Collaborating for Quality NHS Scotland's Quality Improvement hub A New Partnership for Improvement Jane Murkin Associate Director of Improvement

Session aims Outline the design and development of NHS Scotland's Quality Improvement Hub Context of healthcare today and its relationship with quality improvement Consider the application of improvement science and methodologies in relation to knowledge management Roles and functions Coordination and integration Infrastructure – local and national Identify opportunities to test and implement new and different ways of working An opportunity to identify and participate in designing and shaping the future state

Care is not safe – Institute of Medicine report “Between the care we have and the care we could have, lies not a gap, but a chasm”

How many people are harmed in our healthcare system?

Adverse Events in Hospital 3.7% Harvard 1991 16.6% Australia 1995 10.8% London 2001 50% PREVENTABLE 3 million bed days in UK £1 billion per annum in UK Acute hospitals 9.5% - HAI (July 2007 HPS) Pre work SPSP SPSP Data – what are we learning in relation to harm

Global Trigger Tool Reviews 3 Exemplar Hospitals (900 notes) 40 Bed rural Hospital (300 notes) 10 Hospital Research Project (240 notes) 7 Hospital System (3000 notes) Multi-state Tertiary System (2000 notes) Events/1000 Days 83 90 NA 119 86 Events/100 admissions 45 40 37 41 38 Admissions with adverse events 32% 30% 29%

A Major Study of Reliability in American Health Care… McGlynn, et al: The quality of health care delivered to adults in the United States. NEJM 2003; 348: 2635-2645 (June 26, 2003) 439 indicators of clinical quality of care 30 acute and chronic conditions Medical records for 6712 patients Participants had received 54.9% of scientifically indicated care (Acute: 53.5%; Chronic 56.1%; Preventative 54.9%) Conclusion: The Defect Rate in technical quality of American health care is approximately 45%

How safe are clinical systems? Primary research into the reliability of systems within 7 NHS organisations and ideas for improvement ( Health Foundation May 2010) Reliability in healthcare – This is not simply a matter of putting in place proper guidelines and expecting practitioners to follow them. It involves identifying in advance the points at which those mistakes can happen, the different elements that contribute to those mistakes and the systems that practitioners should follow in order to ensure pt safety

Converting research to care Publication Bibliographic databases Submission Reviews, guidelines, textbook Negative results variable 0.3 year 6. 0 - 13.0 years 50% 46% 18% 35% 0.6 year 0.5 year 9.3 years Dickersin, 1987 Koren, 1989 Balas, 1995 Poynard, 1985 Kumar, 1992 Poyer, 1982 Antman, 1992 Lack of numbers Expert opinion Inconsistent indexing 17:14 Original research Acceptance Patient Care Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yrbk of Med Informatics 2000; 65-70 17 years to apply 14% of research knowledge to patient care! 9

Mid Staffordshire report Brings me on to, “we have 2 jobs to do 10

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Remember…

A Model for Learning and Change When you combine the 3 questions with the… …the Model for Improvement. PDSA cycle, you get… The Improvement Guide, API, 2009. 15

Develop the Quality Improvement Hub, reflecting a new partnership for improvement between NHS National Services Scotland (NSS), NHS Quality improvement Scotland (QIS), NHS Heath Scotland, NHS National Education for Scotland (NES), and the Scottish Government Health Directorates Improvement and Support Team (IST). Scottish Government, May 2010

QI Hub – What is it all about? Collaboration between NES, NHSHS, NHS QIS, NSS, IST and SGHD A coherent and cohesive national approach to supporting QI Maximising resources – the whole is greater than the sum of its parts Brokering access to resources and support to realise ‘world class’ ambitions of the H/C Quality Strategy

The QI Hub aims to bring improvement science into everyday work and language of NHS staff and to support demonstrable improvement in patient care through quality improvement activity.

Building on sound foundations Improvement work to date Global ‘Improvement Movement’ (SPSP) Bringing coherence to implementation and improvement support methodology(NHS Healthcare Improvement Scotland /QEST) Drawing on NES’ developing educational infrastructure for QI Measurement for Improvement (NSS/ISD)

We are not alone … Mention that all centers are different with different opportunities to succeed in various areas within the organization. Experts & Expertise.

Shaped and designed by NHS Scotland The NHS Scotland Quality Improvement Hub works in partnership by providing a coordinated national resource to care teams and organisations. Facilitating: Implementation support – flexible and responsive Education and learning about QI – Accessible and relevant Measurement of QI which is meaningful Facilitating QI networks for NHS staff Underpinned by creativity and innovation

Progress to date The Quality Improvement Hub –”Delivering to improve” – April 2010 Our approach – Partnership, initiation, shaping the development, set up, action planning, execution plan, launch, go live and implementation Stakeholder consultation – May 2010 Stakeholder event – Shaping the development – June 2010 Formulation of work programme aligned to Quality strategy and national priorities Regional events – Developing the community ,Improvement Directory Ongoing stakeholder engagement – Board visits - learning Proof of concept testing March – June 2011 An improvement approach

Making it happen.... Coordinating centre - Elliott House Small core team – Exec Leadership, Associate Director, Improvement Advisor, Data Systems Manager – link to ISD, Business Manager, Project support Evidence into Practice Portal – virtual communities Building a Community of Improvement Practitioners (Directory) Planned and ‘bespoke’ programmes Prioritisation process – levels 1 - 5

Brokering support from NHS Scotland Staff Proof of concept work – Supporting the development of a Mortality Reduction Improvement Plan, Building capacity and capability for QI, Patient safety in Primary Care, National Audit work Testing a brokerage model with boards Directory of Improvement Practitioners Developing our workforce So many opportunities and so much potential

The Challenge Complex healthcare systems Competing priorities Initiative overload Project weary staff Project failure rate In some NHS Boards same staff – multiple hats History of a target culture Policy/politics Our resources are limited – people being the greatest How can we achieve more and maximise the potential?

“NHS Scotland has undertaken a bold, comprehensive, and scientifically grounded programme to improve patient safety.  The dedication of NHS leadership at all levels to this endeavor is apparent to me, and bodes well for success.  In its scale and ambition, the Scottish Patient Safety Programme marks Scotland as leader – second to no nation on earth – in its commitment to  reducing harm to patients dramatically and continually.” Don Berwick June 2008

What will it take to improve quality and safety? Winning the hearts and minds of the staff Focusing on improvement not targets Leadership Integration Making it daily work Creating infrastructure Creating capability and capacity Measurement that has meaning Understanding context and culture Momentum

What's our collective aim? Integrating and aligning knowledge management expertise and resources to support local and national quality improvement activities and implementation of our quality strategy Creative Thinking Creativity implies having thoughts that are outside the normal pattern. What can you do to have “new” thoughts? How do we “provoke” new thinking? What can we test and implement How do we learn ourway into a new world How much and by when? 28

"We cant change the human condition, but we can change the conditions under which humans work" James Reason

The power of words