDP

Heat (mental health)

8


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

Psychological

Therapies HEAT

Target -

information.

Mental Health

(Psychological

services)

Deliver faster

access to mental

health services

by delivering 26

weeks referral to

treatment for

specialist Child

and Adolescent

Mental Health

Services

(CAMHS) from

March 2013;

reducing to 18

weeks by

December 2014;

and 18 weeks

referral to

treatment for

Psychological

Therapies from

December 2014

There is currently

no electronic

outcomes

measurement

within the

psychological

therapies services

in North Highland.

Each department

collects their own

paper-based

outcomes

measures but there

is no means of

collating these.

In Argyll and Bute

we are currently

implementing the

Core.net outcome

For North Highland

Employment of a fixed term,

full time Band 4 Clinical

Assistant. This post will

collate the currently

collected information then

pull all together onto a

database for use by all until

an electronic system is in

place.

For Argyll & Bute

Appointment of 1.0 WTE

Band 4 system

administrator for 6 months

to supervise the

implementation of the

system; assist clinicians

with setting up the system;

and dealing with early

implementation problems.

All records will in

future be held on the

central Patient

Management System

(PMS) later in the

year

LDP


9


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

Psychological

Therapies HEAT

Target - Outcome

Measurement.

measure tool. To

fully establish this

system there is a

need to appoint a

system

administrator for a

fixed term period

until the system is

fully operational

across the CHP








committee

Mental Health

(Psychological

services)

Deliver faster

access to mental

health services

by delivering 26

weeks referral to

treatment for

specialist Child

and Adolescent

Mental Health

Services

(CAMHS) from

March 2013;

reducing to 18

weeks by

December 2014;

and 18 weeks

Admin staff in the

clinical psychology

department in New

Craigs Hospital

spend a significant

amount of time

dealing with patient

appointments. As

a result they have

less time to support

clinical staff, who in

turn carry out their

own admin tasks,

thus impacting on

clinical availability.


full time Band 5 post to

work with the NHS Highland

Patient Focussed Booking

Team to introduce PFB into

the clinical psychology

department at New Craigs

Hospital.







Patient Focused

Booking was

established in NHS

Highland some time

ago and this is part f

the roll out of this

service to others

specialties

LDP


10


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

referral to

treatment for

Psychological

Therapies from

December 2014

Psychological

Therapies HEAT

target - admin

and clinical time


committee

Mental Health

(CAMHS)

Deliver faster

access to mental

health services

by delivering 26

weeks referral to

treatment for

specialist Child

and Adolescent

Mental Health

Services

(CAMHS) from

March 2013;

reducing to 18

weeks by

December 2014;

and 18 weeks

Additional admin

hours will assist in

ensuring reception

cover is in place

which allows the

Band 4 members

of the team to

utilise their skills

appropriately to

support the clinical

team as opposed

to using Band 4

hours to cover a

reception role.

Employment of a fixed term

Band 2 post for 10 hours

per week to supplement the

current admin team for

CAMHS.

Raigmore senior

management team

oversees actions and

reports to Waiting times

access group which in turn

reports to Board

Improvement committee

Mental Health

redesign is currently

being undertaken to

assess is more

appropriate skill mix

alignment can take p

lace to ensure that

this is not required on

a recurrent basis

without re provision

elsewhere

LDP


11


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

referral to

treatment for

Psychological

Therapies from

December 2014

CAMHS HEAT

Target

Mental Health

(CAMHS)

Deliver faster

access to mental

health services

by delivering 26

weeks referral to

treatment for

specialist Child

and Adolescent

Mental Health

Services

(CAMHS) from

March 2013;

reducing to 18

weeks by

December 2014;

and 18 weeks

referral to

treatment for

The Helensburgh

based CAMHS

team transferred to

NHS Highland from

NHS GG&C in

2012. Due to delay

in appointing to the

part time admin

posts there is a

significant backlog

of work in

transferring data on

to the helix system.

This work need to

be completed

before the move

across to trakcare/

PMS later in the

Employment of a 6 month

fixed term 0.5 WTE Band 2

post to supplement the

current part time secretary

for the Helensburgh

CAMHS team

Data held on helix will

be up to date prior to

the transfer to

trakcare/PMS

LDP


12


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

Psychological

Therapies from

December 2014

CAMHS HEAT

Target

year.

