plenary 1 driving quality through innovation
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Derek Feeley
Director-General Health and Social Care and Chief Executive NHSScotland
Jason Leitch
Clinical Director, The Quality Unit, Scottish Government
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The Edge of Glory?
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A legitimate Statement of Values
“The Lothian Way” has been developed within NHS Lothian as a set of emergent values and associated behaviours identified as vital elements of the culture that NHS Lothian wants to build. Patients are first and foremost in this set of values however staff motivation and organisational reputation are central too. They are as follows: – Person Centred – Partnership – Integrity – Accountability – Innovation
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Many organisations have unwritten rules which
describe ‘the way we do things around here’. In
NHS Lothian the following have been described
consistently to us in one-to-one interviews: • Suppression of bad news – do not write it down • Gloss • You are on your own – ‘Just fix It’ “
Underlying cultural assumptions (the unwritten rules)
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Some less prominent headlines (in May alone…)
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The real world?
• Performance continues to improve
• In many areas it is better than ever (and world class)
• We can’t afford to stand still
• Attitudes, ethics and values are as important as technical excellence
• Reliability just as important in these areas – every person every time
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We should choose to learn!
“What if we choose to change? Could we
craft joy from loss, pride from revision, and
excellence from invention?
Yes we can.”
Don Berwick; British Journal of General Practice; Feb 2009
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To change and to persist!
“There were a number of definitions of courage, but now I was seeing it in its simplest form: you do what has to be done day after day, and you never quit.” ― Eric Greitens, The Heart and the Fist: The Education of a Humanitarian, the Making of a Navy SEAL
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To make the right thing easier to do!
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Tough Love?
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So what if……?
• We had the courage to persist in our pursuit of world-class care
• We continued to make care safer, more effective and more person-centred
• We choose to learn together
• We share and renew our ethics and values
• We make the right thing easier to do
• We get ready for the next curve
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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
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2020 Vision Everyone is able to live longer healthier lives at home, or in a
homely setting.
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Getting to the third curve
Time
Perform
ance
Performance
Improvement
Co-production& assets
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What will it take?
• Redesign, creativity and innovation
• New technologies and better use of existing technology
• Prevention, assets and activation
• Up our game on person centred care
• Continued focus on performance and improvement
• Shared and renewed ethics and values
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JL
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Getting to the third curve
Time
Perform
ance
Patients and fa
milies
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Getting to the third curve
Time
Perform
ance
Performance
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0
20
40
60
80
100
120
Mar
-08
Jul-0
8
Nov-08
Mar
-09
Jul-0
9
Nov-09
Mar
-10
Jul-1
0
Nov-10
Mar
-11
Jul-1
1
Nov-11
Mar
-12
Quarter ending
Wai
t (d
ays)
Median (days) 90th percentile (days)
Median and 90th percentile waits for IP/DC
3525
105
63
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50%
60%
70%
80%
90%
100%
Jan
-11
Feb
-11
Mar
-11
Ap
r-11
May
-11
Jun
-11
Jul-
11
Au
g-1
1
Sep
-11
Oct
-11
No
v-11
Dec
-11
Jan
-12
Feb
-12
Mar
-12
Month
Pat
ien
t jo
urn
eys
wit
hin
18
wee
ks% of patient journeys within 18 weeks
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“The overall financial performance of the NHS is good”
Audit Scotland, 2011
good = euphoria
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Getting to the third curve
Time
Perform
ance
Performance
Improvement
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“The Scottish Patient Safety Programme is without doubt one of the most ambitious patient safety initiatives in the world – national in scale, bold in aims, and disciplined in science. It
harnesses the energies and wisdom of Scotland’s health care leaders –NHS executives, QIS experts, clinical professionals,
civil servants, and more – all aligned toward a common vision, making Scotland the safest nation on earth from the viewpoint
of health care.”
