Welcome Main title slide page Improving Quality in Mental Health - The South of England Quality and Patient Safety improvement Collaborative

Main title slide page Where we came from In 2009 the South west SHA ran a Improvement collaborative, when they discovered how succesful the collaborative was tey decidie to trial one in Mental health. Starting in the southwest and then and following intrest from the rest of the Sout of engalnd it spread to the whole of the south of england. In 2015 it became funded by the AHSN’s in the south of england

Main title slide page Why the collaborative is here today

The South of England Mental Health Quality and Patient Safety Improvement Collaborative Who do we work for

Over 4K staff 160 teams AHSN Trusts South West Cornwall Partnership NHS Foundation Trust Devon Partnership NHS Trust Live Well Southwest Somerset Partnership NHS Foundation Trust West of England 2gether NHS Foundation Trust Avon and Wiltshire Mental Health Partnership NHS Trust Wessex Dorset Healthcare University NHS Foundation Trust Southern Health NHS Foundation Trust Solent NHS Trust Isle of Wight NHS Trust Oxford Oxford University Hospitals NHS Foundation Trust Berkshire Healthcare NHS Foundation Trust Central and North West London NHS Foundation Trust Kent Surrey and Sussex Kent and Medway NHS and Social Care Partnership Trust Surrey and Borders Partnership NHS Foundation Trust Sussex Partnership NHS Foundation Trust Over 4K staff 160 teams Over 4k staff members directly being influenced by the improvement work, 162 teams have a project happening in their place of work.

Who is in the Faculty ? Who is in the faculty

Increasing Awareness & Trust Evolution of A Culture of Safety and Reliability GENERATIVE Safety is how we do business around here Constantly Vigilant PROACTIVE Anticipating and preventing problems before they occur Increasing Awareness & Trust CALCULATIVE We have systems in place to manage all hazards REACTIVE Safety is important. We do a lot every time we have an accident PATHOLOGICAL Who cares as long as we’re not caught Chronically Complacent *Adapted from Safeskies 2001, “Aviation Safety Culture,” Patrick Hudson, Centre for Safety Science, Leiden University 7 7

What we know it feels like some days We know that sometimes a day at work can feel like this

So What Does The Collaborative Do ? Supporting organisations to develop a safety culture and to become a system for learning; Build the quality improvement capability in members, supporting them from being learners of quality improvement to becoming leaders of quality improvement; Develop the capacity and capability for co-production in quality improvement work of participating organisations; Reduce variation in clinical practices and aim for 95% reliability in care processes; Create a network that uses measurement for improvement and learning, and uses the model for improvement to develop test and spread new or existing, local and national innovation;

So, how do we deliver the Collaborative ?

2016 Learning session Teams of 10 from each organisation LS themed March 2 days July 2 days November 2 days Teams of 10 from each organisation LS themed QI Masterclasses QI coaching on Projects Content experts presenting

Action Period Action Period Qi WebEx Coaching from PM Problem Team Exec sponsor Identify your theory an ideas for change Identify how and what you will measure Set up on the life system Start testing Gain reliability Spread and share Qi WebEx Coaching from PM Coaching on life system

All Projects

What we know about Improving Qulity But we need more than hope if we want to improve We have to acknowldege and understand where QI sits alongside Q assurance and Q planning We need to understand that we need a methodolgy to implement QI We know we have to understand how culture will impact on our improvement efforts We have sway with the change to sustain are aims and achievments

Model for Improvement

Why do many changes efforts fail? Is it will, ideas, or execution?

How do you routinely make change in your organisation? Convene a group of subject matter experts to develop a Guideline Convene a group of subject matter experts to develop a policy and procedure Bring back something you learned at a meeting and try to make it work in your area And then………

A Miracle Happens

How do you make changes ?

Driver diagram template Definition: a driver diagram is used to conceptualise an issue and determine its system components which will then create a pathway to get to the goal PRIMARY DRIVER Education and training SECONDARY DRIVERS A staff training B Culture exploration C D Reduce Violence and aggression by 50% by march 2017 PRIMARY DRIVER Identification of risk SECONDARY DRIVERS A Zoning B risk assessment C D PRIMARY DRIVER Engagement with patients SECONDARY DRIVERS A increase 1:1 B C D Primary drivers are system components which will contribute to moving the primary outcome Secondary drivers are elements of the associated primary driver. They can be used to create projects or change packages that will affect the primary driver

Model for Improvement

To reduce the number of incidents of violence and aggression by 50% by March 2017

PDSA? People’s Dispensary for Sick Animals PDSA does not stand for:

However, in this context, PDSA is: Plan Do Study Act …how to explicitly test a small change …what you have planned to do …the outcomes, expected and unexpected, of the test …on the results to modify and improve A PDSA is undertaken on a sample, or small section of patients, or small part of the patient pathway or service. It is tested for a short period, such as a month and operates alongside current processes. Plan  Determine the improvement to be made, the improvement method and the method for evaluating the results. What do you want to be accomplished? By What method will you achieve this objective? How will you know when you have reached this objective? Do Perform the activities defined in the plan. Study Measure and compare the results with those desired and learn from them Act Take advantage of what you have learned and determine where to apply changes that will result in improvement. When a pass through these four steps does not result in the need to improve, refine the scope to which PDSA is applied until there is a plan that involves improvement.

