Lothian’s Clinical Quality Programme & Academy Simon Edgar Nikki Maran Jo Bennett

Our Intention

Our Reality Safe – 10-15% harm Effective – up to 50% of patients don’t receive treatment recommended by evidence base Person Centred - ? Or clinician centric Timely – waits, breaches Equitable – postcode lottery? Efficient – unnecessary variation, overuse, repeat

Why a Refocus on quality?

More for less Feels as if we have shaved off all the easy savings

Lothian Clinical Quality Approach We’re going to have to do something different

Lothian Clinical Quality Approach Commitment Steering Committee Definition & Goals Have a coordinated plan and measures Training & Support Communications Recognition & Celebration Collaborations

Lothian Clinical Quality Approach Clinical Quality Programme Clinical Change Platform Clinical programmes Data & Analytics inc finance Clinical Quality Leadership Academy Quality improvement support Clinical leadership Clinical change forum QI skills training IHI open school BMJ Quality QIST support

Lothian Clinical Quality Programme Identify all of our major clinical programs and associated spend

Intermountain Healthcare

£ “Move Upstream” strategies 30% Genetics (illustrations) Physical environment; social networks; public health 20% £ Population Health housing for chronic homeless Personal health behaviors (tightly linked to general education level) 40% Contribution to Total Health £ 1o Care AMH Iora patient activation SDM Hot spotting 2o Care Accountable medical homes IORA health team based car and health coaches Shared decision making – Choosing Wisely Disease Treatment System 10% Hospital Care (including Emergency Room) £ End of Life (EOL)

Lothian Clinical Quality Programme Identify all of our major clinical systems Define which are our key processes to improve High activity High morbidity / mortality High cost High degree of VARIATION

Individual clinician level data 80% of patients had similar severity and complexity of disease without major complications and similar outcomes BUT massive variation in clinician practice and two-fold difference in cost.

NHS Atlas http://www.rightcare.nhs.uk/index.php/nhs-atlas/

Lothian Clinical Quality Programme Identify all of our major clinical care processes Define which are our key processes to improve Develop understanding of linked clinical processes within individual pathways using data sources

Process mapping

Lothian Clinical Quality Programme Identify all of our major clinical care processes Define which are our key processes to improve Develop understanding of linked clinical processes within individual pathways using data sources Reach concensus on standard of care locally based on best evidence

QI methodology

Lothian Clinical Quality Programme Identify all of our major clinical care processes Define which are our key processes to improve Develop understanding of linked clinical processes within individual pathways using data sources Reach concensus on standard of care locally based on best evidence Use QI methodology to test and implement locally

Lothian Clinical Quality Programme Identify all of our major clinical care processes Define which are our key processes to improve Develop understanding of linked clinical processes within individual pathways using data sources Reach concensus on standard of care locally based on best evidence Use QI methodology to test and implement locally Utilise e-health solutions to drive & support data collection

Lothian Clinical Quality Programme Identify all of our major clinical care processes Define which are our key processes to improve Develop understanding of linked clinical processes within individual pathways using data sources Reach concensus on standard of care locally based on best evidence Use QI methodology to test and implement locally Utilise e-health solutions to drive & support data collection Continuous monitoring on quality ‘dashboards’ within service

Lothian clinical Quality Programme Support QI support – process mapping, QI methodology, coaching Data analytics – current & future Finance – activity based costing E-health Clinical lead Clinical Quality Academy QI Leadership QI skills

Lothian Clinical Quality Academy

QI Leadership Training Course Give participants the knowledge, tools and skills required to lead, conduct & manage clinical practice improvement AMDs, CDs, CNMs, service managers, Clinical quality leads 12-25 participants 2 courses / year

QI Leadership Training Course 4 month training program 2 days / month Blended learning Clinical Project based Learning & action periods Mentorship Webex support “Graduation with completed QI project’

QI Skills Training Course Give participants the knowledge, tools and skills required to carry out small scale improvement projects in clinical practice Quality improvers in service inc QIT members 30 – 50 participants 3 courses / year

QI Skills Training Course 3 month training program 1 days / month Blended learning IHI open school introductory modules Clinical Project based Learning & action periods Mentorship & Webex support BMJ Quality learning platform Structured workbook Poster presentation Access to publication

Other resources IHI open school [April ‘16] Scottish Improvement Skills Courses Scottish Improvement Leadership Course Scottish Patient Safety & Quality Fellowship School for Health & Care Radicals Harvard / IHI QI MOOC – web link Clinical Change Forum website Local QI support team

CQacademy@nhslothian.scot.nhs.uk CQprogramme@nhslothian.scot.nhs.uk

Do you know how good you are? And What Might Better Look Like?