elft qi conference

Quality improvement annual conference

Interact from your mobile deviceGo to slido.com and enter the code 6789

You’ll be able to see the slides we present, ask questions, take part in our polling, and tweet your thoughts using #QIConf

Welcome

Auzewell ChiteweQI Lead

“Wake and Shake”

Ged PattisonHead of Security for

Forensics

Let’s say hello to our colleagues in Bedfordshire

Marie Gabriel (Chair) and Mary Elford (Vice-Chair)

Messages from NHS Improvement &

Kaiser Permanente

Interact from your mobile device

You’ll be able to see the slides, ask questions, take part in polling, and tweet your thoughts using Slido

Introduction to the tech we’ll be using today…

Tim GillProgramme Manager

…ask questions during the

event

…vote in live polls

Use on your tablets and phones to…

…view presentations

in real time

Ways you can contribute today

www.slido.com

…tweet #qiconf

event code: 6789

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Enter the event code: 6789www.slido.comTo access visit

Phone/tablet view Web page view


Slides will change in real time but you can go back

if you miss something

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Scroll up and down the app to move between

slides, questions, tweets and votes

Change tabs to ask questions, tweet or vote

Bookmark slides you’d like to study

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event code: 6789


Practice Live Poll

A look back at our first 2 years of QI…

Dr Amar ShahAssociate Medical

Director for QI

James InnesHead of QI

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. Newsletters (paper and electronic)2. Stories from QI projects - at Trust Board, newsletters3. Annual conference4. Celebrate successes – support submissions for awards5. Share externally – social media, Open mornings, visits,

microsite, engage key influencers and stakeholders

1. Build and develop central QI team capability2. Online learning options3. Pocket QI for those interested in QI4. Improvement Science in Action waves5. Develop cohort and pipeline of QI coaches6. Bespoke learning, including Board sessions & commissioners

1. Embed local directorate structures & processes to support QI

2. Align projects with directorate and Trust-wide priorities3. Support staff to find time and space for QI work4. Support deeper service user and carer involvement5. Support team managers and leaders to champion QI6. Align research, innovation, improvement and operations

Reducing Harm by 30% every year1. Reduce harm from inpatient violence2. Reduce harm from pressure ulcers3. Other harm reduction projects (not priority areas)

Right care, right place, right time1. Improving access to services2. Improving physical health 3. Other right care projects (not priority areas)


quality mental


care in England by

2020

Build the will

QI Stories at Trust Board

QI Visibility Wall

Electronic & paper newsletters

12 projects published or submitted for

publication

qi.elft.nhs.uk

100,000

Open days

ELFT experience day

Jason Leitch

Jeremy Taylor Jocelyn Cornwall

Visits to see QI at ELFT

Influencing national policy and thinking

Video – Nigel Crisp & Jennifer Dixon

12Awards

Shortlisted

Staff experience and engagement

2010 2011 2012 2013 2014 20153.5

3.6

3.7

3.8

3.9

4

Overall Engagement Score

ELFT Score

National Median

Scor

e

2010 2011 2012 2013 2014 20153.5

3.6

3.7

3.8

3.9

4

4.1

4.2 Staff Motivation to Work

Scor

e

2010 2011 2012 2013 2014 20153.3

3.4

3.5

3.6

3.7

3.8

3.9

4

4.1 Staff job satisfaction

Scor

e

2010 2011 2012 2013 2014 201555

60

65

70

75

80

85

90 Staff able to contribute towards improvements at work

Scor

e (%

)


quality mental


care in England by

2020

Build improvement

capability

Pocket QI commenced in October 2015. Aim to reach 200 people by

Dec 2016.All staff receive intro to QI at

induction

480 people have undertaken the ISIA so far. Wave 5 = Luton/Beds

(Sept 2016 – Feb 2017)

29 QI coaches graduated in January 2016. To identify and train

second cohort in mid-late 2016

Most Executives will have undertaken the ISIA.

Annual Board session with IHI & regular Board development

discussions on QI

Currently have 4 improvement advisors, with 1.5 wte deployed to QI. To increase to 8 IA’s in 2016/17

(6 wte).

Bespoke QI learning sessions for service users and carers. Over 40

attended in 2015. Build into recovery college syllabus, along with

confidence-building, presentation skills etc.

Estimated number needed to train = 5000Needs = introduction to quality

improvement, identifying problems, change ideas, testing and measuring change

Estimated number needed to train = 1000Needs = deeper understanding of

improvement methodology, measurement and using data, leading teams in QI

Estimated number needed to train = 40Needs = deeper understanding of

improvement methodology, understanding variation, coaching teams and individuals

Needs = setting direction and big goals, executive leadership, oversight of improvement, being a champion, understanding variation to lead

Estimated number needed to train = 11Needs = deep statistical process control,

deep improvement methods, effective plans for implementation & spread

Needs = introduction to quality improvement, how to get involved in improving a service, practical skills in

confidence-building, presentation, contributing ideas, support structure for

service user involvement

Experts by experience Expe

rts b

y exp

erie

nce

All staff

Staff involved in or leading QI projects

QI coaches

Board

Internal experts (QI

team)

Experts by experience

Prework Workshop9/29-10/1

Webex 110/14

Webex 211/2

Supports:• Listserve• Assignments

AP-1 AP-2Webex 3

11/30AP-3

ProjectPlanning Reliability Sustaining

Gains

Workshop

(3 days)

Webex #2Webex #1

• Faculty consults• Webex calls• Coaching calls

Webex #3 Learning Set 2 &

graduation

AP-5AP-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.

Improvement Science in Action

- 6 month learning path

Learning set 1

75 123

176 106

Workshop 1

Overview to using QI

Workshop 3

PDSAs and testing

Workshop 4

QI Tools

All 4 workshops are between 2-3 hours in a classroom format and rotate in location throughout the

geography of the Trust.

