engaging and supporting teams working on safety improvement … · 2015-05-27 · programme...

WELCOME TO THIS SIGN UP TO SAFETY WEBINAR

Engaging and supporting teams working on safety improvement in

mental health

All participants lines are muted to reduce background noise

web qi.elft.nhs.uk email qi@elft.nhs.uk @ELFT_QI Conflicts of interest: None

Mental health services Newham, Tower Hamlets, City & Hackney

Forensic services All above & Waltham Forest, Redbridge, Barking & Dagenham, Havering

Child & Adolescent services, including tier 4 inpatient service Regional Mother & Baby unit

Community health services Newham

Urgent care centre

Newham

IAPT Newham, Richmond and Luton

Speech & Language

Barnet

Challenges and

opportunities in East London

Cultural diversity

Social deprivation

Geographical diversity

Commissioning arrangements

Financial stability and

strong assurance systems

The strategic case for change

Make quality our absolute priority

• Improving quality of care is our core purpose

• Of greatest importance to all our stakeholders

• Build on the excellent work already happening to improve quality

National drivers

• The need to focus on a more compassionate, caring service with patients first and foremost

• More structured and bottom-up approach to improvement

Enable our staff to lead change

• The desire to engage, free and support our staff to innovate and drive change

• Engaged and motivated staff leads to improved patient outcomes

The economic climate

• The need to do more with less – improving quality whilst reducing cost

The culture we want to nurture

A listening and learning organisation

Empowering staff to drive improvement

Increasing transparency and openness

Re-balancing quality control, assurance and

improvement

Patients, carers and families at the heart of all

we do

Assurance & performance management

Research & innovation

Continuous improvement

Our quality

improvement programme

How?

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

Build improvement

capability

Alignment

QI Projects

1. Launch event & roadshows 2. Microsite 3. Using the power of narrative 4. Celebrate successes 5. Network of champions / ambassadors 6. Learning events

1. Initial assessment of alignment & capability 2. Recruiting central QI team 3. Online training 4. Face-to-face training 5. Follow-up coaching on projects 6. Develop in-house training for 2016 onwards

1. Align all projects with improvement aims 2. Align team / service goals with improvement aims 3. Align all corporate and support systems 4. Patient and carer involvement in all improvement

work 5. Embed improvement within management structures

Reducing Harm by 30% every year 1. Reduce harm from inpatient violence 2. Reduce harm from falls 3. Reduce harm from pressure ulcers 4. Reduce harm from medication errors 5. Reduce harm from restraints

Right care, right place, right time 1. Improving patient and carer experience 2. Reliable delivery of evidence-based care 3. Reducing delays and inefficiencies in the system 4. Improving access to care at the right location

STARTING TO BUILD THE WILL

• The events led the trust to question

whether it had the right processes in place to deliver quality care

• Robust assurance • Staff and patient experience feedback not

very good • Arrival of MD from NPSA who made a

case for more co-ordinated and systemic trust wide approach.

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

QI microsite the online hub for the programme qi.elft.nhs.uk

Staff and service user newsletter reaches 5000 people every month

QI launch event and roadshows attended by over 1000 staff, service users and carers

Bespoke QI learning events for staff, service users, commissioners, governors

@ELFT_QI

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

50,000

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

50,000 page views of the QI microsite in the last year

our one-stop shop for QI

built and managed by the QI team, total cost £300

qi.elft.nhs.uk

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

1,000

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

1,000 Staff, service users, carers, Governors,

commissioners engaged in the first 4 months of the programme

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

Bespoke learning sessions

Specialist services

leadership

Service users and carers

Finance team

Health visitors Nursing students

Band 3 nursing staff

Psychology trainees

Trainee doctors

External partners

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

5,000

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

5,000 staff receiving the monthly QI e-newsletter

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

Percentage of staff opening the e-newsletter

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

550

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

550 local services receiving the quarterly paper

newsletter, including GP practices and voluntary sector organisations

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will 9

projects shortlisted for regional or

national awards

1 regional award

7 projects being written up for

publication with BMJ

6 teams presenting

their work to the Trust board each year

1. How would you rate the will to apply continuous quality improvement in your team / organisation?

2. What are the barriers stopping you from undertaking this work?

Building the Will

AIM: To provide the highest

quality mental

health and community

care in England by

2020 Build improvement

capability

Face to face improvement training - hundreds of staff, services users, Governors to be trained over the next few years

