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QUALITY: MKA whole system approach to quality improvement

Milton Keynes, June 2009

Sue Lacey Bryant, Programme ManagerSue.Lacey-Bryant@mkpct.nhs.uk

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Working in partnership

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NHS Milton Keynes

LINKs-MK

Centre for Evidence Based Medicine

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Our aim

Create a self-improving system to make a reality of three widely used slogans…

• Evidence based

• Primary care led

• Patient engagement

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How are we going about it?

Repeated cycles oflearning from projects

Create relevant…•Culture and values•Skills and capacity•Systems & processes

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Commissioning for improvement:Service review and redesign

•Smoking cessation: revised pathway•Alcohol introduction of brief interventions •Weight management new service for children•Diabetes: care planning approach

community based service•Mild/moderate depression user designed service

…. At varying stages of progress, all based on evidence with clinicians on each group & combinations of public engagement and user involvement in service design

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In practice and across primary care

evidence-based

discussion groups Share and spread –

inc. supporting 3

prescribing projects

•E-B skills training & toolkit•Librarian support•Pharmacist support

inc. toolkits

IMPACTE groups Improving Medical Practice by Assessing CurrentT Evidence

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Patient and public engagement

• Two PPE representatives

on each TaF • Training workshops for

commissioners• Learning from experience• Appropriate approaches• Rules of engagement• Embedding patient and

public involvement in the

planning process

 

• Patient empowerment

through information• Patient participation

groups

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Building a self-improving system Multiple channels for innovation and improvement; Mainstreaming a systematic approach to service review

and redesign Clinical effectiveness; Map of Medicine as default Defining, documenting: tools & templates

communications, engagement, evidence, prescribing Assuring information data flows System and process inc. PEC, HR Learning culture Public and patient engagement Seeing it through; supporting the change leads Making it easier to work with these values, than not to ..

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What have we learned?

Lead with valuesListen; trust patients and

service usersSupport skill development

consistent with values and

identify QI skills as coreBe prepared to make, admit

& learn from mistakesBe persistent Tighten programme mgt

Embed change into the system. Change: values agenda setting planning process decision criteria resource allocation and align organisational

processes with values

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Things to do sooner ... or differently

Recruit clinical

championsStrengthen channels for

engagement and inviting

local expertise Offer better information &

support for PPEClearer terms of referenceExplicit accountability

Worry less about QI

process techniques Use data persuasively:

Generate light, not heat

Pay more attention to

how to implement changeDiagnose barriers

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... and from the project leads

Use the evidencePrioritise“Raise the flag”Importance of leadershipClear objectivesFocus on outcomesNurture the partnerships Build the teamChallenge assumptionsReflect

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How are we getting on?

“A dynamic & organic shift”

“The success of this programme can be seen in the high level of patient and clinician involvement”

“... with greater use of evidence”

“There is an explosion of patient involvement”

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Roadmap to quality improvement

Best practice

Guidance on “how to”

Tools, techniques to deliver Quality Improvement

Explaining the system

Setting out the process