Workshop 2Using

measurement for improvement

Pocket QI- 2 month learning path

QI Coaches

29

Intro to QI - for service users & carers

40


rts b

y exp

erie

nce

All staff


QI coaches

Board


team)

Experts by experience

So how are we doing so far?

75%Estimated number needed to train = 800

134 people trained in Pocket QI

467 people have undertaken the ISIA so

farExperts by experience Expe

rts b

y exp

erie

nce

All staff


QI coaches

Board


team)

Experts by experienceACHIEVED


Band 3 Band 4 Band 5 Band 6 Band 7 Band 8a Band 8b Band 8c Band 8d Band 9 Doctor0%

10%

20%

30%

40%

50%

60%

70%

80%

90%0.

31%

1.82

%

2.62

%

5.85

%

14.6

3%

33.5

6%

34.6

9%

51.8

5%

80.9

5%

73.6

8%

30.0

3%

1.88

%

1.82

%

1.89

%

2.00

%

0.95

%

2.71

%

2.04

%

3.70

%

0.00

%

0.00

%

1.86

%

% of staff trained across the trust (excluding Luton and Bedfordshire)

ISIA Pocket QI

% o

f sta

ff tr

aine

d

75%97%

Estimated number needed to train = 800




far

29 QI coaches graduated


rts b

y exp

erie

nce

All staff


QI coaches

Board


team)



75%97%57%






far


Currently have 4 improvement advisors


rts b

y exp

erie

nce

All staff


QI coaches

Board


team)



5 Executives have undertaken the ISIA course.

75%97%57%






far




rts b

y exp

erie

nce

All staff


QI coaches

Board


team)



Estimated number needed to train = 7 71%

5 Executives have undertaken the ISIA course.

75%97%57%






far




rts b

y exp

erie

nce

All staff


QI coaches

Board


team)




Annual Board session with IHI & regular Board

development discussions on QI

Estimated number needed to train = 15 100%

71%


quality mental


care in England by

2020

Alignment

QI ResourcesService User Input

Support around every team

Project Sponsor QI Coach

QI Forums

QI Team

Little i Regularly

consulted during lifetime of the

project

Big I Act as a full member

of the QI project team

Surveys

Focus groups

Community meetings

Service user

forum

Service user input in projects

QI ResourcesService User Input

Support around every team

Project Sponsor QI Coach

QI Forums

QI Team

See and search for other QI work in the Trust

Taking data to the next level

Data at Trust, directorate or team level


quality mental


care in England by

2020

QI Projects

155Active

Projects

Our QI Projects

155Active

Projects

REDUCE HARM BY 30% EVERY YEAR

26RIGHT CARE, RIGHT PLACE, RIGHT TIME

129

Our QI Projects

155Active

Projects

REDUCE HARM BY 30% EVERY YEAR

9

PHYSICAL HEALTH

ACCESS TO SERVICES

PRESSURE

ULCERS

VIOLENCE REDUCTION

3 19 18

26RIGHT CARE, RIGHT PLACE, RIGHT TIME

129

Our QI Projects

Our QI Projects

Sep-14

Oct-14

Nov-14

Dec-14

Jan-15Fe

b-15

Mar-15

Apr-15

May-15

Jun-15Jul-1

5

Aug-15Se

p-15Oct-

15

Nov-15

Dec-15

Jan-16Fe

b-1660

70

80

90

100

110

120

130

140

150

No. of active projects per month

No.

of n

ew p

roje

cts

Our QI Projects

16-Mar-15 30-Mar-15 13-Apr-15 27-Apr-15 19-May-15 28-May-15 15-Jun-15 07-Jul-15 13-Aug-15 02-Sep-15 07-Oct-15 03-Nov-15 01-Dec-15 12-Jan-16 02-Feb-16 08-Mar-16

14 12 11 11 15 11

60

25 22 24 2213 9 9 11 9

16 17 17 18 1515

15

3128 29

2329

28

47 46 45

31 29 25 23 2522

21

35 44 41

3631

31

28 2825

19 1920 20

2426

25 29 29 32

3134

32

30 2523

9 9 13 13

1716

15 15 1415

1414

13

14 18

17

97 10 10

1217

17 19 1918

1917

21

20 24

25

2 67 7

9 9

10 8 7 7

67

7

77

7

3 32 2

4 3

3 4 45

34

4

44

5

1 1 2 2

5 7

7 10 89

44

3

45

6

44

1112

15

1514

14

06-J

an-1

4

20-J

an-1

4

03-F

eb-1

4

17-F

eb-1

4

03-M

ar-1

4

17-M

ar-1

4

31-M

ar-1

4

14-A

pr-1

4

28-A

pr-1

4

12-M

ay-1

4

26-M

ay-1

4

09-J

un-1

4

23-J

un-1

4

07-J

ul-1

4

21-J

ul-1

4

04-A

ug-1

4

18-A

ug-1

4

01-S

ep-1

4

15-S

ep-1

4

29-S

ep-1

4

13-O

ct-1

4

27-O

ct-1

4

10-N

ov-1

4

24-N

ov-1

4

08-D

ec-1

4

22-D

ec-1

4

05-J

an-1

5

19-J

an-1

5

02-F

eb-1

5

16-F

eb-1

5

02-M

ar-1

5

16-M

ar-1

5

30-M

ar-1

5

13-A

pr-1

5

27-A

pr-1

5

11-M

ay-1

5

25-M

ay-1

5

08-J

un-1

5

22-J

un-1

5

06-J

ul-1

5

20-J

ul-1

5

03-A

ug-1

5

17-A

ug-1

5

31-A

ug-1

5

14-S

ep-1

5

28-S

ep-1

5

12-O

ct-1

5

26-O

ct-1

5

09-N

ov-1

5

23-N

ov-1

5

07-D

ec-1

5

21-D

ec-1

5

04-J

an-1

6

18-J

an-1

6

01-F

eb-1

6

25

35

45

55

65

75

85

95

67.8

51.1

UCL

LCL

Incidents resulting in physical violence (Trust-wide) - C Chart

No.

