Improving Patient Care conferenceJane Mac donald presentation

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This document discusses initiatives to improve patient safety in Greater Manchester. It outlines (A) the Sign up to Safety pledges that organizations can commit to, (B) the Patient Safety Collaborative topics being addressed, and (C) the Q Initiative to train 5,000 patient safety fellows by 2020. The overarching goals are to reduce avoidable harm, continually learn from patients and staff, be transparent about progress and mistakes, collaborate across services, and support staff in improving safety and celebrating successes. Patient safety remains the central focus of these efforts to create a culture of partnership and learning.

Healthcare

Continually Improving Patient
Safety
Jane Macdonald
Director of Nursing and Improvement
@GM_AHSN

AHSN – National Context
Innovation Health andWealth
AHSN Licence
Focus on the needs of patients and
local populations
Speed up adoption of innovation into
practice to improve clinical outcomes and
patient experience
Build a culture of partnership and
collaboration
Create wealth through
co-development, testing, evaluation
and early adoption and spread of new
products and services.

Greater Manchester AHSN – Local
context
GM AHSN footprint
4Universitie
s
1
Ambulance Service

Executive team
Mike Burrows Managing Director
• Martin Gibson
• Gary Leeming
• Sarah Thew
Research and
Informatics
• Linda Magee
• Keith Chantler
Industry and
Wealth
• Donal O’Donoghue
• Jane Macdonald
Health and
Implementation

Improving Patient Safety…..as easy as
ABC?
A. Sign up to Safety
B. Take your Patient Safety Collaborative
(PSC) forward
C. See yourself as part of the Q initiative
Q

A. The 5 Sign up to Safety pledges are
• Putting safety first. Commit to reduce avoidable harm in the NHS
by half and make public our locally developed goals and plans
• Continually learn. Make organisation more resilient to risks, by
acting on the feedback from patients and staff and by constantly
measuring and monitoring how safe our services are
• Being honest. Be transparent with people about our progress to
tackle patient safety issues and support staff to be candid with
patients and their families if something goes wrong
• Collaborating. Take a lead role in supporting local collaborative
learning, so that improvements are made across all of the local
services that patients use
• Being supportive. Help people understand why things go wrong
and how to put them right. Give staff the time and support to
improve and celebrate progress.

Sign up to Safety
Members that have currently signed up:
• Salford Royal NHS Foundation Trust
• The Christies NHS Foundation Trust
• Bolton NHS Foundation Trust
• Tameside NHS Foundation Trust
• Central Manchester NHS Foundation Trust
• East Lancashire NHS Foundation Trust
• North West Ambulance Service NHS Trust
• AQuA
• Greater Manchester Academic Health Science Network
• Manchester Mental Health and Social care trust
• Pennine Care NHS FT
• Pennine Acute NHS Trust
• University Hospital of South Manchester NHS FT
• Stockport NHS FT
• Bolton Clinical Commissioning Group
:

NICE CG 180 - 2014
Current prescribing of anticoagulants for AF in England
NICE Costing report: AF (2014) IMS Disease Analyser 2012/13 and GRASP-AF database download April 2014
Treatment Percentage of AF
Population
Number of
people
No treatment 28.99% 258, 000
Aspirin 22.49% 200,000
Warfarin 34.32% 305,000
NOACS 14.20% 126,000

Why is this not safe…
1 in 6 strokes occurs in people with AF
Of the next 10 patients with AF who have a
stroke:
– 8 would have been known to be high risk
of stroke
– 6 should have been on warfarin / NOAC
– 3 will go home
– 5 will end up in supported care
– 2 will die....

THE NUMBER AND COST OF STROKE
*Publically available data
Hospital Episode Statistics* (HES)

C. The Q Initiative
• Began life as ‘5000 Safety
Fellows’ following the
Berwick report
• Initial Founding Cohort
150 - 250, 10 places for
each AHSN
• Consider the structure
the long term design
• 5,000 in this initiative by
2020
• Funding in 2015, 2million

Q initiative – the Founding Cohort in GM
Vanessa Gardener May Moonan Michael Spence Abigail Harrison Alison Dwyer Caroline Poole
Chelliah Selvasekar Lesley Lappin Maria Ahmed Katie Pieroni Andrea McGuinness Jane Macdonald

IN SUMMARY
• So the future is bright!!!
• And safer…..
Q
• Productivity Challenge / Spending Review
• Structure and format for delivery
A. Sign up to Safety
B. Patients Safety Collaborative (PSC)
C. Q Initiative
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Standards in Sport: Ethics, Integrity and Governance 22/06/2017

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Officials make around 245 decisions per game in football, averaging about one decision every 22 seconds. 45 of these decisions are technical calls related to goal kicks, corners, or throw ins. Another 200 decisions involve physical contact and potential disciplinary actions. Only 35 decisions are visible fouls or restarts of play. Officials are estimated to be correct in their calls 98% of the time, missing around 5 calls per game. Assistant referees make about 50 decisions per game, with 45 being offside calls and only 4 resulting in a flag for offside. Video review technology could help increase accuracy even further.