Mental Health

(CAMHS)

Deliver faster

access to mental

health services

by delivering 26

weeks referral to

treatment for

specialist Child

and Adolescent

Mental Health

Services

(CAMHS) from

March 2013;

reducing to 18

weeks by

December 2014;

and 18 weeks

referral to

treatment for

Psychological

Therapies from

Each of the

CAMHS teams in

Argyll & Bute,

based in

Helensburgh and

Lochgilphead, have

1 secretary to

support the teams.

As a result of the

transfer from Helix

to Trakcare/PMS

later this year,

there is expected

to be a period of

increased demand

on those staff as

data is migrated

across resulting in

a loss of direct

admin support for

Employment of 2 x 6 month

fixed term 0.5WTE Band 2

Admin posts to supplement

the current CAMHS

secretaries in Lochgilphead

and Helensburgh

This will mitigate the

reduced availability of

admin support to the

teams during the data

migration ensuring

that clinical staff can

focus on direct patient

care without the need

to undertake

additional admin

duties

LDP


13


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

December 2014

CAMHS HEAT

Target

the clinical staff.

This in turn will

result in clinical

staff spending

more time on

admin duties rather

than on direct

patient contact.

Mental Health

(CAMHS)

Deliver faster

access to mental

health services

by delivering 26

weeks referral to

treatment for

specialist Child

and Adolescent

Mental Health

Services

(CAMHS) from

March 2013;

reducing to 18

weeks by

December 2014;

and 18 weeks

referral to

treatment for

0.5 WTE Band 4

admin hours are

required to backfill

similar within the

CAMHS Team to

allow work which

has been

discussed to be

progressed around

quality

improvement work

which will improve

processes for the

admin team which

will have an impact

on the clinical

team. Without

backfill we are not

Employment of a fixed term

0.5WTE Band 4 Admin post

to supplement the current

CAMHS admin team.

Raigmore senior

management team

oversees actions and

reports to Waiting times

access group which in turn

reports to Board

Improvement committee

Mental Health

redesign is currently

being undertaken to

assess is more

appropriate skill mix

alignment can take p

place to ensure that

this is not required on

a recurrent basis

without re provision

elsewhere

LDP


14


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

Psychological

Therapies from

December 2014

CAMHS HEAT

Target

in a position to

progress the work

we have

discussed.

Mental Health

(CAMHS &,

Psychological

services)

Deliver faster

access to mental

health services

by delivering 26

weeks referral to

treatment for

specialist Child

and Adolescent

Mental Health

Services

(CAMHS) from

March 2013;

reducing to 18

weeks by

December 2014;

and 18 weeks

referral to

treatment for

Psychological

Therapies from

Both CAMHS and

Psychological

Therapies in North

Highland are

planning to start, or

continue existing

DCAQ, LEAN and

other service

improvement work.

This work will have

a natural link to the

SPSP MH

Programme in

terms of reduction

in risk by

streamlining patient

flow.


full time Band 5 post shared

between CAMHS and Adult

Psychological Therapies to

facilitate LEAN/KAIZEN

events for both services in

tandem with the planned

DCAQ in Psychological

therapies








committee

Building capacity and

capability for quality

improvement in the

services is a key part

of the Highland

Quality Approach.

This post is short term

funding to enable

training and

development to be

undertaken

LDP


HQA Improvement

Science

Methodology

Patient centred care

15


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

December 2014

Psychological

Therapies and

CAMHS HEAT

Targets -

efficiency and

productivity;

SPSP MH

Programme

General

Capacity and

Capability

Building

Highland Quality

Approach

(Leadership &

Culture)

Leading the way

workshops

Cultural shift,

Training and

Communication

across all NHS

Highland

managers

Development and roll out of

standard workshop

HQA leadership group

oversees and reports to

NHS H Board

Building awareness,

capacity and


improvement in the


of the Highland

Quality Approach.

Reduce harm, waste

and managing

variation

General

Capacity and

Capability

Building

Highland Quality

Approach

(Leadership &

Culture)

"Beauly Porter"

training for all

staff

Cultural shift,

Training and

Communication

across ALL NHS

Highland staff

Development and roll out of

standard training

programme



NHS H Board

Building awareness,

capacity and


improvement in the


of the Highland

Quality Approach.

HQA

Leadership &

Culture, workforce

development.

