1. The changing face of stroke care – fast forward NHS Stroke Improvement Programme Ian Golton Director Stroke developments…

4. What is the Stroke Improvement Programme? “To support local networks the Department of Health is establishing a central team within the NHS … The main task of this team will be to ensure that specific support is available to develop stroke networks “ (National Stroke Strategy, p58) Part of NHS Improvement, also supporting networks in cardiac and lung care, and working with cancer networks Based on 8 years experience improving heart disease services Work closely with the Department of Health and key national organisations Our job: support the development of Stroke Care Networks and implementation of the Stroke Strategy

5. Clinical Microsystems

6. Layers of the onion: the ‘systems within systems’ that work together to provide care for patients National, policy, legislation, evidence Macro- organisation Clinical Microsystem Individual care-giver & patient Self- care

7. National, policy, legislation, evidence

10. “ …there is uncertainty everywhere, and every meeting includes conversations of ‘no money’ and how can savings be made” Stroke Specialist Nurse with over 20 years NHS experience “I’ve never experienced so much turmoil - it feels on the coal face that we are waiting for some disaster to happen”

13. http://www.nice.org.uk/aboutnice/cof/ConsultationOnCOFIndicators.jsp

16. “In stroke, the best care is also the most cost- effective care…” Professor Sir Roger Boyle, Former National Director for Heart Disease & Stroke

17. Performance Data 1090 bed days saved Reduction of inpatient stroke beds from 56 to 34 Maintenance of inpatient performance within reduced bed base Stroke service LOS reduced – 21 days to 12 days

21. Macro- organisation

25. www.atastroke.org.uk Ossie Newell MBE Founder of @astroke

28. Layers of the onion: the ‘systems within systems’ that work together to provide care for patients Clinical Microsystem

29. Workforce Development Small groups Task Force Team Crew  PLAN DO STUDY ACT PDSA cycles Flow charts & deployment charts Fishbone diagrams Meeting skills & disciplines Variable 0 5 10 15 20 25 30 35 40 Date Ounces Run charts & control charts Global Aim Template Data & measures F £ CS Clinical value compass Ladder of inference Left-hand column Generative relationships S T A R

33. More top tips… Get the wind behind you - alignment with policy, guidelines, strategic goals, organisation priorities etc. Get (as much as possible) management support, up to and including chief executives Be clear what you’re trying to do an why - there are only 3 reasons to change Involve (as much as possible) the whole team Test, test and test again before anything irrevocable or expensive is done Gather data - meaningful, good quality, minimal - to show the effects and track progress Use your patients as your guide and support

34. http://www.patientopinion.org.uk/

37. Individual care-giver & patient

38. Harry Clarke, Counsellor and Stroke Survivor

39. “Give time to listen. And a much undervalued word is kindness. Be kind…be kind to that person. Kindness doesn’t cost any money. Just be kind”

41. www.improvement.nhs.uk/stroke