Derek FeeleyDirector-General Health and Social Care and Chief            Executive NHSScotland                 Jason Leitc...
The Edge of Glory?
A legitimate Statement of Values“The Lothian Way” has been developed within NHS Lothian  as a set of emergent values and a...
Underlying cultural assumptions     (the unwritten rules)Many organisations have unwritten rules whichdescribe ‘the way we...
Some less prominent headlines (in May alone…)
The real world?• Performance continues to improve• In many areas it is better than ever (and  world class)• We can’t affor...
We should choose to learn!“What if we choose to change? Could wecraft joy from loss, pride from revision, andexcellence fr...
To change and to persist!“There were a number of  definitions of courage, but  now I was seeing it in its  simplest form: ...
To make the right thing easier to              do!
Tough Love?
So what if……?• We had the courage to persist in our  pursuit of world-class care• We continued to make care safer, more  e...
AimsTo deliver the highest  quality healthcareservices to the people     of ScotlandFor NHSScotland to be recognised as wo...
2020 VisionEveryone is able to live longerhealthier lives at home, or in a        homely setting.
Getting to the third curve                                           Co-production                                        ...
What will it take?• Redesign, creativity and innovation• New technologies and better use of  existing technology• Preventi...
JL
Getting to the third curvePerformance                                                  s                                  ...
Getting to the third curvePerformance               Performance                             Time
Median and 90th percentile waits for IP/DC                             Median (days)   90th percentile (days)             ...
Patient journeys within 18 weeks                 50%                       60%                             70%            ...
“The overall financialperformance of the NHS is good”        Audit Scotland, 2011         good = euphoria
Getting to the third curvePerformance                             Improvement               Performance                   ...
“The Scottish Patient Safety Programme is without doubt one of the most ambitious patient safety initiatives in the world ...
Ja            10            12            14            16            18            20            22            24        ...
Surgical Mortality                     28%
Scotland HSMR – 9.5% reduction                                                          Standardised Mortality Ratio (SMR)...
20%
11.5%
Median Time to IV Fluids                                                                            Percentage Oxygen Comp...
Harm-free care
Katy: Zero PressureUlcers Stages 3 & 4                                    To: Memorial Hermann Katy Hospital              ...
Northwest: Zero RetainedForeign Bodies                                       To: Memorial Hermann Northwest Hospital      ...
Sugar Land: Zero CentralLine Blood Stream Infections                                   To: Memorial Hermann Sugar Land Hos...
High ReliabilityCertified Zero Hospitals   Central Line Associated Bloodstream Infections (4)          Ventilator Associat...
"Quality is never an accident;it is always the result of high    intention, sincere effort,    intelligent direction and  ...
Getting to the third curve                                           Co-production                                        ...
~6500 people
Bedday rate for patients aged 75+,                                             emergency admissions                       ...
Doors
Person centred health and    care programme        Coming soon
DF
Assets vs DeficitsAssets thinking               Deficit thinking•Strengths based              •Problem orientated•How can ...
Values on the way to work
Derek’s Values•   Advocacy•   Accessibility•   Ambition•   Authenticity
Jason’s values•   Person-centred•   Pioneering•   Restless•   Aspiring
The Edge of GloryPlease complete your cards
Ethics and Glory“Glory, built on selfish principles, is shame and  guilt”      William Cowper“Glory follows virtue as if i...
So are you ready to……?• Show the courage to persist in our pursuit  of world-class care• Continue to make care safer, more...
The Edge of Glory!
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
Plenary 1 Driving Quality Through Innovation
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Plenary 1 Driving Quality Through Innovation

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  • A quick reminder of the differences. Assets based and deficit based approaches take policies and services down radically different routes, radically different ways of thinking and going about the business Christie and others link many of our current intractable problems in policies and services which define people by what they can’t do or their problems, treat them as passive recipients incapable of and not to be trusted with determining their own lives and so further disempowering and alienating them. They argue that doing things to people has been ineffective and resource intensive. Structural inequalities reinforce powerlessness and hopelessness and create barriers to self fulfillment and realisation of assets allowing inequalities in outcomes such as health to flourish. A lack of assets creates and sustains transient and troubled communities which are disconnected, powerless and passive. Lacking connections, self worth and empathy, they are riven by prejudice, intolerance. Sectarianism, anti social behavior, hate crimes and disrespect thrive in weak and threatened communities and on poverty and inequality.
