Presentation on theme: "Fiona McQueen Executive Nurse Director"— Presentation transcript:
1Fiona McQueen Executive Nurse Director The Quality AgendaFiona McQueenExecutive Nurse Director
2What is world class healthcare? Where are we now?Where do we want to be2 years5 years20 yearsCall to action for the journey
3Cabinet Secretary NHSScotland Healthcare Quality Strategy At its heart is a simple but very ambitious aim:“To make the NHS in Scotland a world leader in the quality of health care services that it delivers.”“That aim is not just good for patients, it is alsoright for staff.”Scottish Parliament, Debate 13 May 2010
4Quality Strategy built on people’s priorities •Caring and Compassionate health services•Collaborating with patients and everyone working for and with NHSScotland•providing a Clean and safe care environment•improved access and Continuity of care•Confidence and trust in healthcare services•delivering Clinical excellence
5Person-Centred - Mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision making.Effective - The most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.Safe - There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.
6SafeQualityEffectivePersonCentredQuality occurs more frequently when the three ambitions are delivered together
8Aim Primary Driver Secondary Driver Everyone getsthe best start inlife and is ableto live a longerhealthier life athome or in thecommunity .Healthcare issafe for everyperson everytime and everyexperience ofhealthcare willbe positive,delivered bystaff who feelsupported andengaged.Leadership – executive leaders demonstrate that everything in the culture is patient focusedNothing about me without meHealthcare systems deliver reliable, quality careThe care team installs confidence by providing collaborative, evidence based carePatients get the outcomes of care they expectThe Care Experience of patients and their families is improvedPartnership working with communities served as equal partnersAsset based service redesignServices reflect an asset based approach (place-based, relationship-based, citizen-led and promote social justice/equality)Outcomes based commissioningAll services are co-producedHospital Standardised Mortality Ratio are best in class for ScotlandClinicians review all unexpected deaths as a matter of routine and continuously learn and make improvementThere are no needless deathsNo patient is subjected to needles harm due to unreliable systems and or processesAny episode of harm is reviewed as a matter of routine and continuously learn and make improvementsThere is no needless harmStaff are recruited for valuesStaff governance standards are adhered to consistentlyAn asset based approach to staff well-being is takenCompassionate communication and teamwork are essential competencies‘One set of rules’ for allCommunity benefit in all employee contractsStaff experience and well being is improved
9World Class Healthcare The people of Ayrshire and Arran have the best possible start and live longer healthier lives in settings of their choice whenever possible.Care is co-produced to deliver no needless waitsThere are no needless deathsThere is no needless harmEvery experience of Healthcare is positiveAll staff who deliver healthcare feel supported engaged and valued
10Do you agree? Take 10 minutes to discuss at your tables Is this what world class healthcare looks like? Tell us what is missing
11High performing organisations Culture and leadership focus – high value organisations define and relentlessly and consistently demonstrates valuesSpecification and planning: high-value organisations base operational and core clinical decisions on explicit criteria and organise effectivelyInfrastructure design: High-value organisations create highly effective teams at the micro level, to meet the needs of patient and families.For example, Dartmouth's Spine Center uses a detailed intake assessment—which includes a survey, visual aids, and shared decision making—to triage patients based on the likelihood that they will achieve better outcomes with medical or surgical care.Within those microsystems, tasks are allocated to clinical team members based on skill and training, and assistive personnel is provided with all necessary resources through careful information and equipment supply chain design. According to Bohmer, microsystem design represents "an important shift away from general-services-organization designs that use a single platform to meet the needs of many different patient groups."
12High performing organisations Measurement and oversight: High-value organisations use measurements of clinical operations for internal process monitoring to drive improvement.Staff focus - high value organisations ensure staff involvement and ownershipThe learning organisation: high value organisations examine positive and negative deviations in care and outcomes, using the information create common tools to improve outcomes.
14CultureYour culture is an outcome of the way employees behave. So how are we encouraging our employees to behave? Lived values = positive behaviours Relentless modelling of positive behaviours delivers positive attitudes.
