Why a New/Refocus on quality Lothian Clinical Quality Approach Why a New/Refocus on quality

QA is a find those bad apples set up – ie can only be due to incompetence or negligence 8 conditions in medicare where mortality was a good model of outcome

Variation [Appropriate & Inappropriate] The key to appropriate variation is standardisation Variation [Appropriate & Inappropriate]

All teach, All Learn 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.

Why a New/Refocus on quality What might better look like? Why a New/Refocus on quality

Our Blueprint for Quality Commitment Steering Committee Definition & Goals Have a coordinated plan and measures Training & Support Communications Recognition & Celebration

Defn: What is Quality Quality in Fact Quality in Perception Doing the right thing Doing it the right way Doing it right the first time Doing it on time Delivering the right product or service Satisfying customer needs Meeting expectations Treating everyone with integrity, courtesy and respect

6 recognised dimensions of quality All the right care (no underuse/equitable) But only the right care (no overuse/effective) Delivered free from injury (no misuse/safe) At the lowest necessary cost (efficient) Coordinated along the full continuum of care (timely) Under each patient's full knowledge and control (patient-centered)

Clinical quality approach A management and measurement system to focus on front line value adding clinical processes Clinical quality approach

A series of actions or steps taken in order to achieve a particular end All processes have parallel outcomes of physical (clinical), cost, service Every process is perfectly set up to deliver the outputs that it does Processes

clinical quality Academy Developing capacity & capability & leadership ability Widening access to learning: 100% participation Supporting Coaching in the Clinical Setting Developing a shared language, understanding and focus clinical quality Academy

Clinical quality programme Selection: Activity, Cost, Acuity, Variation, Engagement Development: Academy Support: Quality (QIST) Data, Finance Infrastructure & Leadership Facilitate Change Clinical quality programme

Expert on the tools and focusing on health of team Primary role is engagement of front line staff Choose leverage points, set goals and timeline

Communications Clinical Change Forum BMJ Quality Social Media Brent James DVD Partnership Communications

Clinical integration Identify processes Information system for parallel clinical and financial management Organisational structure to facilitate this data being used Incentivisation Clinical integration

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HIS Scot Gov IMH UoE Lothian Foundation NES