of I

ncid

ents

VIOLENCE REDUCTION

2013 2014 2015150

200

250

300

350

400

450

500

550Physical violence to patients (per 100,000

occupied bed days)

No.

of I

ncid

ents

2013 2014 2015300

400

500

600

700

800

900Physical violence to staff (per 100,000

occupied bed days)

No.

of I

ncid

ents

25% reduction

Tower Hamlets Violence Reduction Collaborative

57% reduction


57% reduction

14% reduction

Cedar Ward, MHCOP

Mar

-14

Apr-

14

May

-14

Jun-

14

Jul-1

4

Aug-

14

Sep-

14

Oct

-14

Nov-

14

Dec-

14

Jan-

15

Feb-

15

Mar

-15

Apr-1

5

May

-15

Jun-

15

Jul-1

5

Aug

-15

Sep-

15

Oct

-15

Nov-

15

Dec-

15

Jan-

16

0

2

4

6

8

10

12

14

16

5.4

2.8

UCL

LCL

Incidents resulting in physical violence (Clerkenwell ward, Forensics) - C Chart

No.

of I

ncid

ents

48% reduction


57% reduction

14% reduction

Cedar Ward, MHCOP

Clerkenwell Ward, Forensics

PRESSURE ULCERS

228 Pressure Ulcers

healed in 2015 !28

-Apr

-14

19-M

ay-1

409

-Jun

-14

30-J

un-1

421

-Jul

-14

11-A

ug-1

401

-Sep

-14

22-S

ep-1

413

-Oct

-14

03-N

ov-1

424

-Nov

-14

15-D

ec-1

405

-Jan

-15

26-J

an-1

516

-Feb

-15

16-M

ar-0

006

-Apr

-15

27-A

pr-1

518

-May

-15

08-J

un-1

529

-Jun

-15

20-J

ul-1

510

-Aug

-15

31-A

ug-1

521

-Sep

-15

12-O

ct-1

502

-Nov

-15

11-J

an-1

60%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

57.30%

73.10%

92.01%

UCL

LCL

Waterlow Completion Rate - P Chart

Com

plet

ion

Rat

e / %

07-A

pr-1

428

-Apr

-14

19-M

ay-1

409

-Jun

-14

30-J

un-1

421

-Jul-1

411

-Aug

-14

01-S

ep-1

422

-Sep

-14

13-O

ct-1

403

-Nov

-14

24-N

ov-1

415

-Dec

-14

05-J

an-1

526

-Jan

-15

16-F

eb-1

509

-Mar

-15

30-M

ar-1

520

-Apr

-15

11-M

ay-1

501

-Jun

-15

22-J

un-1

513

-Jul-1

503

-Aug

-15

24-A

ug-1

514

-Sep

-15

05-O

ct-1

526

-Oct

-15

16-N

ov-1

507

-Dec

-15

0

1

2

3

4

5

6

7

8

9

10

3.5

2.5

UCL

LCL

Grade 2 Pressure Ulcers - C Chart

No. of P

ress

ure Ulcers

61% increase

29% decrease

ACCE

SS T

O S

ERVI

CES

COLL

ABO

RATI

VE

- Baseline data

Jan-

14Feb

-14

Mar

-14

Apr

-14

May

-14

Jun-

14Ju

l-14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15Feb

-15

Mar

-15

Apr

-15

May

-15

Jun-

15Ju

l-15

Aug

-15

Sep

-15

Oct

-15

Nov

-15

Dec

-15

Jan-

16Feb

-16

19%

24%

29%

34%

39%

32.21%25.23%

UCL

LCL

Non-attendance at first face to face appt - P Chart

DNA /

%

Jan-

14F

eb-1

4M

ar-1

4A

pr-1

4M

ay-1

4Ju

n-14

Jul-1

4A

ug-1

4S

ep-1

4O

ct-1

4N

ov-1

4D

ec-1

4Ja

n-15

Feb

-15

Mar

-15

Apr

-15

May

-15

Jun-

15Ju

l-15

Aug

-15

Sep

-15

Oct

-15

Nov

-15

Dec

-15

Jan-

16F

eb-1

6

700

800

900

1000

1100

1200

1300

1400

1500

1600

1700

1021.71213.1

UCL

LCL

No. of referrals received - I Chart

No.

of R

efer

rals

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun-

14

Jul-1

4

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb

-15

Mar

-15

Apr

-15

May

-15

Jun-

15

Jul-1

5

Aug

-15

Sep

-15

Oct

-15

Nov

-15

Dec

-15

Jan-

16

Feb

-16

40

45

50

55

60

65

70

60.7

51.0

UCL

LCL

Average waiting time from referral to 1st face to face appt - X-bar Chart

Ave

rage

Wai

ting

Tim

e / D

ays

ACCESS TO SERVICES

16% reduction

19% increase22% decrease

67

MSK Therapy Team, CHN

41% reduction

Newham Borough-wide, Psychological Services

80% reduction

68

MSK Therapy Team, CHN

41% reduction

Newham CFCS, Children’s

19% reduction

Newham Borough-wide, Psychological Services

80% reduction

PHYSICAL HEALTH

Professor Jason Leitch

National Clinical Director, Scottish Government

Senior fellow, Institute for Healthcare Improvement

Pose your questions to Jason from your mobile deviceGo to slido.com and enter the code 6789

