1. The UCLH Quality Improvement Framework Guy Young Head of Quality Improvement

2. What is quality? Excellence in meeting customers’ expectations In healthcare 3 components: –Is it safe? –Is it effective? –Is the experience good for the patient?

3. Why do we need a quality improvement programme?

7. Ward reception desk Midwives station Midwives station Discharge lounge Clean utility Treatment room Dirty utility Patient bathroom Patient board 2. 36 3.3. 1. 4 5. 6.6. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2526 27 28 29 30 31 32 33 34 35 Paeds room 37 38 39 40 41 42 SPAGHETTI DIAGRAM OF ONE MIDWIVES’S TRAVEL ON POSTNATAL WARD Key Findings: In one hour, one midwife in charge of discharging women from the ward had 62 different stop offs Clusters of stop offs at patient boards, midwives stations, bays of women being discharged and in the clean utility room Midwife was interrupted twelve times with questions and queries from colleagues, women and their partners Difficult to identify which woman to discharge next because of information on the patient white boards. Ward environment increases hunting and gathering time. 43 44 45 46 47 4849 50 51 52 53 54 55 56 57 58 59 60 61 62

9. The UCLH Quality Improvement Framework A way of delivering continuous quality improvement at ward/unit level driven by frontline staff –Draws on: Transforming Care at the Bedside Productive Ward Lean Aligns well with HIAs and Energising for Excellence

10. Key themes Transformational Leadership Safe and Reliable Care Vitality and Teamwork Patient-Centered Care Value-added Care Processes

11. Cross cutting interventions Intentional rounding Patient status boards SBAR The Well Organised Ward (5S) Care bundles

12. How it is done? Change driven by frontline staff Staff agree areas for improvement and identify potential solutions (snorkel) Small tests of change Adoption and spread

13. Results of a snorkel

14. Small tests of change Small means small! –One nurse –One patient –One time/one shift

15. The PDSA Model Components P lan an activity or improvement test D o the activity (implement the improvement plan) S tudy the Impact of the improvement plan (what was learned) A ct determine what changes are to be made in light of what you have learned.

16. Measures Display Boards

17. Patient status board

18. Environments after 5s

19. Situation to date 8 pathfinder wards –4 TCAB –4 Productive ward 6 new wards this year From May onwards 4 wards to join every 2 months 1 full day start up training required (5 staff)