  • Plenary 1 Driving Quality Through Innovation

    1. 1. Derek FeeleyDirector-General Health and Social Care and Chief Executive NHSScotland Jason Leitch Clinical Director, The Quality Unit, Scottish Government
    2. 2. The Edge of Glory?
    3. 3. A legitimate Statement of Values“The Lothian Way” has been developed within NHS Lothian as a set of emergent values and associated behaviours identified as vital elements of the culture that NHS Lothian wants to build. Patients are first and foremost in this set of values however staff motivation and organisational reputation are central too. They are as follows: – Person Centred – Partnership – Integrity – Accountability – Innovation
    4. 4. Underlying cultural assumptions (the unwritten rules)Many organisations have unwritten rules whichdescribe ‘the way we do things around here’. InNHS Lothian the following have been describedconsistently to us in one-to-one interviews:• Suppression of bad news – do not write it down• Gloss• You are on your own – ‘Just fix It’ “
    5. 5. Some less prominent headlines (in May alone…)
    6. 6. The real world?• Performance continues to improve• In many areas it is better than ever (and world class)• We can’t afford to stand still• Attitudes, ethics and values are as important as technical excellence• Reliability just as important in these areas – every person every time
    7. 7. We should choose to learn!“What if we choose to change? Could wecraft joy from loss, pride from revision, andexcellence from invention?Yes we can.”Don Berwick; British Journal of General Practice; Feb 2009
    8. 8. To change and to persist!“There were a number of definitions of courage, but now I was seeing it in its simplest form: you do what has to be done day after day, and you never quit.” ― Eric Greitens, The Heart and the Fist: The Education of a Humanitarian, the Making of a Navy SEAL
    9. 9. To make the right thing easier to do!
    10. 10. Tough Love?
    11. 11. So what if……?• We had the courage to persist in our pursuit of world-class care• We continued to make care safer, more effective and more person-centred• We choose to learn together• We share and renew our ethics and values• We make the right thing easier to do• We get ready for the next curve
    12. 12. AimsTo deliver the highest quality healthcareservices to the people of ScotlandFor NHSScotland to be recognised as world- leading in the quality of healthcare it provides
    13. 13. 2020 VisionEveryone is able to live longerhealthier lives at home, or in a homely setting.
    14. 14. Getting to the third curve Co-production & assetsPerformance Improvement Performance Time
    15. 15. What will it take?• Redesign, creativity and innovation• New technologies and better use of existing technology• Prevention, assets and activation• Up our game on person centred care• Continued focus on performance and improvement• Shared and renewed ethics and values
    16. 16. JL
    17. 17. Getting to the third curvePerformance s il ie d fam s an t ti en Pa Time
    18. 18. Getting to the third curvePerformance Performance Time
    19. 19. Median and 90th percentile waits for IP/DC Median (days) 90th percentile (days) 120 105 100Wait (days) 80 63 60 35 40 25 20 0 Ju 8 Ju 9 Ju 0 Ju 1 2 M 8 M 0 M 9 M 1 N 8 N 0 N 1 N 9 -0 -1 -0 -1 -1 -0 -0 -1 -1 l-0 l-0 l-1 l-1 ar ar ar ar ar ov ov ov ov M Quarter ending
    20. 20. Patient journeys within 18 weeks 50% 60% 70% 80% 90% 100% Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11Month Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 % of patient journeys within 18 weeks
    21. 21. “The overall financialperformance of the NHS is good” Audit Scotland, 2011 good = euphoria
    22. 22. Getting to the third curvePerformance Improvement Performance Time
    23. 23. “The Scottish Patient Safety Programme is without doubt one of the most ambitious patient safety initiatives in the world – national in scale, bold in aims, and disciplined in science. Itharnesses the energies and wisdom of Scotland’s health care leaders –NHS executives, QIS experts, clinical professionals,civil servants, and more – all aligned toward a common vision,making Scotland the safest nation on earth from the viewpoint o of health care.” Don Berwick
    24. 24. 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- 10Ap r- 1 0 Ju l-1 0O ct -1 0Ja % ICU mortality n- 11Ap r- 1 1 Ju l-1 1O ct 24% improvement -1 1 13.9%
    25. 25. Surgical Mortality 28%
