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