Dr. Frances Elliot
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Dr. Frances Elliot, CEO, NHS Quality Improvement Scotland

Dr. Frances Elliot, CEO, NHS Quality Improvement Scotland
'Reforming Healthcare - The Scottish experience'

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  • I quote from the Cabinet Secretary’s opening remarks in the foreward - “The ultimate aim of our Quality Strategy is to deliver the highest quality healthcare services to people in Scotland and through this to ensure that NHSScotland is recognised by the people of Scotland as amongst the best in the world.“ What will make Scotland a world leader will be the combined effect of millions of individual care encounters that are consistently person-centred, clinically effective and safe, for every person, all the time. People in Scotland have told us that they need and want the following things from the NHS and we have built this strategy around these priorities: ●Caring and compassionate staff and services; ●Clear communication and explanation about conditions and treatment; ●Effective collaboration between clinicians, patients and others; ●A clean and safe care environment; ● Continuity of care; and ● Clinical excellence. Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making. There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times. The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.
  • The six healthcare Quality Outcomes are: · Everyone gets the best start in life, and is able to live a longer, healthier life · People are able to live well at home or in the community · Healthcare is safe for every person, every time · Everyone has a positive experience of healthcare · Staff feel supported and engaged · The best use is made of available resources
  • This is in line with the Scottish Government’s Healthcare Quality Strategy published in May 2010.
  • Improvement is everybody's business.
  • Work on maternity services is likely to expand to neonates and further consideration of supporting the SG drive to support early years of children's development. The Scottish Quality Improvement Hub is a collaboration between a number of national health boards and Scottish Government to build capacity and capability for improvement science in Scotland. It will use an educational framework for improvement to support this activity.
  • At a recent conference in November 2011 for Scottish Public Sector leaders we were urged to consider these 6 questions in all of our work.
  • Goleman speaks of transparency and creating a culture of candour as the free flow of information within an organisation and between the organisation and its many stakeholders, including the public. Ibsen coined the term “vital lies” for the operative fictions that cover a more disturbing truth in troubled families. A vital lie masks a truth that is too threatening, dangerous or painful to be spoken aloud. The vital lie preserves the surface harmony of the family but at great cost. Problems that are not acknowledged rarely get better on their own. “ Vital lies” play a role in keeping essential truths from surfacing, first in families and later in businesses and other organisations. Self deception can skew decision making.
  • This year we are adding work on early recognition and treatment of sepsis and prevention of venous thromboembolism in medical wards and emergency medicine.
  • At a recent conference on quality and safety in healthcare, one speaker described a future scenario where regulators could request CCTV coverage of clinical areas to check that what is being claimed by organisations is actually the reality of what goes on behind closed doors.
  • What expectations do board members have from all their units of delivery? This should then be mandated from the board level.

Dr. Frances Elliot Dr. Frances Elliot Presentation Transcript

  • T h e S c o t t is h A p p r o a c h t oR e f o r m in g H e a lt h c a r e – Q u a lit y ,E f f ic ie n c y a n d P r o d u c t iv it yNational Healthcare Conference, 22 March 2012Frances Elliot | Chief Executive
  • T H E P R E S E N T A T IO NT h e S c o t t is h n a t io n a l c o n t e x t f o rq u a lit y in h e a lt h c a r eM y o r g a n is a t io nO u r a c t iv it yW h a t c a n y o u le a r n ?