Reduce harm, waste

and managing

variation

16


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

General

Capacity and

Capability

Building

Mental Health

Acute Flow

Highland Quality

Approach

(Leadership &

Culture

Improvement

Science

Methodology &

Focus &

Delivery)

Development of

Quality Hub

(corporate

services)

Concentrated focus

on delivery of key

quality

improvement

initiatives

embracing the

whole

Significant learning has

been gained over the past

12 months, following visits

to Virginia Mason Medical

Centre and to Tees, Esk

and Wear Valleys NHS

Foundation Trust and it is

now clear that a different

approach is required.

Departments within

corporate support functions

including Public Health,

eHealth, Planning, Finance,

HR, Research and

Development, Clinical

Advisory Group, Risk

Management and Clinical

Governance will now be

asked to provide dedicated

resource to ensure that

specialist skills and

expertise is made available

to deliver successful

change and service

improvement.


HQA database is

established for all

Quality Improvement

work. Managed by

each of the

operational units.

Evidence from

previous Quality

improvement work

has shown that

informal

arrangements

receiving support from

corporate functions

such as E health and

Public Health work

well but are

dependent on a

degree of goodwill

and networks.

Establishment of the

Quality Hub mirrors

that of the National

Quality Hub and

allows a more formal,

dedicated

Reduce harm, waste

and managing

variation


Safe working

17


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link


NHS H Board

arrangement to be

developed this

encouraging a

“standard work “

approach to the

quality improvement

work

General

Capacity and

Capability

Building

Highland Quality

Approach

(Leadership &

Culture

Improvement

Science

Methodology &

Focus &

Delivery)

Development of

Quality Hub

(clinical fellows)

Clinical

engagement and

leadership of

Quality

Improvement

Initiatives

In addition a critical key to

success is the provision of

overall Clinical Leadership

for the Quality Hub and

dedicated clinical leadership

resource is now required.

Funding from existing

resources in the form of a

Public Health Clinical Lead

has now been confirmed.

To enhance clinical

engagement and leadership

and appropriate challenge

more widely however, it is

proposed to establish a

Clinical Fellowship

Programme which will

comprise of 4 clinicians with

a dedicated 2 days per

There is significant

evidence that strong

Clinical leadership is

key to implementation

and sustaining of

quality improvement

Our strong links with

Virginia mason and

Tees Esk and wear

valley have also

shown us the benefit

of a physician and

clinical compact in

shifting culture from

performance, through

improvement and on

to co production

Reduce harm, waste

and managing

variation


Safe working

18


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

week to the Quality Hub.

Recruitment for these posts

will be for 1-2 years and it is

hoped that this will be

recognised as a prestigious

post for clinicians to hold.

In addition work on

developing a

Physicians/Staff Compact

needs to be progressed to

ensure that our staff are

fully engaged in the quality

improvement agenda

moving forward.



NHS H Board

General

Capacity and

Capability

Building

Highland Quality

Approach

(Leadership &

Culture

Improvement

Science

Methodology &

Focus &

Building stable

infrastructure for

Quality

Improvement

leadership and

support

At the centre of the Quality

Hub will be the Quality

Improvement Office,

(currently the Quality

Improvement Support

Team), led and managed by

the Director of Quality

Improvement and staffed by

This is a stepped

change for NHS

Highland and a key

part of our work is in

now building capacity

and capability for all

improvement

methodologies within

Reduce harm, waste

and managing

variation


Safe working

19


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

Delivery)

Development of

Quality Hub

(Quality

Improvement

Office)

a number of Senior Quality

Improvement practitioners

(3 x Band 8a), Quality

Improvement Practitioners

(3.6 x Band 7), Trainee

Quality Improvement

Practitioner (1 x Band 6)

and Administrative support

(1.5 x Band 3). It is

anticipated that the posts

will support all of the Quality

Improvement

Methodologies. However

dedicated support for SPSP

will continue and the

Programme will benefit from

the overall enhancement of

resources.



