1. Intelligent targets

2. Director of Research and Development
Dr Alan Willson
Director of Research and Development
NLIAH

3. What we don’t want Perversity Imposed targets
Lovely targets but no change

5. Wales stroke audits over 5 years What is worse?
Brain scan in 24 hours – 60% to 38%
OT assessment - 62% to 50%
Home visit before discharge – 80% to 53%
What is better?
Aspirin started – 72% to 76%
MDT goals agreed – 58% to 70%

6. What are we actually trying to do?
Improve the reliability of care in Wales
Raise the standards of care in Wales

7. A Quote
Although clinicians setting targets is the way forward, how do we re-educate them to move away from end line inspection to on line inspection? They have grown up in organisations which review complaints, undertake audit, reflect on research….which all have their place, but amazingly with such a captured audience ‘the patient’ they fail miserably to monitor, measure and improve quality at the bedside. Can you imagine a world whereby all staff were involved in quality questioning…. I would predict a stepped change in complaints!

8. The Intelligent Targets Approach
Focus on process of change
Use expert groups for subject knowledge
Use model for change as a standard
Greenhalgh criteria

9. Greenhalgh Criteria It must have clear relative advantage
It must have compatibility with the user’s values and ways of working
Complexity must be minimised
Users will adopt more readily if innovations allow trialability
There must be observability, that is it must be seen to deliver benefit
Reinvention is the propensity for local adaptation

10. An evidence based model for producing clinical change
The Model for Improvement
Agreed process changes (care pathways and driver diagrams)
Outcome and Process measures
Appropriate Performance Management
Support for improvement (will/ ideas/ execution)
Tools- data handling, driver diagrams, collaborative learning

11. Model for Improvement

12. Acute Phase Driver Diagram

13. Measurement and Management
Domain
Examples
Uptake (organisational conditions
Identified management lead
Identified clinical champion
Intranet sign up
Data submitted
Teams trained
Local communication strategy in place
Process change (Intelligent Targets)
Bundle compliance
Uptake of new practice (specific to driver diagram)
Outcome change (consequence of process)
Reduced morbidity
Reduced mortality
Reduced dependency
Reduced hospital stay