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ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
ELFT Quality improvement roadshow - 2014
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ELFT Quality improvement roadshow - 2014

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Slides from the East London NHS Foundation Trust roadshow on quality improvement

Slides from the East London NHS Foundation Trust roadshow on quality improvement

Published in: Healthcare
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  • The PDSA cycle is a tool we use to distinguish changes that are effective from those that are not so that we can concentrate our efforts
  • Four parts of the cycle:
    Plan:
    Decide what change you will make, who will do it, and when it will be done. Formulate an hypothesis about what you think will happen when you try the change. What do you expect will happen?
    Identify data that you can collect (either quantitative or qualitative) that will allow you to evaluate the result of the test.
    Do:
    Carry out the change.
    Study:
    Make sure that you leave time for reflection about your test. Use the data and the experience of those carrying out the test to discuss what happened. Did you get the results you expected? If not, why not? Did anything unexpected happen during the test?
    Act:
    Given what you learned during the test, what will your next test be? Will you make refinements to the change? Abandon it? Keep the change and try it on a larger scale?
  • The PDSA cycle is a tool we use to distinguish changes that are effective from those that are not so that we can concentrate our efforts
  • The PDSA cycle is a tool we use to distinguish changes that are effective from those that are not so that we can concentrate our efforts
  • References:
    1. Accelerating the pace of improvement: interview with Thomas Nolan. Journal of Quality Improvement. 1997;23(4).
    2. Berwick DM. A primer on leading the improvement of systems. BMJ. 1996;312:619-622.
    3. Langley G, Nolan K, Nolan T, Norman C, Provost L. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, CA: Jossey-Bass Publishers; 1996.
    4. Lloyd R. Quality Health Care: A Guide to Developing and Using Indicators. Sudbury, MA: Jones and Bartlett Publishers; 2004.
    5. Moen R, Nolan T, Provost L. Quality Improvement Through Planned Experimentation. 2nd ed. New York, NY: McGraw-Hill Companies; 1998.
    6. The Improvement Handbook. Austin, TX: Associates in Process Improvement; 2005.
  • Notes: The design of your change will depend on what you are trying to change
  • The PDSA cycle is a tool we use to distinguish changes that are effective from those that are not so that we can concentrate our efforts
  • Four parts of the cycle:
    Plan:
    Decide what change you will make, who will do it, and when it will be done. Formulate an hypothesis about what you think will happen when you try the change. What do you expect will happen?
    Identify data that you can collect (either quantitative or qualitative) that will allow you to evaluate the result of the test.
    Do:
    Carry out the change.
    Study:
    Make sure that you leave time for reflection about your test. Use the data and the experience of those carrying out the test to discuss what happened. Did you get the results you expected? If not, why not? Did anything unexpected happen during the test?
    Act:
    Given what you learned during the test, what will your next test be? Will you make refinements to the change? Abandon it? Keep the change and try it on a larger scale?
  • Instructions: Ask the learner which of the above three is a good aim? Answer is the second one because it is specific, measurable, determines a timeframe
  • Transcript