Support for improvement work from

the Trust’s QI team

IHI Open School available to all

Strategic partnership with IHI

Board sessions

@ELFT_QI

Experts

Front line staff

Clinical leaders

Directorate improvement

leads

Board

Estimated number = 3300 Requirement = introduction to quality improvement, identifying problems, change ideas, testing and measuring

change Time-frame = train 10-20% in 2 years

Estimated number = 250 Requirement = deeper understanding

of improvement methodology, measurement and using data, leading

teams in QI Time-frame = train 30-50% in 2 years

Estimated number = 30 Requirement = deeper understanding

of improvement methodology, understanding variation, coaching

teams and individuals Time-frame = train 100% in 2 years

Estimated number = 10 Requirement = setting direction and

big goals, executive leadership, oversight of improvement, being a

champion, understanding variation to lead

Time-frame = train 100% in 2 years

Estimated number = 5 Requirement = deep statistical process control, deep improvement methods, effective plans for implementation &

spread Time-frame = train 100% in 2 years

Where are we?

On track to train over 500 people through 5 six-month waves of learning between

2014-16. First 3 waves delivered with the IHI

On track. All senior staff being encouraged to join QI

training over next 2 years

New need recognised. Developing improvement

coaches programme will train 30 QI coaches in 2015

On track. Most Executives will have undertaken the

ISIA, and Board training has been delivered in 2015.

Currently have 3 improvement advisors, with

1.5wte deployed to QI. Will need to build more

capacity at this level.

AIM: To provide the highest

quality mental

health and community

care in England by

2020

1,100 Build

improvement capability

AIM: To provide the highest

quality mental

health and community

care in England by

2020

1,100 Open School lessons completed

Build improvement

capability

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build improvement

capability

Recruited a central QI team

Board sessions

Developed 3 improvement advisors

1. What improvement capability exists in your organisation?

2. How could you shuffle existing resources to create some capacity to start improvement work?

3. How would you build a business case and convince your leadership team about the need to invest in building capability and capacity for improvement?

Building Capability

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Alignment

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Alignment

1. What would you have to change to produce alignment in your organisation?

2. How do you look at data, and talk about improvement and safety at every level?

3. What can you change, stop or review to create space for improvement? What are the structures in place to support improvement?

Alignment

Starting an

Improvement Project

At ELFT

qi.elft.nhs.uk

39

To assist in this process we

have a Project Charter form that defines

what we want to accomplish.

Assistance with your Driver Diagrams

The ELFT QI Team has created a page on their microsite which will assist you in filling out and completing your driver diagram. Please go to:

http://qi.elft.nhs.uk/driver-diagrams/

Complete Your Charter and Driver Diagram!

• Email to QI team

• qi@elft.nhs.uk

• QI team will get in contact in a few days

QI Team

QI Resources

Project Sponsor

QI Forums

QI Coach

Coaching teams from the very start

Success

Form a team

Agree the quality issue to be tackled

Ensure patient (and

carer) involvement

Find time to meet

@ELFT_QI

PreworkWorkshop

9/29-10/1

Webex 1

10/14

Webex 2

11/2

Supports:

• Listserve

• Assignments

AP-1 AP-2Webex 3

11/30AP-3

Project

PlanningReliability

Sustaining

Gains

Workshop

(3 days)

Webex #2

Webex #1

• Faculty consults • Webex calls • Coaching calls

Webex #3

Learning Set 2 &

graduation

AP-5 AP-4

The two learning sets will be focused on sharing the participants’ work on their projects and learning from each other. These sessions also will reinforce the

content from the Webex calls and the ISIA workshop.

