Scotland’s Approach to
Safety and Quality
Jason Leitch
Clinical Director
The Quality Unit, Scottish Government
@jasonleitch
• 5 million people
• £12 billion
• 14 Health Boards
• 8 Support Boards
• Integrated delivery
• Moving towards
social care
...
Public Finances
Fall in Government expenditure
Health Budget
191119311951197119912011
Source: Scotland 2011 Census
Scotland’s Demographics 1911 - 2011
Projected % Change in Scotland’s Population
by age group 2006-2031
Source: GRO Scotland, 2007
Strategic Objectives
Aims:
To deliver the highest
quality healthcare services
to the people of Scotland
For NHSScotland to be
recognised as wor...
The Healthcare Quality Strategy for Scotland
Person-Centred - Mutually beneficial partnerships between
patients, their fam...
Triple Aim
Health of the
Population
Experience of
Care
Best Value
for Money
The IHI Triple Aim
Evidence based discovery
Evidence based delivery
17 years to get 14% of evidence
into practice
Implementing at scale….
can it be done?
Improve Safety of
Healthcare
Services in
Scotland
(15% reduction in
HSMR by end of
2012)
Boards accept SPSP as a
key strat...
By what method?
W. Edwards Deming
DESIGN DESIGN DESIGN DESIGN APPROVE
Conference Room
Real World
The Typical Approach…
IMPLEMENT
DESIGN
TEST &
MODIFY
TEST &
MODIFY
APPROVE
IF NECESSARY
Conference Room
Real World
TEST &
MODIFY
The Quality Improvement A...
Our change theory
 A clear and stretch goal
 A method
 Predictive, iterative testing
Breakthrough Series Collaborative
‘This model is not magic, but it is
probably the most useful single
framework I have encountered in
twenty years of my own...
NHSScotland Surgical Safety Briefings
23% reduction from median
NHSScotland Surgical Mortality
Hospital Standardised Mortality Ratios
(Seasonally Adjusted) Scotland: Dec 2002 to Mar 2012
0.6
0.7
0.8
0.9
1.0
1.1
1.2
1 ...
How has the frontline done it?
Get goals
Get bold
Get together
Get a model (and stick
with it)
Get patients and
famil...
The Early Years Collaborative -
Ambition
To make Scotland the best place in the world to
grow up in by improving outcomes,...
The Early Years Collaborative - Aims
1. To ensure that women experience positive pregnancies which result in the birth of
...
Scotland’s 2020 Vision:
The Quality Strategy:
The Quality Improvement Hub:
Some Useful Links
Institute for Healthcare Impr...
@jasonleitch
Abordagem da Escócia para a Segurança e a Qualidade (Scotland’s approach to safety and quality)
Abordagem da Escócia para a Segurança e a Qualidade (Scotland’s approach to safety and quality)
Abordagem da Escócia para a Segurança e a Qualidade (Scotland’s approach to safety and quality)
Abordagem da Escócia para a Segurança e a Qualidade (Scotland’s approach to safety and quality)
Abordagem da Escócia para a Segurança e a Qualidade (Scotland’s approach to safety and quality)
Abordagem da Escócia para a Segurança e a Qualidade (Scotland’s approach to safety and quality)
Abordagem da Escócia para a Segurança e a Qualidade (Scotland’s approach to safety and quality)
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Abordagem da Escócia para a Segurança e a Qualidade (Scotland’s approach to safety and quality)

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Aula em inglês de Jason Leitch, diretor clínico da Unidade de Qualidade do Governo Escocês, durante o II Seminário Internacional sobre Qualidade em Saúde e Segurança do Paciente - evento do Qualisus - que ocorreu dias 13 e 14 de Agosto de 2013, no Ministério da Saúde, em Brasília.

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  • Scotland’s 65+ population projected to rise by 21% between 2006 – 2016By 2031 it will have risen by 62%For the 85+ age group specifically, a 38% rise is projected for 2016And, for 2031, the increase is 144%
  • MFI is made up of 2 parts – the thinking part and the doing partThe 3 questions – the thinking part prepares you for the test by asking the ‘so what’ questionThey need to be thought through, answered and written down by the improver to ensure that they, and therefore their colleagues, are clear on the benefits to them and their work.That message often gets lost in the many things we are expected and asked to do and is one of the reasons why so many interventions are not implemented reliably.If we are not clear on the benefits of something we are much less likely to do it.The Plan Do Study Act cycle is a simple tool that’s used to test out ideas that will improve your systems and processes while learning what works and doesn’t work.It’s a structured approach for making small incremental changes to systems that allow you to test on a small scale, learn from successes and failure and redesign as you goIt builds learning and buy in incrementally as tests ramp up and allows clinicians knowledge about their own system is built in to the process
  • Data from at least 9 out of 10 Boards with Data available on Extranet. Each month has an average sample size of 2949 procedures
  • Smoothed the seasonal effect. Fit regression line: shows a marked acceleration over the most recent two year period. Why is this ?We cant say for certain – but one explanation is the cumulative additive effect of the many many small changes and improvements made across a nation.Made by you and the people you work with The so called aggregation of marginal gains The sum is greater than the whole- there is probably a synergistic effect beyond the simple addition or cumulation- achieving a critical mass.Fits with our thinking- focus on processes – and outcomes will follow – often after a delay or lag
  • Abordagem da Escócia para a Segurança e a Qualidade (Scotland’s approach to safety and quality)

