1. Why a New/Refocus on quality
Lothian Clinical Quality Approach
Why a New/Refocus on quality

2. QA is a find those bad apples set up – ie can only be due to incompetence or negligence
8 conditions in medicare where mortality was a good model of outcome

7. Variation [Appropriate & Inappropriate]
The key to appropriate variation is standardisation
Variation [Appropriate & Inappropriate]

8. All teach, All Learn
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.

9. Why a New/Refocus on quality
What might better look like?
Why a New/Refocus on quality

10. Our Blueprint for Quality
Commitment
Steering Committee
Definition & Goals
Have a coordinated plan and measures
Training & Support
Communications
Recognition & Celebration

11. Defn: What is Quality Quality in Fact Quality in Perception
Doing the right thing
Doing it the right way
Doing it right the first time
Doing it on time
Delivering the right product or service
Satisfying customer needs
Meeting expectations
Treating everyone with integrity, courtesy and respect

12. 6 recognised dimensions of quality
All the right care (no underuse/equitable)
But only the right care (no overuse/effective)
Delivered free from injury (no misuse/safe)
At the lowest necessary cost (efficient)
Coordinated along the full continuum of care (timely)
Under each patient's full knowledge and control (patient-centered)

13. Clinical quality approach
A management and measurement system to focus on front line value adding clinical processes
Clinical quality approach

14. A series of actions or steps taken in order to achieve a particular end
All processes have parallel outcomes of physical (clinical), cost, service
Every process is perfectly set up to deliver the outputs that it does
Processes

18. clinical quality Academy
Developing capacity & capability & leadership ability
Widening access to learning: 100% participation
Supporting Coaching in the Clinical Setting
Developing a shared language, understanding and focus
clinical quality Academy

20. Clinical quality programme
Selection: Activity, Cost, Acuity, Variation, Engagement
Development: Academy
Support: Quality (QIST) Data, Finance
Infrastructure & Leadership
Facilitate Change
Clinical quality programme

21. Expert on the tools and focusing on health of team
Primary role is engagement of front line staff
Choose leverage points, set goals and timeline

22. Communications Clinical Change Forum BMJ Quality Social Media
Brent James DVD
Partnership
Communications

23. Clinical integration Identify processes
Information system for parallel clinical and financial management
Organisational structure to facilitate this data being used
Incentivisation
Clinical integration

25. END

26. HIS
Scot Gov
IMH
UoE
Lothian Foundation
NES