Some insights from the 19th Annual IHI/BMJ International Forum on Quality and Safety in Healthcare, Paris, 08-11 April 2014: The theme of this year’s Forum was “Strive for Excellence, Seek Value, [and] Spark a Revolution!” in healthcare. The meeting attracted over 3000 delegates from over 75 countries – and so it was a great opportunity to cross-fertilise ideas and share cutting-edge practices across international boundaries. Our work from across NHS Education for Scotland attracted much interest and discussion – not only at the NHS Scotland exhibition stand, but also at the workshop presentations and poster sessions. Internationally, over 200 sessions were presented by leading thinkers in the field; and covered the following streams: • Patient and family centred care • Leading effective change • Improving population and community health • Improving clinical performance • Technology and innovation • Safe and reliable care One core theme however, appeared to be patient safety stories, and staff & patient experiences. The ethos was on reflecting on person centred care – really listening to patients and service users, and understanding what really matters to them. In addition, there were deliberations on taking healthcare completely outside the formal healthcare system and in engaging in health every day. Whilst this concept is not new, it resonates with the notion that “prevention is better than cure”. One keynote in particular presented the power of narrative in compelling action and transformational positive change. Another presentation focussed on shadowing the patient journey – to review process maps, the voice of patients, family members and staff, and transitions in care. Using this real-time collection of data and narrative, the organisation was able to review the team effort around the patient, to improve services, interactions and processes. The emphasis was on co-designing services with patients through engagement, partnership and in closing any identified gaps to ideal care delivery. In summary, a key message emanating is how the complementary nature of data and narrative/story will compel action, catalyse improvements, and drive transformative change for excellence in service delivery.

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The 19th
Annual Institute of Healthcare Improvement and BMJ
International Forum on
Quality & Safety in Healthcare
Dr Nancy El-Farargy
NHS Education for Scotland
‘Teach-Back’ Session: 20 May 2014
Strive for Excellence, Seek Value, Spark a Revolution
Paris, 08-11 April 2014
What Matters to You?
Patient Safety Stories and Experiences

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International Forum on Quality & Safety
in Healthcare, Paris 2014
• Privileged to learn from international leaders
• Over 3000 guests from over 75 countries
• Share NHS Education for Scotland research
• What Matters to You? Using Patient Safety Stories to Enhance
Patient Safety and Patient Experiences
• Making the Most of Patient Safety Stories

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• Joint NHS Scotland Exhibition Stand attracted a wide audience
• Scottish Government
• Healthcare Improvement Scotland
• NHS Education for Scotland
International Forum on Quality & Safety
in Healthcare, Paris 2014

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‘Team Scotland’
• 08.00 ‘huddle’ every morning!
• Sharing learning with NHS Scotland staff and beyond
Picture via @ejsreid

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Patient Safety Stories and Experiences
• Lots of learning, discussions and topics
• Today focusing on
• Patient stories
• Narrative
• Improving experiences
• Theme seemed to resonate throughout the Forum

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Asking Patients: ‘What Matters to You?’
• Reflections from Keynote 1:
Maureen Bisognano,
President and CEO, Institute
of Healthcare Improvement
• What matters to you?
• Trusting the young
• What are your likes and
dislikes?

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The Scottish Experience
• Scottish Patient Safety
Programme (SPSP)
• A national approach to
safety and innovation
across the Scottish
healthcare system
• Translating policy to
frontline action

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The Consultant is the Patient
• Personal family reflections
• Consultant treated in his own hospital
• Factors for change in medical culture
• Person-centred care; listen to patients
• Balance between ‘patient centred systems v checklist patient
assessments
Buist, M.D. (2010). How I nearly met my maker: A story of clinical futile cycles and survival. The Joint Commission
Journal on Quality and Patient Safety, 36(7):334-336. Available online:
http://www.utas.edu.au/__data/assets/pdf_file/0008/135674/Buist-2010.pdf [Accessed 19 May 2014].
‘Doctor in the House’ Documentary (2009). Available online: http://www.abc.net.au/austory/specials/doctorhouse/
[Accessed 19 May 2014].