Stages of PDSA How to conduct PDSA’s – a framework of considerations to help guide your project Plan the Trial Define the objectives State the scope of the PDSA What are you going to do? Why are you doing it? How are you doing it? When are you doing it? How long will the PDSA continue? Are there any circumstances when you would stop the trial? Who needs to be involved? Does everyone understand their role? How will you communicate with these people? How will you know if the PDSA is a success? What data collection methods are you using? Who will collect the data? How will you feedback to the team? Do ; Undertake the PDSA Carry out the trial Encourage continual feedback - you may wish to set up midpoint meetings to discuss progress Reassure staff involved Motivate staff Encourage and support staff Collect information Study the Results of the Trial Examine your findings Review and compare information from before, during and after the trial Reflect on what was learned What did it feel like? Did staff and patients notice an improvement? Was the process shorter or longer? Did you acheive your objective? If not, why not? What went well? What could be improved? Act upon the Results of the Trial Use the information that you have gained Do you need to retest? You may choose to modify your process and test again. Do you have enough information? Does the trial need to be longer? Can you implement the change immediately? Who do you need to share your findings with? Can other areas benefit from your knowledge? How will you performance manage the process in the longer term? Implement the new process! During the 'do' stage of PDSA, staff involved may need lots of support and encouragement as well as reassurance. Undertaking any degree of change involves a degree of risk and adjustment. It is common for people to say that it is not working and want to stop. Your earlier planning will have dictated any circumstances when you may wish to halt the PDSA. Encouraging staff to verbalise their fears or insecurities will allow you to reassure and support them. Provide as much positive feedback as you can. Explain that if the PDSA does not result in a measurable improvement it will not be repeated. You can learn as much from things that don't work as things that do – it is all part of the learning process. As described earlier, PDSA cycles are a good way to introduce change in a safe and planned manner. If you are intending to use PDSA, remember to start small – lots of small PDSAs allow you to identify exactly which changes work and which don't. In addition, remember that effective communication is the key to successful redesign.

Developing improvement with PDSAs Implementing new procedures & systems - sustaining change PLAN DO STUDY ACT PLAN DO STUDY ACT Accumulating information and knowledge Testing and refining ideas PLAN DO STUDY ACT PLAN DO STUDY ACT PDSAs build on each other It may take several PDSA cycles to get to an implemented improvement PLAN DO STUDY ACT PLAN DO STUDY ACT Bright idea!

Model for Improvement

Phillip Confue: Chief Executive The patient safety collaborative has been a game changer for CFT in the way patient safety is understood from the Board to the ward. Our reporting culture has improved, staff are more engaged and empowered in making positive changes and patients are getting the benefits from safer care’ Phillip Confue: Chief Executive Cornwall Partnership NHS Foundation Trust Being a part of this programme has allowed us to skill up our workforce so that using improvement methodology is becoming the way we do business. - our staff now ask how they can use improvement methodology to solve their harm problems’   Dr Helen Smith: Co Medical Director Devon Partnership NHS Trust The collaboration has raised the profile of safety improvement across the organisation and has helped us focus our attention on delivering reliable, safe processes and the spreading of best practice across the organisation and has been instrumental in encouraging collaboration with other mental health providers in delivering safe care. The method of improvement approach has driven the embedding of real change that has led to tangible improvements in the quality of care provided to people using our services.’ Billy Hatifani: Director of Risk & Safety/ Deputy DoN/ Emergency Planning Lead Fettle ward was an early adopter of the methodology. They now make no changes without testing, especially with patient feedback. Their ward was rated "outstanding" by CQC.

Reduced the number of self harm incidents and sustained this, Oxford The level of harm as a result of Absence without Leave (detained) incidents is sustained as zero on all wards, 2gether aim of reducing the number of AWOLS which has been achieved and sustained, Oxford Trust wide there has been a 23% reduction in prone restraint incidents from 2014-15 to 2015-16. Seclusion incidents have reduced by 46% from 201415-2015/16. Rapid tranquilisation incidents have reduced by 26% over the same period. An RCA is now completed for all rapid tranquilisation. The number and timeliness of the completion of RCAs has improved within adult mental health which will support prompt learning. Dorset Reduced the number of self harm incidents and sustained this, Oxford Patient Safety Walk Rounds by the Executive Team have resulted in actions to improve patient safety concerns as identified by frontline staff. 94% of actions have been closed and sustained. 2gether This programme has supported our staff to make widespread improvements including a 51% reduction in falls, 30% reduction in AWOL, 95% medication reconciliation, DPT

What your organisation agrees to do By joining the South of England Mental Health Quality and Safety Improvement Collaborative, Chief Executives are committing to:  Personally sponsor safety in their own organisation; Personally attend (as a minimum)1 learning set a year; Identifying a lead Executive in their organisation who will act as their organisation’s collaborative lead; The lead Executive attending the first day of all Learning Sets; Identify an appropriately senior Clinical Lead for safety who will attend; Learning Sets and become a member of the Clinical Faculty; Identify, via their lead Executive and program manager, workstream leads and work stream teams; Meeting the transport and accommodation costs of their staff who attended Learning Sets; Identify an internal program manager who will; Co-ordinate internal improvement initiatives with the Executive lead, Identify internal workstream leads, Support workstream leads, Attend all Learning Sets Facilitating the release of workstream leads to attend Learning Sets; Collaborate with other members of the Collaborative by sharing knowledge, skills and data (associated with work streams within the programme).  

What you will receive

Cont…….

with love and vision. Love of your patients. Love of your “Quality improvement begins with love and vision. Love of your patients. Love of your work. If you begin with technique, improvement won’t be achieved.” A. Donabedian, M.D

Thank you Heather.pritchard1@nhs.net @IQMentalHealth @HeatherpNHS Main title slide page Co-brand logo here Thank you Heather.pritchard1@nhs.net @IQMentalHealth @HeatherpNHS