1. Scottish Improvement Skills
Quality improvement
and why it matters
SIS: Group A Quality Improvement Introduction and Principles: Module - Quality Improvement and Why It Matters: Facilitator
This module provides an opportunity to demonstrate to participants that the programme has the endorsement of key stakeholders.
If this session is led by a speaker who is not one of the facilitation team for the rest of the programme, add their name and designation to this slide.

2. Quality Improvement and why it matters
By the end of this session you will be able to:
outline the policy context for Quality Improvement in Scotland
describe how your improvement project aligns with this policy context.
Discovery
Aim/Key messages
Learning outcomes
To generate interest in listening to the Lead facilitator/Speaker to find similarities and differences in their own thinking
Also for participants to begin thinking about people issues (thoughts and feelings around change)
Timing: 30 mins max for this section
Lead facilitator or visiting speaker
Talk through learning outcomes on slide – or ask participants to read it.
Divide participants into groups (between 3 – 5 people in each group, depending on how many at each table)
Discuss: Why do you think quality improvement matters? (5 mins)
Debrief: elicit responses from a few people (quickly – not every table – 1-2 mins)

3. NHS Scotland 20:20 Vision
Lead facilitator
Aim is to move 200,000 bed days from hospital to home
WHY – for the patients and their families
Next we will look at what and how.
Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting.

4. Route map to the 20:20 Vision
Key messages
As highlighted in bold below.
We have a document called the Route map to the 2020 vision which shows that in order to deliver against our quality ambitions we are focusing on 3 main strategic areas:
Quality of Care
Health of the Population
Value and Financial Stability
(This is based on the IHI Triple Aim but with one important addition – that of integration.) This means having an integrated health service but also integrating health and social care.
Under each of these themes we have also identified 12 priority areas for action – where the evidence shows that by focusing on these high impact changes the greatest improvement in health outcomes can be achieved. So for example we have prioritized our work on patient safety, working on early years and also development of our workforce – with the latter based on the very strong evidence that well motivated and educated staff deliver better outcomes for patients and service users

5. Aims:
To deliver the highest quality healthcare services to the people of Scotland.
For NHSScotland to be recognised as world-leading in the quality of healthcare it provides.
The foundation of NHS Scotland’s approach is the Healthcare Quality Strategy, which was published in 2010.
Elicit:
Have you come across it?
Have you read it?
As well as setting out the aim to delver the highest quality healthcare services to the people of Scotland it also confirms our very ambitious aim to be recognised as world-leading in the quality of healthcare we provide.
We can only be ambitious as an organisation if we are ambitious as individuals.

6. Quality Ambitions
Person-centred: Mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision making. Effective:The most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. Safe: There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.
The Quality Strategy sets out three specific ambitions around delivering care.
Elicit what the 3 ambitions are: Person-centred, effective and safe.
However, thinking has moved on since 2010 – current thinking is that everything we do should be person-centred
Ie person-centred safe care
Person-centred effective care

7. Six dimensions of quality
The 3 quality ambitions represent three of the Institute of Medicines 6 dimensions of quality
Elicit:
Why don’t we use the same 6 as our quality ambitions?
We firmly believe that by focusing specifically on these three elements we will also be able to deliver care that is efficient, timely and accessible.
Effective = are we complying with the evidence base/national standard?
So this is the overall strategy and vision. How does this translate into practice?
Lead facilitator provides an example of a story of what this might look like in practice. eg
Care of the elderly ward meal planner example case.
New hospital at Larbert in NHS Forth Valley. Introduced a new process for patients meal selection. Menus provided to patients for the week and Healthcare Support Worker entered their choices in a hand held pda.
In a care of the elderly ward one of the HCSW noticed that often the patients with memory loss found it difficult to make selections and often could not remember what they had selected. This led to these patients not eating and meals being wasted.
When she was on a shift, she started to sit with these patients and note down for them what they had chosen. When she spoke to patients’ families this came up in the conversation, and the families started saying what their relatives’ likes and dislikes were.
She had the idea that it would be good to involve the families in helping make the meal selections and in leaving a note with the patient. She wondered what she should do and decided to explain her idea to the ward sister. The ward sister was supportive and said they could try it out for a week or so to see how things would go. She drew up a simple form with days of the week and meal choices for breakfast, dinner and tea. The families really enjoyed helping the patient, it gave them something to discuss and helped them feel involved. A written note indicating what they had chosen was left beside each bed. The patients had food they enjoyed and the portion they could manage and there was less food waste.
Small groups (2-3 people): how do you think this relates to the three quality ambitions (or 6 IoM components)?
Person-centred – yes, involving patients and their families
Effective – yes, receiving meals appropriate for them
Safe – yes, arguably contribute to safety (eg patients get the nutrition they need so less likely to fall or get pressure ulcers)
This idea worked so well in the care of the elderly ward that they decided to try it out in the stroke ward.
There are examples like this all over Scotland where staff are making improvements and doing it without knowing about the tools and ideas we are going to cover during the programme.
Imagine the difference - the transformation we could make if we were aware of even some of the tools that could help achieve improvements more rapidly and reliably.

