The document outlines Aqua's mission to enhance healthcare quality and safety in the northwest, established in 2010 with 70 members. It emphasizes collaboration, employee capability building, and the application of improvement methodologies to address key quality issues such as mortality, harm, and patient experience. The document also details governance principles, board development programs, and the integration of patient and staff feedback to promote a culture of continuous improvement.

1. The Boards Role in Leading for Quality and Safety - A Regional Approach
Lesley Massey, Director
14.10.2014

2. •Established in 2010
•70 Members
•2 AHSNs – GM ASHN NW AHSN Key Partnerships
-NW LA
-Haelo
-Health Foundation
-The King’s Fund

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“AQuA’s mission is to support our members and customers to
improve the quality of healthcare”
Our vision is that over the next decade we will support AQuA’s members to transform the health and quality of healthcare of people living in the North West. We will use learning from this to inspire and help all those working in healthcare… in the NHS and beyond.
We will do this by
Supporting all of our members to build their own culture and system for improvement.
Helping our members to work collaboratively to share good ideas and learn from each other.
Working with partners to align our collective efforts to support improvement.
Spreading learning from our work.
We will work outside AQuA to Spread what we are learning and to gain new knowledge ourselves. We will do this if:-
It fits with our capabilities and our priorities (we must be able to make a difference).
We can generate a financial return to invest back into our membership.
We have the capacity to do this work without compromising the service to our members.

4. Our Priorities for 2014/15
Our proposed priorities are based on:
•What the data says about where our members most need to improve.
•The big issues identified in the Francis, Keogh and Berwick reports.
•Our understanding of our strengths and capabilities relative to those of other partners
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Don’t hurt or harm me
Improving safety of care and reducing mortality
Provide me with the best care every time
Evidence of the consistency and reliability of care
Be kind to me and involve me in decisions about my care
Improving patient experience
Join things up and work as a team for me
Integration and system leadership for service transformation
Give staff the skills to improve my care
Building capability

5. The Improvement Capability and Leadership Framework
Novice to expert (Benner 1982)
Knowledge skills & attitudes (Bloom 1956)
Commit to Improve
Lead to Improve
*Quality Improvement Basics (previously QI Fundamentals)
*Introduction to Improvement Methodologies (previously AIM)
*Improvement Practitioner
*Advanced Team Training Programme
*Introduction to Lean
*Advanced Improvement Practitioner
*Board Development
*Improvement Science Fellowships
Level 1 Foundation (Novice)
Level 2
Practitioner
Level 3 Advanced Practitioner (Expert)
Leader

6. The Best Boards
1.Focus their time and attention on quality and safety and get to the heart of the real issues
2.Set ambitious aims which are translated into measurable goals
3.Use data and intelligence wisely to identify problems and to measure progress
4.Deeply engage patients and families in their work
5.Work effectively together as a Board balancing support and challenge, continuously improving, and managing tough conversations well
6.Engage everyone in the organisation in the drive to improve quality and build supportive relationships with external stakeholders – Building a quality improvement Culture
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7. The ‘Big Ticket’ Quality issues
•Mortality – HSMR, SHMI, RAMI crude
•HCAIs – MRSA, Cdiff, other
•Avoidable Harm
–Safety Thermometer
–Patient safety incidents
•Staff Experience – Survey, Absence, Appraisals
•Patient Experience
–Friends and Family Test
–Complaints
–Patient survey
•The quality impact of cost savings plans
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•How well are you doing?
•How do you know?
•What’s the plan to improve?

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The Quality Curve
Spread to move the curve to the right
Minimum standard
Support innovation amongst the leading edge performers
Support to those with the most challenges

9. The Comparison Dashboard
•How do we compare to…
–Other hospitals?
–Regulatory standards?
–Targets?
–Pay for performance thresholds?
•Hundreds of measures
–Processes
•Measures are typically
–Externally defined
–risk-adjusted
–apples to apples (rates per procedure e.g.)
–Slow
–Tinged with fear
The Strategic Dashboard
•Are we on track to achieve our aims?
–Reduce harm
–Improve outcomes
–Improve satisfaction
–Reduce costs
•A few key measures
–Outcomes, Drivers
•Measures are typically
–Internally defined
–Close to real time
–“Good enough”
Compliance
Transformation
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10. Testing the Plan 4 Questions?
•Do you know how good you are?
oQualitative and quantitative
oHow and what is reported
oHow do you know what patients think
•Do you know where your variation exists?
•Do you know where you stand relative to the best?
oLooking across the system building will to learn from the best
•Do you know your rate of improvement over time?

11. The Healthy NHS Board 2013 Principles for Good Governance The Measurement and Monitoring of Safety (April 2013) Taking safety on board: the board’s role in patient safety (October 2013)

12. Board, Governing Body and Senior Leader Development
Economy-wide led improvement, oversight and governance of quality & patient safety Provider and Commissioners
Board, governing body and senior leader development programme Consolidation & further development for providers, introduce commissioner provision
Boards on Board in partnership with NWLA
Provider organisations
29 Boards completed
2009/13
2014/15
2015/16

13. Next Phase
New programme design, pilot and test phase
Aligned to the ‘Sign Up to Safety’ Campaign
2- day advanced board programme on quality and safety for provider trusts
Masterclass on Human Factors aimed at Exec teams & senior leaders
Clinical Leaders development day. Scenario based
AQuA faculty development

14. Cont’d
•Addressing needs of the ‘safe’ domain - CQC
How Safe is your organisation’s care?
•Content covering:
Track record on safety “past harm”- (Lagging Indicators)
Lessons learnt, and improved safety standards adopted
Reliable systems, processes and practices
Assessing and monitoring safety in real time
Risk anticipation and advanced planning (Leading Indicators)
•Coming away with new or improved safety strategy
(Measurement and Monitoring of Safety Framework
Charles Vincent et al.)