quality and safety in palliative care - the view from nhs qis

Quality and Safety in Palliative Care

- the view from NHS QIS

Quality and Safety in Palliative Care

- the view from NHS QIS

Dr Frances ElliotChief Executive

3 December 2009

www.nhshealthquality.org

Better Health, Better Care (2007)

Better Cancer Care (2008)

Living and Dying Well (2008)

Scottish Government Quality Strategy (2009)

Strategic context Strategic context

Special Health Board established by the Scottish Parliament in 2003

independent in our advice, assessments and recommendations

NHS QIS NHS QIS

Our vision and purposeOur vision and purpose

To deliver internationally recognised excellence in quality improvement

To deliver internationally recognised excellence in quality improvement

What we do

We : provide advice and guidance on effective clinical

practice, including setting standards drive and support implementation of improvements in

quality assess the performance of the NHS, reporting and

publishing the findings

Increasingly we do this as an integrated approach

NHS QIS

Key Activity

Advice, guidance and

standards

Implementation and

improvement support

Assessment, measurement and reporting

Local improvement

cycles

Assurance

Accountability

ImplementationImplementation

Scottish Patient Safety Programme

New Directorate of Improvement and Implementation Support

Networks

Clinical

Practice development

Clinical governance support

Scottish Patient Safety Programme

New Directorate of Improvement and Implementation Support

Networks

Clinical

Practice development

Clinical governance support

Changing RoleChanging Role

Healthcare Improvement Scotland

- a new body responsible for scrutinising health services, including independent healthcare

- retains and emphasises current functions of NHS QIS in relation to quality improvement

Healthcare Improvement Scotland

- a new body responsible for scrutinising health services, including independent healthcare

- retains and emphasises current functions of NHS QIS in relation to quality improvement

The futureThe future

Integrated improvement programmes

Based on a robust analysis of the evidence base

Will include a package of advice and guidance for the service

Integrated improvement programmes

Based on a robust analysis of the evidence base

Will include a package of advice and guidance for the service

The futureThe future

“Care bundle” approach with appropriate improvement tools for the service to enable implementation

Support from QIS and partners to make it happen

Key quality indicators to enable local self-assessment and reporting on progress, with proportionate external quality assurance

“Care bundle” approach with appropriate improvement tools for the service to enable implementation

Support from QIS and partners to make it happen

Key quality indicators to enable local self-assessment and reporting on progress, with proportionate external quality assurance

Quality Performance Indicator Development Process

Quality Performance Indicator Development Process

Preparatory work (QIS Knowledge Management Team)

Consultation(Regional Cancer Networks)

Finalisation (NHS QIS, QPI development core group)

Publication(NHS QIS)

Indicator Development(QPI development group)

Scoping(QPI development group, NHS QIS KMT)

QPI Development Group Launch Meeting(QPI development group)

Cancer Taskforce Ratification of QPI ’(Scottish Cancer Taskforce)6-

8 M

onth

s








’(Scottish Cancer Taskforce)6-

8 M

onth

s








’(Scottish Cancer Taskforce)6-

8 M

onth

s

QPI Development Group Launch MeetingQPI Development Group Launch Meeting

Agree scope of preparatory work Define criteria for QPI development Plan for inaugural meeting

Secretariat?

Agree scope of preparatory work Define criteria for QPI development Plan for inaugural meeting

Secretariat?

Preparatory Work (2 months)Preparatory Work (2 months)

NHS QIS Knowledge Management Team

Assess current guidance/evidence (AGREE) Suggest scope for indicator development Develop scope of indicators – background

and need

NHS QIS Knowledge Management Team

Assess current guidance/evidence (AGREE) Suggest scope for indicator development Develop scope of indicators – background

and need

Scoping (1 – 2 months)Scoping (1 – 2 months)

NHS QIS knowledge management team and QPI development group

Briefing paper Overview of preparatory work Summarise key information Recommendations for draft QPI’s Filter recommendations using agreed

criteria/framework

NHS QIS knowledge management team and QPI development group

Briefing paper Overview of preparatory work Summarise key information Recommendations for draft QPI’s Filter recommendations using agreed

criteria/framework

Indicator Development Group (1-2 months)Indicator Development Group (1-2 months)

Review briefing paper and consider proposed draft QPI’s

Create short list (?10) Define numerators, denominators and

exclusions for each draft QPI

Review briefing paper and consider proposed draft QPI’s

Create short list (?10) Define numerators, denominators and

exclusions for each draft QPI

Draft Indicators RatifiedDraft Indicators Ratified

Draft QPI’s presented to LDW Steering Group for approval prior to wider consultation

Draft QPI’s presented to LDW Steering Group for approval prior to wider consultation

Consultation (1 – 3 months)Consultation (1 – 3 months)

Consultation via local palliative care networks

Who should we consult with? For what purpose? Level of user involvement?

Consultation via local palliative care networks

Who should we consult with? For what purpose? Level of user involvement?

Finalisation (2 months)Finalisation (2 months)

NHS QIS, QPI Development Group Collate feedback from consultation Refine QPI’s including numerators,

denominators, exclusions Final ratification by LDW Steering Group

Publication and dissemination to Boards

NHS QIS, QPI Development Group Collate feedback from consultation Refine QPI’s including numerators,

denominators, exclusions Final ratification by LDW Steering Group

Publication and dissemination to Boards

InvolvementInvolvement

LDW Steering Group Agree proposed QPI development process

and final sign off

LDW Steering Group Agree proposed QPI development process

and final sign off


Quality Performance Indicators Development Group Short life group clinical experts Review information on topics referred from LDW

task groups Draft QPI’s Definitions

Quality Performance Indicators Development Group Short life group clinical experts Review information on topics referred from LDW

task groups Draft QPI’s Definitions


NHS QIS Review of evidence Prepare briefing paper Quality assurance, consistency checking,

advice on implementation

ISD Alignment with national datasets Ensure measurability Input to definitions

NHS QIS Review of evidence Prepare briefing paper Quality assurance, consistency checking,

advice on implementation

ISD Alignment with national datasets Ensure measurability Input to definitions

For Consideration and DiscussionFor Consideration and Discussion

Ownership of the process Ownership of the final output How do we “badge” How do we address clinical issues with

little or no evidence Generation of the evidence base Generation of research questions

Ownership of the process Ownership of the final output How do we “badge” How do we address clinical issues with

little or no evidence Generation of the evidence base Generation of research questions

quality and safety in palliative care - the view from nhs qis

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