8. “... the Quality Strategy will be the means by which we ensure that these longer-term transformational challenges are addressed.”
The Quality Strategy is also the means by which the key systems challenges will be addressed. (ie the how)
But I want to focus for a minute on the term ‘transformational’ in this quote. We use the term transformational a lot and so it is important to be sure we understand what it means.

9. Transformational change
A definition:
A change that is not merely an extension or improvement over the past, but a state change. 
This state change in social systems can be personal and/or organisational.
Achieving this state change requires altering and expanding the limiting mindset in which the individual/the organisation operates.
Key messages See phrases in bold
Timing
For this slide + activity below: 8 mins
Transformational change requires a state change – not just an extension of what we have done or even an improvement
It requires us to change mindsets i.e. change values and behaviours as well as applying technical solutions
IT analogy:
Some improvements involve bolting on new hardware or files or programs to the existing operating system.
A transformational change would involve changing the entire operating system.
Groups (2s or 3s) 3 – 4 mins
Discuss a time you were involved in a transformational change - it could be personal or at work.
What was the change?
What did you do that was different from what you did before?
How did you behave outside your comfort zone?
What did it feel like, what were your emotions - good and bad?
Plenary debrief (1 – 2 mins): elicit some of the emotions – good and bad

10. Achieving that change
Before the fact the new level of performance envisioned is audacious. It calls for a new way to do the work with a new level of fearlessness, of innovation and collaboration.
After the fact, you will say that we have more than a large improvement, we have a different person or organization, a state- change, a transformation.
So how do we go about making that change? We need to be Audacious

11. Lead Facilitator
And here are some other words associated with being audacious – the larger ones are the behaviours we want to promote:
Courageous
Brave
Innovative
Bold
Enterprising
Link back words above to any relevant examples they provided during the discussion about their experience of transformational change – Did any of these words apply? (or with ref to Forth Valley menu example)
This is where all of you become even more important because NHSScotland can’t achieve its vision without all of you.

12. "Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.”
So in summary NHS Scotland has chosen to embark on a journey of transformational change based on delivering high quality health and care – summed up by this quote from William Foster way back in 1941
William A. Foster 1941 12

13. QI and why it matters: summary
Quality Strategy
Six dimensions of quality
20:20 Vision
Route map to the 20:20 vision
Transformational change
Aim
To briefly recap the session content:
- to support a sense of learning and accomplishment
- to aid memory of the session later
An opportunity for participants to ask any outstanding questions from any part of the session.
Timing
1 – 2 minutes, depending on time available
Lead Facilitator
In everything you do, you should be thinking about how your aims align with policy.
Elicit what content was covered for each of the bullets eg
What are the 3 quality ambitions?
What are the other three dimensions of quality identified by the Institute of Medicine?
What is the main aim of the 20:20 vision?
What are some of the 12 priority areas for action in the Route Map? Eg Patient Safety, Early Years, Workforce. How have they been identified? (evidence base that these provide the greatest impact in terms of outcome)

14. References and further resources
Scottish Government 2010 The Healthcare Quality Strategy for NHSScotland Edinburgh: Scottish Government Scottish Government and NHS Education for Scotland Vision Scottish Government Local policy and strategy documents eg Local delivery plan.