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Parallel Session 2.9 Scrutiny and Improvement – The Integrated Cycle


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Parallel Session 2.9 Scrutiny and Improvement – The Integrated Cycle

  2. 2. CONTEXT• the Scottish context• Quality Strategy• external confidence and assurance at a time of financial constraint and rising expectations• shifting balance in power between health professionals and patients• integration of care - regulation & scrutiny with fewer boundaries
  5. 5. TIMELINE6th June 2011Cabinet Secretary announcement directing HIS toundertake inspections of care of older people in acute care29th November 2011Scottish Parliament Health and Sport Committee Reportpublished on Inquiry into the Regulation of Care for OlderPeople1st December 2011Letter to Chair HIS setting out the policy context fromDirector General
  6. 6. TIMELINEOctober – January 20126 test inspections completed3rd February 2012Letter to Chief Executive, HIS asking for the formalprogramme of inspections to commence as swiftly aspossible
  7. 7. 6 INSPECTIONS UNDERTAKEN• Western Infirmary 21st February• Hairmyres Hospital 5th March• Royal Alexandra Hospital 14th March• Western General Hospital 11th April• Glasgow Royal Infirmary 2nd May• Wishaw General Hospital 28th MayReports published with improvement action plans
  8. 8. INTEGRATED CYCLE OF IMPROVEMENT • Improving Older People’s Care in Acute Hospital programme •Key themes adapted to other work• Local self assessment•Local inspection report•Older People in AcuteCare Clinical Standards•National Care Standards •Inspection of Older People’s•Review of literature: Services in acute careCAAP process (April 2012) •Learning from other reports•Relevant reports eg AuditScotland
  9. 9. AREAS OF STRENGTH• Caring behaviours of staff, taking account of privacy, dignity and respect AREAS OF IMPROVEMENT• Staff don’t always act to safeguard the best interests of patients with dementia, their families and carers(legal and ethical implications)• Food, fluid and nutrition• Pressure ulcer care
  11. 11. USING THE EVIDENCE• Patient and User feedback• Observation in the ward• Research and evidence• Reports and Reviews• Standards of practice and care• Common Sense
  12. 12. WHAT NEXT ?• We know the size of the problem• We know where we want to get to• What are the few things which we know will make a difference ?• How do we bring them together ?
  13. 13. BUILDING THE IMPROVEMENT PROGRAMME Research and Development. Driven by need Prototype Ideas shaped by small scale tests of change Spread Good practice supported by Quality Improvement Sustainability Part of normal working ensured by Scrutiny
  14. 14. Improving care for older people in acute hospital Integration of Scrutiny and Improvement3 Improvement Plan Admission and In-patient2 Transitions Assessment care Inspection Themes Continence Nutritional Falls Tissue Dementia care Viability1 Local NHS board test sites
  15. 15. Improving care for older people in acute hospital Integration of Evidence and Improvement MUST screen in 24 hours Nutritional care Assistance at meal times Hydration
  16. 16. Improving care for older people in acute hospital Integration of Evidence and Improvement Environmental issues Falls Falls Prevention Assessment
  17. 17. THANK YOUAny Questions ?
  18. 18. QUESTIONS• What are the challenges/opportunities in integrating inspection and improvement ?• What opportunities do you see in integrating inspection and improvement of older people?• How do you ensure the patient/carer is central to all scrutiny and improvement work?