Intelligent targets

Director of Research and Development Dr Alan Willson Director of Research and Development NLIAH

What we don’t want Perversity Imposed targets Lovely targets but no change

Wales stroke audits over 5 years What is worse? Brain scan in 24 hours – 60% to 38% OT assessment - 62% to 50% Home visit before discharge – 80% to 53% What is better? Aspirin started – 72% to 76% MDT goals agreed – 58% to 70%

What are we actually trying to do? Improve the reliability of care in Wales Raise the standards of care in Wales

A Quote Although clinicians setting targets is the way forward, how do we re-educate them to move away from end line inspection to on line inspection? They have grown up in organisations which review complaints, undertake audit, reflect on research….which all have their place, but amazingly with such a captured audience ‘the patient’ they fail miserably to monitor, measure and improve quality at the bedside. Can you imagine a world whereby all staff were involved in quality questioning…. I would predict a stepped change in complaints!

The Intelligent Targets Approach Focus on process of change Use expert groups for subject knowledge Use model for change as a standard Greenhalgh criteria

Greenhalgh Criteria It must have clear relative advantage It must have compatibility with the user’s values and ways of working Complexity must be minimised Users will adopt more readily if innovations allow trialability There must be observability, that is it must be seen to deliver benefit Reinvention is the propensity for local adaptation

An evidence based model for producing clinical change The Model for Improvement Agreed process changes (care pathways and driver diagrams) Outcome and Process measures Appropriate Performance Management Support for improvement (will/ ideas/ execution) Tools- data handling, driver diagrams, collaborative learning

Model for Improvement

Acute Phase Driver Diagram

Measurement and Management Domain Examples Uptake (organisational conditions Identified management lead Identified clinical champion Intranet sign up Data submitted Teams trained Local communication strategy in place Process change (Intelligent Targets) Bundle compliance Uptake of new practice (specific to driver diagram) Outcome change (consequence of process) Reduced morbidity Reduced mortality Reduced dependency Reduced hospital stay