Tweet your thoughts using #QIConf

Sustaining Large Scale Change

Professor Jason LeitchNational Clinical Director

Scottish Government

@jasonleitch

• 5 million people• £12 billion• 14 Health Boards• 8 Support Boards• Integrated delivery• Moving towards

social care integration

http://www.google.co.uk/url?sa=i&source=images&cd=&cad=rja&docid=xUPyAAiuVntolM&tbnid=cO0AnkMIJDAWSM:&ved=0CAgQjRwwAA&url=http://www.dailyrecord.co.uk/all-about/nhs%20scotland&ei=u6aoUe_jMqi0igKkoYCwBA&psig=AFQjCNE6IXhvKM9j3SHZCcUimjSIzSVxEA&ust=1370093627870440

ftp://ftp.cs.vu.nl/pub/dick/tartan/Baird.gif

% 30 day Mortality of ICD 10 A40/A41

21 % Reduction

% 30 day Mortality of ICD 10 A40/A41

NHS Greater Glasgodw & Clyde PICUVAP Rate per 1000 Ventilation Days

Jan 2013 – Sep 2015

48 % Reduction

NHS Greater Glasgodw & Clyde PICUVAP Rate per 1000 Ventilation Days

Jan 2013 – Sep 2015

Median: 5.3

Scottish Stillbirth Rate (per 1000 births)2000 - 2014

Median: 5.3

15 % Reduction

Scottish Stillbirth Rate (per 1000 births)2000 - 2014

General Medical Services

Pharmacy

Community Nursing Dentistry

Policy & Politics

Learning System

Communications

Policy & Politics

Aims:To deliver the highest quality healthcare services to the people of Scotland

For NHSScotland to be recognised as world-leading in the quality of healthcare it provides

Learning System

Learning System

System level measures

Explicit theory or rationale for

system changes

Segmentation of the

population

Learn by testing

changes sequentially“Act for the

individual learn for the population”

Learning during scale-up and spread & plan to go to

scale

Periodic review

People to manage &

oversee the learning system

Source: Tom Nolan

Improvement Science Leadership for Improvement

IntroductoryKnowledge

AdvancedKnowledge

AdvancedKnowledge

Improvement Capacity Building:Scotland’s Approach


IHI Improvement Advisor Waves


AdvancedKnowledge

AdvancedKnowledge


Scottish Improvement Leader (ScIL)



Quality Improvement Fellowship


AdvancedKnowledge

AdvancedKnowledge







AdvancedKnowledge

AdvancedKnowledge



Impr Science in Action





AdvancedKnowledge

AdvancedKnowledge




Boards on Board





AdvancedKnowledge

AdvancedKnowledge




Boards on Board

Improvement Collaboratives

Communications

Policy & Politics

Learning System

Communications

@jasonleitch

Legends A Suite Legends B Suite

Break-out sessions

Session A Session B

World café session where you will hear

from 3 project teams

Physical health & panel discussion

At 11am there will be time for a 15 minute coffee break before we swap round

Take a look at your lanyard…

Rooms

World Café Physical health and Panel discussion

Take a look at your lanyard…Table cloth colour and table number

Two different breakout sessions:

Breakout session 1 -09:55-11:00Tea break 11:00-11:20

Breakout session 2 -11:20-12:25

Break-out sessions

Time per session: 65 minutes per session

Legends A Suite Legends B Suite

Break-out sessions

Session A Session B

Move into Legends A – table colour and number

on lanyard

Come into the central section as we’ll have a more informal

panel discussion

After tea break - swap round into other room

Time for the breakout Sessions

Breakout Session B

Physical Health and Panel Discussion

1. Physical health as a priority area

2. Service user experience of QI

3. Physical activity session

4. Panel discussion

Structure of the session

Emma Binley Darzi Fellow in QI

Our QI work on physical health

with Dr Kevin Cleary (Medical Director)

Why did ELFT make physical health a priority area?

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiHo7qQpbbLAhUHHxoKHQQDBC0QjRwIBQ&url=http://www.rcpsych.ac.uk/pdf/FINAL%20report%20for%20the%20second%20round%20of%20the%20National%20Audit%20of%20Schizophrenia%20-%208.10.14v2.pdf&psig=AFQjCNFySQ3NfTmoHpKxBQQFhGA0WbzA9g&ust=1457705169211897



http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiSja3YpbbLAhUBPg8KHRPCAu0QjRwIBw&url=http://navigator.health.org.uk/content/national-institute-health-and-care-excellence-nice-national-institute-health-and-clinical&bvm=bv.116573086,d.d2s&psig=AFQjCNFLRmS3KP1XrPwHaOtYSl2RciclHQ&ust=1457705329457532

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjTwMmfp7bLAhUHvBQKHU-qCmoQjRwIBw&url=http://clahrc-yh.nihr.ac.uk/our-themes/mental-health-co-morbidities&bvm=bv.116573086,d.d2s&psig=AFQjCNFrHt-hQ1K5X7ECHBBQVsBE2AdnOg&ust=1457705717915561

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiWoL_Zp7bLAhVL6RQKHXbsDqMQjRwIBQ&url=http://www.rcpsych.ac.uk/pdf/Executive%20summary%20FINAL-%20NAS%20National%20report.pdf&v6u=https://s-v6exp1-ds.metric.gstatic.com/gen_204?ip=212.250.30.1&ts=1457619468957408&auth=zdshu3dsqghr2nqbm66lu7cdgsmcjc2x&rndm=0.7320530965201706&v6s=2&v6t=13333&psig=AFQjCNGHzACNeKRsQBB_2_XlS963kELHyw&ust=1457705868897482

AIM:

Reduce cardiovascular

risk for all adults and children for

whom we initiate or change

psychotropic medication

Information provision

Minimum standards & checks

Pods for community settings

Assessment

Health promotion (exercise, diet, education)

Smoking cessation

Involvement in all QI areas

Monitoring

Communication between services

Improving physical health

collaborative;Driver Diagram

Overview

Leadership

Prescribing

3. Measuring and Reporting• Template development: define

scope, data, spec• Reports & dashboards

1. Equipment

2. Assessment & monitoring

3. Intervention

4. Service user & staff

engagement

Infrastructure

AIM:







Assessment

Monitoring



Overview



1. Equipment


AOS

SCMHT

NCMHT

EQUIP

AIM:




psychotropic medication Health promotion (exercise, diet,

education)

Smoking cessation




Overview

Prescribing

3. Intervention

Our QI work on Health Promotion

Physical activity

Behavioural interventions, e.g. motivational interviewing

Informal and formal support; professional and family/peer

Diet and nutrition

Education and information

Communication /pathway between

services

Smoking cessationIn

terv

entio

n Prescribing

Health promotion

Steve Yarnold(Matron & QI Coach)

Sapphire ward

What’s next…

Health Promotion QI projects

Wolfson House

John Howard Centre

Newham centre for

Mental Health

AIM:









Overview

Leadership


engagement

Infrastructure

Service user’s perspective of QI

What do you think of Bridge Club?


