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Quality of life
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Changing complex systems• Complex systems seek stability• People living in complex systems take comfort
from stability and fear change• Attempts to change them often result in
unanticipated consequences • Those trying for change get the blame whatever
the outcome• We tend, therefore to tinker round the edges
rather than trying for transformational change
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Complex adaptive systems
• Not machines so no traditional forms of control• Leadership is distributed. The boss can’t control
everything• Small changes in one area might have large
impacts elsewhere and vice versa• Outcomes are unpredictable so continual
monitoring and learning and chage is part of the process of change
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Changing complex systems
• Challenge the stability of existing behaviours and structure
• Set simple, order generating rules• Expect new insights and ideas to emerge• Have an open, learning attitude, using plan,
do, study act cycles• Keep calm and carry on!
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Albert Einstein
• Insanity “is doing the same thing over and over again and expecting different results”
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Improvement science
• W Edwards Deming (1900-1993)– “In God we trust, all others must bring data”– “By what method? Only the method counts.”
• Don Berwick– “Some is not a number. Soon is not a time.”
• Scottish Patient Safety Programme– “By how much and by what method?”
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Hospital SMR – 9.3% reduction
0.5
1.0
1.5
Oct-Dec2006
Jan-Mar2007
Apr-Jun
2007
Jul-Sep2007
Oct-Dec2007
Jan-Mar2008
Apr-Jun
2008
Jul-Sep2008
Oct-Dec2008
Jan-Mar2009
Apr-Jun
2009
Jul-Sep2009
Oct-Dec2009
Jan-Mar2010
Apr-Jun
2010
Jul-Sep2010
Oct-Dec2010
Jan-Mar
2011p
Apr-Jun
2011p
Jul-Sep
2011p
Sta
ndar
dise
d M
orta
lity
Rat
io
Standardised Mortality Ratio (SMR) Regression line
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0
0.5
1
1.5
2
2.5
Jan-
08
Apr-0
8
Jul-0
8
Oct-08
Jan-
09
Apr-0
9
Jul-0
9
Oct-09
Jan-
10
Apr-1
0
Jul-1
0
Oct-10
Jan-
11
Apr-1
1
Jul-1
1
Oct-11
General ward C.Difficile rate(per thousand patient days)
1.15
0.12
90% reduction
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0
0.5
1
1.5
2
2.5
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4
Jan-
08
Mar
-08
May
-08
Jul-0
8
Sep
-08
Nov
-08
Jan-
09
Mar
-09
May
-09
Jul-0
9
Sep
-09
Nov
-09
Jan-
10
Mar
-10
May
-10
Jul-1
0
Sep
-10
Nov
-10
Jan-
11
Mar
-11
May
-11
Jul-1
1
Sep
-11
Nov
-11
Central line infection rate (per thousand line days)
2.8
0.84
70% reduction
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Life expectancy trendsLife expectancy: Scotland & other Western European Countries, 1851-2005
Source: Human Mortality Database
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
1851
-185
3
1855
-185
7
1859
-186
1
1863
-186
5
1867
-186
9
1871
-187
3
1875
-187
7
1879
-188
1
1883
-188
5
1887
-188
9
1891
-189
3
1895
-189
7
1899
-190
1
1903
-190
5
1907
-190
9
1911
-191
3
1915
-191
7
1919
-192
1
1923
-192
5
1927
-192
9
1931
-193
3
1935
-193
7
1939
-194
1
1943
-194
5
1947
-194
9
1951
-195
3
1955
-195
7
1959
-196
1
1963
-196
5
1967
-196
9
1971
-197
3
1975
-197
7
1979
-198
1
1983
-198
5
1987
-198
9
1991
-199
3
1995
-199
7
1999
-200
1
2003
-200
5
Portugal
Scotland
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Life expectancy trends
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
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Walsh, D. et al. Eur J Public Health 2010 20:58-64; doi:10.1093/eurpub/ckp063
Male life expectancy at birth West Central Scotland and 10 post-industrial regions
Post industrial regions of Europe
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Male mortality 15-75Scotland and 15 other European countries
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Female mortality 15-75Scotland and 15 European countries
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Attention to detail
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Suggestions for collaborative working
• Early years and children• Young persons offending• Physical activity across the population• Planning and design of communities• Entrepreneurship
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Adverse childhood events risk of alcoholismAdverse childhood events risk of alcoholism
Hillis et al 2011
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Adverse childhood eventsAdverse childhood eventsrisk of perpetrating violencerisk of perpetrating violenceBoys experiencing physical abuseBoys experiencing physical abuse
Duke et al 2010
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Risk of heart disease and early adversityRisk of heart disease and early adversity
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Social connectedness
• 148 studies comprising 308,849 participants, high levels of social integration conferred a 50% increased likelihood of survival.
• Complex patterns of social integration conferred a 90% increase in survival.
• Simple connections such as living with others versus living alone conferred a survival benefit of 19%.
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SGLAsNHS3rd
Sector
Enhancing social connectedness
1. Light the fire
2. Build communitie
s
Help to connect peopleCoproduction
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Risk Factors- mortality Blair et al BJSM 2009
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Risk reduction associated with physical activity
Chronic condition Risk reductionAll cause mortality 30% risk reductionCVD, stroke 20-35% reductionDiabetes 30-40% reductionHip fractures 36-68% reductionColon cancer 30% reductionBreast cancer 20% reductionLoss of function 30% reductionDepression/dementia 20-30% reduction