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Quality and Safety in Palliative Care
- the view from NHS QIS
Quality and Safety in Palliative Care
- the view from NHS QIS
Dr Frances ElliotChief Executive
3 December 2009
www.nhshealthquality.org
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Better Health, Better Care (2007)
Better Cancer Care (2008)
Living and Dying Well (2008)
Scottish Government Quality Strategy (2009)
Strategic context Strategic context
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Special Health Board established by the Scottish Parliament in 2003
independent in our advice, assessments and recommendations
NHS QIS NHS QIS
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Our vision and purposeOur vision and purpose
To deliver internationally recognised excellence in quality improvement
To deliver internationally recognised excellence in quality improvement
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What we do
We : provide advice and guidance on effective clinical
practice, including setting standards drive and support implementation of improvements in
quality assess the performance of the NHS, reporting and
publishing the findings
Increasingly we do this as an integrated approach
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NHS QIS
Key Activity
Advice, guidance and
standards
Implementation and
improvement support
Assessment, measurement and reporting
Local improvement
cycles
Assurance
Accountability
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ImplementationImplementation
Scottish Patient Safety Programme
New Directorate of Improvement and Implementation Support
Networks
Clinical
Practice development
Clinical governance support
Scottish Patient Safety Programme
New Directorate of Improvement and Implementation Support
Networks
Clinical
Practice development
Clinical governance support
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Changing RoleChanging Role
Healthcare Improvement Scotland
- a new body responsible for scrutinising health services, including independent healthcare
- retains and emphasises current functions of NHS QIS in relation to quality improvement
Healthcare Improvement Scotland
- a new body responsible for scrutinising health services, including independent healthcare
- retains and emphasises current functions of NHS QIS in relation to quality improvement
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The futureThe future
Integrated improvement programmes
Based on a robust analysis of the evidence base
Will include a package of advice and guidance for the service
Integrated improvement programmes
Based on a robust analysis of the evidence base
Will include a package of advice and guidance for the service
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The futureThe future
“Care bundle” approach with appropriate improvement tools for the service to enable implementation
Support from QIS and partners to make it happen
Key quality indicators to enable local self-assessment and reporting on progress, with proportionate external quality assurance
“Care bundle” approach with appropriate improvement tools for the service to enable implementation
Support from QIS and partners to make it happen
Key quality indicators to enable local self-assessment and reporting on progress, with proportionate external quality assurance
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Quality Performance Indicator Development Process
Quality Performance Indicator Development Process
Preparatory work (QIS Knowledge Management Team)
Consultation(Regional Cancer Networks)
Finalisation (NHS QIS, QPI development core group)
Publication(NHS QIS)
Indicator Development(QPI development group)
Scoping(QPI development group, NHS QIS KMT)
QPI Development Group Launch Meeting(QPI development group)
Cancer Taskforce Ratification of QPI ’(Scottish Cancer Taskforce)6-
8 M
onth
s
Preparatory work (QIS Knowledge Management Team)
Consultation(Regional Cancer Networks)
Finalisation (NHS QIS, QPI development core group)
Publication(NHS QIS)
Indicator Development(QPI development group)
Scoping(QPI development group, NHS QIS KMT)
QPI Development Group Launch Meeting(QPI development group)
’(Scottish Cancer Taskforce)6-
8 M
onth
s
Preparatory work (QIS Knowledge Management Team)
Consultation(Regional Cancer Networks)
Finalisation (NHS QIS, QPI development core group)
Publication(NHS QIS)
Indicator Development(QPI development group)
Scoping(QPI development group, NHS QIS KMT)
QPI Development Group Launch Meeting(QPI development group)
’(Scottish Cancer Taskforce)6-
8 M
onth
s
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QPI Development Group Launch MeetingQPI Development Group Launch Meeting
Agree scope of preparatory work Define criteria for QPI development Plan for inaugural meeting
Secretariat?
Agree scope of preparatory work Define criteria for QPI development Plan for inaugural meeting
Secretariat?
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Preparatory Work (2 months)Preparatory Work (2 months)
NHS QIS Knowledge Management Team
Assess current guidance/evidence (AGREE) Suggest scope for indicator development Develop scope of indicators – background
and need
NHS QIS Knowledge Management Team
Assess current guidance/evidence (AGREE) Suggest scope for indicator development Develop scope of indicators – background
and need
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Scoping (1 – 2 months)Scoping (1 – 2 months)
NHS QIS knowledge management team and QPI development group
Briefing paper Overview of preparatory work Summarise key information Recommendations for draft QPI’s Filter recommendations using agreed
criteria/framework
NHS QIS knowledge management team and QPI development group
Briefing paper Overview of preparatory work Summarise key information Recommendations for draft QPI’s Filter recommendations using agreed
criteria/framework
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Indicator Development Group (1-2 months)Indicator Development Group (1-2 months)
Review briefing paper and consider proposed draft QPI’s
Create short list (?10) Define numerators, denominators and
exclusions for each draft QPI
Review briefing paper and consider proposed draft QPI’s
Create short list (?10) Define numerators, denominators and
exclusions for each draft QPI
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Draft Indicators RatifiedDraft Indicators Ratified
Draft QPI’s presented to LDW Steering Group for approval prior to wider consultation
Draft QPI’s presented to LDW Steering Group for approval prior to wider consultation
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Consultation (1 – 3 months)Consultation (1 – 3 months)
Consultation via local palliative care networks
Who should we consult with? For what purpose? Level of user involvement?
Consultation via local palliative care networks
Who should we consult with? For what purpose? Level of user involvement?
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Finalisation (2 months)Finalisation (2 months)
NHS QIS, QPI Development Group Collate feedback from consultation Refine QPI’s including numerators,
denominators, exclusions Final ratification by LDW Steering Group
Publication and dissemination to Boards
NHS QIS, QPI Development Group Collate feedback from consultation Refine QPI’s including numerators,
denominators, exclusions Final ratification by LDW Steering Group
Publication and dissemination to Boards
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InvolvementInvolvement
LDW Steering Group Agree proposed QPI development process
and final sign off
LDW Steering Group Agree proposed QPI development process
and final sign off
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InvolvementInvolvement
Quality Performance Indicators Development Group Short life group clinical experts Review information on topics referred from LDW
task groups Draft QPI’s Definitions
Quality Performance Indicators Development Group Short life group clinical experts Review information on topics referred from LDW
task groups Draft QPI’s Definitions
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InvolvementInvolvement
NHS QIS Review of evidence Prepare briefing paper Quality assurance, consistency checking,
advice on implementation
ISD Alignment with national datasets Ensure measurability Input to definitions
NHS QIS Review of evidence Prepare briefing paper Quality assurance, consistency checking,
advice on implementation
ISD Alignment with national datasets Ensure measurability Input to definitions
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For Consideration and DiscussionFor Consideration and Discussion
Ownership of the process Ownership of the final output How do we “badge” How do we address clinical issues with
little or no evidence Generation of the evidence base Generation of research questions
Ownership of the process Ownership of the final output How do we “badge” How do we address clinical issues with
little or no evidence Generation of the evidence base Generation of research questions