  • N H S S C O T L A N•D5.1 million population • One integrated NHS system • £10.3 billion • Integrated health and social care • 14 territorial boards • Special boards – Healthcare Improvement Scotland – NHS Education for Scotland – NHS Health Scotland – NHS National Services Scotland – Scottish Ambulance Service – State Hospital – Golden Jubilee National Hospital – NHS 24
  • T H E S C O T T IS H C O N T E X T
  • Q U A L IT Y A M B IT IO N SM u t u a lly b e n e f ic ia l p a r t n e r s h ip s b e t w e e np a t ie n t s , t h e ir f a m ilie s a n d t h o s e d e liv e r in gh e a lt h c a r e s e r v ic e s w h ic h r e s p e c t in d iv id u a ln e e d s a n d v a lu e s a n d w h ic h d e m o n s t r a t ec o m p a s s io n , c o n t in u it y , c le a r c o m m u n ic a t io na n d s h a r e d d e c is io n -m a k in g .T h e r e w ill b e n o a v o id a b le in ju r y o r h a r m t op e o p le f r o m h e a lt h c a r e t h e y r e c e iv e , a n d a na p p r o p r ia t e , c le a n a n d s a f e e n v ir o n m e n t w illb e p r o v id e d f o r t h e d e liv e r y o f h e a lt h c a r es e r v ic e s a t a ll t im e s . T h e m o s t a p p r o p r ia t e t r e a t m e n t s ,in t e r v e n t io n s , s u p p o r t a n d s e r v ic e s w ill b ep r o v id e d a t t h e r ig h t t im e t o e v e r y o n e w h o
  • Q U A L IT Y A N D E F F IC IE N C Y –G E T T IN G T H E B A L A N C ER IG H T
  • N A T IO N A L P E R F O R M A N C EF R A M E W O R K 2 0 11
  • Q U A L IT Y O U T C O M E IN D IC A T O R Se a lt h c a r e n d e r 7 5 m o r t a lit ye x p e r ie n c e ra teta ff e ng a g e m e nt a t i e n t /u s e ra n d p o t e n t ia l re p o rte d o u tc o me me a s ure se a lt h c a r ea s s o c ia t e din f e c t io n e lf -a s s e s s e d g e n e r a l h e a lt hme rg e nc ya d m is s io n e r c e n t a g e o f t im er a t e /b e d d a y s in la s t 6 m o n t h s o f lif e s p e n t a t
  • TR A N S P A R E N C Ye f in it io n o f t r a n s p a r e n t : a llo w in glig h t t o p a s s t h r o u g h s o t h a t o b je c t sb e h in d c a n b e e a s ily s e e n ; e a s ilyu n d e r s t o o d ; o f s u c h a k in d t h a t t h et r u t h b e h in d it is e a s ily p e r c e iv e d ;c le a r a n d u n m is t a k e a b lef t e n d e s c r ib e d in t e r m s o f h o win d iv id u a ls b e h a v e a n do r g a n is a t io n s f u n c t io n e . g . w it hc a n d o u r , in t e g r it y , h o n e s t y , e t h ic s ,c la r it y , f u ll d is c lo s u r e , le g a l
  • H E A L T H C A R E IM P R O V E M E N TS C O TL A N DS e t u p b y a n A c t o f S c o t t is hP a r l i a m e n t o n 1 A p r i l 2 0 11.T w o k e y f u n c t io n s :E n h a n c in g a n d p r o t e c t in g t h es a f e t y a n d w e llb e in g o f a ll p e r s o n sw h o u s e s e r v ic e s p r o v id e d u n d e rt h e n a t io n a l h e a lt h s e r v ic e a n din d e p e n d e n t h e a lt h c a r e s e r v ic e s .U n iq u e ly in t h e U n it e d K in g d o m w ef u lf il b o t h a n im p r o v e m e n t a n ds c r u t in y r o le w it h r e g a r d t o h e a lt hs e r v ic e s .
  • V IS IO NT o d e liv e r e x c e lle n c e inim p r o v in g t h e q u a lit y o ft h e c a r e a n d e x p e r ie n c eo f e v e r y p e r s o n inS c o t la n d e v e r y t im e t h e ya c c e s s h e a lt h c a r e .
  • IN T E G R A T E D C YC L E O FIM P R O V E M E N T
  • IM P R O V E M E N TT h e c o m b in e d a n d u n c e a s in g e f f o r t so f e v e r y o n e – h e a lt h c a r ep r o f e s s io n a ls , p a t ie n t s a n d t h e irf a m ilie s , r e s e a r c h e r s , p a y e r s ,p la n n e r s , a d m in is t r a t o r s , e d u c a t o r s– t o m a k e c h a n g e s t h a t w ill le a d t ob e t t e r p a t ie n t o u t c o m e , b e t t e rs ys te m p e r fo r m a n c e , a n d b e tte rp r o f e s s io n a l d e v e lo p m e n t . ”a t a l d e n P , Da v id o f f F . Qu a l . S a f .