Standards in Sport: Ethics, Integrity and Governance 22/06/2017

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This document discusses the Sport Integrity Global Alliance (SIGA), a multi-stakeholder coalition aimed at promoting integrity in sport. SIGA's vision is for sport to be governed with the highest integrity standards and free from unethical activity. Its mission is to provide leadership in promoting good governance and safeguarding integrity in sport through universal standards. SIGA focuses on financial integrity, good governance, and sports betting integrity. It holds consultations and forums to develop these universal standards and encourages their adoption. The standards are designed to apply progressively based on an organization's capabilities. SIGA also conducts independent assessments of adherence to the standards.

Standards in Sport: Ethics, Integrity and Governance 22/06/2017

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Standards in Sport: Ethics, Integrity and Governance 22/06/2017

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This document discusses the formation and mission of the Sport Integrity Global Alliance (SIGA), a multi-stakeholder coalition aimed at safeguarding sport integrity through a set of universal standards. SIGA was established in 2015 with the goal of providing leadership in promoting good governance and protecting sport from criminal activity. SIGA is developing core principles and universal standards on good governance, financial integrity, and sports betting integrity. These standards will be implemented gradually by organizations through a self-assessment and independent evaluation process. The document outlines SIGA's activities over the past two years in developing these standards and building its membership through forums and meetings.

Standards in Sport: Ethics, Integrity and Governance 22/06/2017

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The document discusses improving board effectiveness in sports bodies. It defines governance and outlines the key roles of the board chair and board members. A successful board promotes a collective vision, operates with aligned culture and values, provides good governance through understanding its role and ensuring delivery of purpose. Board composition should include appropriate skills, diversity, and independence. Principles of sound decision making and factors inhibiting effectiveness are also covered. The document stresses the importance of organizational culture and having the right values embedded to protect public investment and enhance reputation. Cultural markers and ways to assess organizational culture through measurable, evidential, and judgemental indicators are presented.

Standards in Sport: Ethics, Integrity and Governance 22/06/2017

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This document discusses the importance of ethics and values in governance and business. It notes that establishing a code of ethics and clear values helps organizations set standards of conduct for employees and builds trust. An effective ethics program clearly communicates values, provides training and guidance, and monitors adherence through accountability. Such programs support ethical decision-making and encourage employees to speak up about issues or concerns. Embedding values and ethics throughout an organization's culture and operations can benefit the business through greater trust, reputation, and performance.

Standards in Sport: Ethics, Integrity and Governance 22/06/2017

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The document discusses challenges in impact measurement and lessons learned from implementing a new impact measurement system. Some key points: 1) Charities often struggle with impact measurement, not having easy and complete data collection in one place. This can make reporting difficult and inefficient. 2) The Football Foundation addressed this by developing their own impact system, Upshot, to better manage projects, monitor outcomes, and demonstrate impact internally and externally. 3) Implementing changes can be challenging, as was seen in a case study with London Legacy Development Corporation where partner buy-in and consistent data collection had to be improved. Ongoing challenges include organizations using multiple systems and measuring soft outcomes.

Standards in Sport: Ethics, Integrity and Governance 22/06/2017

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This document discusses safeguarding children in sport. It argues that current approaches to child protection in sport focus too narrowly on procedures, perpetrators, and risks of harm, rather than the wider culture and children's holistic well-being. The document advocates listening to children's perspectives and priorities to better understand their actual experiences. Research suggests children experience more emotional abuse than is reported, and that behavior tolerated in sport would not be in other contexts. The document concludes sport safeguarding should promote children's voices, welfare, and involvement in decisions to build trust and create conditions for their own protection.

Standards in Sport: Ethics, Integrity and Governance 22/06/2017

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The document outlines a code for sports governance with 5 key principles: structure, people, communication, standards and conduct, and policies and processes. It applies to every organization receiving public funds and has 3 tiers of requirements based on organization size. The code provides guidance on board structure, skills-based appointments, transparency, integrity, and legal/financial compliance to promote better governance.