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ELFT Quality improvement roadshow - 2014

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Slides from the East London NHS Foundation Trust roadshow on quality improvement

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ELFT Quality improvement roadshow - 2014

  1. 1. Quality Improvement Roadshow
  2. 2. Roadshow Video
  3. 3. Our quality improvement programme Why?
  4. 4. The strategic case for change
  5. 5. Changing the culture through quality improvement Involvement of service users and carers through every step of the journey
  6. 6. The culture we want to nurture
  7. 7. Our quality improvement programme How?
  8. 8. Long-term mission and stretch aims The mission To provide the highest quality mental health and community care in England by 2020 Quality improvement strategy Reduce harm by 30% every year Right care, right place, right time Two stretch aims
  9. 9. Long-term mission and stretch aims
  10. 10. How many incidents of harm were reported in 2013? How much harm currently occurs in our care? 1. Under 100 6. 2000 – 3000 2. 100 – 250 7. 3000 – 4000 3. 250 – 500 8. 4000 – 5000 4. 500 – 1000 9. 5000 – 6000 5. 1000 - 2000 10. 6000 - 7000
  11. 11. How many incidents of harm were reported in 2013? How much harm currently occurs in our care? 1. Under 100 6. 2000 – 3000 2. 100 – 250 7. 3000 – 4000 3. 250 – 500 8. 4000 – 5000 4. 500 – 1000 9. 5000 – 6000 5. 1000 - 2000 10. 6000 - 7000 Answer = 2881
  12. 12. Long-term mission and stretch aims
  13. 13. What proportion of our patients currently state they are extremely likely to recommend our services to their friends and family? Patient experience? 1. Under 10% 2. 10 – 20% 3. 20 – 40% 4. 40 – 60% 5. 60 – 80% 6. 80 – 100%
  14. 14. What proportion of our patients currently state they are extremely likely to recommend our services to their friends and family? Patient experience? 1. Under 10% 2. 10 – 20% 3. 20 – 40% 4. 40 – 60% 5. 60 – 80% 6. 80 – 100%
  15. 15. Long-term mission and stretch aims Central QI team Functions Coordinate the programme Improvement expertise to support frontline work Learning and sharing – internally & externally Make-up Programme director (Medical Director) Deputy programme director (Associate Medical Director) Programme manager Continuous improvement and measurement lead 2 x rotating clinical secondments Programme support
  16. 16. Central QI team Building the will Long-term mission and stretch aims Traditional engagement Grassroots movement / campaign • Launch event & roadshows • Through formal directorate structures • Local champions • Q30 (staff) and Q12 (service user) groups to shape our comms • Microsite – as a central resource • Branding & identity
  17. 17. Central QI team Building the will Long-term mission and stretch aims Aligning our systems Clinical audit Real-time patient experience feedbackLearning from complaints Datix improvements Reviewing our inductions Integrated quality data available to all Embedding a structure for listening Outcome measures Influencing contracts and CQUINs Financial measures Stopping activity of lower value
  18. 18. Central QI team Building the will Long-term mission and stretch aims Aligning our systems Building improvement skills Successful improvement requires a specific set of skills Most of us have not been trained in improvement Improvement at scale needs a consistent approach Appointment of an external partner to build skills within our workforce at scale & pace
  19. 19. Methodology How do we deliver a consistent approach to quality?
  20. 20. Introduction to our external partner
  21. 21. Independent, not-for-profit organisation Based in Cambridge, Massachusetts Leading innovator, convenor, partner and driver of results in health and healthcare worldwide 5 key areas of work • Improvement capability • Patient and family-centred care • Patient safety • Quality, cost and value • Triple aim for populations (improving health outcomes, experience and per capita cost)
  22. 22. The Model for Improvement
  23. 23. “What will happen if we try something different?” “Let’s try it!”“Did it work?” “What’s next? ” The PDSA Cycle
  24. 24. Spread to other sites / groups / popn Develop a change Implement a change Test a changeTheory and Prediction Test under a variety of conditions Make part of routine operations The Steps to Change
  25. 25. Measurement and Using Data for Improvement
  26. 26. How Do ELFT Use Measurement? MMSE CQUINS & KPIs Clinical Trials and Research Service user outcomes Service user experience Waiting lists BPRS Blood results
