perhaps the end of the beginning · 21st april 2016 dr brian robson mbchb, mrcgp, mph, drcog...

21st April 2016

Dr Brian Robson MBChB, MRCGP, MPH, DRCOG

Executive Clinical Director Health Foundation / IHI Quality Improvement Fellow

..PERHAPS THE END OF THE BEGINNING...

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

LET’S STAND UP

4

• 5.3 million population• £12 billion health budget• 14 territorial boards• Special boards

- NHS Education for Scotland

- NHS Health Scotland

- NHS National Services Scotland

- Scottish Ambulance Service

- State Hospital

- NHS 24

• Moving to integrated health & social care• Public Body - Healthcare Improvement

Scotland

WHAT WE DO

Death Certification Review Service

ALL TOOLS FOR IMPROVEMENT Quality Planning

Provides a system that is capable of meeting quality standards

Quality ControlUsed to determine when corrective action is required

Quality ImprovementSeeks better ways of doing things

Dr Joseph Juran

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

“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

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)

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

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

EARLY SUPPORT

NEW TOOLS ...

“We are going to need a bigger boat ....”

Martin Brody,

Police Chief, Amity Island (1975)

QI CAPACITY AND CAPABILITY BUILDING

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

laura.allison@nes.scot.nhs.uk

NHS Scotland

UK

International

Gene NelsonThe Dartmouth

Institute27 July

Maxine PowerHaelo26 May

Geoff MulganNESTA19 April

QI CONNECT 2016: INNOVATION & INTEGRATION

Tim Brown & guestsIDEO

27 October

Derek FeeleyIHI

30 June

David BatesPartners HealthCare

System31 March

Steve Spear

29 Sept

Don BerwickIHI

28 January

Jo BibbyThe Health Foundation22 February

Peter LachmanGreat Ormond Street Hospital

November (Date TBC)

APR

IL 2

016

QI Connect: our reach

organisations

401

@HISQIConnect

OUR GLOBAL REACH

LEARNING TOGETHER..... AGAIN ... AND AGAIN... 

http://www.healthcareimprovementscotland.org/our_work/clinical_engagement/qi_connect.aspx

“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

LET’S STAND UP

Deliver Results

RELENTLESS MEASUREMENT

“In God we trust… All others bring data.”

W. Edwards Deming

DATA ON EVERY WARD .... IN PUBLIC !

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ysNHS 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

NHS Fife, Lomond WardRates of Incidents of Restraint 

Courtesy of Malcolm Daniel

SEPSIS 6 60

CHARLES’ ‘BUBBLES’ BROADENED OUR THINKING

43

44

Safety is not a measure or a datasetSafety is a process of inquiry

Engage Across Boundaries

SAFETY .. IS NOT...

Staged Approach

Stage 1 General Medical Services

Proto-type and testing 2010–2012

Programme launch March 2013

Stage 2 Community Pharmacy and Nursing

Proto-typing and testing from autumn 2014

Stage 3 Dentistry and Optometry

Exploratory work from 2015 onwards

By April 2014,90% of all GP practices in 

Scotland  had completed the 

Safety Climate Survey 

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

Median: 5.3

Scottish Stillbirth Rate (per 1000 births) 2000 ‐ 2014

Shape Culture

….over 1,700 leadership walkrounds have been conducted in Scotland.

Since 2008…….

Driven by Persons & Community

NEW TOOLS ...

• A new tool for 21st century healthcare professionals ?

• See healthcare for what it is – faults and solutions

• See through other’s eyes• Try it when you get back

IMPROVEMENT GOGGLES

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)

It’s about people

brian.robson@nhs.net@brobson3

Thank You