    • 1. Quality Improvement Roadshow
    • 2. Roadshow Video
    • 3. Our quality improvement programme Why?
    • 4. The strategic case for change
    • 5. Changing the culture through quality improvement Involvement of service users and carers through every step of the journey
    • 6. The culture we want to nurture
    • 7. Our quality improvement programme How?
    • 8. Long-term mission and stretch aims The mission To provide the highest quality mental health and community care in England by 2020 Quality improvement strategy Reduce harm by 30% every year Right care, right place, right time Two stretch aims
    • 9. Long-term mission and stretch aims
    • 10. How many incidents of harm were reported in 2013? How much harm currently occurs in our care? 1. Under 100 6. 2000 – 3000 2. 100 – 250 7. 3000 – 4000 3. 250 – 500 8. 4000 – 5000 4. 500 – 1000 9. 5000 – 6000 5. 1000 - 2000 10. 6000 - 7000
    • 11. How many incidents of harm were reported in 2013? How much harm currently occurs in our care? 1. Under 100 6. 2000 – 3000 2. 100 – 250 7. 3000 – 4000 3. 250 – 500 8. 4000 – 5000 4. 500 – 1000 9. 5000 – 6000 5. 1000 - 2000 10. 6000 - 7000 Answer = 2881
    • 12. Long-term mission and stretch aims
    • 13. What proportion of our patients currently state they are extremely likely to recommend our services to their friends and family? Patient experience? 1. Under 10% 2. 10 – 20% 3. 20 – 40% 4. 40 – 60% 5. 60 – 80% 6. 80 – 100%
    • 14. What proportion of our patients currently state they are extremely likely to recommend our services to their friends and family? Patient experience? 1. Under 10% 2. 10 – 20% 3. 20 – 40% 4. 40 – 60% 5. 60 – 80% 6. 80 – 100%
    • 15. Long-term mission and stretch aims Central QI team Functions Coordinate the programme Improvement expertise to support frontline work Learning and sharing – internally & externally Make-up Programme director (Medical Director) Deputy programme director (Associate Medical Director) Programme manager Continuous improvement and measurement lead 2 x rotating clinical secondments Programme support
    • 16. Central QI team Building the will Long-term mission and stretch aims Traditional engagement Grassroots movement / campaign • Launch event & roadshows • Through formal directorate structures • Local champions • Q30 (staff) and Q12 (service user) groups to shape our comms • Microsite – as a central resource • Branding & identity
    • 17. Central QI team Building the will Long-term mission and stretch aims Aligning our systems Clinical audit Real-time patient experience feedbackLearning from complaints Datix improvements Reviewing our inductions Integrated quality data available to all Embedding a structure for listening Outcome measures Influencing contracts and CQUINs Financial measures Stopping activity of lower value
    • 18. Central QI team Building the will Long-term mission and stretch aims Aligning our systems Building improvement skills Successful improvement requires a specific set of skills Most of us have not been trained in improvement Improvement at scale needs a consistent approach Appointment of an external partner to build skills within our workforce at scale & pace
    • 19. Methodology How do we deliver a consistent approach to quality?
    • 20. Introduction to our external partner
    • 21. Independent, not-for-profit organisation Based in Cambridge, Massachusetts Leading innovator, convenor, partner and driver of results in health and healthcare worldwide 5 key areas of work • Improvement capability • Patient and family-centred care • Patient safety • Quality, cost and value • Triple aim for populations (improving health outcomes, experience and per capita cost)
    • 22. The Model for Improvement
    • 23. “What will happen if we try something different?” “Let’s try it!”“Did it work?” “What’s next? ” The PDSA Cycle
    • 24. Spread to other sites / groups / popn Develop a change Implement a change Test a changeTheory and Prediction Test under a variety of conditions Make part of routine operations The Steps to Change
    • 25. Measurement and Using Data for Improvement
    • 26. How Do ELFT Use Measurement? MMSE CQUINS & KPIs Clinical Trials and Research Service user outcomes Service user experience Waiting lists BPRS Blood results
    • 27. • Research (efficacy) • Improvement (efficiency and effectiveness) • Accountability (reassurance, comparison) The Three Faces of Measurement
    • 28. Research Aim New Knowledge (efficacy) Methods: Test observability Tests are blinded or controlled Bias Designed to eliminate bias Sample size ‘Just in case data’ (very large data sets) Flexibility of hypothesis Fixed hypothesis Testing Strategy One large test Determining if a change is an improvement Enumerative Statistics (t-test, p-values)
    • 29. Improvement Aim Improvement of care (efficiency and effectiveness) Methods: Test observability Tests are observable Bias Accept consistent bias Sample size ‘Just enough data’, small sequential samples Flexibility of hypothesis Flexible and changes as learning takes place Testing Strategy Sequential test over time Determining if a change is an improvement Analytical statistics. Run and Control charts
    • 30. Accountability Aim Comparison, choice, reassurance, motivation for change Methods: Test observability No test, evaluate current performance Bias Measure and adjust to reduce bias Sample size Obtain 100% of available, relevant data Flexibility of hypothesis No hypothesis Testing Strategy No tests Determining if a change is an improvement No change focus
    • 31. • Research (efficacy) • Improvement (efficiency and effectiveness) • Accountability (reassurance, comparison) The Three Faces of Measurement
    • 32. Does this represent improvement? 1.Yes 2. No
    • 33. • How can you tell if you are improving? • Data collection and analysis are central to QI • Helps identify quality problems but also opportunities for improvement • Allows us to track improvement over time • Success of programme will hinge on the measurements we put in place Why Measure?
    • 34. Training Plan for the Organisation
    • 35. • IHI Open School programme available to all staff • Face to face training for 200 staff in next year • Learning Events (Autumn 2014) Training Plan for the Organisation
    • 36. “I’m In” Video
    • 37. Break
    • 38. Starting an Improvement Project
    • 39. qi.eastlondon.nhs.uk
    • 40. Key Ingredients for Success
    • 41. And why is this important? (the strategic and business case) What are We Trying to Accomplish?
    • 42. • Involve members familiar with all different parts of the process • Effective teams require three kinds of expertise – System leadership – Improvement advice – Day to day leadership - Project leader • Aim to meet every 1-2 weeks for 30-45 minutes • How will you communicate? • How to bring data to meeting? Choose your team
    • 43. The Driver Diagram is a tool to help us understand the system, its outcomes and the processes that drive the outcomes Defining your messy system
    • 44. AIM Primary driver Primary driver Secondary driver Secondary driver Secondary driver Secondary driver Secondary driver Change 1 Change 2 Change 3
    • 45. AIM: Lose 5kg in 3 months Calories in Calories out Limit daily intake Substitute low calorie food Avoid alcohol Exercise Fidgeting Track calories Plan meals Drink water, not Coke Work out 3 times a week Cycle to work Hacky sack in office
    • 46. AIM PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS Improving quality of care on an inpatient female psychiatric ward
    • 47. Draw a Driver Diagram
    • 48. The Model for Improvement
    • 49. Video: Overview of the model for improvement
    • 50. • A strong, measurable aim with a clear time frame will help keep your project on course • It has to be important to those involved The Aim
    • 51. • Be creative Developing Changes
    • 52. • Measurement is critical for testing and implementing changes • Different from measurement for research Measurement
    • 53. Video: The Model for Improvement, Developing Changes and Measurement
    • 54. The PDSA Cycle “What will happen if we try something different?” “Let’s try it!” “Did it work?” “What’s next? ”
    • 55. Video: The PDSA Cycle
    • 56. Complete Project Charter • Email to QI team • qi@eastlondon.nhs.uk • QI team will get in contact in a few days
    • 57. • Make sure you have right ingredients for success • Help finalise charter • Make sure your project aligns with programme aims • Link you with support on project and methodology • Provide support and access to BMJ Quality platform The QI Team Will…
    • 58. Draft Measurement Framework
    • 59. Mission and Aims Mission: Highest Quality Mental Health and Community Care in England Stretch Aim 1: Right care, Right Time Stretch Aim 2: Reduce Harm
    • 60. Improved Patient Experience
    • 61. Summary and Close

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