1. Lothian’s Clinical Quality Programme & Academy
Simon Edgar
Nikki Maran
Jo Bennett

2. Our Intention

3. Our Reality
Safe – 10-15% harm Effective – up to 50% of patients don’t receive treatment recommended by evidence base Person Centred - ? Or clinician centric Timely – waits, breaches Equitable – postcode lottery? Efficient – unnecessary variation, overuse, repeat

4. Why a Refocus on quality?

5. More for less
Feels as if we have shaved off all the easy savings

6. Lothian Clinical Quality Approach
We’re going to have to do something different

7. Lothian Clinical Quality Approach
Commitment
Steering Committee
Definition & Goals
Have a coordinated plan and measures
Training & Support
Communications
Recognition & Celebration
Collaborations

8. Lothian Clinical Quality Approach
Clinical Quality Programme
Clinical Change Platform
Clinical programmes Data & Analytics inc finance Clinical Quality Leadership Academy Quality improvement support Clinical leadership
Clinical change forum
QI skills training
IHI open school
BMJ Quality
QIST support

9. Lothian Clinical Quality Programme
Identify all of our major clinical programs and associated spend

10. Intermountain Healthcare

13. £ “Move Upstream” strategies 30% Genetics
(illustrations)
Physical environment; social networks;
public health
20%
Population Health
housing for
chronic
homeless
Personal health behaviors
(tightly linked to general education level)
40%
Contribution to Total Health
1o Care
AMH
Iora patient
activation
SDM
Hot spotting
2o Care
Accountable medical homes
IORA health team based car and health coaches
Shared decision making – Choosing Wisely
Disease Treatment System
10%
Hospital Care
(including Emergency Room)
End of Life (EOL)

14. Lothian Clinical Quality Programme
Identify all of our major clinical systems
Define which are our key processes to improve
High activity
High morbidity / mortality
High cost
High degree of VARIATION

17. Individual clinician level data
80% of patients had similar severity and complexity of disease without major complications and similar outcomes BUT massive variation in clinician practice and two-fold difference in cost.

18. NHS Atlas http://www.rightcare.nhs.uk/index.php/nhs-atlas/

19. Lothian Clinical Quality Programme
Identify all of our major clinical care processes
Define which are our key processes to improve
Develop understanding of linked clinical processes within individual pathways using data sources

20. Process mapping

21. Lothian Clinical Quality Programme
Identify all of our major clinical care processes
Define which are our key processes to improve
Develop understanding of linked clinical processes within individual pathways using data sources
Reach concensus on standard of care locally based on best evidence

22. QI methodology

23. Lothian Clinical Quality Programme
Identify all of our major clinical care processes
Define which are our key processes to improve
Develop understanding of linked clinical processes within individual pathways using data sources
Reach concensus on standard of care locally based on best evidence
Use QI methodology to test and implement locally

24. Lothian Clinical Quality Programme
Identify all of our major clinical care processes
Define which are our key processes to improve
Develop understanding of linked clinical processes within individual pathways using data sources
Reach concensus on standard of care locally based on best evidence
Use QI methodology to test and implement locally
Utilise e-health solutions to drive & support data collection

25. Lothian Clinical Quality Programme
Identify all of our major clinical care processes
Define which are our key processes to improve
Develop understanding of linked clinical processes within individual pathways using data sources
Reach concensus on standard of care locally based on best evidence
Use QI methodology to test and implement locally
Utilise e-health solutions to drive & support data collection
Continuous monitoring on quality ‘dashboards’ within service

26. Lothian clinical Quality Programme Support
QI support – process mapping, QI methodology, coaching
Data analytics – current & future
Finance – activity based costing
E-health
Clinical lead
Clinical Quality Academy
QI Leadership
QI skills

27. Lothian Clinical Quality Academy

28. QI Leadership Training Course
Give participants the knowledge, tools and skills required to lead, conduct & manage clinical practice improvement AMDs, CDs, CNMs, service managers, Clinical quality leads participants 2 courses / year

29. QI Leadership Training Course
4 month training program
2 days / month
Blended learning
Clinical Project based
Learning & action periods
Mentorship
Webex support
“Graduation with completed QI project’

30. QI Skills Training Course
Give participants the knowledge, tools and skills required to carry out small scale improvement projects in clinical practice
Quality improvers in service inc QIT members
30 – 50 participants 3 courses / year

31. QI Skills Training Course
3 month training program
1 days / month
Blended learning
IHI open school introductory modules
Clinical Project based
Learning & action periods
Mentorship & Webex support
BMJ Quality learning platform
Structured workbook
Poster presentation
Access to publication

32. Other resources IHI open school [April ‘16]
Scottish Improvement Skills Courses
Scottish Improvement Leadership Course
Scottish Patient Safety & Quality Fellowship
School for Health & Care Radicals
Harvard / IHI QI MOOC – web link
Clinical Change Forum website
Local QI support team

33. CQacademy@nhslothian.scot.nhs.uk CQprogramme@nhslothian.scot.nhs.uk

34. Do you know how good you are?
And What Might Better Look Like?