1. The national patient safety collaboratives - creating the conditions for patient safety improvement
Phil Duncan
Head of Improvement Programmes

2. Session Outline
Background to national patient safety improvement programmes in England
Thinking differently about large-scale change
Overview of the national Collaboratives
Using the framework for clinical excellence - creating the conditions for a safety culture

3. The Francis Report - March 2013
Key messages from the Francis Inquiry recommendations, 4,000 pages
The Francis Report - March 2013

4. This safety programme is built on sound evidence based methodologies and routed in science, and where hope is definitely not the plan! Painted on the wall at the IHI HQ offices!

5. Back to Berwick
“Culture will trump rules, standards, and control strategies every single time. A safer NHS will depend far more on major cultural change than on a new regulatory regime.“

6. Frank Federico IHI

7. Thinking Differently about Large-Scale Improvement
Improvement programmes are typically based on a clinical problem or challenge
Many struggle to demonstrate measurable improvement, sustainability and spread
An additional focus on culture can provide a key component of an overall improvement plan
Quality improvement science and an understanding of safety culture can develop the often missing ‘HOW’ to improve
What
Why
When
?How

8. The National Patient Safety Collaborative Programme

9. Improving the safety of patients in England
Our collective ambition
Berwick response ‘A commitment to Act’ 2013
NHS - safest healthcare system in the world
Building a culture of safety, continuous learning and improvement
Regional collaboration – practical and systematic QI approaches
National partnership support and formation of networks
Alignment – with other safety initiatives
Goal: By 2019, everyone (patients and the public) can be confident that care is safer for patients based on a culture of openness, continual learning and improvement.

10. Key Messages for NHS Staff
To participate actively in the improvement of systems of care
To acquire the skills to do so
To speak up when things go wrong
To involve patients as active partners and co- producers in their own care

11. Key Questions
Are we thinking about patient safety in the right way? – Is the definition of harm too narrow?
How is safety achieved in different settings? – Has only part of the healthcare system been addressed?
Do we need a wider range of safety strategies and interventions? – Has current progress been slower than anticipated?
Can a framework of strategies and interventions be developed? Across care settings - hospital, home, primary care. Across levels - patient, frontline, organisation, regulation and government?

12. Goal: By 2019, everyone (patients and the public) can be confident that care is safer for patients based on a culture of openness, continual learning and improvement.
Academic Health Science funded local delivery mechanism x15
Primary focus on clinical harm, culture, leadership and measurement
Local engagement and focus on clinical safety concerns across a range of settings
Test change ideas and develop solutions measure impact
Improved mechanism for spread and adoption of improvement
Harness talents - staff, patients, academia and industry
Build local / regional QI science capability
Test bed for spread and adoption of innovation and improvement
The Patient Safety Collaboratives, funded and national coordinated by NHS Improvement and led by England’s 15 Academic Health Sciences Networks (AHSNs). The programme aims to support and encourage a culture of safety, continuous learning and improvement across the health and care system, helping to reduce the risk of harm and make care safer for all.
PSC was established in response to the Berwick report:
“The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end.” Berwick
The PSC is designed to be a a programme of practical hands on improvement projects based on local need using tried and tested quality improvement methods, working through networks and developing partnerships. The PSC is
building capability around safety improvement;
creating capacity to work on safety issues within collaborative networks; and
providing opportunities to continually learn from each other.

13. Logic Model – focus on Leadership for safety at all levels
Culture assessment debrief and action (through a safety lens)
QI Capability building
Continuous Learning – transparent systems to learn from error and excellence
Measurement for improvement skills
Process – improving the reliability of clinical care processes
Innovation for safety in healthcare AHSN partnerships
In terms of where we focus of efforts we looked at the evidence in the literature and worked wth research and evaluation icolleagues n NHS England to develop a logic model
For those who may not be aware logic models are an explicit, often visual, statement of the areas of focus and activities that will bring about change and the results you expect to see. A logic model helps participants in the effort moving in the same direction by providing a common language and point of reference. – making it more likely to effect change.
Activities and interventions were themed into these categories

14. National Workstreams
Strength in collaboration across the patient safety collaboratives
Accelerate the pace and scale of learning and improvement
Actively look for common themes
Measure collective impact nationally
Creating the conditions for a culture of safety
Supporting the maternal and neonatal health safety collaborative
Early recognition of deterioration

15. The maternal and neonatal
health safety collaborative

16. What is the aim?
To improve the safety and outcomes of maternal and neonatal care by reducing unwarranted variation and provide a high quality healthcare experience for all women, babies and families across England

17. What is the ambition of the collaborative?
By March 2020 each organisation, local maternity system and network will have:
significant capability and capacity for improvement
detailed knowledge of the local safety culture
understood their priorities and gaps, and developed a local improvement plan
made significant improvement to the local service and system quality and safety
data to share with their board, staff and commissioners that reflect these improvements
…to create the conditions for a safety culture and a national maternal and neonatal learning system

