1. RCSI Masterclass 6-11-12 Dr. Philip Crowley, National Director Quality Improvement Quality and safety the national context

2. The challenge that faces us  Budget  Medical and nursing recruitment and retention  Limited measurement of quality  Media and morale  New divisions – focus vs integration  Fire fighting (comfortable) Vs process, practice and care improvement

3. Nursing and Midwifery Developments  Expanding roles  Nurse and Midwifery Prescribing (medicinal products and X-ray)  Advanced practice (eg EDs, sexual assault, chronic disease mangement)  Driving key safety initiatives  NEWScores/IMews  Collaboratives, pressure ulcers, falls  Measuring Care (Nursing and midwifery) metrics  Leading Quality Improvements

4. Mid Staffs and nurse leadership  Presented to HSE leadership team X 2  Communication to system re acting up  Audit:  229 CNM2/CMM2 posts acting up  = 14%  Ongoing support for developing CNM/CMM2 competency  Moderate levels of empowerment, time to lead?  And DoNs, ADoNs, CNM3???

5. Flipping Healthcare Move from “What’s the matter?” to “What matters to you?”  The patient is not the problem (Muir Gray)  “Minimally Disruptive Medicine” (Victor Montori)  Having conversations with the patient, understanding patients (not just their diseases) and their lives  Patient goal setting Source: Barry MJ, Edgman-Levitan S. ”Shared Decision Making – The Pinnacle of Patient-Centered Care.” N Engl J Med. 366;9. pp 780-782. Montori, VM. “Shrinking the health care footprint.” Minnesota Physician. XXV(1). April, 2011

7. Quality led by Staff  Staff experience – seek and value feedback and ideas for improvement  Quality and safety Walk-rounds  Enable people to do a better job  ‘Walk in my shoes’  Do reinvent the wheel

8. QI Tools Driver DiagramRun Chart

9. Greatest impact at ward level Collaboratives Pathways EWS Guidelines Quality Improvement of Patient care National Trust Ward Conditions Leadership Patient involvement Clinical Governance Education & Learning: - Measurement - QI Methods Conditions Leadership Patient involvement Clinical Governance Education & Learning: - Measurement - QI Methods

10. Increasing capacity for QI Now over 200 staff trained in QI from the Diploma, Scottish Patient Safety and CAWT Programmes.

11. Pressure Ulcer to Zero Collaborative 73% Reduction in Pressure Ulcers

12. Collaborative methodology February AprilJune Final Celebratory Event

13. Overall Collaborative trend over time

14. Comments Overall key learning was Teamwork – the benefits of working with a team/group and the visual impact of keeping data’ Key learning was the importance of working together, good collaboration and communication. If managers support QI initiatives, teams can achieve great results. It’s all about teamwork and communication with a smile. Great team building experience My only advice or request is if you could organise the kind of learning sessions often, that would be a great help and encouragement.

15. Academic Hospital Groups

16. Can we move from “teaching hospitals” to “learning hospitals” and care settings? Where learning together about how we can improve quality and safety is at the heart of what we do

17. Clear roles for Quality and Safety  Board  Providing direction and leadership  Overseeing/obtaining assurance on clinical care quality and safety (Board Q +S committee)  Executive  Operationally managing clinical care quality and safety (Executive Q+S committee)  Staff  Delivering quality safe compassionate care  Contributing improvement solutions

18. How can QI division support you? Quality Improvement Division Patients and Staff partnership Quality Improvement Capacity building Strategy and innovation Quality data analysis and audit

20. Quality Improvement “We have two jobs: our job and the job of improving our job” Donald Berwick

21. Philip Crowley Philip.crowley@hse.ie www.hse.ie/go/qps