Learning set 1

@ELFT_QI Learning and coaching over 6 months

AIM: To provide the highest

quality mental

health and community

care in England by

2020

QI Projects

QI Projects – 110+ active projects across Trust Directorates, teams are working on improvement projects that support our ambition to Reducing Harm by 30% every year and deliver Right care, right place, right time

Improving Physical Health Monitoring Following Rapid

Tranquillisation

Reducing violence on inpatient wards

Improving the handover process for on-call doctors

Collaborative learning systems

• Bring together large number of wards/clinics/hospitals to seek improvement in particular area

• Short term learning system (6-18 months)

Collaboratives

• They link experts in the topic with the parties interested in improving

• They provide structure

Right Care, Right Place, Right Time

MHCOP Larch Lodge, Cedar Lodge, Sally Sherman Ward

CHN EPCS Teams (North East, North

West, Central, South) Multiple I/P Wards

Forensics Clerkenwell

REDUCE HARM BY 30% EVERY

YEAR

RIGHT CARE, RIGHT PLACE, RIGHT TIME

VIOLENCE REDUCTION

PHYSICAL HEALTH

ACCESS TO SERVICES

PRESSURE ULCERS

TH Collaborative Roman, Globe, Bricklane, Lea, Millharbour, Rosebank

Forensics Woodberry, Victoria, Limehouse, Morrison

2015 Priority Activity

Children’s Newham CFCS, Community

CAMHS TH, OT, Health Visiting

CHN / MHCOP Newham Memory Service

Podiatry

C&H South CMHT, AOS & CRRT, North

Team 1 Recovery/Primary Care

Psychological Older People Richmond /

Newham, City and Hackney, Newham

City & Hackney Adult Psychiatry CMHT, All CMHT’s, Assertive Outreach, Rehab, Joshua, Conolly

Newham CMHT’s, Newham Centre for Mental Health

CHN / MHCOP Urgent Care Centre

Children’s All Community CAMHS, Adolescent MHT

Forensics Woodberry, Victoria, Limehouse, Morrison

Psychological / LD Community Learning Disability Service

Smoking Forensics, Millharbour

Concept B

Concept C

Concept A

Concept D

Collaborative learning by testing multiple change ideas for a single aim

AIM: To reduce inpatient physical violence at Tower Hamlets Centre for Mental Health by 30% by Dec 2015

Testing 6 change concepts in parallel means we can learn 6 x faster

OU

TCO

ME

MEA

SUR

ES

Tower Hamlets Violence Collaborative Bi-weekly report – 20 May 2015

Trust-wide data

Tower Hamlets data

Combined wards data

Individual ward data

Key

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Incidents resulting in staff injury (PICU's only) - T Chart

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Incidents resulting in Physical Violence - C Chart

UCL

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Incidents resulting in staff injury - C Chart

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Incidents of Physical Violence (Acute wards only) - C Chart

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Incidents of Physical Violence (PICU's only) - C Chart

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Incidents resulting in staff injury (Acute wards only) - T Chart

Bu

ildin

g w

ill

Build a broad coalition for

change

Take time to bring people

with you

Shift decision-making to the

edge

Develop a compelling narrative

Find some clear signals

of change

Use the power of stories

Take every opportunity to

celebrate

Bu

ildin

g ca

pab

ility

&

cap

acit

y

Be prepared to invest

Train all levels and across disciplines

Realign existing

resources

Stop lower value work

Alig

nm

ent

& in

tegr

atio

n

Start at the top Create a support

structure

Build a learning system

Ensure patients and carers are

integral

Ensure the context is ripe

Line of sight from team to system goals

Organisational culture is created by what leaders pay attention to…

web qi.elft.nhs.uk email qi@elft.nhs.uk @ELFT_QI