1. Boards on Board
The Role of the Board in Quality and Safety
See the problem, own the problem,
fix the problem
Derek Feeley
22 February 2012

2. Scotland’s Triple Aim + (or
new readers start here)
• Health (prevention and
anticipation)
• Healthcare Quality
• Value (i.e. quality/cost)
• Integration and collaboration

3. High Ambition – to be a world
leader
The ultimate aim of our Quality
Strategy is to deliver the
highest quality healthcare
services to people in Scotland
and through this to ensure that
NHSScotland is recognised by
the people of Scotland as
amongst the best in the world.
We want to achieve this aim in
a way this is recognisable and
meaningful to everybody.

4. Built on people’s priorities
• caring and compassionate health services
• collaborating with patients and everyone
working for and with NHSScotland
• providing a clean and safe care environment
• improved access and continuity of care
• confidence and trust in healthcare services
• delivering clinical excellence

5. The Healthcare Quality Strategy
Ambitions
• 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.
• 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.
• 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.

6. Priorities for progress towards our 3 Quality
Ambitions – Safe, Effective and Person
Centred
• Everyone gets the best start in life, and is able to live a
longer, healthier life
• People are able to live well at home or in the community
• Healthcare is safe for every person, every time
• Everyone has a positive experience of healthcare
• Staff feel supported and engaged
• The best use is made of available resources

7. Strategic Narrative; ‘20:20 Vision’
Everyone is able to live longer healthier
lives, at home, or in a homely setting

8. Vision for Adult Health and Social Care
• Older people are supported to live well at
home or in the community for as much time as
they can
• They have a positive experience of health and
social care when they need it

9. Integration of Health and Social Care
• Legislation:
– nationally agreed outcomes
– joint accountability
– integrated budgets across primary care, community health and
social care, and some of acute care
• CHP committees will be taken off the statute book and replaced by
Health and Social Care Partnerships – joint and equal
responsibility of the NHS and Local Authority
• Jointly appointed senior accountable officer will report to the Chief
Executives of the NHS and Local Authority
• Annual accountability meetings will enable accountability through
Boards to Ministers

10. Implications for Boards

11. Quality and Efficiency

12. The 3 curves?
Viability
Optimizing the
Current Model
Transforming the
Patient Organization
Inflection
Point
Time
12
Adapted from The Second Curve,
Models Ian Morrison 1996

13. Under the first curve…
• Financial Position?
• HEAT Performance?

14. What about….
• Medication • Do you know how
many medication
errors occurred – last
month, last quarter,
last year?
• Has the number gone
up or down
• Do you know where
they occurred

15. Under the 2nd Curve; Acute Emergency Admissions by Practice for >75
population
2007/08
5000
4500
4000
3500
3000
£/weighted head
2500
2000
1500
1000
500
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61

16. Board 1, Hospital 2 – 17.8%
1.5
Standardised Mortality Ratio
1.0
0.5
Oct- Apr- Oct- Apr- Oct- Apr- Oct- Apr- Oct- Apr-
Dec Jun Dec Jun Dec Jun Dec Jun Dec Jun
2006 2007 2007 2008 2008 2009 2009 2010 2010p* 2011p

17. Board 1, Hospital 1 – 5.2%
1.5
Standardised Mortality Ratio
1.0
0.5
Oct- Apr- Oct- Apr- Oct- Apr- Oct- Apr- Oct- Apr-
Dec Jun Dec Jun Dec Jun Dec Jun Dec Jun
2006 2007 2007 2008 2008 2009 2009 2010 2010p* 2011p

18. Public Services Improvement Bundle

20. Looking ahead to the next 2 days
• Building on firm foundations
– Boards on Board – January 2011 and Jim Conway
– Developed through SPSP
• Welcome to Jamie Orlikoff
• Support from the National Leadership Unit
• Recognition of expertise within the audience