1. The Scottish Early Years Collaborative

4. 1941, William A. Foster "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.”

5. Quality planning Quality assurance Quality improvement Juran’s trilogy

7. Quality Improvement “Quality Improvement is a broad range of activities of varying degrees of complexity and methodological and statistical rigor through which … providers develop, implement and assess small-scale interventions and identify those that work well and implement them more broadly in order to improve clinical practice.” Mary Ann Bailey, The Hastings Center

8. Implementing at scale…. can it be done? Will Ideas Execution

9. Evidence based discovery  Evidence based delivery 17 years to get 14% of evidence into practice

10. 25.1 harms per 100 admissions

12. Our change theory A clear and stretch goal A method Predictive, iterative testing

13. “By what method?” W.Edwards Deming A Breakthrough Series Collaborative underpinned by the Model for Improvement A clear aim Over 40 measures Five change packages Site visits, a listserve, learning sessions

14. IHI Breakthrough Series Collaborative Select Topic (develop mission) Planning Group Develop Framework & Changes Participants (10-100 teams) Prework LS 1 P S AD P S AD LS 3 LS 2 Supports Email (listserv) Phone Conferences Visits Assessments Monthly Team Reports AD P S Expert Meetings AP1AP2 AP3 LS – Learning Session AP – Action Period Holding the Gains

15. IHI Breakthrough Series Collaborative Select Topic (develop mission) Planning Group Develop Framework & Changes Participants (10-100 teams) Prework LS 1 P S AD P S AD LS 3 LS 2 Supports Email (listserv) Phone Conferences Visits Assessments Monthly Team Reports AD P S Expert Meetings AP1AP2 AP3 LS – Learning Session AP – Action Period Holding the Gains

16. What did the teams achieve?

17. HSMR – Jan. – Mar. 2012 Deaths and discharges = 221,674 Observed deaths = 6401 Expected deaths = 7167 HSMR = 6401/7176 = 0.89 9902 fewer than expected deaths since January 2008 902 in this quarter alone

18. Compiled from reported data by Jason Leitch – September 2012 HSMR: Scotland Jan. ’08  Mar. ‘12 1.03 0.89 10.6% reduction

19. Surgical Mortality 35% 0.51% 0.78%

20. Prepared 1 st March 2012 General ward C.Difficile rate (per thousand patient days) 1.15 0.12 90% reduction

21. ~6500 people

22. Act your way into culture change

24. Communities

26. The Improvement Guide, API Aim Measures Changes Execution

27. New measurement skills Run charts Transparency All-or none measurement

28. You can only learn as quickly as you test.

29. Having the best professionals in the world is no longer enough

31. @jasonleitch