15Team work Efficiency Equality Excellence Care Improvement Current valuesTeam workEfficiencyEqualityExcellenceCareImprovement
16What behaviours are required to build a culture of excellence? Select your top five behaviours from the cards at your table.As a board what is your role in the delivery of ‘lived’ values to improve culture ?
27“When something goes wrong it is how the organisation acts that redefines and reshapes the culture.” Jeanette Clough, President & Chief Executive OfficerMount Auburn Hospital, Boston, MA, USA
28What did we find? Failures Identification of sick patients Clinical ObservationVariation in Record KeepingNeed for Palliative and End of Life CareCodingUnreliable and Variable CareClinical EscalationFailure to RescueDNA CPRInfection and FallsFailuresIdentification of sick patientsPlanning and execution of care and treatmentRescue of deteriorating patients
32Improvement methodology SPSP tools and methods to support implementation of improved practicesPlan-Do-Study–Act (PDSA) cycles to develop improvements in clinical practiceEngaging all staff to ensure ownership of new ways of working
33Teams must own the processes to achieve improvement Improvement ExpertsInvolvementSpread SustainPlan, do, study, actImprovement
35General ward spreadBack to Basics programme spread across Crosshouse. - completed in all in-patient areas. All wards monitoring and measuring MEWS, Safety Brief and SBAR plus all other GW measuresImprovement programme spreading at Ayr – 6 wards complete and monitoring and measuring compliance with all BTB /General Ward measures.Spread to continue through to March 2013
40Spread of work in theatres Percent of patients who have peri-operative briefing.Excellent compliance across all theatres in surgical pause and briefing prior to surgery
41Person centred – some examples of the good 92% of in-patients said they were treated with dignity and respect (2011 n=3600)90% of patients rate the overall care experience received from their GP Surgery as positive (2012 n=8672)Patients rate the quality of consultation with many doctors, nurses and AHP’s highly (CARE measure mean score 45/50 – mean score normative data 43/50)
42Person centred – some examples of the not so good 40% of all the formal complaints are customer service related (i.e. communication, attitude, courtesy, respect)Overall customer service satisfaction rating to be 56.3% positive (2011 n= 752 staff and patients)47% of patients were not told how long they would have to wait in A&E (2011 n=3600)22% of patients were unable to book a GP appointment 3 or more days in advance (2012 n=8672)
43Immediate interventions to support improvements in Patient Centred Care Quality of Consultation - Use of the CARE measureCustomer Care CommitmentsCaring Behaviours Assurance System (CBAS)‘Teach back’ approach to improving communication with patientsBetter Together ProgrammeImproving Patient and family involvement in careDeveloping volunteer opportunitiesDeveloping Co-production approaches
45As a Board Member, do you know the names of the people who have been harmed or killed in your hospitalsand healthcare systems becauseof unsafe, unreliable systems ?
46As a Board Member, do you know how many clinicians have been damaged as a result of unreliable or unsafe systems and processes of care?
47What approach would you want the Board to take if it was your mother, father, partner, child ?
48What assurance does the Board need that we are providing world class health services and that we are learning from events. Discuss at your table and agree the top 2 things that would provide you with assurance
49Ah … but! Safety improvement excellent in pilot sites Person centred care excellent in some areasSpread taking for all taking longer than we need to drive improvementNew commitment to- 20% reduction in Mortality- 95% patients receive harm free care- Improved person centred careCapacity and capability building is required to enable change and improvement
50Capability and capacity Capability – the people have the confidence and the knowledge and skills to lead the change.Capacity – having the right number and level of people who are actively engaged and able to take action.Helen Bevan,Journal of Research Nursing 2010; 15:
51Take 10 minutes at your table to discuss … How the organisation can build the capacity and capability necessary to drive quality improvement at pace and scale
52What skills are needed?Many PeopleFew PeopleA key operating assumption of building capacity is that different groups of people will have different levels of need for Improvement knowledge and skill.Change agentsMiddle ManagerLevelAllstaffOperationalLeadersExpertsOur approach will be to make sure that each group receives the knowledge and skill sets they need when they need them and in the appropriate amountsDeepKnowledgeShared KnowledgeContinuum of Improvement Knowledge and Skills