1. Collaborating for Quality NHS Scotland's Quality Improvement hub
A New Partnership for Improvement Jane Murkin
Associate Director of Improvement

2. Session aims
Outline the design and development of NHS Scotland's Quality Improvement Hub
Context of healthcare today and its relationship with quality improvement
Consider the application of improvement science and methodologies in relation to knowledge management
Roles and functions
Coordination and integration
Infrastructure – local and national
Identify opportunities to test and implement new and different ways of working
An opportunity to identify and participate in designing and shaping the future state

3. Care is not safe – Institute of Medicine report
“Between the care we have
and the care we could have,
lies not a gap, but a chasm”

4. How many people are
harmed in
our healthcare system?

5. Adverse Events in Hospital
3.7% Harvard 1991
16.6% Australia 1995
10.8% London % PREVENTABLE
3 million bed days in UK
£1 billion per annum in UK
Acute hospitals 9.5% - HAI
(July 2007 HPS)
Pre work SPSP
SPSP Data – what are we learning in relation to harm

6. Global Trigger Tool Reviews
3 Exemplar Hospitals (900 notes)
40 Bed rural Hospital (300 notes)
10 Hospital Research Project (240 notes)
7 Hospital System (3000 notes)
Multi-state Tertiary System (2000 notes)
Events/1000 Days 83 90 NA
119 86
Events/100 admissions 45 40 37 41 38
Admissions with adverse events
32%
30%
29%

7. A Major Study of Reliability in American Health Care…
McGlynn, et al: The quality of health care delivered to adults in the United States. NEJM 2003; 348: (June 26, 2003)
439 indicators of clinical quality of care
30 acute and chronic conditions
Medical records for 6712 patients
Participants had received 54.9% of scientifically indicated care (Acute: 53.5%; Chronic 56.1%; Preventative 54.9%)
Conclusion: The Defect Rate in technical quality of American health care is approximately
45%

8. How safe are clinical systems?
Primary research into the reliability of systems within 7 NHS organisations and ideas for improvement ( Health Foundation May 2010) Reliability in healthcare – This is not simply a matter of putting in place proper guidelines and expecting practitioners to follow them. It involves identifying in advance the points at which those mistakes can happen, the different elements that contribute to those mistakes and the systems that practitioners should follow in order to ensure pt safety

9. Converting research to care
Publication
Bibliographic databases
Submission
Reviews, guidelines, textbook
Negative results
variable
0.3 year
years
50%
46%
18%
35%
0.6 year
0.5 year
9.3 years
Dickersin, 1987
Koren, 1989
Balas, 1995
Poynard, 1985
Kumar, 1992
Poyer, 1982
Antman, 1992
Lack of numbers
Expert
opinion
Inconsistent
indexing
17:14
Original research
Acceptance
Patient Care
Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yrbk of Med Informatics 2000; 65-70
17 years to apply 14% of research knowledge
to patient care! 9

10. Mid Staffordshire report
Brings me on to, “we have 2 jobs to do 10

11. 11

14. Remember…

15. A Model for Learning and Change
When you combine the 3 questions with the…
…the Model for Improvement.
PDSA cycle, you get…
The Improvement Guide, API, 2009. 15

16. Develop the Quality Improvement Hub, reflecting a new partnership for improvement between NHS National Services Scotland (NSS), NHS Quality improvement Scotland (QIS), NHS Heath Scotland, NHS National Education for Scotland (NES), and the Scottish Government Health Directorates Improvement and Support Team (IST).
Scottish Government, May 2010

17. QI Hub – What is it all about?
Collaboration between NES, NHSHS, NHS QIS, NSS, IST and SGHD
A coherent and cohesive national approach to supporting QI
Maximising resources – the whole is greater than the sum of its parts
Brokering access to resources and support to realise ‘world class’ ambitions of the H/C Quality Strategy

18. The QI Hub aims to bring improvement science into everyday work and language of NHS staff and to support demonstrable improvement in patient care through quality improvement activity.

19. Building on sound foundations
Improvement work to date
Global ‘Improvement Movement’ (SPSP)
Bringing coherence to implementation and improvement support methodology(NHS Healthcare Improvement Scotland /QEST)
Drawing on NES’ developing educational infrastructure for QI
Measurement for Improvement (NSS/ISD)

20. We are not alone …
Mention that all centers are different with different opportunities to succeed in various areas within the organization. Experts & Expertise.

21. Shaped and designed by NHS Scotland
The NHS Scotland Quality Improvement Hub works in partnership by providing a coordinated national resource to care teams and organisations.
Facilitating:
Implementation support – flexible and responsive
Education and learning about QI – Accessible and relevant
Measurement of QI which is meaningful
Facilitating QI networks for NHS staff
Underpinned by creativity and innovation

22. Progress to date
The Quality Improvement Hub –”Delivering to improve” – April 2010
Our approach – Partnership, initiation, shaping the development, set up, action planning, execution plan, launch, go live and implementation
Stakeholder consultation – May 2010
Stakeholder event – Shaping the development – June 2010
Formulation of work programme aligned to Quality strategy and national priorities
Regional events – Developing the community ,Improvement Directory
Ongoing stakeholder engagement – Board visits - learning
Proof of concept testing March – June 2011
An improvement approach

23. Making it happen.... Coordinating centre - Elliott House
Small core team – Exec Leadership, Associate Director, Improvement Advisor, Data Systems Manager – link to ISD, Business Manager, Project support
Evidence into Practice Portal – virtual communities
Building a Community of Improvement Practitioners (Directory)
Planned and ‘bespoke’ programmes
Prioritisation process – levels 1 - 5

24. Brokering support from NHS Scotland Staff
Proof of concept work –
Supporting the development of a Mortality Reduction Improvement Plan,
Building capacity and capability for QI,
Patient safety in Primary Care,
National Audit work
Testing a brokerage model with boards
Directory of Improvement Practitioners
Developing our workforce
So many opportunities and so much potential

25. The Challenge Complex healthcare systems Competing priorities
Initiative overload
Project weary staff
Project failure rate
In some NHS Boards same staff – multiple hats
History of a target culture
Policy/politics
Our resources are limited – people being the greatest
How can we achieve more and maximise the potential?

26. “NHS Scotland has undertaken a bold, comprehensive, and scientifically grounded programme to improve patient safety.  The dedication of NHS leadership at all levels to this endeavor is apparent to me, and bodes well for success.  In its scale and ambition, the Scottish Patient Safety Programme marks Scotland as leader – second to no nation on earth – in its commitment to  reducing harm to patients dramatically and continually.” Don Berwick June 2008

27. What will it take to improve quality and safety?
Winning the hearts and minds of the staff
Focusing on improvement not targets
Leadership
Integration
Making it daily work
Creating infrastructure
Creating capability and capacity
Measurement that has meaning
Understanding context and culture
Momentum

28. What's our collective aim?
Integrating and aligning knowledge management expertise and resources to support local and national quality improvement activities and implementation of our quality strategy
Creative Thinking
Creativity implies having thoughts that are outside the normal pattern.
What can you do to have “new” thoughts?
How do we “provoke” new thinking?
What can we test and implement
How do we learn ourway into a new world
How much and by when? 28

29. "We cant change the human condition, but we can change the conditions under which humans work"
James Reason

31. The power of words