18. Aim
Primary Drivers
Secondary Drivers
Creating the conditions for a culture of safety and continuous improvement
Improve the proportion of smoke free pregnancies
To improve the safety and outcomes of maternal and neonatal care by reducing unwarranted variation and provide a high quality healthcare experience for all women, babies and families across maternity and neonatal care settings in England
Reduce the rate of stillbirths, neonatal death and brain injuries occurring during or soon after birth by 20% by 2020
Develop safe and highly reliable systems, processes and pathways of care
Improve the optimisation and stabilisation of the very preterm infant
Improve the experience of mothers, families and staff
Improve the detection and management of diabetes in pregnancy
Learn from excellence and harm
Improve the detection and management of neonatal hypoglycaemia
Improve the early recognition and management of deterioration during labour & early post partum period
Improving the quality and safety of care through Clinical Excellence

19. How is the collaborative structured?
National Learning Set
(Trust Improvement)
Trust
Local Learning Systems
(Trust & System Improvement)
Trust
LMS

20. How are the meetings structured?
National Learning Event
Annual progress and learning shared from active wave organisations – scale up
Three x 3-day training and support meetings for organisation based local improvement leads
Development for board level safety champions (executive sponsors)
Tailored unit level support by central programme team
National Learning Set
Quarterly local learning system meetings
Facilitated by PSCs
Supported by all stakeholders
Bring together all organisations and professional groups including commissioners and parents/families
Local Learning Systems

21. Working and learning together
Local Learning Systems
Trust
LMS
The collaborative learning systems are the local improvement communities that support the national driver diagram and system level improvement
All organisations (waves 1-3) and key stakeholders share and learn from each other
System groups will meet up to four times per year
All providers and key stakeholders will be included from the outset

22. Measurement
Patient Safety Measurement Unit (PSMU) established to support improvement programmes
Developing measurement strategy and measures framework
Baseline assessment - now building PSC measurement for improvement capability
Support the dissemination of learning, evidence and impact
Help to improve the measurement of safety in the system
A real push now on measurement now we have established the PSMU. Addresses the issue of effectively measuring patient safety improvement by having central resource to collect and analyse data specifically around patient safety improvement.
Working to develop the strategy and develop a balanced set of metrics
Carried out an assessment of all PSCs in terms of capability with a plan for support
Extracting the learning and impact
and spread and adoption of learning and notable practice across the NHS
Scope for greater alignment or synergy with other programmes

23. Framework for Clinical Excellence
Creating an environment where people feel comfortable and have opportunities to raise concerns or ask questions.
Being held to act in a safe and respectful manner given the training and support to do so.
Transparency
Leadership
Psychological Safety
Negotiation
Teamwork &
Communication
Accountability
Reliability
Improvement
&
Measurement
Continuous Learning
Engagement of Patients & Family
Facilitating and mentoring teamwork, improvement, respect and psychological safety.
Developing a shared understanding, anticipation of needs and problems, agreed methods to manage these as well as conflict situations
Openly sharing data and other information concerning safe, respectful and reliable care with staff and partners and families.
Gaining genuine agreement on matters of importance to team members, patients and families.
Applying best evidence and minimizing non-patient specific variation with the goal of failure free operation over time.
Regularly collecting and learning from defects and successes.
Improving work processes and patient outcomes using standard improvement tools including measurements over time.
© IHI and Allan Frankel

24. Using Cultural Measurement with QI
Measure culture
Debrief results
Apply improvement methodology
Make changes
Engage local team & leaders

25. Underpinning Improvement
A clear and practical framework made up of two “organ systems” - culture and learning process, if the culture isn’t right there will be no learning. The learning system is underpinned by culture, the foundation for the delivery of safe, high quality care
©Alan Frankel and IHI 2013

26. Culture – the foundations
Culture is uniquely local - the social glue in an organisation, ‘the way we do things round here’
High performing teams have clearly agreed norms of behaviour and structures that support behaviours that create value for the patient, staff and the organisation.
Measuring culture provides valuable (personal) insights into what it really feels like to work in that environment in a particular role
Insights can be quite disparate - "the doctors or managers think it's fine, and no one else does"
Evidence on culture - perceptions about teamwork, safety, and leadership correlate with the quality of care and ‘excellence’
Critical components of culture in healthcare are Leadership, Psychological Safety, Accountability, Negotiation and Teamwork
©Alan Frankel and IHI 2013

27. Learning – a system
Every day skilled healthcare professionals face challenges with basic defects and flaws that make it difficult to deliver high quality care
A learning system provides a methodical way to visibly capture concerns and act on them by introducing a cycle of learning and improvement
This is an essential component of high performing organisation
Critical components of a learning system are Reliability, Improvement and Measurement, and Continuous Learning
©Alan Frankel and IHI 2013

28. Improvement Value
Not just about safety – potential framework for all improvement work
Traditional improvement focus on measurement and reliability alone
Improvement work will have a better chance of succeeding, under the right conditions and environment
Important to consider and assess each component of the framework at the start of any improvement work
Culture focussed QI allows learning and improvement to flourish
And to sustain…

29. Questions
Thank you
@phil_duncan1