NHS Highland Quality and Patient Safety Framework Quality Care to Every Patient, Every Day Supporting Better Value Presentation relates to NHS Scotland and NHS Highland Quality Strategy / Framework. Both issued at the same time NHS H Framework is our plan to deliver NHS Scotland Strategy

Context Better Health, Better Care Action Plan 2007 – commitment to improving the health of the Scottish population In 2009, agreement to develop a Quality Strategy for NHS Scotland, with aim to deliver the very best healthcare possible Strategy issued on 10th May 2010

What is the Quality Strategy? Firstly, it is about putting people at the centre of our NHS. It will mean that the NHS will listen to patients’ views, gather information about their perceptions and personal experience of care and respond to what people tell us Secondly, it is about building on the values of our staff and their commitment to providing their best possible care reliably – for every person, every time Thirdly, it is about making measurable improvement in the aspects of quality of care that patients and their families see as really important Based around concept of MUTUALITY Acknowledges existing staff commitment to delivering a high quality service – provides a framework and support to embed this Based around a structured approach to measurement to demonstrate progress in standards of quality

“What will make Scotland a world leader will be the combined effect of millions of individual care encounters that are consistently person-centered, clinically effective and safe for every person, all the time”

How do we define Quality Healthcare? Show care and compassion Be clear in our communications and explanations Effectively collaborate as we work closely with others Provide clean and safe care environments Ensure there is continuity of care to support people Reliably maintain the clinical excellence patients have come to expect

What Matters Most to Patients (Better Together Priorities Survey) A clean ward Staff cleaning their hands before touching patients Being treated quickly in an emergency Getting the best treatment for my condition Doctors knowing enough about my condition and treatment Clear explanations about what will happen during an operation or procedure Being told the risks and benefits of any treatment in a way I can understand Clear explanations of my condition or treatment Being treated with dignity and respect Being told how my operation has gone in a way I can understand Quality Strategy is also based on what patients say matters to them A priorities survey was undertaken prior to the development of the Better Together survey to identify the areas to focus on

Institute of Medicine: Framework for Quality Patient focused providing care responsive to individual preferences, needs and values Safe avoiding injuries to patients from care that is intended to help them Effective providing services based on scientific knowledge Efficient avoiding waste – of equipment, supplies, ideas and energy Equitable care that does not vary in quality due to personal characteristics such as gender, ethnicity, geographical location, socio-economic status Timely reducing waits and delays for those who receive and give care Institutes of Medicines six dimensions of Quality. Scotland Quality Strategy based on this. Already referred to in a range of healthcare policies. Focus will be on driving quality through delivering a patient centred, safe and effective healthcare system, whilst ensuring efficiency, equity and timeliness are embedded within the joined up actions being taken forward locally and nationally. Builds on the major national and local improvement programs where significant progress is already being made. Efficiency without quality unthinkable, quality without efficiency unsustainable

Institute of Medicine’s Six Dimensions of Quality But it is not one individual approach or activity. Interlinking of all of these domains which contributes to a quality service

NHS Highland Quality and Patient Safety Framework Patient Experience Based around the NHS Highland objective of quality care to every patient, every day In NHS Highland, the developing move is towards a quality and safety framework, echoing the national focus of driving quality through delivering a patient-centered, safe, and effective healthcare system, whilst ensuring efficiency, equity, and timeliness are embedded DEFINITION OF QUALITY OF CARE It is clear from recent publications and from direct experience of implementing initiatives such as the Scottish Patient Safety Programme that improving quality of care is what excites and energises staff. In addition there is evidence that when people are in the care of the NHS, it is the quality of that care that matters. At the individual patient level the three important dimensions of quality are: Patient centered - FEEDBACK / COMPLAINTS AND COMPLIMENTS / PARTICIPATION providing care that is responsive to individual patient preferences, needs and values and assuring that patient values guide all clinical decisions Effective - OUTCOMES / CLINICAL AUDIT / EVIDENCE BASED PRACTICE providing services based on scientific knowledge Safe - SPSP / LEARNING FROM INCIDENTS / RISK ASSESSMENT avoiding injuries to patients from care that is intended to help them We will be referring to these different domains through the presentation

What does this mean for Patients and Staff? Patient experience Quality of care includes quality of caring. This means how personal care is – in essence it is about treating patients as individuals, with compassion, dignity and respect Clinical Effectiveness This means delivering care based on the best evidence and understanding success rates from different treatments for different conditions. An important aspect of this is knowing how effective the care is from the patient’s own perspective. Examples include knowing complication rates, improvement in pain free movements after joint replacement or ability to return to work after treatment for depression. It is also important to know what processes have been followed, an example may be uptake of a recommended drug therapy. Patient Safety We must do no harm to patients. This means having a safe and clean environment, reducing avoidable harm such as excessive drug errors or rates of healthcare associated infection

What does this mean for NHS Highland?

Discussion What do you want to do differently, which would enable you to deliver a higher quality of care to patients – what is the first thing you would start with? What else needs to change to support you in delivering the highest quality healthcare?

How will we know we have been successful? Developing Quality Measures As a first step we have agreed a number of hospital based quality metrics Adverse event rate Clostridium Difficile Infections Staphylococcus Aureus Bacteraemias Total Mortality Rate Hospital Standardised Mortality Rate (HSMR) Readmission within 7 days Readmission within 28 days Length of stay Complaints Sickness absence

Proposed Suite of 12 National Quality Outcome Measures Healthcare experience Staff experience Staff attendance Healthcare associated infection Emergency admissions Adverse events Hospital standardised mortality rate (HSMR) Proportion of people who live beyond 75 years Patient reported outcomes Patient experience of access Self assessed general health Percentage of last 12 months of life spent in preferred place of care To be agreed by October 2010 for implementation with HEAT targets for 2011/12 Nationally identifying national outcomes which have the greatest impact and most closely track improvements to incorporate into the QUALITY MEASUREMENT FRAMEWORK QUALITY MEASUREMENT FRAMEWORK will align National Performance Framework, Single Outcome Agreement, HEAT

Prototype of NHS Highland Hospital Clinical Dashboard Grouped into Safe Effective Patient experience Workforce Other Mid Staff report identified the need to look across multiple indicators for warning signs, eg complaints + staff absence + incidents + deaths

The Dashboard The organisation (Board) is ‘driving the car’ and looks at the dashboard to see how the journey is progressing The mechanics gather the data and decide how to display it The staff provide the right gauges and look at how to calibrate the process If the goal is high quality care, the dashboard is a tool to help get there. It is a ‘springboard for discussion’ rather than an end in itself (From Laurie Larson, How to Drive a Quality Dashboard) What is a dashboard? Graphic array of information that highlights an organizations performance in a number of designated areas of quality Intended to be visual, focused data Why is it useful? If a dashboard is properly constructed it should give the organisation a good idea of how it is performing in key areas against expectations for itself.

Next Steps: Quality Survey issued to all NHS Highland – please respond and encourage others Development of an Implementation and Communication Plan for NHS Highland’s Quality and Patient Safety Framework Work required for the National Quality Strategy Identify and develop Clinical Quality Measures for Community Hospitals, Mental Health and Primary Care

Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek. Barack Obama