“Thank you for sponsoring the

bridge club”

“I think it’s really good, for health-wise; fitness and stuff like that”” “It’s a good

look, yeah!”

“It’s good to be with my

friends”

James Cook (MBE)

British & European Super-Middleweight

Champion

Boxercise

Boxercise with James Cook

Butabika Link

Moses Wasswa Mulimira(Co-Founder of Uganda Diaspora Health

Foundation)

Olivia Carmichael Butabika Link Coordinator

Be Inspired, Be activeEnhancing physical activity, recovery and reducing mental health stigma through

football at butabika Hospital, kick started the visit

Opening the training workshops

Cohort one

Cohort Two

Ward visits

Key stakeholder engagement

To Summarise…

Jen Taylor-WattQI Lead

Panel discussion

Pose your own questions from your mobile device

Go to slido.com and enter the code 6789


Let’s Introduce Our Panel

Dr Navina Evans

Dr David Bridle

Dr Paul Gilluley

Prof Jonathan Warren

Paul Binfield

Picture to be added

Time for a break

Breakout Session B

Physical Health and Panel Discussion

1. Physical health as a priority area

2. Service user experience of QI

3. Physical activity session

4. Panel discussion

Structure of the session


Our QI work on physical health

with Dr Kevin Cleary (Medical Director)

Why did ELFT make physical health a priority area?




http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiSja3YpbbLAhUBPg8KHRPCAu0QjRwIBw&url=http://navigator.health.org.uk/content/national-institute-health-and-care-excellence-nice-national-institute-health-and-clinical&bvm=bv.116573086,d.d2s&psig=AFQjCNFLRmS3KP1XrPwHaOtYSl2RciclHQ&ust=1457705329457532

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjTwMmfp7bLAhUHvBQKHU-qCmoQjRwIBw&url=http://clahrc-yh.nihr.ac.uk/our-themes/mental-health-co-morbidities&bvm=bv.116573086,d.d2s&psig=AFQjCNFrHt-hQ1K5X7ECHBBQVsBE2AdnOg&ust=1457705717915561

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiWoL_Zp7bLAhVL6RQKHXbsDqMQjRwIBQ&url=http://www.rcpsych.ac.uk/pdf/Executive%20summary%20FINAL-%20NAS%20National%20report.pdf&v6u=https://s-v6exp1-ds.metric.gstatic.com/gen_204?ip=212.250.30.1&ts=1457619468957408&auth=zdshu3dsqghr2nqbm66lu7cdgsmcjc2x&rndm=0.7320530965201706&v6s=2&v6t=13333&psig=AFQjCNGHzACNeKRsQBB_2_XlS963kELHyw&ust=1457705868897482

AIM:








Assessment

Health promotion (exercise, diet, education)

Smoking cessation


Monitoring




Overview

Leadership

Prescribing



1. Equipment


3. Intervention


engagement

Infrastructure

AIM:







Assessment

Monitoring



Overview



1. Equipment


AOS

SCMHT

NCMHT

EQUIP

AIM:




psychotropic medication Health promotion (exercise, diet,

education)

Smoking cessation




Overview

Prescribing

3. Intervention

Our QI work on Health Promotion

Physical activity

Behavioural interventions, e.g. motivational interviewing

Informal and formal support; professional and family/peer

Diet and nutrition

Education and information

Communication /pathway between

services

Smoking cessationIn

terv

entio

n Prescribing

Health promotion

Steve Yarnold(Matron & QI Coach)

Sapphire ward

What’s next…

Health Promotion QI projects

Wolfson House

John Howard Centre

Newham centre for

Mental Health

AIM:









Overview

Leadership


engagement

Infrastructure

What do you think of Bridge Club?


“Thank you for sponsoring the

bridge club”

“I think it’s really good, for health-wise; fitness and stuff like that”” “It’s a good

look, yeah!”

“It’s good to be with my

friends”

James Cook (MBE)

British & European Super-Middleweight

Champion

Boxercise

Boxercise with James Cook

Butabika Link

Moses Wasswa Mulimira(Co-Founder of Uganda Diaspora Health

Foundation)

Olivia Carmichael Butabika Link Coordinator

Be Inspired, Be activeEnhancing physical activity, recovery and reducing mental health stigma through

football at butabika Hospital, kick started the visit

Opening the training workshops

Cohort one

Cohort Two

Ward visits

Key stakeholder engagement

To Summarise…

Jen Taylor-WattQI Lead

Panel discussion

Pose your own questions from your mobile device

Go to slido.com and enter the code 6789

Tweet your thoughts using #QIconf

Let’s Introduce Our Panel

Dr Navina Evans

Dr David Bridle

Dr Paul Gilluley

Prof Jonathan Warren

Paul Binfield

Picture to be added

Legends A joins Legends B

Poster Competition

And the winner is…

Let’s hear from…

Dr Robert Dolan (Chief Executive)

Dr Kevin Cleary (Medical Director)

Let’s hear from the IHI…

Derek Feeley, Chief Executive

Dr Robert Lloyd, Vice President

Andy Cruickshank(Associate Clinical

Director, Borough Lead Nurse & Head of Nursing

for QI)