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Shadowing the Patient Journey
• Looking at improvements through the eyes of both patients and
staff experiences
• No industry survives without focusing on the needs (and ‘wants’)
of end users
• Shadowing patients
• Determine current state and process maps accurately
• Great for ‘on-boarding’
• Continuously engage with users in real-time – co-design
• Break down any perceived and real silos
• The value is in the experience – how patients progress
through to wellness
DiGioia, A.M. & Greenhouse, P.K. (2011). Patient and family shadowing: Creating urgency for change. Journal of
Nursing Administration, 41(1): 23-28.
Hawkes, N. (2013). Patients’ actual care pathways often differ markedly from doctors’ perceptions. BMJ,
347:F6728. Available online: http://www.bmj.com/content/347/bmj.f6728 [Accessed 19 May 2014].

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What Matters to You? Poster Presentation
• I presented our NHS Education for
Scotland research on patient
safety stories
• Listening, reflecting, learning and
changing practices through data
and emotive narrative
• Looking at improvements through
the eyes of both patients and staff
experiences
• Where:
• Board meetings
• Safety briefs
• Handover
What matters to you? Using patient safety stories to enhance patient safety and patient experiences. (El-Farargy,
et al., 2014, International Forum on Quality and Safety in Healthcare. Paris, 08-11 April 2014).

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Making the Most of Patient Safety Stories
• Stakeholders told us:
• How stories are gathered
• Where they are
disseminated
• Preferred formats
• Outcomes and lessons
learned
• Onward improvements
• Caveats
• New to the area
• Ethical issues
• Evidence base v
anecdotes
Making the most of patient safety stories: Enhancing patient safety and patient experiences. NHS Education for
Scotland. Available online:
http://www.nes.scot.nhs.uk/media/2514414/enhancing-the-patient-experience-via-storytelling20140121.pdf
[Accessed 19 May 2014].

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Voices of Staff and Patients

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Engaging Hearts and Minds
• Why do stories matter?
• Turning data into an experience
• Resonating with experiences
• Establishing connections
• Emotive narrative
• Creating significance
• Catalysing improvement and change

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• Our vision is that by 2020 everyone is able to live longer
healthier lives at home, or in a homely setting.
• We will have a healthcare system where we have integrated
health and social care, a focus on prevention, anticipation and
supported self management.
• When hospital treatment is required, and cannot be provided
in a community setting, day case treatment will be the norm.
• Whatever the setting, care will be provided to the highest
standards of quality and safety, with the person at the centre
of all decisions.
• There will be a focus on ensuring that people get back into
their home or community environment as soon as appropriate,
with minimal risk of re-admission.
Strategic Backdrop: “2020 Vision”
Scottish Government , 2020 Workforce Vision. Available online:
http://www.scotland.gov.uk/Topics/Health/NHS-Workforce/Policy/2020-Vision [Accessed 19 May 2014].

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What is Quality Improvement?
• The systematic, data-guided activities designed to bring about
immediate, positive changes in the delivery of health care in
particular settings.
• While quality improvement uses a wide variety of methods, they
all involve deliberate actions to improve care, guided by data
reflecting the effects.
• Depending on the activity, quality improvement can look like a
type of practical problem solving, an evidence-based
management style, or the application of a theory-driven science
of how to bring about system change.
• (p. S5)
• Addition: ongoing journey of improvement (in any setting)
Baily, M.A. et al (2006). The ethics of using QI methods to improve health care quality and safety. A Hastings
Center Special Report. Available online:
http://www.thehastingscenter.org/uploadedFiles/Publications/Special_Reports/using_qi_methods_to_improve_healt
h_care_quality_safety.pdf [Accessed 19 May 2014].

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Reflections from the BMJ
• “What matters to you?”
• Listening to patients and responding to concerns
• Co-producing health with patients
• “Prevention is better than cure” – out-with formal healthcare
systems
• Treat every patient as a family member
Richards, T. (2014). “All I ask is that you listen”. British Medical Journal Group Blogs. Available online:
http://blogs.bmj.com/bmj/2014/04/14/tessa-richards-all-i-ask-is-that-you-listen/ [Accessed 19 May 2014].

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Everyone Matters: Everyone Contributes
• Co-producing healthcare between staff, patients and families
• One example:
• Patient Opinion website
• https://www.patientopinion.org.uk/

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Delivering Education for
Excellence in Service Delivery

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Thank You
The 19th
Annual Institute of Healthcare Improvement and BMJ
International Forum on
Quality & Safety in Healthcare
Dr Nancy El-Farargy
Nancy.El-Farargy@nes.scot.nhs.uk
NHS Education for Scotland, 20 May 2014
Strive for Excellence, Seek Value, Spark a Revolution
Paris, 08-11 April 2014
What Matters to You?
Patient Safety Stories and Experiences