Improving Quality of Care How do we address the implementation challenge? Iain Wallace Interim Medical Director NHS Quality Improvement Scotland

An expert is somebody who is more than 50 miles from home, has no responsibility for implementing the advice he gives, and shows slides. Edwin Meese III

……first something about NHS QIS

NHSQIS Excellence in leading the use of knowledge to improve the quality of healthcare for the people of Scotland

Dimensions of Quality in Health Care Effective Safe Patient Centered Timely Efficient Equitable Institute of Medicine 2004

QIS, QI and QA NHS QIS Key Activity Advice, guidance and standards Implementation and improvement support Assessment, measurement and reporting Local improvement cycles Assurance Accountability

Advice and guidance   SIGN guidelines   Standards   Assessment of clinical and cost- effectiveness of health interventions   Health technology assessments   Evidence notes   NICE advice

Implementation Scottish Patient Safety Programme Infection Improvement and Implementation Programme SIGN Rockets QOF & SPICE pc

Assessment and measurement   Performance assessment against standards   National audits   External quality assurance   Healthcare Environment Inspectorate

But………

How can we do things better?

A systematic narrative review of quality improvement models in health care AE Powell, RK Rushmer, HTO Davies

How to do it…….

Factors for successful implementation of QI Apply method consistently over a sufficiently long timescale with sustained commitment and support

Factors for successful implementation of QI Involve doctors and other health professionals in a wide team effort while providing adequate training and development

Factors for successful implementation of QI Integrate quality improvement into other activities and tailor methods to local circumstances

Factors for successful implementation of QI Good information systems to enable measurement of processes and impact

Factors for successful implementation of QI Acknowledge and ameliorate as far as possible the impact of competing activities and changes

Adoption/spread Easier where an improvement initiative offers: Relative advantage Compatibility Simplicity Trialability Observability

HIT implications……….

Improve the system then add IT “We know that if you try to apply IT to something that is fundamentally screwed up it doesn’t help very much!” Prof. Michael Porter Harvard Business School MIT Symposium on Healthcare IT July 2006

HIT and QI Information for decision-making Portal Point of care decision support e Care bundles Relevant real time feedback

HIT and QI Computers really can improve your health, or at least make your doctor less likely to kill you. The Guardian, Jan 2006

QIS Support for Implementation Training in improvement methods measurement Development of care bundles Enhancing leadership capacity Supporting clinical teams through learning events

The future Integrated approach across primary and secondary care Improvement ‘bundles’ as the main currency Measurement of change/ improvement at local level Learning from others Building on an effective e health platform