    26. 26. Scotland HSMR – 9.5% reduction Standardised Mortality Ratio (SMR) Regression line 1.5Standardised Mortality Ratio 1.0 0.5 Oct- Apr- Oct- Apr- Oct- Apr- Oct- Apr- Oct- Apr- Oct- Dec Jun Dec Jun Dec Jun Dec Jun Dec Jun Dec 2006 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011p
    27. 27. 20%
    28. 28. 11.5%
    29. 29. Median Time to IV Fluids Percentage Oxygen Complance Sepsis bundle compliance 120%02:0901:55 100%01:40 80%01:2601:12 60%00:57 40%00:43 10000:28 20%00:14 90 0%00:00 02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12 02/04/12 80 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12 70 Median Time to Blood Cultures Percentage Compliance IV Fluids 120%02:5202:24 60 100% 80%01:55 50 60%01:2600:57 40 40% 20%00:28 30 0%00:00 02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12 02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12 20 Median Time to Lactate 02:52 10 Percentage Compliance of Blood Cultures 45% 40% 02:24 0 35% 01:55 02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 30% 07/05/12 14/05/12 25% 01:26 20% 15% 00:57 10% 5% 00:28 0% 00:00 02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12 02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
    30. 30. Harm-free care
    31. 31. Katy: Zero PressureUlcers Stages 3 & 4 To: Memorial Hermann Katy Hospital Zero Pressure Ulcers for 36 Months January 1, 2008 to December 31, 2010 Zero Pressure Ulcers x 36 Months
    32. 32. Northwest: Zero RetainedForeign Bodies To: Memorial Hermann Northwest Hospital Zero Retained Foreign Bodies for 24 Months January 1, 2010 to December 31, 2010 Zero Retained Foreign Bodies x 24 Months
    33. 33. Sugar Land: Zero CentralLine Blood Stream Infections To: Memorial Hermann Sugar Land Hospital Zero Central Line Associated Blood Stream Infections for 36 Months February 1, 2008 to January 31, 2011 Zero CLABSIs x 36 Months
    34. 34. High ReliabilityCertified Zero Hospitals Central Line Associated Bloodstream Infections (4) Ventilator Associated Pneumonias (7) 2012 Surgical Site Infections40Awards Retained Foreign Bodies (9) Iatrogenic Pneumothorax (4) Accidental Punctures and Lacerations Pressure Ulcers Stages III & IV (8) Hospital Associated Injuries (2) Deep Vein Thrombosis and/or Pulmonary Embolism (1) Deaths Among Surgical Inpatients with Serious Treatable Complications Birth Traumas (4) Serious Safety Events (1)
    35. 35. "Quality is never an accident;it is always the result of high intention, sincere effort, intelligent direction and skillful execution; itrepresents the wise choice of many alternatives.” 1941, William A. Foster
    36. 36. Getting to the third curve Co-production & assetsPerformance Improvement Performance Time
    37. 37. ~6500 people
    38. 38. Bedday rate for patients aged 75+, emergency admissions 6500Bedday rate per 1000 aged 75+ 6000 Borders Lothian 5500 ~550 beds Board average 5000 Highland Ayrshire & Arran 4500 Tayside Re-shaping Care Prog/LTC Prog 4000 0 6 0 7 0 8 0 9 1 0 1 1 M ar- M ar- M ar- M ar- M ar- M ar- Sept-11 Year ending Prepared by Peter Knight JIT June12
    39. 39. Doors
    40. 40. Person centred health and care programme Coming soon
    41. 41. DF
    42. 42. Assets vs DeficitsAssets thinking Deficit thinking•Strengths based •Problem orientated•How can we create •How to fix this problem?community spirit? •Someone needs to sort this•What can I do? •Us versus them•We’re all in this together •Problems are embedded•We’re getting there •Do things to people•Work with engaged people •People are a problem•People have the answers •People can’t be trusted to•People control their lives decide/be in control
    43. 43. Values on the way to work
    44. 44. Derek’s Values• Advocacy• Accessibility• Ambition• Authenticity
    45. 45. Jason’s values• Person-centred• Pioneering• Restless• Aspiring
    46. 46. The Edge of GloryPlease complete your cards
    47. 47. Ethics and Glory“Glory, built on selfish principles, is shame and guilt” William Cowper“Glory follows virtue as if it were its shadow” Cicero“Glory lies in the attempt to reach one’s goal and not in reaching it” Mahatma Ghandi
    48. 48. So are you ready to……?• Show the courage to persist in our pursuit of world-class care• Continue to make care safer, more effective and more person-centred• Choose to learn together• Share and renew our ethics and values• Make the right thing easier to do• Get ready for the next curve
    49. 49. The Edge of Glory!
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