Supporting NHS Wales to Deliver World Class Healthcare All Wales Stroke Services Improvement Collaborative All Nations Centre, Cardiff 4 th November 2008

Slide 2 All Wales Stroke Services Improvement Collaborative How to Guide Michelle Price Programme Manager AWSSIC

Slide 3 All Wales Stroke Services Improvement Collaborative Learning Objectives – the theory The 3 questions of the Model for Improvement (MFI) PDSA cycles Run charts – the practice Team aim for Stroke Services The ‘How’ of measurement The PDSA Cycle related to a Stroke service change

Slide 4 All Wales Stroke Services Improvement Collaborative How to Guide Choosing the Right Subjects The Bundles Collaborative Methodology Getting started- forming the team

Slide 5 All Wales Stroke Services Improvement Collaborative Improving Stroke Care Impressive array of service development initiatives already happening in Wales Evidence based RCP Guidance on all aspects of stroke care Programme of work from WAG covering whole stroke care pathway

Slide 6 All Wales Stroke Services Improvement Collaborative Deciding on the priorities Health Foundation report “Bridging the Quality Gap” Guidance from expert panel Gap analysis of SSIP workstream A Preliminary report of RCP Stroke Sentinel Organisational Audit 2008 Welsh expert opinion

Slide 7 All Wales Stroke Services Improvement Collaborative Interventions that prevent fatal or disabling stroke

Slide 8 All Wales Stroke Services Improvement Collaborative Potential effect of four key interventions on improving outcome following stroke

Slide 9 All Wales Stroke Services Improvement Collaborative Numbers that need to be treated to benefit one patient

Slide 10 All Wales Stroke Services Improvement Collaborative Estimated impact of four interventions for Stroke

Slide 11 All Wales Stroke Services Improvement Collaborative Avoidable burden of disease from selected interventions

Slide 12 All Wales Stroke Services Improvement Collaborative Cost-effectiveness analysis for three interventions

Slide 13 All Wales Stroke Services Improvement Collaborative What guidance is there? Health Foundation report “Bridging the Quality Gap” Guidance from expert panel Gap analysis of SSIP Workstream A Preliminary report of RCP Stroke Sentinel Organisational Audit 2008 Welsh expert opinion

Slide 14 All Wales Stroke Services Improvement Collaborative Sentinel Stroke Organisational Audit 2008 “ Thrombolysis for stroke is highly effective but only if given to the right patients in the right way…” They recommend that: “hospitals do not rush into providing thrombolysis before the other components of the service are functioning well”

Slide 15 All Wales Stroke Services Improvement Collaborative Focus on Acute Stroke Care Provides benefit for most patients Is most cost effective intervention Fits with the local and regional action plans that have been submitted to WAG Will provide a solid platform of high quality acute care on which to build thrombolysis and other services

Slide 16 All Wales Stroke Services Improvement Collaborative Driver Diagram

Slide 17 All Wales Stroke Services Improvement Collaborative Measures

Slide 18 All Wales Stroke Services Improvement Collaborative Successful Collaboratives Have subjects where: There is evidence of effective interventions and of gaps between best and current practice There are real examples of how improvements have been made in practice Professionals feel the proposed improvement is important and are motivated to achieve it The subject is likely to be strategically important to the organisations Participant s can exchange ideas and suggestions which can be applied in different settings to stimulate ideas and motivation to change

Slide 19 All Wales Stroke Services Improvement Collaborative Benefits of being part of Collaborative Opportunities: To improve the quality of patient care For professional development (new skills) To work with a wider range of peers To share good practice and lessons learnt For improving professional co-operation A way: To start a change culture Of being exposed to new ideas Of getting measurable improvements quickly

Slide 20 All Wales Stroke Services Improvement Collaborative The Successful Team has: The Successful Team has: Active support of leadership Multidisciplinary input with diversity of knowledge and experience, but with common agreed aims Ideas for improvement A clear understanding of the roles and responsibilities of the team An understanding of the benefits of being involved in the collaborative Clear communication lines within and without the team A Champion who will maintain the momentum A Project Lead who: Is self motivated Has drive and determination Is close enough to frontline to know what’s actually going on, but has enough authority to actually make things happen Has the support of the whole team and leadership

Slide 21 All Wales Stroke Services Improvement Collaborative In Summary Not all change is an improvement but All improvement requires change For change to stick it must be owned by those affected by change There is a already an enormous will and drive to develop and improve stroke services in Wales The How to Guide and AWSSIC, as part of the SSIP, will provide a framework to support the acceleration this improvement