Welcome Main title slide page Co-brand logo here Welcome Bringing a QI perspective to Clinical Audit and NICE Devon Partnership Trust

Welcome Clinical Audit and QI Game (shamelessly stolen from CASC!!) Main title for slide set Optional sub title or name Identify the missing word! Big Collection George Practice Urine Size Inputting Margin Patient Monkey NCA Tarts Home Charts Simply Amber, Green Data Best Sample Error Survey POP Run Red

Situation Welcome In April 2017, Clinical Audit and NICE were moved to sit within the QI team portfolio The aim was to close the loop between NICE, Clinical Audit and Quality Improvement work It required a significant culture shift in the organisation Main title for slide set Optional sub title or name

Welcome Background Clinical Audit and NICE are mandatory Main title for slide set Optional sub title or name Clinical Audit and NICE are mandatory CQC monitors compliance with both processes Recent internal audit reports for both processes identified areas for improvement Historically, Clinical Audit and NICE were held within the Clinical Audit department

Welcome Benefits to others Main title for slide set Optional sub title or name Improvements in assurance levels against NICE and other areas of evidence based practice Leading to improvements in quality of care delivered to people who use our services Leading to less variation in quality and standards of care delivered to people who use our services Clinicians are able to have focused time on key clinical audit areas Improvements in assurance levels against NICE and other areas of Evidence Based Practice and Leading to improvements in quality of care delivered to people who use our services - we now have confidence that we have compliance against the high standards as recommended by NICE etc. In our local audits best practice is measured locally and we have done this by listening to the feedback from the people who use our services and their families Leading to less variation in quality and standards of care delivered to people who use our services - it is really important to us that the people who use our services have confidence in our abilities to deliver the same high standards of care wherever they happen to experience our care / service. It is important that it doesn’t change from place to place. Assessing ourselves against the evidence based practice with audit and with QI. We now have a robust process in place (identifying the standards, doing the audit, improvement work) so closing the loop. We use Clinical audit to assess ourselves against the ebp and the use QI work to address the gaps.

Assessment Welcome Main title for slide set Optional sub title or name

Assessment Welcome Main title for slide set Optional sub title or name

Welcome What have we changed? Main title for slide set ‘The most important part of the audit cycle is making change’ - Professor Richard Baker et al Welcome Main title for slide set Optional sub title or name NICE Excel tracker system and dashboard Directorate level tracker system CEAG meeting Methods of completion Team level Cross directorate workshop programme Link with ICP bundles Starting to use clinical audits as a way to evidence compliance – still areas for improvement Clinical Audit Restructure of clinical audit programme (reprioritising based on HQIP) Flow chart, resource pack and registration form process Visual tracker Training programme Different levels of QI team support – adapt our approach to the need of the individual Clinical audit sitting in a QI process To make these changes we have had to be: - Enthusiastic to gain buy-in Resilient and tenacious Strong and see the bigger picture Reflective Good communicators

Welcome What are we measuring? Clinical Audit NICE Main title for slide set Optional sub title or name Clinical Audit Number of audits registered on central programme Number of audits completed (to include improvement work) Number of staff trained in Clinical Audit for Improvement NICE Total guidance with a compliance statement Guidance completed in a workshop Now have a measurement plan in place and this is what we are measuring….

Welcome Recommendations Main title for slide set Optional sub title or name Learning Importance of role modelling and being visible Have the difficult conversations Power of coaching conversations Break it down into small chunks Make it relevant Challenges Culture change Decrease in clinical audits registered Continued challenges engaging clinicians in National Audit Programme and recognising the benefit of it / how it can be used to improve services Sitting the National Audit Programme within a QI process – we should be using the National audit data to drive improvement work Some of the challenges include: Culture change Through our new process we have found that there are now less audits being registered due to the change in process but the quality of the audits are better due to clinicians completing them. Continued challenges engaging clinicians in National Audit Programme and recognising the benefit of it / how it can be used to improve services Sitting the National Audit Programme within a QI process – we should be using the National audit data to drive improvement work Our learning includes: The importance of role modelling and being visible – we now have good representation at our CEAG – from Board members, senior directorate leads, physical health lead, meds optimisation team and the central QI team Having those difficult conversations but providing coaching has helped support and overcome these Breaking it down into small chunks and making it relevant – it is important to translate the theory around clinical audit and the data that comes out of the audit to then translate it into practice. If there is a gap then we should be doing something about it!

Welcome The key improvement message we have learnt! Main title for slide set Optional sub title or name Our key improvement message that we have taken away from this work is that by having robust proactive processes and ensuring the narrative includes the impact on people who use our services and their families and carers, we can ensure that we continue to improve and provide services that keeps them safe and well and at the centre. If we get it wrong then it is them that suffer.