UTI collaborative cohort one. Hosted by NHS Improvement.

1. Identifying your improvement focus
Ranvir Virk – Quality Improvement Advisor NHSI
ranvir.virk@nhs.net

2. 2
Improvement skills:
Process mapping
What?
• Visual way of showing the steps in a process or system
• The average current process/journey
• Gives an overview to everyone involved in the current process
How?
• Bring the team together
• Describe who does what and when
start of
the
process
task task
decision
end of
the
process
task
direction

3. 3
Improvement skills:
using process maps
• Analyse
• What works well?
• Even more effective if…ie issues?
• Prepare to redesign the process
• Co-ordinate the process
• Reduce number of handoffs or steps
• Plan your PDSA cycles
Issues to
focus on?
decision
end of
the
process
task
direction
start of
the
process
task task

4. Flowchart Template for YOUR project

5. Symbols used to Process Map
5
Start & End of the process
Represents an activity
The diamond represents where a
‘yes’ or ‘No’ question is being
asked or decision is required.
You can mark the value added and
wasted steps (red and green post-its)

6. 6

7. Getting out of bed in the morning
7

8. Getting to work
8

9. 9
Working with your process map

10. Our collaborative journey
C. the difference
Ros Pounds
Infection Prevention Nurse

11. In 2015/16 trajectory for CDI was exceeded by 48%
Sampling
Isolation
Our aim: to protect patients from harm by
reducing CDI incidence
Why us?

12. • 3 wards with highest incidence
• MDT engagement
Who?

13. The First meeting

14. Audits 

15. 0
20
40
60
80
100
1 2 3 4 5 6 7 8 9 101112131415
Auditcompliance(%)
Week of collaborative
Figure 1: IPS Isolation audit compliance (%)
Audit results 

16. PDSA cyclePDSA Cycle / Driver diagram

17. Small things…

18. • Weekly meetings
• Positive feedback
• Share ideas
• Update PDSA cycles
• Ward teams coming to
national events
• Supporting teams to
own it
Keeping the momentum

19. Success!Success!

20. 21 wards in 21 days!

21. Results
• Isolation audit compliance improved from 51% to 100%
• CDI incidence reduced from 15 for the five months
before the collaborative to 8 for the next five months
• An improved diarrhoea care plan
• The average days between CDI cases improved from 12
days before the collaborative, to 20 days during – an
increase of 67%
• Following the collaborative no patient developed CDI
for 49 days – a success that had not been achieved at
the trust before the collaborative
Results

22. Sharing the learning

23. We reduced patients developing C.diff by two thirds
Collaborative 2
0
5
10
15
20
25
30
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
Feb-18
Mar-18
C. difficile infection April 2017 - March 2018
2017/18 Monthly
2017/18 Cumulative
Threshold
Trajectory
Change
package was
tweeted in
October 2017

24. Our challenge: how to engage with the workforce to share this work?
C.difficile change package