engaging and supporting teams working on safety improvement … · 2015-05-27 · programme...
TRANSCRIPT
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 [email protected] @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 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
0
20
40
60
80
10
-Jan-1
4
21
-Mar-
14
27
-Mar-
14
22
-Ap
r-14
26
-Jun-1
4
20
-Jul-1
4
06
-Au
g-1
4
25
-Au
g-1
4
29
-Se
p-1
4
30
-Oct-
14
12
-No
v-1
4
20
-No
v-1
4
29
-No
v-1
4
20
-De
c-1
4
21
-De
c-1
4
07
-Jan-1
5
11
-Jan-1
5
13
-Jan-1
5
03
-Feb
-15
14
-Feb
-15
23
-Feb
-15
21
-Mar-
15
23
-Mar-
15
27
-Mar-
15
Tim
e b
etw
een
even
ts /
d
ays
Incidents resulting in staff injury (PICU's only) - T Chart
UCL
LCL
0
5
10
15
20
25
30
35
6-J
an-1
4
20
-Jan-1
4
3-F
eb-1
4
17
-Feb
-14
3-M
ar-
14
17
-Mar-
14
31
-Mar-
14
14
-Ap
r-14
28
-Ap
r-14
12
-May-1
4
26
-May-1
4
9-J
un-1
4
23
-Jun-1
4
7-J
ul-14
21
-Jul-1
4
4-A
ug
-14
18
-Au
g-1
4
1-S
ep
-14
15
-Se
p-1
4
29
-Se
p-1
4
13
-Oct-
14
27
-Oct-
14
10
-No
v-1
4
24
-No
v-1
4
8-D
ec-1
4
22
-De
c-1
4
5-J
an-1
5
19
-Jan-1
5
2-F
eb-1
5
16
-Feb
-15
2-M
ar-
15
16
-Mar-
15
30
-Mar-
15
13
-Ap
r-15
27
-Ap
r-15
No
. o
f In
cid
en
ts
Incidents resulting in Physical Violence - C Chart
UCL
LCL 0
1
2
3
4
5
6
7
6-J
an-1
4
20
-Jan-1
4
3-F
eb-1
4
17
-Feb
-14
3-M
ar-
14
17
-Mar-
14
31
-Mar-
14
14
-Ap
r-14
28
-Ap
r-14
12
-May-1
4
26
-May-1
4
9-J
un-1
4
23
-Jun-1
4
7-J
ul-14
21
-Jul-1
4
4-A
ug
-14
18
-Au
g-1
4
1-S
ep
-14
15
-Se
p-1
4
29
-Se
p-1
4
13
-Oct-
14
27
-Oct-
14
10
-No
v-1
4
24
-No
v-1
4
8-D
ec-1
4
22
-De
c-1
4
5-J
an-1
5
19
-Jan-1
5
2-F
eb-1
5
16
-Feb
-15
2-M
ar-
15
16
-Mar-
15
30
-Mar-
15
13
-Ap
r-15
27
-Ap
r-15
No
. o
f In
cid
en
ts
Incidents resulting in staff injury - C Chart
UCL
LCL 0
2
4
6
8
10
12
14
06
-Jan-1
4
20
-Jan-1
4
03
-Feb
-14
17
-Feb
-14
03
-Mar-
14
17
-Mar-
14
31
-Mar-
14
14
-Ap
r-14
28
-Ap
r-14
12
-May-1
4
26
-May-1
4
09
-Jun-1
4
23
-Jun-1
4
07
-Jul-1
4
21
-Jul-1
4
04
-Au
g-1
4
18
-Au
g-1
4
01
-Se
p-1
4
15
-Se
p-1
4
29
-Se
p-1
4
13
-Oct-
14
27
-Oct-
14
10
-No
v-1
4
24
-No
v-1
4
08
-De
c-1
4
22
-De
c-1
4
05
-Jan-1
5
19
-Jan-1
5
02
-Feb
-15
16
-Feb
-15
02
-Mar-
15
16
-Mar-
15
30
-Mar-
15
13
-Ap
r-15
27
-Ap
r-15
No
. o
f In
cid
en
ts
Incidents of Physical Violence (Acute wards only) - C Chart
UCL
LCL 0
5
10
15
20
25
6-J
an-1
4
20
-Jan-1
4
3-F
eb-1
4
17
-Feb
-14
3-M
ar-
14
17
-Mar-
14
31
-Mar-
14
14
-Ap
r-14
28
-Ap
r-14
12
-May-…
26
-May-…
9-J
un-1
4
23
-Jun-1
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7-J
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-Jul-1
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-Se
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-Se
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-Oct-
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4
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v-1
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8-D
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4
22
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5-J
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5
19
-Jan-1
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2-F
eb-1
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-Feb
-15
2-M
ar-
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-Mar-
15
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-Mar-
15
13
-Ap
r-15
27
-Ap
r-15
No
. o
f In
cid
en
ts
Incidents of Physical Violence (PICU's only) - C Chart
0
50
100
5-J
an-1
4
13
-Jan-1
4
29
-Jan-1
4
29
-Jan-1
4
12
-Feb
-14
7-M
ar-
14
30
-Mar-
14
5-A
pr-
14
19
-Ap
r-14
19
-Ap
r-14
22
-Ap
r-14
30
-Ap
r-14
1-M
ay-1
4
2-J
un-1
4
20
-Jun-1
4
21
-Jun-1
4
26
-Jun-1
4
2-J
ul-14
9-A
ug
-14
21
-No
v-1
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8-M
ar-
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-Ap
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6-M
ay-1
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Tim
e b
etw
een
even
ts /
d
ays
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 [email protected] @ELFT_QI