  • IM P R O V E M E N TW e r u n t h e S c o t t is h P a t ie n t S a f e t yP r o g r a m m e , a P a e d ia t r ic S a f e t y P a t ie n tP r o g r a m m e a n d a r e d e v e lo p in g n e wn a t io n a l p r o g r a m m e s f o r p r im a r y c a r e ,m e n t a l h e a lt h , m a t e r n it y s e r v ic e s a n dp e rs o n c e ntre d c a reW e a ls o h a v e a n u m b e r o f o t h e rim p r o v e m e n t p r o g r a m m e s , f o r e x a m p leH e a lt h c a r e A s s o c ia t e d In f e c t io n ( H A I) ,c a r d io v a s c u la r d is e a s e , n e u r o lo g ic a lc o n d it io n sT h e S c o t t is h Q u a lit y Im p r o v e m e n t H u bW e s u p p o r t n a t io n a l in it ia t iv e s s u c h a s
  • The Improvement Guide, API
  • S IX Q U E S T IO N S F O RH E A L T H C A R E P R O V ID E R SD o e s e v e r y o n e in t h e s y s t e m k n o ww h a t w e a r e t r y in g t o a c h ie v e ?A r e w e p r io r it is in g t h e im p r o v e m e n t slik e ly t o h a v e t h e b ig g e s t im p a c t o nt h e a im a n d s t o p p in g t h o s e t h a t h a v elit t le im p a c t ?Is e v e r y o n e c le a r a b o u t t h e m e a n s o fs e c u r in g im p r o v e m e n t s t o w a r d s o u ra im ?A r e w e a b le t o m e a s u r e a n d r e p o r tp r o g r e s s o n o u r a im ?D o w e k n o w h o w a n d w h e r e t o d e p lo yr e s o u r c e s w h e n im p r o v e m e n t iss lo w e r t h a n r e q u ir e d ?D o w e h a v e a w a y o f t e s t in g a n din n o v a t in g a n d t h e n s p r e a d in g n e wle a r n in g ?
  • T H E C O S T O F Q U A L IT YH a v in g t o r e d o o p e r a t io n s a n d in t e r v e n t io n sR e a d m is s io n s – in it ia l p r o b le m n o t f ix e dH e a lt h c a r e a s s o c ia t e d in f e c t io nD e la y e d d is c h a r g e sP o o r c o m m u n ic a t io nD r u g in t e r a c t io n s a n d r e a c t io n sP o o r p a t ie n t f lo w a lo n g c a r e p a th w a ysC o m p la in t s a n d lit ig a t io n .
  • TR U S TT r u s t a n d t r a n s p a r e n c y a r e a lw a y s lin k e dT h e u n im p e d e d f lo w o f in f o r m a t io n is e s s e n t ia l f o r h e a lt h y r e la t io n s h ip s a n d f o r o r g a n is a t io n a l h e a lt hIb s e n d e f in e s “ v it a l lie s ” a s t h e o p e r a t iv e f ic t io n s t h a t c o v e r a m o r e d is t u r b in g t r u t h in t r o u b le d f a m ilie sIn o r g a n is a t io n s t h e y p la y a r o le in a t t e m p t in g t o k e e p e m b a r r a s s in g t r u t h s f r o m s u r f a c in g .
