"Quality in action...for every patient, every time" by Derek Feeley


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n this opening plenary session of the NHSScotland Event 2011, Derek Feely talks about progress on quality. Along with Jason Leitch, Derek reflects on some of the challenges facing the service and how NHSScotland would respond. He also celebrates some of the successes over the last year across NHSScotland.

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"Quality in action...for every patient, every time" by Derek Feeley

  1. 1. Quality in Action …for Every Patient Every Time
  2. 2. Introducing the Clarks
  3. 3. The Strategic Narrative <ul><li>Challenges </li></ul><ul><li>Demography </li></ul><ul><li>Scotland’s public health </li></ul><ul><li>Economic outlook </li></ul>
  4. 4. The Strategic Narrative <ul><li>Response </li></ul><ul><li>Commitment for the founding principles of NHS </li></ul><ul><li>Integration and collaboration not competition or markets </li></ul><ul><li>Less care in acute settings and more at home/in the community </li></ul><ul><li>Integration of health and social care </li></ul><ul><li>Greater efficiency and productivity </li></ul>
  5. 5. The Strategic Narrative <ul><li>The Conditions </li></ul><ul><li>Quality improvement must drive this agenda </li></ul><ul><li>With people not to them </li></ul><ul><li>In partnership with our staff and those who work with us </li></ul>
  6. 6. Where are we now on Quality? <ul><li>Best ever performance on access and waiting </li></ul><ul><li>Care is safer </li></ul><ul><li>Emergency bed days declining </li></ul><ul><li>Financial balance </li></ul><ul><li>Collaborative efforts bearing fruit </li></ul><ul><li>The world is watching! </li></ul>
  7. 7. Some highlights on Safety <ul><li>6% reduction in HSMR </li></ul><ul><li>43% reduction in ventilator acquired pneumonia </li></ul><ul><li>73% reduction in critical care central bloodstream infections </li></ul><ul><li>73% reduction in C.Diff in the over 65’s </li></ul><ul><li>New programmes in paediatrics, mental health and primary care </li></ul>
  8. 8. Some highlights on person-centered care <ul><li>121,000 people benefitting from self management fund (in 81 projects) </li></ul><ul><li>58,000 people better managing their medicines through the chronic medication service </li></ul><ul><li>Strong patient experience feedback through Better Together (90% rate care as excellent or good) </li></ul>
  9. 9. Highlights on Effective Care <ul><li>In 2009/10 older people required 125,000 fewer days in hospital </li></ul><ul><li>29,000 people got tele-care at home </li></ul><ul><li>Rollout of Anticipatory Care Summaries and ePCS </li></ul>
  10. 10. And so…… <ul><li>Let’s celebrate that success </li></ul><ul><li>Let’s build on it </li></ul><ul><li>Let’s accelerate the pace of improvement </li></ul><ul><li>Let’s get it right for every person in every family every time </li></ul>
  11. 11. Thank you
  12. 12. The good news
  13. 14. The ambitions <ul><li>Person-Centred - 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. </li></ul><ul><li>Clinically Effective - 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. </li></ul><ul><li>Safe - There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times. </li></ul>
  14. 15. The less good news
  15. 16. <ul><li>No needless deaths </li></ul><ul><li>No needless pain or suffering </li></ul><ul><li>No helplessness in those served or serving </li></ul><ul><li>No unwanted waiting </li></ul><ul><li>No waste </li></ul><ul><li>No one left out </li></ul>Another lens? From Don Berwick
  16. 17. <ul><li>More guidelines </li></ul><ul><li>More programmes </li></ul><ul><li>More targets </li></ul><ul><li>More work…. </li></ul>What we need…..
  17. 18. <ul><li>Use implementation evidence </li></ul><ul><li>Be person-centred </li></ul><ul><li>Link quality and cost </li></ul><ul><li>Set aims for quality at every level </li></ul>Evidence-based execution
  18. 19. Use implementation evidence
  19. 20. Kotter’s eight steps for change…
  20. 21. <ul><li>The six questions to be asked of EVERY change programme: </li></ul><ul><li>Aim? yes/no </li></ul><ul><li>Correct changes? yes/no </li></ul><ul><li>Clear change theory? yes/no </li></ul><ul><li>Measurement? yes/no </li></ul><ul><li>Capability? yes/no </li></ul><ul><li>Spread plan? yes/no </li></ul><ul><li>Only proceed if all six are yes – all-or-none measurement. </li></ul>
  21. 22. Be person-centred
  22. 23. <ul><li>Wrong site surgery </li></ul><ul><li>In-patient suicide </li></ul><ul><li>Retained instrument after surgery </li></ul><ul><li>Maternal death after c-section </li></ul><ul><li>Etc. </li></ul>
  23. 24. Random acts of goodness vs always events
  24. 25. Always Event(s): The Always Event is to always listen to the patient during hand-offs by encouraging teach-back opportunities—during hospitalization and upon arrival in the next care setting. Always use the Teach-back method.
  25. 26. Always Event(s): Always communicate with, inform and respect the patient through the following behaviours in every patient/family encounter: 1) Introducing yourself and describing the reason you are there at each encounter, 2) Addressing and referring to patients by the name that they choose; not by their disease, 3) Displaying your name badge at all times, 4) Treating those whom you serve with the same respect you would wish them to show you, 5) Encouraging patients and families involvement in decision making, 6) Welcoming and being respectful to those defined by the patient as “family”
  26. 27. <ul><li>Standardised procedures 2) Individualised care </li></ul>
  27. 28. Lauren’s list
  28. 29. A Powerful Evolution Do it to me. Do it for me. Do it with me. Martha Hayward Patient Advocate
  29. 30. Link quality and cost
  30. 31. Set aims for quality at EVERY level
  31. 32. 11.5 Healthcare that Is safe is defined by our Clinical Excellence goal   The care we deliver will be safe and effective.  We commit to having excellent clinical care with no preventable injuries or deaths by July 2008 “ There will be no avoidable injury or harm”
  32. 34. Always…
  33. 35. <ul><li>Use implementation evidence </li></ul><ul><li>Be person-centred </li></ul><ul><li>Link quality and cost </li></ul><ul><li>Set aims for quality at every level </li></ul>Evidence-based execution
  34. 36. What does this mean for you? <ul><li>Check your programmes against the six questions </li></ul><ul><li>Continue to be person-centred </li></ul><ul><li>Come and hear Gerry </li></ul><ul><li>Set aims for quality </li></ul><ul><li>Need to lead on improving quality </li></ul>
  35. 37. “ Do not be content with mediocrity. Do your job so well that nobody could do it better.” Martin Luther king Jr.