Embedding Sustainable Change in our future workforce – a story from Wales

Emma Thomas, Improving Quality Together Lead for Higher Education, 1000 Lives Improvement

Wales

Population 3.1 million

7 integrated Health Boards

3 NHS Trusts

Approx 70,000 staff

National Quality Improvement Journey

Where we are in Wales

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

IHI 100,000 Lives

Campaign

Safer Patients Initiative+ = 1000 Lives patient

safety Campaign1000 Lives Plus

– national programme in NHS

Wales

Bespoke support for Health

Organisations in Wales

We must achieve a common and consistent language and approach

to improvement across Wales

1000 Lives Plus will be the core NHS improvement programme

Current National policy context

Double Goal, Quality Assurance and Quality Improvement

25% of the workforce to be trained in Quality improvement by 2014

• Recognise with clarity and courage the needed for wide systemic change – all improvement begins with recognition of the need to improve.

• Reassert the primacy of working with patients and carers to set and achieve quality goals.

• Use quantitative targets with caution.

• Recognise that transparency and open communication is essential.

• Give the people of the NHS – top to bottom – career long help to learn and apply modern QI/QA methods.

• Make sure pride and joy in work, not fear, infuse the NHS

Berwick Report...

“Improving Quality Together is patient-driven.It’s also staff-driven. By improving quality, we cantake away some of the stress and strainson staff.”

Chris Rowland

Aims

Measurement

Ideas, hunches,other people etc.

Three fundamental questions for improvement

How to make change happen

Langley et al (1996) – cited 1000 Lives plus (2012)

So what framework do we use?

Improving Quality Together aims to support a

change in mindset in NHS Wales, where each

individual demonstrates a belief that:

They have one job and two roles: to do and improve.

Small step changes can make a big impact.

Audit PostersInternational Forum for Quality & Patient Safety 2013

Process & System Improvement

Posters

International Forum for Quality & Patient Safety 2013

• Common language of improvement

• Focus on person-centred care

• Consolidation of quality improvement in NHS to date

Framework of quality improvement skills:

• Quality improvement backbone for NHS Wales

• Integrated in learning & development

• Integrated into practice

IQT Framework• 3 levels of development:• Bronze – what• Silver – how• Gold – teach

• Complemented by Board level development.

So where are we?• 1507 Completed IQT Silver online• 2 Silver cohorts across Wales• 50 improvement projects underway across Wales• Integrating into Pharmacy, Nursing, AHP, Medical

curriculums

So where are we?• Three network events held to date:• 40 - 50 staff attended

• Higher Education Partnership Group set up• All universities in Wales engaged and attending• Preceptorship, mentor and student members• share and coordinate best practice across education• vehicle for the structured integration of IQT across

Wales• ensure equity and parity across a Pathway to IQT

Silver across all professions and institutions.

So what is success?• Success requires collaboration and innovation

from team members working together

• Combining professional knowledge with improvement knowledge is very powerful for providing safer and better care

So what is success?Success is ...

• improving how students safely and humanely meet the needs of our patients

• focusing on processes, not blaming others

• allowing students to have positive learning experiences with quality improvement

• enabling students to communicate with and engage staff and creates continuous improvement

What did we do?Over the last 18 months ...

• Engagement with key professionals within the universities

• Changed learning to suit students who may not have been into the workplace

• Focussed on communication and teamworking skills

• Empowered students to ‘lead’ improvement right from the start of their careers

• Made links between quality improvement and required staff skills