Launching a National Collaborative March 2018 Doha Launching a National Collaborative Derek Feeley President & CEO Institute for Healthcare Improvement @derekfeeleyIHI

82% reduction in c-diff cases in the over-65s since 2007 Quarterly rates of Clostridium difficile per 100,000 bed days (65+, 15-64 and 15+) 82% reduction in c-diff cases in the over-65s since 2007 There are many different factors that influence this data – reliability of reduction of infection…. CEL19 link Source: Health Protection Scotland

21 % Reduction % 30 day Mortality of ICD 10 A40/A41 Despite it being challenging, Teams across Scotland are making improvements that are impacting on peoples lives every day No l cant tell you about everything that is happening but here is just a selection of your fantastic work At a national level

NHSScotland Surgical Mortality

The SPSP Journey…. Collaboration Model for Improvement Knowledge & skills Common goal - aim high Evidence-based interventions Compelling vision

Improve Safety of Healthcare Services in Scotland Primary Drivers Secondary Drivers SPSP Driver Diagram Ownership of agreed upon set of outcomes Review of outcomes at each meeting Quality and safety comprise 25% of agenda Recovery plans for unmet outcomes Infrastructure supports improvement and measurement Involve patients in safety Boards accept SPSP as a key strategic priority for effective governance Scottish Government sets SPSP as strategic priority Deliver the programme Build a sustainable infrastructure for improvement Align SPSP with national improvement programmes and measures Demonstrable results to community Clear, shared measurement set Visible on all senior leader agenda Patient Safety Alliance represents and demonstrates cohesive and united programme Improve Safety of Healthcare Services in Scotland (15% reduction in HSMR by end of 2012) Establish and implement BTS collaborative Acceptance of pragmatic science Royal Colleges support SPSP International expert clinical faculty Faculty expert at improvement methods and coaching Programme design and structure Inventory national programmes and measurements Meet with programme leaders to understand programme intent, audience, history Harmonise our metrics

The Typical Approach… In the conference room DESIGN DESIGN DESIGN APPROVE …..and in the real world. Traditionally we have not been good at making change for improvement reliable – because we have not tested whether it will be delivered appropriately in various conditions and environments before we expect all to implement and make part of every day business. e.g. previous experience of launching new protocols/guidelines – as of Mon am….. expect all to comply fully without really knowing that it’s practical for every system – then we wonder why people don’t comply and the system is unreliable. IMPLEMENT

The Quality Improvement Approach In the conference room DESIGN APPROVE IF NECESSARY …..and in the real world. Traditionally we have not been good at making change for improvement reliable – because we have not tested whether it will be delivered appropriately in various conditions and environments before we expect all to implement and make part of every day business. e.g. previous experience of launching new protocols/guidelines – as of Mon am….. expect all to comply fully without really knowing that it’s practical for every system – then we wonder why people don’t comply and the system is unreliable. START TO IMPLEMENT TEST & MODIFY TEST & MODIFY TEST & MODIFY

A Better System Design: Bring Together 2 Types of Knowledge Evidence-based Subject Matter Knowledge Protocols Guidelines Standards How to change performance of the system Implementation Knowledge Leadership/governance System re-design Financial strategies Resources Engaging patients & families Clinical & Systems knowledge Data for Improvement Learning communities Improvement W. E. Deming and Associates in Process Improvement

“Up to 70% of improvement projects never spread.” Eccles R, Miller Perkins K, Serafeim G. How to Become a Sustainable Company. MIT Sloan Management Review 2012; 53(4): 43-50.

A Learning System for Getting to Full Scale Best Practice exists Phases of Scale-up Set-up Build Scalable Unit Test Scale- Up Go to Full-Scale New Scale-up Idea Adoption Mechanisms Support Systems Leadership, communication, social networks, culture of urgency and persistence Learning systems, data systems, infrastructure for scale-up, human capacity for scale-up, capability for scale-up, sustainability

Breakthrough Series Collaborative

National Patient Safety Collaborative National Driver Diagram Aim Primary Drivers Secondary drivers Improve Safety of Healthcare Services initially focusing on Sepsis and VTE Through working towards 95% compliance with the sepsis 6 bundle as per the healthcare partners guideline. The identified facilities/units will achieve this by the end of December 2018. & 100% of eligible patients across healthcare partners, to have a VTE risk assessment carried out within 24 hours of situational need, and appropriate thromboprophylaxis prescribed and administered as per the healthcare partners guideline. The identified facilities/units will achieve this by the end of December 2018.   Ministry of Health and EMC Accept Safety as Key Strategic Priority for Effective Governance   Ownership of agreed upon set of outcomes Review of outcomes at each Executive/senior leadership meeting Quality and safety comprises 25% of agenda Leaders understand their role in leading QI Recovery plans developed for unmet outcomes Infrastructure within each organization supports improvement and measurement Time given to support front line improvement teams Involve patients and carers in safety Qatar Healthcare Executives Sets NPSC as Strategic Priority Demonstrable results to community Clear, shared measurement set Visible on all senior leader agenda   Robust, evidence based proven clinical changes Acceptance of pragmatic science Qatar University Supports NPSC Driver Diagrams & change packages support achievement of collaborative aims IHI/HHQI/local Team Expert at Content, Coaching and Program Management International expert clinical faculty Faculty expert at improvement methods and coaching Programme design and structure Local faculty developed HHQI developed to support improvement nationally   Align National Patient Safety Collaborative with national improvement programs and measures Inventory national programs and measurements Meet with programme leader to understand programme intent, audience, history Harmonize measures required for national reporting  

Add Systems to Create a Framework

Framework for Clinical Excellence Creating an environment where people feel comfortable and have opportunities to raise concerns or ask questions. Being held to act in a safe and respectful manner given the training and support to do so. Transparency Leadership Psychological Safety Negotiation Teamwork & Communication Accountability Reliability Improvement & Measurement Continuous Learning Engagement of Patients & Family Developing a shared understanding, anticipation of needs and problems, agreed methods to manage these as well as conflict situations Facilitating and mentoring teamwork, improvement, respect and psychological safety. Gaining genuine agreement on matters of importance to team members, patients and families. Openly sharing data and other information concerning safe, respectful and reliable care with staff and partners and families. Regularly collecting and learning from defects and successes. Applying best evidence and minimizing non-patient specific variation with the goal of failure free operation over time. Improving work processes and patient outcomes using standard improvement tools including measurements over time.

Culture Eats Strategy for Breakfast Culture is a result of what an organization has learned from dealing with problems and organizing itself internally. Your culture always helps and hinders problem solving Solve problems by identifying and resolving associated discrepancies between values and behavior Do not oversimplify culture. It’s far more than “how we do things around here.” Leaders should not focus on culture change. Focus on a business problem. Culture is a group phenomenon. Engage focus groups to define how the culture is helping and hindering work on a problem. A ar Schein All courtesy of Edgar Schein

It Is All Related….. Royal Academy of Engineering; Engineering Better Care 2017

10 Keys to Delivering Quality Improvement across a Whole System Get goals Get bold Get together Get a method (and stick with it) Get patients and families Get the facts Get to the field Get a clock Get the numbers Get the stories

Nothing Ever Grows in a Comfort Zone