Developing an effective local quality improvement programme
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Carl Walker, the chair of the National Quality Improvement and Clinical Audit Network (NQICAN), gave a presentation on developing an effective quality improvement program. He discussed that quality improvement aims to improve patient outcomes and experiences by changing provider behaviors and organizations through systematic methods. Effective programs have strategies, structures and systems to support quality improvement, a culture of collaboration and learning, and technical support like training. Clinical audits can be used for assurance of standards, identifying areas for improvement, and research. Measuring improvement requires tracking outcome, process and balancing measures over time rather than single spot check audits.
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Developing an effective local quality improvement programme
- 1. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Developing an effective local quality improvement programme and supporting staff to deliver quality care Carl Walker National Quality Improvement & Clinical Audit Network (NQICAN) chair @cwwalker10 @nqican #clinicalaudit #healthqi
- 2. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Who am I? • Worked in Clinical Audit / Quality improvement roles at University Hospitals of Leicester NHS Trust since graduating from university 15+ years ago with BSc in Stats/Business • Been clinical audit manager for last 6 years • Recently completed IHI course on Quality Improvement • Elected as National Quality Improvement & Clinical Audit Network (NQICAN) chair (October 15) • Been to Ethiopia to teach clinical audit
- 3. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Why is the next 30 minutes going to be useful to you? • Share evidence / experiences as to what works and why • Explain how best to measure the effectiveness of your quality improvement projects • Clarify Clinical audits role as a quality improvement process • Examples of case studies / resources that are available to help
- 4. To find out more about your regional network and how to join visit: www.nqican.org.uk NQICAN brings together 15 regional clinical audit/effectiveness networks from across England, providing ‘a voice’ for staff working in these areas in health and social care organisations. NQICAN supports the development of regional networks, national clinical audit as well as engaging, influence and being a point of contact for key organisations such as HQIP. @nqican @cwwalker10 Email: nqican@gmail.com
- 5. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 X
- 6. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016
- 7. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 3 things in life are certain • Taxes • Death • Change or quality improvement
- 8. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 We’re all quality improvers! Challenge
- 9. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016
- 10. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Quality Improvement “ QI is better patient experience and outcomes achieved through changing provider behaviour and organisation through using a systematic change method and strategy” Ovreveit
- 11. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 menofmaxima.com Current position
- 12. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 3 types of measurement in healthcare • Assurance / Accountability / Judgement – are we meeting our standards? • Improvement – we’ve got a problem / we know we need to improve • Research – we don’t know the best way to treat this group of patients • Clinical audit ‘rightly or wrongly’ is used for all 3 of these and sometimes all in the same project
- 13. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016
- 14. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Source: QI Tools
- 15. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Quality Improvement – should be built into all services provided
- 16. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Assurance v Improvement Dashboard Run chart
- 17. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 UHL Model Project Plan – Improvement or Assurance? Do we know how we are doing? Yes Do we need to improve? Yes – QI methods No – reject plan No Should we know how we are doing? Yes – classic clinical audit (assurance) No – reject plan
- 18. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Improving systems • Every system is perfectly designed to deliver the results it gets ……..Paul Batalden
- 19. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Ideal
- 20. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Ref: Healthcare Quality Quest - Quality Improvement for Healthcare Manual
- 21. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 What’s needed for success? – Strategy – Structure and systems – Culture – Technical support Ref: Healthcare Quality Quest - Quality Improvement for Healthcare Manual Original studies of the sustained implementation of quality improvement in healthcare organizations in the USA identified that continuously successful improvement programmes are associated with the presence of these four dimensions in the organization
- 22. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 What’s needed for success? • Strategy — integrating quality improvement-related goals into the organization’s strategic priorities and defining the organization’s direction, policies and roles relating to quality improvement • Structure and systems — defining how the organization’s improvement programme is directed, supervised, facilitated and monitored, how learning about quality improvement is disseminated in the organization, and systems such as access to data to support improvement Ref: Healthcare Quality Quest - Quality Improvement for Healthcare Manual
- 23. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 What’s needed for success? • Culture — committing to a shared purpose related to quality improvement and the use of scientific principles and practices to achieve improvement, and developing clinical teams to work collaboratively with frontline staff participation and continuous learning • Technical support — providing appropriate and effective training on quality improvement tools for staff and providing skilled ‘enablers’ to advise on and support improvement programmes and activities. Ref: Healthcare Quality Quest - Quality Improvement for Healthcare Manual
- 24. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Case study – QI Structure / Approach
- 25. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 QI Strategy Case study
- 26. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Building the picture/ Growing the culture Quality Improvement Audit Patient Experience / Complaints Performance Peer Review Soft Intelligence Serious Incidents Mortality Review Inspection Finance
- 27. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Search ‘Gondar Audit’ Gondar ‘Can do’ attitude
- 28. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016
- 29. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016
- 30. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 UHL Clinical Audit Programme – Overview : Process & outcome measures Process measures • No of projects registered • % running to schedule • % action plans implemented to deadlines Outcome measures • % of re-audits showing improvements
- 31. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 IHI PH556x: Practical Improvement Science in Healthcare: A Roadmap for Getting Results
- 32. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Model for improvement Image: The Model for Improvement, developed by the Associates for Process Improvement, - IHI course
- 33. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 3 types of measures Outcome Measures: Voice of the customer or patient. How is the system performing? What is the result? Process Measures: Voice of the workings of the system. Are the parts/steps in the system performing as planned? Balancing Measures: Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures? (e.g. unanticipated consequences, other factors influencing outcome, outcomes in other conditions that share processes)
- 34. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016
- 35. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Results from 2 spot check audits: 40 70 60 30 0 10 20 30 40 50 60 70 80 1st Audit (April 2015) Re-audit (Jan 2016) Complaincewithstandard % Yes No What conclusion would you make from this result?
- 36. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Did we improve by 30%? • Answer – No / Impossible to tell based on this info • Spot check audits are for assurance / judgement – not measuring improvement
- 37. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Did we improve by 30%? Was the same methodology repeated? Was there any potential bias introduced by the methods used? Context? What is the sample size? If yes is it representative of the patient population? Audit results based on samples are estimates of the whole population. What had changed since last years audit? If nothing then this is just variation or sample error Danger of providing false assurance
- 38. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016
- 39. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Rapid cycle audit / knowing how you are doing
- 40. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 “If I had to reduce my message for management to just a few words, I’d say it all had to do with reducing variation.” Dr. W. Edwards Deming
- 41. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016
- 42. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 "Collaborative learning through safety and quality improvement networks can be extremely effective and should be encouraged across the NHS. The best networks are those that are owned by their members, who determine priorities for their own learning." (Berwick Report, 2013) Determining own priorities… The NHS Change Model
- 43. Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican Clinical Audit for Improvement 5th October 2016 Thanks for listening carl.walker@uhl-tr.nhs.uk nqican@gmail.com www.nqican.org.uk @cwwalker10 @nqican #clinicalaudit