Don Berwick
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1012141618202224262830
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
% ICU mortality
18.2%
13.9%
24% improvement
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Surgical Mortality
28%
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Scotland HSMR – 9.5% reduction
0.5
1.0
1.5
Oct-Dec2006
Apr-Jun
2007
Oct-Dec2007
Apr-Jun
2008
Oct-Dec2008
Apr-Jun
2009
Oct-Dec2009
Apr-Jun
2010
Oct-Dec2010
Apr-Jun
2011
Oct-Dec
2011p
Sta
ndar
dise
d M
orta
lity
Rat
io
Standardised Mortality Ratio (SMR) Regression line
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20%
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11.5%
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Percentage Oxygen Complance
0%
20%
40%
60%
80%
100%
120%
02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
Median Time to IV Fluids
00:00
00:14
00:28
00:43
00:57
01:12
01:26
01:40
01:55
02:09
02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
Percentage Compliance IV Fluids
0%
20%
40%
60%
80%
100%
120%
02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
Median Time to Blood Cultures
00:00
00:28
00:57
01:26
01:55
02:24
02:52
02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
Percentage Compliance of Blood Cultures
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
Median Time to Lactate
00:00
00:28
00:57
01:26
01:55
02:24
02:52
02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
0
10
20
30
40
50
60
70
80
90
100
02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
Sepsis bundle compliance
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Katy: Zero Pressure Ulcers Stages 3 & 4
To: Memorial Hermann Katy HospitalZero Pressure Ulcers for 36 Months
January 1, 2008 to December 31, 2010
Zero Pressure Ulcers x 36 Months
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Northwest: Zero Retained Foreign Bodies
To: Memorial Hermann Northwest HospitalZero Retained Foreign Bodies for 24 Months
January 1, 2010 to December 31, 2010
Zero Retained Foreign Bodies x 24 Months
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Sugar Land: Zero Central Line Blood Stream Infections
To: Memorial Hermann Sugar Land Hospital
February 1, 2008 to January 31, 2011
Zero Central Line Associated Blood Stream Infections for 36 Months
Zero CLABSIs x 36 Months
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High ReliabilityCertified Zero Hospitals
Central Line Associated Bloodstream Infections (4) Ventilator Associated Pneumonias (7)
Surgical Site Infections Retained Foreign Bodies (9) Iatrogenic Pneumothorax (4)
Accidental Punctures and LacerationsPressure Ulcers Stages III & IV (8)
Hospital Associated Injuries (2)Deep Vein Thrombosis and/or Pulmonary Embolism (1)
Deaths Among Surgical Inpatients with Serious Treatable Complications
Birth Traumas (4)Serious Safety Events (1)
2012
Awards40
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1941, William A. Foster
"Quality is never an accident; it is always the result of high
intention, sincere effort, intelligent direction and
skillful execution; it represents the wise choice of
many alternatives.”
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Getting to the third curve
Time
Perform
ance
Performance
Improvement
Co-production& assets
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~6500 people
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Prepared by Peter Knight JIT June12
Bedday rate for patients aged 75+, emergency admissions
4000
4500
5000
5500
6000
6500
Year ending
Bed
day r
ate
per
1000 a
ged
75+
Borders
Lothian
BoardaverageHighland
Ayrshire &ArranTayside
Sept-11
Re-shaping Care Prog/LTC Prog
~550 beds
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Doors
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Person centred health and care programme
Coming soon
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DF
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Assets vs Deficits
Assets thinking•Strengths based•How can we create community spirit?•What can I do?•We’re all in this together•We’re getting there•Work with engaged people•People have the answers•People control their lives
Deficit thinking•Problem orientated•How to fix this problem?•Someone needs to sort this•Us versus them•Problems are embedded•Do things to people •People are a problem•People can’t be trusted to decide/be in control
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Values on the way to work
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Derek’s Values
• Advocacy
• Accessibility
• Ambition
• Authenticity
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Jason’s values
• Person-centred
• Pioneering
• Restless
• Aspiring
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The Edge of Glory
Please complete your cards
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Ethics and Glory
“Glory, built on selfish principles, is shame and guilt”
William Cowper
“Glory follows virtue as if it were its shadow”Cicero
“Glory lies in the attempt to reach one’s goal and not in reaching it”
Mahatma Ghandi
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So are you ready to……?
• Show the courage to persist in our pursuit of world-class care
• Continue to make care safer, more effective and more person-centred
• Choose to learn together
• Share and renew our ethics and values
• Make the right thing easier to do
• Get ready for the next curve
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The Edge of Glory!