Service improvement for everyone            Catherine Blackaby        National Improvement Lead     This session will cove...
NHS Service ImprovementSurely it’s not that difficult?  X                        Y  Just do it        Efficient           ...
Surely it’s not that difficult?        X                        Y    Patient encounter     Healthy       with health      ...
MODEL FOR IMPROVEMENT  “All models are wrong but       some are useful”             •          W Deming                   ...
Model for improvement      What are we trying to          aims         accomplish?   How will we know that a           mea...
Define your aim               A good aim•   What we are trying to achieve•   For whom•   How much•   By when•   Compared t...
By July 2011 in 100% of key practices 75% ofpatients on COPD register will have had a reviewin the last 15 months and have...
Understanding the system & the problem                                         8
Process mapping                   •              Everyone involved in the process                   •              Make vi...
All improvement is change –     but not all change is       improvement…HOW WILL WE KNOW IF ACHANGE IS ANIMPROVEMENT?     ...
How will we know whether a change is          an improvement?• Measure…• Measure the baseline• Measure the minimum & what ...
Measurement for Improvement     5 4.9 4.8 4.7 4.6                                              Mortality 4.5 4.4 4.3 4.2  ...
How to measure•   Befriend an analyst•   Use what is there already•   Use what is useful•   Don’t judge, be curious•   Too...
<Process Name>                                                                                                            ...
Change Ideas                             All high risk COPD                                                               ...
PDSADeveloping improvement          Implementing new                                procedures & systemswith PDSAs        ...
Developing improvement                                Improvementwith PDSAs          Improvement                        ? ...
Making it happen• Leadership is not about position or title• Create the vision, identify the first steps,  make people unc...
In summary…• Take a structured approach to messy  problems• Know what you want to achieve• Know where you are starting fro...
Find out more    Visit the NHS Improvement standInformation on service improvement techniques,         case studies and us...
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Breakout 2.5 Service improvement for everyone - Catherine Blackaby

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Breakout 2.5 Service improvement for everyone - Catherine Blackaby
National Improvement Lead
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

Published in: Health & Medicine
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Breakout 2.5 Service improvement for everyone - Catherine Blackaby