NHS H Board

NHS Highland. The

team will provide

leadership, training

and development and

will ensure through a

process of mentorship

and training that the

skills are cascaded

General

Capacity and

Capability

Highland Quality

Approach

(Leadership &

Culture

Building stable

infrastructure for

Quality

Improvement

A programme of coaching,

training and experiential

learning has been

developed and

Reduce harm, waste

and managing

variation

20


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

Building Improvement

Science

Methodology &

Focus &

Delivery)

Development of

Quality Hub

(Quality

Improvement

Bench)

leadership and

support

implemented to build

internal capacity and

capability for Quality

Improvement within NHS

Highland. To assist with

this the NHS Highland

Bench which was

established two years ago

and brought together a

number of staff with

expertise, energy and some

time to work on allocated

quality improvement

projects will be

reinvigorated. This will

ensure that the quality

improvement process and

systems are embedded and

sustained within NHS

Highland. The intention is

that all staff will have some

training and Quality

Improvement experience;

however learning from other

organisations has shown

that there are two phases to


21


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

this cultural shift. ·

· Awareness raising

and engagement and

Standard Implementation.

Having focussed primarily

on awareness raising and

the engagement phase, we

now need to move to the

standard implementation

phase.



NHS H Board

General

Capacity and

Capability

Building

Acute Flow

Mental Health

Highland Quality

Approach

(Leadership &

Culture

Improvement

Science

Methodology &

Focus &

Delivery)

Spread and

Sustain Scottish

Building stable

infrastructure for

Quality

Improvement

leadership and

support

The Scottish Patient

Safety Programme (SPSP)

started in 2008 and is

currently bringing about a

range of local

improvements, including

dedicated initiatives relating

to sepsis, primary care,

paediatric care, mental

health and maternity care.

The aim is to deliver an

integrated and sustained

NHS Highland has a

strong and positive

history with SPSP.

The programme is

being rolled out to

include Mental Health,

Primary care,

Maternity, paediatric

and neonatal care and

Community hospital,

as well as continuing

Reduce harm, waste

and managing

variation


Safe working

Primary care

Integrated working

Unscheduled and

22


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

Patient Safety

Programme

programme for patient

safety improvement that will

support boards across all

the key initiatives and in line

with Scottish Government

ambitions. The SPSP is

being implemented in every

acute hospital in the

country. The initial goals

were to drive improvements

in leadership, critical care,

medicines management

and peri-operative care.

The SPSP is now well

embedded in NHS Highland

and the Board have been

sighted on the success and

the challenges. The

programme is rolling out

over all sites and is

extending to other clinical

areas in including Maternity

Services and General

Practice. The enhancement

of resource in the Quality

Hub and particularly in the

with the Acute phase

1 and phase 2 and

early years

collaborative. All

programmes are

being brought under

the HQA leadership

group, reporting to the

Board and developing

Board dashboards to

ensure governance,

visibility and

continuous

improvement are

maintained

emergency care

23


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

Quality Improvement office

will support the roll out of

the SPSP.



NHS H Board

General

Capacity and

Capability

Building

Acute Flow

Mental Health

Highland Quality

Approach

(Focus &

Delivery)

Various

Rapid Process

Improvement

Workshops

See attached workplan



NHS H Board

This focuses on the

WHAT in the HQA

and the attached is a

small representation

of the calendar of

improvement work

which is underway for

the current year. All

work follows a tier 1, 2

and 3 reporting

structure and report

outs are written up

and on occasions

filmed to ensure that

as many as possible

can participate.

Report outs are

attended by many

executives, and board

Reduce harm, waste

and managing

variation


Safe working

Primary care

Integrated working

Unscheduled and

emergency care

Cancer care

24


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

members who

empower staff to

make the changes

required to improve

patient care

General

Capacity and

Capability

Building

Highland Quality

Approach

(Leadership &

Culture

Improvement

Science

Methodology)

Building Capacity

& Capability.

Training for the

different levels of

Improvement has

and will be

provided from a

number of

sources

Virginia Mason

Lean leader

accreditation

Virginia Mason. 3 staff

members received

Advanced Lean Leadership

Training in Seattle last year

and continue to be

supported through to

certification by Virginia

Mason Institute. This will

involve staff from the

Institute visiting NHS

Highland this calendar year,

to assist with the delivery of

4 Rapid Process

Improvement Workshops

(RPIWS), which are

expected to deliver

significant service benefits,

staff engagement and

awareness and certification

as Advanced Lean Leaders

It is important that we

maintain the rigour

and integrity of the

methodology whether

it is LEAN or SPSP.

In order to ensure

there is no slippage,

we have committed to

learning from as close

to source as we can in

order to ensure that

the purity of the

methodology is

maintained.

