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Quality MK - an introduction 240609


A description Quality MK - a whole system approach to health service development across Milton Keynes supported by the Health Foundation

A description Quality MK - a whole system approach to health service development across Milton Keynes supported by the Health Foundation

Published in Health & Medicine
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  • Thank you; delighted to be asked to share our experience. Quality:MK is one of nine projects comprising a national scheme Engaging with Quality in Primary Care (funded by The Health Foundation. The aim is to establish a whole system approach to improving health care that is driven by primary care, patient engagement and evidence-based practice. So – this is not a victory narrative, and there are parallels with my experience of driving around MK – where I get caught out by a mismatch between the map and the road ahead, and take many a second tour of a roundabout, quality improvement is an iterative, messy yet very worthwhile journey On a journey – starting from a position where could already see all sorts of good practice – yet room for improvement, closer relationships, and not a strong culture of PPE or evidence-based practice
  • – 26 of 27general practices formerly Patient and Public Involvement Forum --- Local Involvement Network NHS Milton Keynes – initiated within the Public Health Directorate of the PCT, sit within the commissioning arm Colleagues in the audience from each of the 3 local partners
  • What are we trying to do? Placing evidence, service users and primary care right at the heart of decision making and the quality improvement agenda - and keeping them there Building our knowledge and understanding of how to deliver and sustain improvement, using the lessons learned through an ambitious programme of Quality:MK projects to help line up the ‘cogs and wheels’ needed to build a self-improving system Explicit focus on learning and improvement process; ongoing process of continual, self-conscious change. The application of best evidence to healthcare will yield quality improvements;
  • Using repeated cycles of learning from projects to design and implement changes in system & organisational process Establish multiple channels for innovation and improvement; Mix of large-scale service review and redesign projects AND Projects initiated by practices – either as “bright ideas” or deriving from discussions of the evidence
  • Mainstreaming a systematic approach to service review and redesign Adopting Map of Medicine 12 task and finish groups: 100+ participants
  • 14 groups in all: 7 for practice staff: 5 in practice – 4 meeting regularly for some time now, plus two new groups 1 IMPACTE central and 1 IMPACTE online – 7 meeting in community services, most on an occasional basis. Well over a 100 participants, over 10 topics discussed Brought in a clinical effectiveness pharmacist to develop projects and toolkits, to to build up a network, to attract change, and support wider adoption of changes in practice All the CATs are listed on our website pages, currently on PCT website Back in Jan 09 - 55 topics discussed across all journal clubs.  36 of these within 5 GP practices.  Of these 36 topics, 32 have been followed up with further investigation 4 have led to an actual change in practice: 1.     Delayed prescribing as strategy to reduce antibiotic use 2.     Interventions for alcohol misuse 3.     Fever in under 5s 4.     Lipid Modification   hot on the heels of preparation of the first 3 implementation toolkits for prescribing projects, steering group will choose their next 3 topics in July.
  • As the current LITs are revamped; guidance on patient and public engagement to be prepared and issued to each LIT Chair on ensuring active involvement. This guidance to model the health:mk approach (whereby there is always some form of patient engagement but it takes different forms eg. perhaps commenting on a specification rather than helping to devise it).   Develop a joint statement on the benefits of public and patient engagement, the benefits of partnership working and the “Golden Rules”, to be taken forward by NHS Milton Keynes, health:mk and LINk:MK as local partners   PPI in planning process includes – enabling patients and the public to place issues on the agenda New guide for PPGs
  • Changes in system and process for service planning: patient engagement, clinical engagement, evidence-based inc. decision-makers need to demonstrate their use of evidence
  • Lessons taken from a presentation that Nick gave in Berlin about the emerging lessons from our work
  • from the Programme Manager These are some the things I wish I had done sooner or differently - - Paul Plsek - Engaging Physicians in a Shared Quality Agenda. IHI
  • These are some of the things the project leads have said: Inc believe the evidence of change management
  • From independent qualitative evaluation by PHRU showing evidence of a positive impact. Focus is on embedding the work, holding the gains and pushing on with the journey.
  • “ Continual improvement is an unending journey.” As first tranche of projects draw to a close over next year, already shaping Quality:MK Mark3 to continue after the close of HF funding – pleased to be asked to support work on review of stroke services, looking to develop a project on Domestic violence, assimilating the learning from another HF project Aim of microsite - to support the integration and ‘embedding’ of the Quality:MK principles into commissioning, planning and delivery. Mid-october If of any use to you in your mission - please make free use of any of the resources there - summaries of keynote papers on QI, current awareness services – new one on cost and quality – Learn from your experience as fellow travellers .. Thank you for yourtime-