  1. 1. Service improvement for everyone Catherine Blackaby National Improvement Lead This session will cover…• Why a structured approach to improvement is important• An introduction to some of the key tools and techniques to help you get started• How to find out more 1
  2. 2. NHS Service ImprovementSurely it’s not that difficult? X Y Just do it Efficient system IHI and RC Lloyd & Associates 2008 2
  3. 3. Surely it’s not that difficult? X Y Patient encounter Healthy with health satisfied professional patient IHI and RC Lloyd & Associates 2008X 3
  4. 4. MODEL FOR IMPROVEMENT “All models are wrong but some are useful” • W Deming 4
  5. 5. Model for improvement What are we trying to aims accomplish? How will we know that a measurements change is an improvement?What changes can we make that will interventionsresult in the improvements that we seek ? Act Plan Study DoWHAT IS OUR AIM? 5
  6. 6. Define your aim A good aim• What we are trying to achieve• For whom• How much• By when• Compared to what• And why? 6
  7. 7. By July 2011 in 100% of key practices 75% ofpatients on COPD register will have had a reviewin the last 15 months and have a British LungFoundation (BLF) Self Care management Plan.Patients will have a better understanding of theirdisease, their medication, how to manageexacerbations and when to seek help. This willlead to a reduction in emergency admissions andreadmissions and better use of healthcareresources for these patients. WHERE ARE WE STARTING FROM? 7
  8. 8. Understanding the system & the problem 8
  9. 9. Process mapping • Everyone involved in the process • Make visible what happens at each step • One step = one sticky note • Who does What • Ask: – How long? How many? How often? – Time between steps? – Why? • If you don’t know, find out<Process Name> ISSUE Consultant review by; ISSUE Medical on- Respiratory Repeat assessment. Variation in discharge information practice? * On-call Team (non respiratory) call team Nurse Is this effiecent? Transfer Co-ordinators? * Elderly care AMU Assessment * Respiratory NO NO GP Physio, OT, Patient SW etc Discharge? YES YES Discharge? ISSUE breathless What happens Self Dept of Junior Doctor Ambulance on general management 999 Medicine assess on-call Respiratory response ward? (OT Elderly DOME team Nurse Discharge? YES NO YES Discharge? Physio?) assessment OOH DOME NO General Ward outreach ISSUE Registrar LOS What does this Daily A&E Review on- assessment NO CHAPS do? How does call team Respiratory Ward access work? Mon-Fri by Dr LOS (6-10 days No onward path??? stay) CDU Social Services Pulmonary Home care hrs rehab referral No onward path??? available Letter to GP from Out of Hours? ISSUE Part-time SW Social Worker / causing delay OT referral 3/7 Hospital OT slowing system wait to see <Function> Equipment Healthcare Medication? Transport? Environmental Equipment – TTOS Tax? Carers -equipment Medical transport? equipment YES Discharge? Clarify Source of TTOS? No onward path??? Discharge to Residential / Pulmonary community Nursing home rehab services CHAP Referral to LTOT Community RNS assessment Appt with community Matron No onward path??? Home Post hospital review ??? BI annual review Self referral to community Letter to GP from Consultant? services?, hopsital? Letter to CHAPS from RNS? Letter to GP from Respiratory Nurse? Outpatient appointment Letter to GP from A&E? with copies of; Nursing MDT letter Copy of discharge letter Letter to GP 9
  10. 10. All improvement is change – but not all change is improvement…HOW WILL WE KNOW IF ACHANGE IS ANIMPROVEMENT? 10
  11. 11. How will we know whether a change is an improvement?• Measure…• Measure the baseline• Measure the minimum & what is useful• Make measurement part of the daily routine.• Measure over time, measure variation & don’t measure averages! Why not just use averages? ‘If I stick my right foot in a bucket of boiling water and my left foot in a bucket of ice water, on average, I’d feel pretty comfortable.’ Davis Balestracci 11
  12. 12. Measurement for Improvement 5 4.9 4.8 4.7 4.6 Mortality 4.5 4.4 4.3 4.2 Last year This yearAverage The real picture12 New10 protocol introduced 8 6 Mortality 4 2 0 Jan Mar May July Sept Nov Jan Mar May July 12
  13. 13. How to measure• Befriend an analyst• Use what is there already• Use what is useful• Don’t judge, be curious• Tools: – NHS Improvement Data Guide – NHS Improvement System SPC tool www.improvement.nhs.uk WHAT CHANGES CAN WE MAKE? 13
  14. 14. <Process Name> ISSUE Consultant review by; ISSUE Medical on- Respiratory Repeat assessment. Variation in discharge information practice? * On-call Team (non respiratory) call team Nurse Is this effiecent? Transfer Co-ordinators? * Elderly care AMU Assessment * Respiratory NO NO GP Physio, OT, Patient SW etc Discharge? YES YES Discharge? ISSUE breathless What happens Self Dept of Junior Doctor Ambulance on general management 999 Medicine assess on-call Respiratory response ward? (OT Elderly DOME team Nurse Discharge? YES NO YES Discharge? Physio?) assessment OOH DOME NO General Ward outreach ISSUE Registrar LOS What does this Daily A&E Review on- assessment NO CHAPS do? How does call team Respiratory Ward access work? Mon-Fri by Dr LOS (6-10 days No onward path??? stay) CDU Social Services Pulmonary Home care hrs rehab referral No onward path??? available Letter to GP from Out of Hours? ISSUE Part-time SW Social Worker / causing delay OT referral 3/7 Hospital OT slowing system wait to see <Function> Equipment Healthcare Medication? Transport? Environmental Equipment – TTOS Tax? Carers -equipment Medical transport? equipment YES Discharge? Clarify Source of TTOS? No onward path??? Discharge to Residential / Pulmonary community Nursing home rehab services CHAP Referral to LTOT Community RNS assessment Appt with community Matron No onward path??? Home Post hospital review ??? BI annual review Self referral to community Letter to GP from Consultant? services?, hopsital? Letter to CHAPS from RNS? Letter to GP from Respiratory Nurse? Outpatient appointment Letter to GP from A&E? with copies of; Nursing MDT letter Copy of discharge letter Letter to GP For every complex human problem there is always one easy answer that is neat, plausible… …and wrong HL Mencken 14
  15. 15. Change Ideas All high risk COPD Patients to have Having a written plan plans Knowing what to do Regular review Standardise use of Rescue Meds Availability of rescue Aim medsincrease the no of patients Confident, active who can effectively Patients & carersSelf manage exacerbations Information for patients Education & carers on COPD & managing breathlessness Available support competent staff Access to Contact numbers for appointments / advice COPD nurses 15
  16. 16. PDSADeveloping improvement Implementing new procedures & systemswith PDSAs - sustaining change Testing and refining ideas Bright idea! 16
  17. 17. Developing improvement Improvementwith PDSAs Improvement ? ? ? ? Improvement ? ? Bright idea! Nosocomial Infection Rates 17
  18. 18. Making it happen• Leadership is not about position or title• Create the vision, identify the first steps, make people uncomfortable about doing nothing• Perseverance• Action• Communication• Believe you can do it! 18
  19. 19. In summary…• Take a structured approach to messy problems• Know what you want to achieve• Know where you are starting from and what really happens now• Prioritise action & take small steps• Measure impact and review progress• Communicate learning and success• Don’t be afraid to have a go Getting startedThe secret of getting ahead is gettingstarted. The secret of getting started isbreaking your complex overwhelming tasksinto small manageable tasks, and thenstarting on the first one.Mark Twain 19
  20. 20. Find out more Visit the NHS Improvement standInformation on service improvement techniques, case studies and using data Visit our website: www.improvement.nhs.uk 20

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