Professor Michael West

Professor of Work and Organisational psychology, Lancaster University Management

School

Head of Thought Leadership, The King’s Fund

Pose your own questions from your mobile deviceGo to slido.com and enter the code 6789


Leadership for Continually Improving and Compassionate Care

Michael WestThe King’s Fund,

Lancaster University Management School

178

Leading cultures for high quality care

1. Prioritising an inspirational vision and narrative – focused on quality

2. Clear aligned goals and objectives at every level

3. Good people management and employee engagement

4. Continuous learning and quality improvement

5. Team-working, cooperation and integration

6. Via a values-based, collective leadership strategy

1. Vision, values and strategyVision sets out clear ambition for the future, to guide and inspire the whole organisation1. It is forward looking2. Makes clear commitments3. Is inspiring to and welcomed by stakeholders

‘To deliver continuously improving, high quality and compassionate care to all in our community’‘To be the safest hospital in England’

2. Clear aligned goals at every level• Clear objectives linked to quality improvement• Aligned, measureable and challenging … at every level and feedback on performance

BMJ Quality and Safety, Sept 2013

http://www.lums.lancs.ac.uk/nhs-quality

http://www.lums.lancs.ac.uk/nhs-quality/

http://www.lums.lancs.ac.uk/nhs-quality/

3. People management and engagement for high quality care

• Patient/service user satisfaction highest where staff have clear goals

• Staff views of leaders linked to patients views of care quality

• Staff satisfaction/commitment predicts patient/service user satisfaction

• High work pressure - patients/service users report too few staff, insufficient support, privacy, respect.• Poor staff health and well-being, high injury rates, audit ratings• Good HRM practices - low patient mortality http://www.dh.gov.uk/health/2011/08/nhs-staff-management/

http://www.dh.gov.uk/health/2011/08/nhs-staff-management/

3. Employee engagement success factors www.kingsfund.org.uk/publications/staff-engagement

A compelling strategic narrative

Inclusive leadership and management styles

Putting staff in charge of service change

• Successful Trusts develop a clear narrative on their purpose and aims

• Salford aimed to be the safest hospital in England

• The happiness of all our staff, through their worthwhile, satisfying employment in a successful business

Values and Integrity

• Successful Trusts have invested in retraining staff to adopt inclusive management styles

• For example, Oxleas has introduced a substantial programme to retrain middle managers in facilitative leadership

• Notts Healthcare NHS FT develops leadership aligned around strategy and values

• Successful Trusts give staff responsibility for leading service change

• Wrightington, Wigan and Leigh works with Unipart to support staff-led change

• Salford’s quality directorate supports teams of frontline staff in testing improvements

• Staff survey evidence highlights importance of values and trust in senior leadership

• Perceptions of unfairness are our best predictor of intention to leave

• In particular, fairness of procedures, bullying and discrimination.

Stable senior leadership

Many of the Trusts with highest levels of engagement have had the same senior leaders for over a decade: CEO of Oxleas in post since 2002, CEO of Salford in post since 2002, CEO of Frimley Park in post since 1998, in comparison

with an average CEO tenure of less than two years.

http://www.kingsfund.org.uk/publications/staff-engagement

Positive emotion and culture

• Leader positive affect, climate and performance• Processing negative emotion – ‘affective shift’• Dealing with intimidating or disruptive behavior

and poor performance

4. Learning and innovation

A promise to learn – A commitment to act• Staff focused on continually improving patient care and on

ensuring zero harm• Reflective practice and learning endemic• Team learning and cross boundary cooperation, trust, and

openness • High levels of dialogue and discussion end to end and top to

bottom• Effective schemes to promote responsible, safe innovation –

lean, QI

Chassin & Loeb (2013). High reliability health care. Millbank Quarterly, 91, 459-490.

5. Team working, cooperation and integration

Team Leadership

• Offer an inspiring vision and clear direction• Ensure regular and positive team meetings• Encourage positive, supportive relationships• Resolve and prevent intense conflicts• Positive group attitudes towards diversity • Be attentive and listen carefully to the team• Lead inter-team cooperation• Nurture team learning, improvement & innovation

Teams are more effective and innovative to the extent that they routinely take time out to reflect upon their objectives, strategies, processes and environments and make changes accordingly.

Reflexivity

Schippers, West & Dawson, 2012 Journal of Management

6. Collective Leadership

• Leadership the responsibility of all - anyone with expertise taking responsibility when appropriate

• Shared leadership in teams• Interdependent, collaborative leadership - working together to

ensure high quality health and social care• Leaders and teams prioritising quality of care across the

system/organisation • Shared approach to leadership within the leadership community

http://www.kingsfund.org.uk/publications/developing-collective-leadership-health-care West, M. A., Lyubovnikova, J., Eckert, R., & Denis, J.L. , (2014),Collective leadership for cultures of high quality health care. Journal of Organizational Effectiveness: People and Performance, 1, 240 – 260. http://dx.doi.org/10.1108/JOEPP-07-2014-0039

http://www.kingsfund.org.uk/publications/developing-collective-leadership-health-care

http://dx.doi.org/10.1108/JOEPP-07-2014-0039

Leadership Typologies

West, Armit, Loewenthal, Eckert, West, & Lee (2015) Leadership and Leadership Development in Health Care: The Evidence Base. London: Faculty of Medical Management and Leadership/The King’s Fund.

How will the organisation ensure the creation of leadership capabilities?

The challenges

health care is facing require

new strategies

New strategies imply new leadership capabilities

These are both

individual and collective leadership capabilities

This requires new and

collective leadership

cultures

Must Deliver These

© Center for Creative Leadership, 2014. Used with permission.

A Leadership Strategy

e.mail [email protected] @westm61

What is compassionate leadership?

