1. Launching a National Collaborative
March 2018
Doha
Launching a National Collaborative
Derek Feeley
President & CEO
Institute for Healthcare Improvement
@derekfeeleyIHI

2. 82% reduction in c-diff cases in the over-65s since 2007
Quarterly rates of Clostridium difficile per 100,000 bed days (65+, and 15+)
82% reduction in c-diff cases in the over-65s since 2007
There are many different factors that influence this data – reliability of reduction of infection…. CEL19 link
Source: Health Protection Scotland

3. 21 % Reduction % 30 day Mortality of ICD 10 A40/A41
Despite it being challenging, Teams across Scotland are making improvements that are impacting on peoples lives every day
No l cant tell you about everything that is happening but here is just a selection of your fantastic work
At a national level

4. NHSScotland Surgical Mortality

5. The SPSP Journey…. Collaboration Model for Improvement
Knowledge & skills
Common goal
- aim high
Evidence-based
interventions
Compelling vision

6. Improve Safety of Healthcare Services in Scotland
Primary Drivers
Secondary Drivers
SPSP
Driver Diagram
Ownership of agreed upon set of outcomes
Review of outcomes at each meeting
Quality and safety comprise 25% of agenda
Recovery plans for unmet outcomes
Infrastructure supports improvement and measurement
Involve patients in safety
Boards accept SPSP as a key strategic priority for effective governance
Scottish Government sets SPSP as strategic priority
Deliver the programme
Build a sustainable infrastructure for improvement
Align SPSP with national improvement programmes and measures
Demonstrable results to community
Clear, shared measurement set
Visible on all senior leader agenda
Patient Safety Alliance represents and demonstrates cohesive and united programme
Improve Safety of Healthcare Services in Scotland
(15% reduction in HSMR by end of 2012)
Establish and implement BTS collaborative
Acceptance of pragmatic science
Royal Colleges support SPSP
International expert clinical faculty
Faculty expert at improvement methods and coaching
Programme design and structure
Inventory national programmes and measurements
Meet with programme leaders to understand programme intent, audience, history
Harmonise our metrics

7. The Typical Approach… In the conference room DESIGN DESIGN DESIGN
APPROVE
…..and in the real world.
Traditionally we have not been good at making change for improvement reliable – because we have not tested whether it will be delivered appropriately in various conditions and environments before we expect all to implement and make part of every day business.
e.g. previous experience of launching new protocols/guidelines – as of Mon am….. expect all to comply fully without really knowing that it’s practical for every system – then we wonder why people don’t comply and the system is unreliable.
IMPLEMENT

8. The Quality Improvement Approach
In the conference room
DESIGN
APPROVE
IF NECESSARY
…..and in the real world.
Traditionally we have not been good at making change for improvement reliable – because we have not tested whether it will be delivered appropriately in various conditions and environments before we expect all to implement and make part of every day business.
e.g. previous experience of launching new protocols/guidelines – as of Mon am….. expect all to comply fully without really knowing that it’s practical for every system – then we wonder why people don’t comply and the system is unreliable.
START TO IMPLEMENT
TEST & MODIFY
TEST & MODIFY
TEST & MODIFY

9. A Better System Design: Bring Together 2 Types of Knowledge
Evidence-based Subject Matter Knowledge
Protocols
Guidelines
Standards
How to change performance of the system
Implementation Knowledge
Leadership/governance
System re-design
Financial strategies
Resources
Engaging patients & families
Clinical & Systems knowledge
Data for Improvement
Learning communities
Improvement
W. E. Deming and Associates in Process Improvement

10. “Up to 70% of improvement projects never spread.”
Eccles R, Miller Perkins K, Serafeim G. How to Become a Sustainable Company. MIT Sloan Management Review 2012;
53(4):

