1. 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

2. 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

3. 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

4. “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”

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. What does this mean for NHS Highland?

12. 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?

13. 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

14. 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

15. 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

16. 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.

17. 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

18. 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