    1. 1. Scotland’s Approach to Safety and Quality Jason Leitch Clinical Director The Quality Unit, Scottish Government @jasonleitch
    2. 2. • 5 million people • £12 billion • 14 Health Boards • 8 Support Boards • Integrated delivery • Moving towards social care integration
    3. 3. Public Finances Fall in Government expenditure
    4. 4. Health Budget
    5. 5. 191119311951197119912011 Source: Scotland 2011 Census Scotland’s Demographics 1911 - 2011
    6. 6. Projected % Change in Scotland’s Population by age group 2006-2031 Source: GRO Scotland, 2007
    7. 7. Strategic Objectives
    8. 8. Aims: To deliver the highest quality healthcare services to the people of Scotland For NHSScotland to be recognised as world- leading in the quality of healthcare it provides
    9. 9. The Healthcare Quality Strategy for Scotland 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. 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.
    10. 10. Triple Aim Health of the Population Experience of Care Best Value for Money The IHI Triple Aim
    11. 11. Evidence based discovery Evidence based delivery 17 years to get 14% of evidence into practice
    12. 12. Implementing at scale…. can it be done?
    13. 13. Improve Safety of Healthcare Services in Scotland (15% reduction in HSMR by end of 2012) Boards accept SPSP as a key strategic priority for effective governance Scottish Government sets SPSP as strategic priority Deliver the programme Build a sustainable infrastructure for improvement Align SPSP with national improvement programmes Primary Drivers Demonstrable results Clear, shared measurement set Visible on all senior leader agendas A cohesive and united programme Secondary Drivers Agreed set of outcomes Review & address outcome delivery Quality & safety on every agenda Infrastructure supports Involve patients Clinical faculty expert at improvement methods and coaching Programme design and structure BTS collaborative Acceptance of pragmatic science Royal Colleges support Inventory of national programmes Engage with national programmes Harmonize metrics
    14. 14. By what method? W. Edwards Deming
    15. 15. DESIGN DESIGN DESIGN DESIGN APPROVE Conference Room Real World The Typical Approach… IMPLEMENT
    16. 16. DESIGN TEST & MODIFY TEST & MODIFY APPROVE IF NECESSARY Conference Room Real World TEST & MODIFY The Quality Improvement Approach STARTTO IMPLEMENT
    17. 17. Our change theory  A clear and stretch goal  A method  Predictive, iterative testing
    18. 18. Breakthrough Series Collaborative
    19. 19. ‘This model is not magic, but it is probably the most useful single framework I have encountered in twenty years of my own work on quality improvement’ Dr Donald M. Berwick Former Administrator of the Centres for Medicare & Medicaid Services Professor of Paediatrics and Health Care Policy at the Harvard Medical School The Model for Improvement
    20. 20. NHSScotland Surgical Safety Briefings
    21. 21. 23% reduction from median NHSScotland Surgical Mortality
    22. 22. Hospital Standardised Mortality Ratios (Seasonally Adjusted) Scotland: Dec 2002 to Mar 2012 0.6 0.7 0.8 0.9 1.0 1.1 1.2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 Quarters Smoothed SMR average annual reduction 4.2% (Apr 2010 to Mar 2012) 1.4% average annual reduction (Oct 2002 to Jan 2010) SmoothedSMR
    23. 23. How has the frontline done it? Get goals Get bold Get together Get a model (and stick with it) Get patients and families Get the facts Get to the field Get a clock Get the numbers Get the stories
    24. 24. The Early Years Collaborative - Ambition To make Scotland the best place in the world to grow up in by improving outcomes, and reducing inequalities, for all babies, children, mothers, fathers and families across Scotland to ensure that all children have the best start in life and are ready to succeed.
    25. 25. The Early Years Collaborative - Aims 1. To ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of stillbirths (from 4.9 per 1,000 births in 2010 to 4.3 per 1,000 births in 2015) and infant mortality (from 3.7 per 1,000 live births in 2010 to 3.1 per 1,000 live births in 2015). 2. To ensure that 85% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review, by end-2016. 3. To ensure that 90% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017.
    26. 26. Scotland’s 2020 Vision: The Quality Strategy: The Quality Improvement Hub: Some Useful Links Institute for Healthcare Improvement:
    27. 27. @jasonleitch

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