Local Improvement following National Clinical Audit Linda Chadburn, Governance Manager, Mersey Care NHS Trust July 2012

Me

Context Experiences of the Trust Using national audit results Practical steps taken to make change happen

Case Studies National Audit of Falls and Bone Health (Round Three) National Audit of Schizophrenia (Round One) 2 NCAs = 2 models

Model one NCA: Falls and bone health –Stakeholders involved: Senior Physiotherapist and me –College Liaison: me –Data collection: Senior Physiotherapist –Considered results: together –Identified issues: together –Developed action plan: together

Lone working Owned the action plan –Senior Physiotherapist Implemented action plan –Senior Physiotherapist Develop policy, changes in process, introduce new assessments, and…. –Senior Physiotherapist Report progress to me: –Senior Physiotherapist

Experiences Using NCA results to make improvements: –Isolated –No-one knows you’re doing it at all –Ineffective Lessons learnt Time to test out another model

Model two NCA: Schizophrenia –Increased number of stakeholders: consultants, service users, carers, audit team and me –Pilot: service users, carers, PALS, RCPSYCH, audit team and me –Three aspects of main audit: Service user: own survey form Carer: own survey form Consultants: own audit tool Audit team: upload consultant data

The continuum Lots of activity Wait for report Risk of inertia Options

Analysing the options Sit and wait for the report Plan strategically Just go for it Benefit: Real results Benefit: Maintain momentum Risk: Break the rules Risk: Inertia Risk: Low risk Benefit: Make best-fit

The strategic option

Framework Step One Step TwoStep ThreeStep FourStep FiveStep Six Benefits: Making use of national audit data Improves patient care Provide high quality service Coalition: Stakeholder discussion Knowledge base Influence and power Strategy: Shared aims & objectives Ownership Champions Work group Barriers: Conflicting priorities Power struggles Accepting responsibility Methodology: Sharing event Gain perspectives of stakeholders Identify areas for improvement Develop action plan Momentum: Maintain enthusiasm Maintain stakeholder involvement Share successes

The session Aim To understand the audit results and engage in discussion, giving own perspective; encouraging the identification of areas for improvement and consideration of ‘CLEVER’ actions.

Involvement & engagement Encourage participation Issues identified in writing Discussed as a group Recommendations for improvement identified Recommendations turned into actions Actions tested

Are the actions CLEVER? Cwhat costs are predicted to implement the action? Lwho will lead the action? Ewhat evidence will confirm implementation of the action? Vwill the action add value to the service? Ewhat is the predicted end date? Rare sufficient resources in place to implement the action?

Template action plan Recommendation: ActionCostsLeadEvidenceValueEnd dateResourcesProgress

Resistance

Ownership Identify champions Maintain momentum and engagement Engagement = motivation NAS Champion Group formed –Monitor action plan –Call upon resources

Model of achievement Share successes Maintain involvement