This is the only

approach which is

approved by NHS

Highland Board who

have fully endorsed it

and are holding the

Reduce harm, waste

and managing

variation


Safe working

Unscheduled and

emergency care

Cancer care

25


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

for the 3 staff members.



NHS H Board

senior management

team to account for

maintaining the

integrity and for

sustaining the

improvements made

General

Capacity and

Capability

Building

Highland Quality

Approach

(Leadership &

Culture

Improvement

Science

Methodology &

Focus &

Delivery)

Training for the

different levels of

Improvement has

and will be

provided from a

number of

sources

Tees Esk & Wear

Valley lean leader

accreditation

The Trust is accredited by

Virginia Mason Institute to

deliver accredited training to

Advanced Lean Leader

level. As a result we can

source an appropriate level

of training within the UK.

NHS Highland have had

three senior staff (Cohort 1),

trained by TEWV’s and they

are at a similar stage to

those staff who have been

trained by Virginia Mason,

in that they are about to be

supported through 3 RPIWs

to achieve their

accreditation. We are

satisfied that the training

and support TEWV’s offer is

It is important that we

maintain the rigour

and integrity of the

methodology whether

it is LEAN or SPSP.

In order to ensure

there is no slippage,

we have committed to

learning from as close

to source as we can in

order to ensure that

the purity of the

methodology is

maintained.

This is the only

approach which is

approved by NHS

Highland Board who

have fully endorsed it

HQA

Leadership &

Culture, workforce

development.

Reduce harm, waste

and managing

variation


Safe working

Unscheduled and

emergency care

Cancer care

26


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

comparable with that of

Virginia Mason institute. An

additional 12 staff members

of staff (Cohort 2) will be

participating in Advanced

Lean Leaders Training in

April and May, with RPIWs

in late summer and autumn

and a 3rd & 4th Cohort is

being considered for

January and August 2014



NHS H Board

and are holding the

senior management

team to account for

maintaining the

integrity and for

sustaining the

improvements made

Enhanced

recovery

Enhanced

Recovery

The benefits are

better patient

outcomes and

satisfaction and

reduction in length

of

stay……releasing

bed days.

Main workstreams are

Orthopaedics

Colorectal

ENT

Urology

Gynaecology

NHS Highland ERAS

Steering Group in

place

The group is

developing metrics to

monitor ERAS e.g.

ALOS, readmissions,

morbidity,

mobilisation,

catheterisation rates,

HQA

Reduce harm, waste

and managing

variation


Safe working

Cancer care

27


programmes /

projects to be

progressed

Articulate the

proposed benefits

and outcomes for

each project






Provide a clear

process for sharing

learning and

spreading

improvements

Strategic link

Breast

Vascular will come on line

with the appointment of the

additional 3rd vascular

surgeon in August 2013

Each specialty has a lead

consultant designated.

Anaesthetics has consultant

representation.

Main support required is

release of clinical time to

support project.

pain scores etc.

NHS Highland

attended the ERAS

National Event in

March 2013 and from

this we have contacts

in other boards to

share and learn. The

output of the ERAS

group is reported to

the Operational

Programme Board.

APPENDIX 2

LEAN LEADERS TRAINING

Date Value Stream Location

13 – 17 May Radiotherapy BreastCancer

Raigmore Hospital

3 – 7 June Colorectal surgery Raigmore Hospital

5-9 August Community Mental Health A&B CHP

26 -30 August Pre Op assessment Raigmore Hospital

2 – 6 September Radiology Resultsreporting

Raigmore Hospital

2 – 6 September Unscheduled Care(Belford)

Belford Hospital, Fort William

7 – 11 October Care at Home South and Mid OperationalUnit

7 – 11 October Primary Care Services A&B CHP

14-18 October Chemotherapy Raigmore Hospital

28 October – 1 November Primary Care Services South and Mid OperationalUnit

28 October – 1 November COPD Raigmore Hospital/South and Mid OperationalUnit

28 October – 1 November Chronic Pain services Caithness General/Golspie

25 – 29 November Stroke Services Raigmore Hospital

25 – 29 November Microbiology Raigmore Hospital

19-13 December Unscheduled care Raigmore Hospital

3 – 9 February Community Hospitals North West Operational

3 – 9 February Radiology scheduling Raigmore Hospital

3 – 9 February Scheduling EmergencySurgery

Corporate, Inverness

4.2 hqa making it happen - progress - nhs highland€¦ · governance standard and the staff...

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