  • S C O T T IS H P A T IE N TS A F E TY P R O G R A M M E
  • S P S P WO R K S TR E A M SC r it ic a l C a r e – Ventilator acquired pneumonia bundle, central line bundleG e ne ra l Wa rd – Early rescue – CommunicationM e d ic in e s M a n a g e m e n t – Medicines reconciliationP e r io p e r a t iv e – Surgical pause, surgical checklist – Infection prevention/control, prevention of venous thromboembolismL e a d e r s h ip – Safety walkrounds – Executive leadership, board patient safety profile
  • MEAS UREMENT ANDD A TA
  • T o e n d o f 2 0 11:• 61% reduction in Ventilator Associated Pneumonia rate• 70% reduction in Central Line Bloodstream Infection rate• There were 14 central line infections in intensive care units in Scotland in 2011• There were zero central line infections in intensive care units in March, June and December 2011• 19% improvement in compliance with critical care multidisciplinary rounds and daily goals• 24% improvement in critical care mortality• 0.5 day reduction in ICU length of stay• 90% reduction in ward C. difficile rate• 40% reduction in ward Staph aureus bacteraemia rate• 20% improvement in compliance with surgical briefing• 18% improvement in medicines reconciliationH S M R – u p t o e n d o f S e p t e m b e r 2 0 11 i m p r o v e d b y 9 .3 %
  • VA P R A TE( P E R T H O U S A N D V E N T IL A T O R D A YS )2018 61% reduction161412 9.1110 8 3.54 6 4 2 0 10 08 11 09 8 1 0 9 8 1 9 0 8 0 1 9 l-0 l-1 l-0 l-1 r- 0 r- 1 r- 0 r- 1 -0 -0 -1 -1 n- n- n- n- ct ct ct ct Ju Ju Ju JuApApApApJaJaJaJaOOOO
  • 75 80 85 90 95 100Jun-08Aug-08Oct-08 85%Dec-08Feb-09Apr-09Jun-09Aug-09Oct-09Dec-09Feb-10Apr-10Jun-10Aug-10Oct-10Dec-10 V A P B U N D L E C O M P L IA N C EFeb-11Apr-11Jun-11 7% improvementAug-11 92%Oct-11Dec-11
  • ( 0.5 1.5 2.5 3.5 0 1 2 3 4Jan-08Mar-08May-08 Jul-08Sep-08 2.8Nov-08Jan-09Mar-09May-09 Jul-09Sep-09Nov-09Jan-10 C E N T R A L L IN EMar-10May-10 IN F E C T IO N R A T E Jul-10 P E R T H O U S A N D L IN E D A YS )Sep-10Nov-10Jan-11 70% reductionMar-11 0.84May-11 Jul-11Sep-11Nov-11
  • Ja 80 85 90 95 100 n- 08Ap r- 0 8 Ju l-0 8 89%O ct -0 8Ja n- 09Ap r- 0 9 Ju C O M P L IA N C E l-0 9O ct -0 9Ja n- 10Ap r- 1 0 Ju l-1 0O C E N T R A L L IN E B U N D L E ct -1 0Ja n- 11Ap r- 1 1 Ju l-1 1O ct 5% improvement -1 94% 1
  • % C O M P L IA N C E W IT HM U L T I-D IS C IP L IN A R YR O U N D S A N D D A improvement100 19% I L YG OALS9590 93%8580 74%75706560 Nov-09 Nov-11 Nov-08 Nov-10 Jan-09 Jul-10 Jan-11 Jul-08 Jul-09 Jul-11 Jan-10 May-11 Mar-10 Sep-10 Mar-11 Sep-09 Sep-08 Mar-09 May-09 May-10 Sep-11
  • Ja 10 12 14 16 18 20 22 24 26 28 30 n- 08Ap r- 0 8 Ju l-0 8O ct -0 8 18.2%Ja n- 09Ap r- 0 9 Ju l-0 9O ct -0 9Ja n- % IC U M O R T A L IT Y 10Ap r- 1 0 Ju l-1 0O ct -1 0Ja n- 11Ap r- 1 1 Ju l-1 1O ct 24% improvement -1 1 13.9%
