Mary Day Chief Executive MMUH Patient Safety Conference 2014 MATER BOARD ON BOARD Quality Improvement Project

BACKGROUND Driven by the MMUH Board of Directors A collaboration between MMUH, HSE and the Scottish Patient Safety fellowship programme Jan 2014 to November 2014 ; Phase1 October- November 2014; handover to Phase 2

Established in city centre in 1861 by Religious Sisters of Mercy University teaching hospital, providing acute and specialist services 610 beds, including day beds Annually - 16,000 patients admitted, including 9,500 emergency admissions - 48,000 day cases - 58,000 emergency department visits - >200,000 OPD visits National centre for: cardiac surgery, heart lung transplant, pulmonary hypertension, spinal injury, national isolation unit MMUH OVERVIEW

Fiduciary responsibility for quality of care and financial control of the hospital 14 members 7 non- executive directors Invited for membership by Sisters of Mercy No maximum duration on board MMUH BOARD OF DIRECTORS

1 2 3 get a comprehensive picture of the quality of clinical care have an understanding of same, and act to hold the hospital accountable on the quality of clinical care (QCC) delivered By Nov 2014 the Board of Directors, individually and collectively: PROJECT AIM

METHODOLOGY The project followed the Model for Improvement methodology The baseline was established through: –Review of board minutes and agenda in the 6 months prior to the project commencing –Interviews with the board of directors (n=14) Planning & Implementing 10 change packages –Picture (2) –Understanding (4) –Action (4) Measuring the changes

Selecting quality indicators Developing a dashboard Targeted reading for board members Shared learning with Sr Stephen Moss ISBAR communication tool for discussion IMPROVEMENT ACTIONS

Board workshop 25% of meeting time on quality Restructuring of board minutes Restructuring of board agenda Quality walk rounds IMPROVEMENT ACTIONS -2

BOARD QUALITY DASHBOARD

UNDERSTANDING: BUILDING KNOWLEDGE Monthly Targeted reading On understanding quality of clinical care Board Workshop Interactive learning session was held with the board on interpreting the quality dashboard Shared Learning Sir Stephen Moss, former chairman of the Mid Staffordshire Hospital ISBAR Tool Development of a summary report for each indicator using the ISBAR tool at Board meeting

ACT: HOLD TO ACCOUNT Spend time at board meeting on discussing quality Non- Executive Quality Walk rounds to meet the clinical providers on the wards Restructuring of board meeting agenda Restructuring of board meeting minutes to reflect recommendations

RESULTS 150% increase in the time spent discussing quality of clinical care at board meetings Dedicated time for the discussion of quality of clinical care at board meetings Quality of clinical care indicators are analysis monthly by the board An improvement in the quality of discussion and the number of recommendations made by the board in relation to quality of clinical care.

SUSTAINABILITY improve information provided to the board on quality of clinical care improve communication and transparency from the board strengthen the governance of quality and safety strengthen patient engagement A further 21 recommendations have been endorsed by the board under 4 headings:

Project must be sponsored at board level Regular interaction and feedback between board and project group Interviews of board members at onset invaluable in setting the approach for the project. Quality Information at board level to be reflected at executive level Project must be sponsored at board level LESSONS LEARNED

Use of outcomes measures at board level Express information in terms of the quality domains in the National standards Indicator selection needs to be reviewed at regular intervals to select most appropriate indicators that reflect the hospital strategy Focus on patient experiences and clinical practice audits Automation of Data for sustainability LESSONS LEARNED - 2

Mr John Morgan Chair MMUH Board Ms Maureen Flynn Director of Nursing Quality and Safety Governance Development, HSE, & External Project Co- lead Dr Jennifer Martin National Lead, Information & Analysis, Quality & Patient Safety Division, HSE, & External Project Co- lead Prof Conor O’Keane, Clinical Director of Quality & Patient safety, MMUH & Joint Project Sponsor Phase 1 Project group Lead by Ruth Buckley, Quality Manager, MMUH ACKNOWLEDGEMENTS

CONTACT Mary Day /