11. A Learning System for Getting to Full Scale
Best Practice exists
Phases of Scale-up
Set-up
Build Scalable Unit
Test Scale- Up
Go to Full-Scale
New Scale-up Idea
Adoption Mechanisms
Support Systems
Leadership, communication, social networks, culture of urgency and persistence
Learning systems, data systems, infrastructure for scale-up, human capacity for scale-up, capability for scale-up, sustainability

12. Breakthrough Series Collaborative

13. National Patient Safety Collaborative National Driver Diagram Aim Primary Drivers Secondary drivers
Improve Safety of Healthcare Services initially focusing on Sepsis and VTE Through working towards
95% compliance with the sepsis 6 bundle as per the healthcare partners guideline. The identified facilities/units will achieve this by the end of December 2018.
&
100% of eligible patients across healthcare partners, to have a VTE risk assessment carried out within 24 hours of situational need, and appropriate thromboprophylaxis prescribed and administered as per the healthcare partners guideline. The identified facilities/units will achieve this by the end of December 2018.
Ministry of Health and EMC Accept Safety as Key Strategic Priority for Effective Governance
Ownership of agreed upon set of outcomes
Review of outcomes at each Executive/senior leadership meeting
Quality and safety comprises 25% of agenda
Leaders understand their role in leading QI
Recovery plans developed for unmet outcomes
Infrastructure within each organization supports improvement and measurement
Time given to support front line improvement teams
Involve patients and carers in safety
Qatar Healthcare Executives Sets NPSC as Strategic Priority
Demonstrable results to community
Clear, shared measurement set
Visible on all senior leader agenda
Robust, evidence
based proven
clinical changes
Acceptance of pragmatic science Qatar University Supports NPSC
Driver Diagrams & change packages support achievement of collaborative aims
IHI/HHQI/local Team Expert at Content, Coaching and Program Management
International expert clinical faculty
Faculty expert at improvement methods and coaching
Programme design and structure
Local faculty developed
HHQI developed to support improvement nationally
Align National Patient Safety Collaborative with national improvement programs and measures
Inventory national programs and measurements
Meet with programme leader to understand programme intent, audience, history
Harmonize measures required for national reporting

14. Add Systems to Create a Framework

15. Framework for Clinical Excellence
Creating an environment where people feel comfortable and have opportunities to raise concerns or ask questions.
Being held to act in a safe and respectful manner given the training and support to do so.
Transparency
Leadership
Psychological Safety
Negotiation
Teamwork &
Communication
Accountability
Reliability
Improvement
&
Measurement
Continuous Learning
Engagement of Patients & Family
Developing a shared understanding, anticipation of needs and problems, agreed methods to manage these as well as conflict situations
Facilitating and mentoring teamwork, improvement, respect and psychological safety.
Gaining genuine agreement on matters of importance to team members, patients and families.
Openly sharing data and other information concerning safe, respectful and reliable care with staff and partners and families.
Regularly collecting and learning from defects and successes.
Applying best evidence and minimizing non-patient specific variation with the goal of failure free operation over time.
Improving work processes and patient outcomes using standard improvement tools including measurements over time.

16. Culture Eats Strategy for Breakfast
Culture is a result of what an organization has learned from dealing with problems and organizing itself internally.
Your culture always helps and hinders problem solving
Solve problems by identifying and resolving associated discrepancies between values and behavior
Do not oversimplify culture. It’s far more than “how we do things around here.”
Leaders should not focus on culture change. Focus on a business problem.
Culture is a group phenomenon. Engage focus groups to define how the culture is helping and hindering work on a problem. A
ar Schein
All courtesy of Edgar Schein

17. It Is All Related…..
Royal Academy of Engineering; Engineering Better Care 2017

18. 10 Keys to Delivering Quality Improvement across a Whole System
Get goals
Get bold
Get together
Get a method (and stick with it)
Get patients and families
Get the facts
Get to the field
Get a clock
Get the numbers
Get the stories

19. Nothing Ever Grows in a Comfort Zone