Leadership for Improvement in Scotland

Professor Jason LeitchNational Clinical Director

Scottish Government

@jasonleitch

Write down your job title on a piece of paper

In one sentence, write down what you do for a living

Scotland’s Context

Alcohol related deaths registered in Scotland (1979-2016)

Source: National Records of Scotland 2017

% of adults overweight & obese in Scotland 2003-2016

Source: Scottish Health Survey

Source: Health Scotland 2015 and ScotPHO June 2015

• 5 million people

• £13 billion

• 3 Regions

• 14 Health Boards

• 8 Support Boards

• Health and social care integration since April 2016

Scotland’s Approach

“Strong evidence for an innovation is necessary but not

sufficient to result in its adoption”

Mark Freeman, 2012, The International Journal of Management Education

•

Juran’s Trilogy

Qu

ality Imp

rove

me

nt

• Monitor Key Process Indicators against targets

• Take Action when not meeting targets

• Regulatory approach

• Process and system improvement

• Reduce Variation

• Align outputs to customer needs

• Continuous & part of daily work

• Science of Improvement

• Inspection-looking for the “Bad Apples”

• Retrospective Review

• Risk Management

NEW PUBLIC MANAGEMENTTargets, sanctions, inspections

QUALITY IMPROVEMENT

MOBILISING SOCIAL ACTION

Ou

tcom

es

Time

Getting to the Third Curve

Sharing power

Keeping power

Ceding power

PERFORMANCE MANAGEMENT

QUALITY IMPROVEMENT

CO-PRODUCTION

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

Strategic Direction of Change

Improving Population Health

“By what method?...only the method

counts”

W Edwards Deming

DESIGN DESIGN DESIGN DESIGN APPROVE

Conference Room

Real World

The Typical Approach…

IMPLEMENT

DESIGN

TEST & MODIFY

TEST & MODIFY

APPROVEIF NECESSARY

Conference Room

Real WorldTEST &

MODIFY

The Quality Improvement Approach

START TO IMPLEMENT

Our change theory

A clear and stretch goal

A method

Predictive, iterative testing

Scotland’s Results

NHSScotland Hospital Standardised Mortality Ratio

January 2011 – September 2017

Rate of Ventilator Associated Pneumonia (VAP) for Scotland’s 2 Paediatric Intensive Care Units

April 2013 – October 2017

EachVentilator Associated

Pneumonia costs between

£6,000- £22,000

Source: BJMP 2009:2(2) 16-19

% 30 day Mortality of ICD 10 A40/A41

A case of sepsis costs approximately £1,400 per day

Source: Scottish Trauma Audit Group, 2010

Total rate of restraint for all reporting mental health wards

Total rate of cardiac arrest for 9 hospitals reporting 2012 - 2016

Scottish Stillbirth Rate (per 1000 births) 2000 - 2015

‘My neonatal colleagues in Edinburgh tell me that they notice more small babies in the cots now - they would previously not have made it to the unit of course…’

Dr Catherine Calderwood, Chief Medical Officer for Scotland

Leading for

Improvement

High Impact Leadership Behaviours

….over 1,700 leadership walkrounds have been conducted in Scotland.

Since 2008…….

Scotland’s Hospital Safety Huddles

Continuously improve quality and safety every day

Improve staff engagement and empowerment

Improve patient and family experiences

I always felt supported in my role – the huddle

has made it better

Gives me an overview of the whole hospital -who needs help Feels like we are

one team working together

Gives me real time information that is

being acted on

Population around 50,000

Coatbridge

10 miles east of Glasgow

40% of population living in one of Lanarkshire’s “15 most

deprived data zones”

18th century centre of Iron Making

27-30 Month Review

In Scotland..... 73% of children are meeting their developmental milestones

at their 27-30 months review

In Coatbridge......81% of children are meeting their developmental

milestones at their 27-30 month review

Source: NHS Lanarkshire

How did they do it?

Practitioner Leadership

Health Visitor Engagement

Early Years Collaborative Support

Improvement Methodology

High Impact Leadership Behaviours

1. Which behaviours are hardest?2. Which behaviours are easiest?3. What will you do differently when

you get back to your team?

Choluteca Bridge, Honduras

1998

@jasonleitch