  27. 27. • Research (efficacy) • Improvement (efficiency and effectiveness) • Accountability (reassurance, comparison) The Three Faces of Measurement
  28. 28. Research Aim New Knowledge (efficacy) Methods: Test observability Tests are blinded or controlled Bias Designed to eliminate bias Sample size ‘Just in case data’ (very large data sets) Flexibility of hypothesis Fixed hypothesis Testing Strategy One large test Determining if a change is an improvement Enumerative Statistics (t-test, p-values)
  29. 29. Improvement Aim Improvement of care (efficiency and effectiveness) Methods: Test observability Tests are observable Bias Accept consistent bias Sample size ‘Just enough data’, small sequential samples Flexibility of hypothesis Flexible and changes as learning takes place Testing Strategy Sequential test over time Determining if a change is an improvement Analytical statistics. Run and Control charts
  30. 30. Accountability Aim Comparison, choice, reassurance, motivation for change Methods: Test observability No test, evaluate current performance Bias Measure and adjust to reduce bias Sample size Obtain 100% of available, relevant data Flexibility of hypothesis No hypothesis Testing Strategy No tests Determining if a change is an improvement No change focus
  31. 31. • Research (efficacy) • Improvement (efficiency and effectiveness) • Accountability (reassurance, comparison) The Three Faces of Measurement
  32. 32. Does this represent improvement? 1.Yes 2. No
  33. 33. • How can you tell if you are improving? • Data collection and analysis are central to QI • Helps identify quality problems but also opportunities for improvement • Allows us to track improvement over time • Success of programme will hinge on the measurements we put in place Why Measure?
  34. 34. Training Plan for the Organisation
  35. 35. • IHI Open School programme available to all staff • Face to face training for 200 staff in next year • Learning Events (Autumn 2014) Training Plan for the Organisation
  36. 36. “I’m In” Video
  37. 37. Break
  38. 38. Starting an Improvement Project
  39. 39. qi.eastlondon.nhs.uk
  40. 40. Key Ingredients for Success
  41. 41. And why is this important? (the strategic and business case) What are We Trying to Accomplish?
  42. 42. • Involve members familiar with all different parts of the process • Effective teams require three kinds of expertise – System leadership – Improvement advice – Day to day leadership - Project leader • Aim to meet every 1-2 weeks for 30-45 minutes • How will you communicate? • How to bring data to meeting? Choose your team
  43. 43. The Driver Diagram is a tool to help us understand the system, its outcomes and the processes that drive the outcomes Defining your messy system
  44. 44. AIM Primary driver Primary driver Secondary driver Secondary driver Secondary driver Secondary driver Secondary driver Change 1 Change 2 Change 3
  45. 45. AIM: Lose 5kg in 3 months Calories in Calories out Limit daily intake Substitute low calorie food Avoid alcohol Exercise Fidgeting Track calories Plan meals Drink water, not Coke Work out 3 times a week Cycle to work Hacky sack in office
  46. 46. AIM PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS Improving quality of care on an inpatient female psychiatric ward
  47. 47. Draw a Driver Diagram
  48. 48. The Model for Improvement
  49. 49. Video: Overview of the model for improvement
  50. 50. • A strong, measurable aim with a clear time frame will help keep your project on course • It has to be important to those involved The Aim
  51. 51. • Be creative Developing Changes
  52. 52. • Measurement is critical for testing and implementing changes • Different from measurement for research Measurement
  53. 53. Video: The Model for Improvement, Developing Changes and Measurement
  54. 54. The PDSA Cycle “What will happen if we try something different?” “Let’s try it!” “Did it work?” “What’s next? ”
  55. 55. Video: The PDSA Cycle
  56. 56. Complete Project Charter • Email to QI team • qi@eastlondon.nhs.uk • QI team will get in contact in a few days
  57. 57. • Make sure you have right ingredients for success • Help finalise charter • Make sure your project aligns with programme aims • Link you with support on project and methodology • Provide support and access to BMJ Quality platform The QI Team Will…
  58. 58. Draft Measurement Framework
  59. 59. Mission and Aims Mission: Highest Quality Mental Health and Community Care in England Stretch Aim 1: Right care, Right Time Stretch Aim 2: Reduce Harm
  60. 60. Improved Patient Experience
  61. 61. Summary and Close

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