  • 1. QUALITY: MKA whole system approach to quality improvement Milton Keynes, June 2009 Sue Lacey Bryant, Programme Manager Sue.Lacey-Bryant@mkpct.nhs.uk health:mk
  • 2. Working in partnership health:mk NHS Milton Keynes LINKs-MK Centre for Evidence Based Medicine health:mk
  • 3. Our aimCreate a self-improving system to make a reality of three widely used slogans…• Evidence based• Primary care led• Patient engagement health:mk
  • 4. How are we going about it? Repeated cycles of learning from projects Create relevant… •Culture and values •Skills and capacity •Systems & processes health:mk
  • 5. Commissioning for improvement:Service review and redesign•Smoking cessation: revised pathway•Alcohol introduction of brief interventions•Weight management new service for children•Diabetes: care planning approach community based service•Mild/moderate depression user designed service …. At varying stages of progress, all based on evidence withclinicians on each group & combinations of public engagementand user involvement in service design health:mk
  • 6. In practice and across primary care evidence-based discussion groups Share and spread – inc. supporting 3 prescribing projects•E-B skills training & toolkit•Librarian support IMPACTE groups Improving Medical Practice by•Pharmacist support Assessing CurrentT Evidence inc. toolkits health:mk
  • 7. Patient and public engagement• Two PPE representatives on each TaF• Training workshops for commissioners• Learning from experience• Appropriate approaches• Rules of engagement • Patient empowerment• Embedding patient and through information public involvement in the • Patient participation planning process groups health:mk
  • 8. Building a self-improving system Multiple channels for innovation and improvement; Mainstreaming a systematic approach to service review and redesign Clinical effectiveness; Map of Medicine as default Defining, documenting: tools & templates communications, engagement, evidence, prescribing Assuring information data flows System and process inc. PEC, HR Learning culture Public and patient engagement Seeing it through; supporting the change leads Making it easier to work with these values, than not to .. health:mk
  • 9. What have we learned?Lead with values Embed change into theListen; trust patients and system. Change: service users  valuesSupport skill development  agenda setting consistent with values and  planning process identify QI skills as core  decision criteriaBe prepared to make,  resource allocationadmit  and align organisational & learn from mistakes processes with valuesBe persistent Tighten programme mgt health:mk
  • 10. Things to do sooner ... or differentlyRecruit clinical championsStrengthen channels for Worry less about QI engagement and inviting process techniques local expertise  Use data persuasively:Offer better information & Generate light, not heat support for PPE Pay more attention toClearer terms of reference how to implement changeExplicit accountability Diagnose barriers health:mk
  • 11. ... and from the project leads Use the evidence Prioritise “Raise the flag” Importance of leadership Clear objectives Focus on outcomes Nurture the partnerships Build the team Challenge assumptions Reflect health:mk
  • 12. How are we getting on?“A dynamic & organic shift”“The success of this programme can be seen in the high level of patient and clinician involvement”“... with greater use of evidence”“There is an explosion of patient involvement” health:mk
  • 13. Roadmap to quality improvement Explaining the Setting out the system process Tools, Best practice techniques to deliver Quality Guidance on Improvement “how to” health:mk