What’s coming up in the next year…

Dr Amar ShahAssociate Medical

Director for QI

James InnesHead of QI

Constantly evolving, constantly iterating

Embedding QI in directorates

Making QI work easier

Scale up and spread

Increasing service user, carer or

customer involvement

Linking quality and cost

Our areas of focus

Embedding QI in directorates

Work currently underway

• Developing clear improvement priorities

• Second cohort of QI coaches

• Redesigning recruitment, performance appraisal & leadership strategy

Making QI work easier

Quality and Performance Dashboard

Access Dashboard

Violence Reduction Dashboard

KPIs

Our New QI Web Platform

Project tabs – all elements of a QI project in one place

Project landing page

Driver Diagram page

Example PDSA

Statistical Process Control (SPC) page

- This is being updated for ELFT

SPC Charts – showing

• Special cause variation• Notes• Linked PDSA’s

Example charts from the Analytics area

Scale up and spread

S + P+ C = OStructure + Process + Culture = Outcomes

Source: Donabedian, A. Explorations in Quality Assessment and Monitoring. Volume I: The Definition of Quality and Approaches To Its Assessment. Ann Arbor,

MI, Health Administration Press, 1980.

Dr. Avedis Donabedian(1919-2000)

Classic approach to delivering outcomes

1. A system for identifying those projects that are starting to produce results

2. A process to help projects think about scale up or spread

3. Ensuring support of local DMT or wider management team

• Treat as new project

• Will this involve scale up or spread within a directorate or across the Trust?

• Assign relevant sponsors and support

AP D

S

AP

D S

APD

S

A P

DS

Learning from data

4. Use QI methodology to scale & spread

Violence reduction on acute wards and Psychiatric Intensive Care Units (PICUs)Orchestrated Testing

Brick Lane Ward

Mill harbour

Rosebank

Lea Ward

Globe Ward

Roman Ward

Ruth Seifert Ward

Brett Ward

Joshua Ward

Gardner Ward

Bevan PICU

Mother and Baby

Unit

Conolly Ward

Topaz Ward

Opal Ward

Emerald Ward

Sapphire Ward

Jade Ward

Ruby Triage

Crystal PICU

City and Hackney

Newham

Provisional agreement by Borough QI Sponsors and

DMT to scale-up from February 2016

First sta

ge of successfu

l scale-up

Current test-b

ed

2012 -2013

2014-2015

2016 >

Tower Hamlets

Globe Ward

Next stage: Planned

experimentation

Shoreditch(For)

Clerkenwell(For)

PICUs/Forensic learning system

Jan-

12

Feb-

12

Mar

-12

Apr

-12

May

-12

Jun-

12

Jul-1

2

Aug

-12

Sep

-12

Oct

-12

Nov-

12

Dec

-12

Jan-

13

Feb-

13

Mar

-13

Apr

-13

May

-13

Jun-

13

Jul-1

3

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb-

14

Mar

-14

Apr

-14

May

-14

Jun-

14

Jul-1

4

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Jan-

15

Feb-

15

Mar

-15

Apr-1

5

May

-15

Jun-

15

Jul-1

5

Aug

-15

Sep

-15

Oct

-15

Nov

-15

Dec

-15

Jan-

16

0

1

2

3

4

5

6

7

8

4.0

0.5

Incidents resulting in physical violence - Run Chart

No.

of

Inci

dent

s

PDSA 1 BVC PDSA 2 BVC + Safety Huddles

87% reduction4 per month

0.5 per month


Brick Lane Ward

Mill harbour

Rosebank

Lea Ward

Globe Ward

Roman Ward

Ruth Seifert Ward

Brett Ward

Joshua Ward

Gardner Ward

Bevan PICU

Mother and Baby

Unit

Conolly Ward

Topaz Ward

Opal Ward

Emerald Ward

Sapphire Ward

Jade Ward

Ruby Triage

Crystal PICU

City and Hackney

Newham



First sta

ge of successfu

l scale-up

Current test-b

ed

2012 -2013

2014-2015

2016 >

Tower Hamlets

Globe Ward

Next stage: Planned

experimentation

Shoreditch(For)

Clerkenwell(For)


0

2

4

6

8

10

12

14

16

5.8

2.5

UCL

LCL

Incidents resulting in physical violence per 1000 occupied bed days (OBD) - U Chart

No.

of I

ncid

ents

per

100

0 O

BD

5.8 per month

2.5 per month

57% reduction


Brick Lane Ward

Mill harbour

Rosebank

Lea Ward

Globe Ward

Roman Ward

Ruth Seifert Ward

Brett Ward

Joshua Ward

Gardner Ward

Bevan PICU

Mother and Baby

Unit

Conolly Ward

Topaz Ward

Opal Ward

Emerald Ward

Sapphire Ward

Jade Ward

Ruby Triage

Crystal PICU

City and Hackney

Newham



First sta

ge of successfu

l scale-up

Current test-b

ed

2012 -2013

2014-2015

2016 >

Tower Hamlets

Globe Ward

Next stage: Planned

experimentation

Shoreditch(For)

Clerkenwell(For)


Increasing service user, carer or

customer involvement

Service User & Carer QI Steering Group

To a

chie

ve %

serv

ice

user

/car

er in

volv

emen

t in

QI

acro

ss E

LFT

Communication (in and out)

Advertising

Access to information

Support structure

Big I

Service user/carer specific role in project team

Training

Structure/process outlining how service users/carers get involved

Payment

Service user/carer led or co-led projects

Little I

Service user/carer feedback

Partnership working between Quality team and QI Team

Overview of service user/carer

involvement

Monitoring & reporting

Regular Reviews

• Booklet outlining all information about involvement in QI

• Clear structure outlining different levels of support and outlining responsibilities

• Service user/carer involvement in QI forum

• Service user/carer lead in QI central team and each project team

• Role descriptions and contracts • Incorporate QI into recovery syllabus • Buddying up • Regular support sessions for service

users/carers similar to coaches. • Training – not focused on methodology

– more focus communication skills and role plays.

