1. Setting the scene 9 September 2010 Setting the scene Alan Willson 9 September 2010

2. Setting the scene 9 September 2010 “..we have to accelerate the adoption and full implementation of best and evidence-based practice in all settings all of the time – there can no longer be any justification for not doing this. Paul Williams letter to Chief Executives, launching 1000 Lives Plus. March 2010. 1000 Lives Plus – Reducing harm, waste and variation.

3. Setting the scene 9 September 2010 Why is this difficult? “Evidence-based therapies that prevent morbidity and death are often not translated into clinical practice. One reason for this is that research often neglects to look at how to deliver therapies to patients. Consequently,errors of omission are prevalent and cause substantial preventable harm” BMJ, Oct 2008, Vol 337

4. Setting the scene 9 September 2010 1000 Lives Plus and the Strategy for NHS Wales - “ National Purpose, Local Action”. How clinically led service improvement will be driven.. For national improvement priorities, HB’s will assemble a clinically- led team. Teams from across Wales come together for peer learning. Teams agree objectives internally and with HB management. Teams agree measures to track process. Teams collect information to track internal trends and to compare progress between teams. Team leaders share experience and help each other via site visits and learning events.

5. Setting the scene 9 September 2010 The 1000 Lives Plus - Drawing on the evidence of what works Pronovost et al (2008) Translating evidence into Practice – A model for large scale knowledge translation. BMJ

6. Setting the scene 9 September 2010 Achieving better outcomes Patient’s experience and outcomes Safe, reliable care Value and efficiency Team performance and staff wellbeing

7. Setting the scene 9 September 2010 Be clear who is holding you to account for progress and how this is aligned with your other objectives. Being accountable for team progress is about providing support and challenge. Monitoring progress needs informal visibility and formal review. Understanding what is being measured and why. Always insist on basing conversations around the data. Understand the importance of testing, implementing reliable processes, spreading and sustaining changes. Be alert to words like ‘audit’; ‘pilot’ and ‘roll-out’. Some key pointers for leaders

8. Setting the scene 9 September 2010 Understand what you are measuring and why.. Measurement for Improvement Measurement for Assurance Board levelFrontline team level Core assurance measures Mortality rates Harm rates Improvement measure % compliance with daily team briefings % patients risk assessed for DVT % patients with titrated doses

9. Setting the scene 9 September 2010 When progress is difficult, the reason is likely to relate to one or more of the following: –Failure of Will e.g. a few strong “blockers,” lack of investment in training and education, lack of back-up from more senior levels. –Failure of Ideas e.g.Not drawing on the evidence base, or not participating in Learning Sets. –Failure of Execution e.g. The leader does not have the authority (as well as the responsibility) to deploy the resources s/he needs. Cross- service links have not been clarified. Competing priorities have not been reconciled. The Model for Improvement is not being used. Obstacles and barriers

10. Setting the scene 9 September 2010 Building accountable leadership and communication by using SBAR Divisional Teams Clinical teams DirectorateTeams Exec Team Situation The processes you are seeking to improve and how far you have progressed towards your aims. Background The context of Transforming Theatres and 1000L+. Assessment Make sure this is supported by data: Progress over time (run charts). Tests of change Obstacles to progress (Will, Ideas, Execution). Recommendation The actions that are needed to unblock obstacles to progress.

11. Setting the scene 9 September 2010