  • Ja 3 3.5 4 4.5 5 5.5 6 n- 08Ap r- 0 8 Ju l-0 8O 4.8 ct -0 8Ja n- 09Ap r- 0 9 Ju l-0 9O ct -0 9Ja n- 10Ap r- 1 0 Ju l-1 0O ct -1 0Ja n- 11Ap r- 1 1 Ju l-1 1 4.3O IC U A V E R A G E L E N G T H O F S T A Y ct -1 1 ½ day improvement
  • G E N E R A L WA R D C . D IF F IC IL E R A T E ( P E R T H O U S A N D P A T IE N T D A YS )2.5 1.15 90% reduction 21.5 1 0.120.5 0 10 08 11 09 8 1 0 9 8 1 9 0 8 0 1 9 l-0 l-1 l-0 l-1 r- 0 r- 1 r- 0 r- 1 -0 -0 -1 -1 n- n- n- n- ct ct ct ct Ju Ju Ju JuApApApApJaJaJaJaOOOO
  • G E N E R A L WA R D S A B R A TE0.6P ( E R T H O U S A N D O C C U P IE D B E D 0.350.5 A Y S ) D 40% reduction0.40.3 0.210.20.1 0 11 10 08 09 12 8 9 0 1 8 9 0 1 9 0 1 8 l-1 l-1 l-0 l-0 r- 0 r- 0 r- 1 r- 1 -0 -0 -1 -1 n- n- n- n- n- ct ct ct ct Ju Ju Ju JuApApApApJaJaJaJaJaOOOO
  • 84 86 88 90 92 94 96 98 Jul-08Sep-08 E WSNov-08 92%Jan-09Mar-09May-09 Jul-09Sep-09Nov-09Jan-10Mar-10 P E R C E N TA G EMay-10 Jul-10Sep-10Nov-10Jan-11 C O M P L IA N C E W IT HMar-11May-11 Jul-11 95%Sep-11Nov-11Jan-12
  • P E R C E N TA G E C O M P L IA N C E W IT H S U R G IC A L B R IE F IN G100 95 94% 90 85 80 75 20% improvement 70 65 74% 60 55 50 09 08 11 10 9 8 0 1 0 8 1 9 8 9 1 0 l-0 l-1 l-1 l-0 r- 0 r- 1 r- 0 r- 1 -0 -1 -0 -1 n- n- n- n- ct ct ct ct Ju Ju Ju JuApApApApJaJaJaJaOOOO
  • P E R C E N T A G E C O M P L IA N C E W IT HP E R I-O P B R IE F IN G S 95% 92%
  • P E R C E N TA G E C O M P L IA N C E W IT H M E D I C I N E S 18% improvement 82%100 R E C O N C IL IA T IO N 95 90 85 80 64% 75 70 65 60 55 50 11 10 08 09 08 09 10 11 08 11 09 10 0 8 9 1 -1 -0 -0 -1 v- v- v- v- b- b- b- b- g- g- g- g- ay ay ay ayNoNoNoNoFeFeFeFeAuAuAuAuMMMM
  • TH E N E W TR A N S P A R E N C Yn e v e r y d a y lif e w e liv e in a g lo b a llyn e t w o r k e d s o c ie t yh e m o b ile p h o n e e q u ip p e d w it h ac a m e ra , a nd C C TV, m e a ns tha t e a c ho f u s is , m o r e o r le s s , a lw a y s u n d e rs c r u t in y a n d o n d is p la yh is n e w , in v o lu n t a r y t r a n s p a r e n c yr e c o g n is e s t h a t t h e r e is n o s u c ht h in g a s s e c r e c y
  • R E C O M M E N D E D R E A D IN G FOR B OARD MEMB ERSHow well does your organisationmeasure up in terms oftransparency?Do you have a mechanism toencourage difficult conversationsin your senior management team,in governance committees and atthe board level?How do your staff raise sensitiveand difficult issues?What support do they receivewhen they do?
  • KEY MES S AGED o n o t b e c o n t e n t w it hm e d io c r it y .D o y o u r jo b s o w e ll t h a t n o b o d yc o u ld d o it b e t t e r . ” a r t in L u t h e r K in g
  • U S E F U L W E B S IT E Sw w w . h e a lt h c a r e im p r o v e m e n t s c o t la n d . ow w w . s c o t la n d p e r f o r m s . c o mw w w . s c o t t is h p a t ie n t s a f e t y . p r o g r a m m e .