• Service user/carer bespoke group – similar to support QI coaches receive.

• Induction to team and/or trust induction.

• A trust wide survey service users/carers can complete about quality of service and/or QI project on that ward/in that team – similar to friends and family test.

Change Ideas – from strategy meeting 29/10/15

• Regular steering group/oversight meeting.

• Monitoring informatics system that reviews service user/carer involvement at all different stages of the QI project.

• Dashboards

Little i Regularly

consulted during lifetime of the

project

Big I Act as a full member

of the QI project team

Surveys

Focus groups

Community meetings

Service user

forum

Service user input in projects

• Add any questions related to QI work you are undertaking

• Up to date data can then be sent to you

Little i: use existing patient experience feedback systems

• ‘Introduction to QI’ now in Recovery College syllabus

• Other courses useful for those wanting to take part in QI highlighted

• Working with OT to create more opportunities to get service users & carers involved

Big I: Linking QI & Recovery

Linking quality and cost

Improved service user and carer

outcomes


outcomes

More efficient, productive and effective teams


outcomes


Intangible benefits


outcomes


Intangible benefitsCash releasing savings

05-A

pr-1

319

-Apr

-13

23-M

ay-1

307

-Jun

-13

16-J

un-1

310

-Jul

-13

11-J

ul-1

321

-Jul

-13

31-J

ul-1

318

-Aug

-13

09-S

ep-1

324

-Sep

-13

18-O

ct-1

324

-Oct

-13

04-N

ov-1

311

-Nov

-13

29-N

ov-1

313

-Jan

-14

11-F

eb-1

425

-Mar

-14

04-A

pr-1

422

-May

-14

06-J

un-1

426

-Jun

-14

12-J

ul-1

422

-Aug

-14

18-N

ov-1

414

-Jan

-15

30-J

an-1

517

-Feb

-15

23-A

pr-1

520

-Jun

-15

09-A

ug-1

5

0

10

20

30

40

50

60

UCLLCL

Days between incidents of physical violence - T Chart

Tim

e be

twee

n ev

ents

/ da

ys

03-N

ov-1

2

26-N

ov-1

2

10-D

ec-1

2

04-J

an-1

3

12-J

an-1

3

29-J

an-1

3

01-F

eb-1

3

28-F

eb-1

3

05-A

pr-1

3

19-A

pr-1

3

13-J

un-1

3

22-A

ug-1

3

24-S

ep-1

3

15-O

ct-1

3

22-O

ct-1

3

03-F

eb-1

4

07-M

ar-1

4

30-A

pr-1

4

28-J

un-1

4

01-N

ov-1

4

22-J

an-1

5

30-J

an-1

5

02-M

ar-1

5

31-M

ar-1

5

21-J

ul-1

5

0

20

40

60

80

100

UCLLCL

Days between staff injury due to physical violence - T Chart

Tim

e be

twee

n ev

ents

/ da

ys

3 days

8 days

8 days

23 days

Apr-13 to Dec-14 Oct-13 to Mar-14 Apr-14 to Dec-14

Number of incidents 44 34 28

Cost attributable to violence £119,988 £72,230 £61,376

Violence ReductionViolence Reduction on older adult wards

Grade 2 Grade 3 Grade 4Pay costs of managing £684 £4530 £17545Non pay costs of managing £129 £945 £8669

Pressure Ulcer Reduction in the community

Apr

-14

May

-14

Jun-

14Ju

l-14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14 .

Sat

07

Mar

15

Sat

14

Mar

15

Sat

21

Mar

15

Sat

28

Mar

15

Sat

04

Apr

15

Sat

11

Apr

15

Sat

18

Apr

15

Sat

25

Apr

15

Sat

02

May

15

Sat

09

May

15

Sat

16

May

15

Sat

23

May

15

Sat

30

May

15

Sat

06

Jun

15S

at 1

3 Ju

n 15

Sat

20

Jun

15S

at 2

7 Ju

n 15

Sat

04

Jul 1

5S

at 1

1 Ju

l 15

Sat

18

Jul 1

5S

at 2

5 Ju

l 15

Sat

01

Aug

15

Sat

08

Aug

15

Sat

15

Aug

15

Sat

22

Aug

15

Sat

29

Aug

15

Sat

05

Sep

15

Sat

12

Sep

15

Sat

19

Sep

15

Sat

26

Sep

15

Sat

03

Oct

15

Sat

10

Oct

15

Sat

17

Oct

15

Sat

24

Oct

15

Sat

31

Oct

15

Sat

07

Nov

15

Sat

14

Nov

15

Sat

21

Nov

15

0%

20%

40%

60%

80%

100%

120%

UCL

LCL

Ivory Ward Bed Occupancy: P Chart

Perc

ent

88%79%

57%

= Baseline dataTarget = 70%

Finance team building a cost model for this work

Looking to spread from Newham to single ward for Hackney/Tower Hamlets

Reducing bed occupancy on older adult functional ward in Newham

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UCL

Total number of working days from start to finish (I chart)

Case number

Day

s

Implemented new documents and offered two hearing dates

at case number 108

107 days52 days

Data for 14-15

Total cost £892,341

Number of cases 29

Average cost per case £30,770

Average number of days suspended 104

Average cost per day of suspension £296

If we can reduce length of suspension by 50 days, we would save £429,200 per annum

Reducing length of the disciplinary process

Your work is having an impact nationally and globally…

We’re Quality Improving

Stephen SandfordLead for Arts Therapies

Dr Stuart WoodMusic Therapy Research Lead, ELFT / Guildhall School of Music and Drama

Vocals and Lyrics: Von-de-viel NetteyRecording: Camilo Tirado

Music Video: Salem Hanna Music & Video content: ELFT staff


Presents

“We’re Quality Improving”

@ELFT_QIqi.elft.nhs.uk [email protected]

elft qi conference

Health & Medicine