Quality Improvement
Roadshow
Roadshow Video
Our quality
improvement programme
Why?
The strategic case for change
Changing the culture through quality improvement
Involvement of service users and carers through every step of the journey
The culture we want to nurture
Our quality
improvement programme
How?
Long-term
mission and
stretch aims
The mission
To provide the
highest quality
mental health
and community
care in England
...
Long-term
mission and
stretch aims
How many incidents of harm were reported in 2013?
How much harm currently occurs in our care?
1. Under 100 6. 2000 – 3000
...
How many incidents of harm were reported in 2013?
How much harm currently occurs in our care?
1. Under 100 6. 2000 – 3000
...
Long-term
mission and
stretch aims
What proportion of our patients currently state
they are extremely likely to recommend our
services to their friends and f...
What proportion of our patients currently state
they are extremely likely to recommend our
services to their friends and f...
Long-term
mission and
stretch aims
Central QI
team
Functions
Coordinate the programme
Improvement expertise to
support fro...
Central QI
team
Building the
will
Long-term
mission and
stretch aims
Traditional
engagement
Grassroots
movement /
campaign...
Central QI
team
Building the
will
Long-term
mission and
stretch aims
Aligning our
systems
Clinical audit
Real-time patient...
Central QI
team
Building the
will
Long-term
mission and
stretch aims
Aligning our
systems
Building
improvement
skills
Succ...
Methodology
How do we deliver a consistent approach to quality?
Introduction to our external partner
Independent, not-for-profit organisation
Based in Cambridge, Massachusetts
Leading innovator, convenor, partner and driver...
The Model for Improvement
“What will happen if
we try something
different?”
“Let’s try it!”“Did it work?”
“What’s next? ”
The PDSA Cycle
Spread to other sites /
groups / popn
Develop a
change
Implement a
change
Test a changeTheory and
Prediction
Test under a
...
Measurement and
Using Data for
Improvement
How Do ELFT Use Measurement?
MMSE
CQUINS & KPIs
Clinical Trials and Research
Service user outcomes
Service user experience...
• Research (efficacy)
• Improvement (efficiency and effectiveness)
• Accountability (reassurance, comparison)
The Three Fa...
Research
Aim New Knowledge (efficacy)
Methods:
Test observability
Tests are blinded or
controlled
Bias Designed to elimina...
Improvement
Aim Improvement of care
(efficiency and effectiveness)
Methods:
Test observability
Tests are observable
Bias A...
Accountability
Aim Comparison, choice,
reassurance, motivation for
change
Methods:
Test observability
No test, evaluate cu...
• Research (efficacy)
• Improvement (efficiency and effectiveness)
• Accountability (reassurance, comparison)
The Three Fa...
Does this represent improvement?
1.Yes 2. No
• How can you tell if you are improving?
• Data collection and analysis are central to QI
• Helps identify quality problem...
Training Plan for the Organisation
• IHI Open School programme available to all
staff
• Face to face training for 200 staff in next
year
• Learning Events (A...
“I’m In” Video
Break
Starting an
Improvement Project
qi.eastlondon.nhs.uk
Key Ingredients for Success
And why is this important?
(the strategic and business case)
What are We Trying to Accomplish?
• Involve members familiar with all different parts of
the process
• Effective teams require three kinds of expertise
– Sy...
The Driver Diagram is a
tool to help us
understand the system,
its outcomes and the
processes that drive the
outcomes
Defi...
AIM
Primary
driver
Primary
driver
Secondary
driver
Secondary
driver
Secondary
driver
Secondary
driver
Secondary
driver
Cha...
AIM:
Lose 5kg
in 3
months
Calories
in
Calories
out
Limit daily
intake
Substitute
low calorie
food
Avoid
alcohol
Exercise
F...
AIM PRIMARY DRIVERS SECONDARY
DRIVERS
CHANGE IDEAS
Improving quality of care on an inpatient female
psychiatric ward
Draw a Driver Diagram
The Model for Improvement
Video: Overview of the model for
improvement
• A strong, measurable
aim with a clear time
frame will help keep
your project on course
• It has to be important to
those...
• Be creative
Developing Changes
• Measurement is critical
for testing and
implementing changes
• Different from
measurement for
research
Measurement
Video: The Model for Improvement,
Developing Changes and Measurement
The PDSA Cycle
“What will happen if
we try something
different?”
“Let’s try it!”
“Did it work?”
“What’s next? ”
Video: The PDSA Cycle
Complete Project Charter
• Email to QI team
• qi@eastlondon.nhs.uk
• QI team will get in contact in a few days
• Make sure you have right ingredients for success
• Help finalise charter
• Make sure your project aligns with programme
...
Draft Measurement
Framework
Mission and Aims
Mission: Highest Quality Mental Health and Community Care in England
Stretch Aim 1: Right care, Right Tim...
Improved Patient Experience
Summary and Close
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

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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
  • ELFT Quality improvement roadshow - 2014

    1. 1. Quality Improvement Roadshow
    2. 2. Roadshow Video
    3. 3. Our quality improvement programme Why?
    4. 4. The strategic case for change
    5. 5. Changing the culture through quality improvement Involvement of service users and carers through every step of the journey
    6. 6. The culture we want to nurture
    7. 7. Our quality improvement programme How?
    8. 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. 9. Long-term mission and stretch aims
    10. 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. 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. 12. Long-term mission and stretch aims
    13. 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. 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. 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. 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. 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. 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. 19. Methodology How do we deliver a consistent approach to quality?
    20. 20. Introduction to our external partner
    21. 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. 22. The Model for Improvement
    23. 23. “What will happen if we try something different?” “Let’s try it!”“Did it work?” “What’s next? ” The PDSA Cycle
    24. 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. 25. Measurement and Using Data for Improvement
    26. 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. 27. • Research (efficacy) • Improvement (efficiency and effectiveness) • Accountability (reassurance, comparison) The Three Faces of Measurement
    28. 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. 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. 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. 31. • Research (efficacy) • Improvement (efficiency and effectiveness) • Accountability (reassurance, comparison) The Three Faces of Measurement
    32. 32. Does this represent improvement? 1.Yes 2. No
    33. 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. 34. Training Plan for the Organisation
    35. 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. 36. “I’m In” Video
    37. 37. Break
    38. 38. Starting an Improvement Project
    39. 39. qi.eastlondon.nhs.uk
    40. 40. Key Ingredients for Success
    41. 41. And why is this important? (the strategic and business case) What are We Trying to Accomplish?
    42. 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. 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. 44. AIM Primary driver Primary driver Secondary driver Secondary driver Secondary driver Secondary driver Secondary driver Change 1 Change 2 Change 3
    45. 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. 46. AIM PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS Improving quality of care on an inpatient female psychiatric ward
    47. 47. Draw a Driver Diagram
    48. 48. The Model for Improvement
    49. 49. Video: Overview of the model for improvement
    50. 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. 51. • Be creative Developing Changes
    52. 52. • Measurement is critical for testing and implementing changes • Different from measurement for research Measurement
    53. 53. Video: The Model for Improvement, Developing Changes and Measurement
    54. 54. The PDSA Cycle “What will happen if we try something different?” “Let’s try it!” “Did it work?” “What’s next? ”
    55. 55. Video: The PDSA Cycle
    56. 56. Complete Project Charter • Email to QI team • qi@eastlondon.nhs.uk • QI team will get in contact in a few days
    57. 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. 58. Draft Measurement Framework
    59. 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. 60. Improved Patient Experience
    61. 61. Summary and Close
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