Introduction to QI West of England Academy David Evans Quality Improvement Programme Manager

At present, the evidence is clear that healthcare is not always safe and can lead to poor patient experience and outcomes. At the same time, the economic downturn means an end to year-on-year financial increases. Healthcare services are being challenged to respond to this not through indiscriminate cuts, but by improving efficiency, driving up quality and reducing levels of harm.’ The Health Foundation 2014

Improving the Service Best evidence based healthcare (science) Improving patient experience More prompt treatment for patients Improving use of limited resources Improved efficiency/reduce waste Better productivity Doing this sustainably – not one off gains Improving Quality

WHAT IS QUALITY IMPROVEMENT SCIENCE?

Quality Improvement is defined as the application of a systematic approach that uses specific techniques to improve quality. The range of different approaches that fit under this umbrella all have the following in common: The concept of a cycle of improvement which involves data collection, problem definition and diagnosis, testing and subsequent implementation the changes. A set of tools and techniques that support individuals to implement improvements. A recognition of the central importance of engaging stakeholders (including patients and their carers) in the improvement of the service. A recognition of the importance of culture and the need for clinical and management leadership. Definition

Aims for Improvement No Needless Deaths No Needless Pain or Suffering No Unwanted Waits No Helplessness No Waste ……For Anyone

Key Requirements for success in quality improvement

“The First Law of Improvement” Every system is perfectly designed to achieve exactly the results it gets.

Building Reliable Systems

Three Types of Improvement Type I: Reducing defects from the viewpoint of the customer Type II: Reducing cost/waste while maintaining or improving quality Type III: Providing a new product or service, or an old one at an unprecedented level

Knowledge Base for Continual Improvement Knowledge for Improvement  Systems  Variation  Psychology  Improvement techniques Continual Improvement Subject and Discipline Knowledge + Adapted from Don Berwick 2015

Why Quality Improvement Methods Matter Best evidence based healthcare (science) Best evidence based healthcare (science)

Old Methodology

Improvement Requires 1.A reason to do it 2.An aim 3.A toolkit of methods 4.Staff, patients and public who have knowledge about Quality Improvement Science and the confidence to apply it in real life settings 5.A willingness to change 6.A ‘Just Culture’

After the baseline audit ask three questions Langley, G.J., Nolan, K.M., Nolan, T.W, Norman, C.L., & Provost, L.P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd Ed.). San Francisco: Jossey-Bass. Model for Improvement