setting up an organisation wide qi programme.pdf
TRANSCRIPT
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Our quality
improvement programme
web qi.elft.nhs.uk email [email protected] @ELFT_QI Conflicts of interest: None
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Mental health services Newham, Tower Hamlets, City & Hackney, Luton & Bedford
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
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Challenges and
opportunities in East London
Cultural diversity
Social deprivation
Geographical diversity
Commissioning arrangements
Financial stability and
strong assurance systems
@ELFT_QI
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Our quality
improvement programme
Why?
@ELFT_QI
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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
@ELFT_QI
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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
@ELFT_QI
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Our quality
improvement programme
How?
@ELFT_QI
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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
@ELFT_QI
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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.
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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.eastlondon.nhs.uk
Staff and service user newsletter reaches 4000 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
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
Build the will
35,000
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
Build the will
35,000 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
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
Build the will
Introducing microsite 2.0
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
Build the will
1,000
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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
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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
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
Build the will
5,000
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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
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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
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
Build the will
550
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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
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
Build the will 6
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
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1. How would you rate the will to undertake a QI programme in your organisation?
2. What are the barriers stopping you from undertaking this work?
3. In light of what you heard today, will you be doing anything differently in order to make a case for change?
Building the Will
Table Discussion
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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 Trusts QI team
IHI Open School available to all
Strategic partnership with IHI
Board sessions
@ELFT_QI
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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.
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
1,100 Build
improvement capability
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
1,100 Open School lessons completed
Build improvement
capability
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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
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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
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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
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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
Table Discussion
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
Alignment
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
Alignment
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
Alignment
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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
Table Discussion
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
QI Projects
How have our projects developed
over time?
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
QI Projects
September 2014
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
QI Projects
October 2014
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
QI Projects
November 2014
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
QI Projects
December 2014
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
QI Projects
January 2015
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
QI Projects
February 2015
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Right Care, Right Place, Right Time
TH Collaborative Roman, Globe, Bricklane, Lea, Millharbour, Rosebank
MHCOP Larch Lodge, Cedar Lodge, Sally Sherman Ward
CHN EPCS Teams (North East,
North West, Central, South) Multiple I/P Wards
C&H Rehab, AOS, Connolly, Bevan
Newham Multiple I/P wards
Newham Psychology
MHCOP Training Lodge
Childrens CDC x2
CAMHS x3
MHCOP Memory Service
C&H All CMHTS
Forensics Clerkenwell
REDUCE HARM BY 30% EVERY
YEAR
RIGHT CARE, RIGHT PLACE, RIGHT TIME
VIOLENCE REDUCTION
PHYSICAL HEALTH
ACCESS PRESSURE
ULCERS
@ELFT_QI
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Is it making a difference?
@ELFT_QI
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UCL
LCL
50
70
90
110
130
150
170
190
210
230
De
c 1
2
Ja
n 1
3
Feb
13
Ma
r 1
3
Ap
r 1
3
Ma
y 1
3
Ju
n 1
3
Ju
l 1
3
Aug
13
Sep
13
Oct 1
3
No
v 1
3
De
c 1
3
Jan 1
4
Feb 1
4
Ma
r 1
4
Ap
r 1
4
Ma
y 1
4
Ju
n 1
4
Ju
l 1
4
Aug
14
Sep
14
Oct 1
4
No
v 1
4
De
c 1
4
Ja
n 1
5
Feb
15
Incid
en
ts e
ach
mo
nth
Month
Incidents of physical violence across the Trust (C Chart)
179 per month
145 per month
19% reduction across the Trust Datix incident reporting
@ELFT_QI
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UCL
LCL
10
20
30
40
50
60
70
80
90
100
Jan-1
2
Feb
-12
Ma
r-1
2
Apr-
12
Ma
y-1
2
Jun-1
2
Jul-1
2
Aug-1
2
Sep-1
2
Oct-
12
No
v-1
2
De
c-1
2
Ja
n-1
3
Feb
-13
Ma
r-1
3
Apr-
13
Ma
y-1
3
Jun-1
3
Jul-1
3
Aug-1
3
Sep-1
3
Oct-
13
No
v-1
3
De
c-1
3
Jan-1
4
Feb
-14
Ma
r-1
4
Apr-
14
Ma
y-1
4
Jun-1
4
Jul-1
4
Aug-1
4
Sep-1
4
Oct-
14
No
v-1
4
De
c-1
4
Jan-1
5
No
. o
f R
estr
ain
ts
Episodes of Restraint in Prone Position - C Chart
UCL
LCL
50
70
90
110
130
150
170
Jan-1
2
Feb
-12
Ma
r-1
2
Apr-
12
Ma
y-1
2
Jun-1
2
Jul-
12
Aug-1
2
Sep-1
2
Oct-
12
No
v-1
2
De
c-1
2
Jan-1
3
Feb
-13
Ma
r-1
3
Apr-
13
Ma
y-1
3
Jun-1
3
Jul-
13
Aug-1
3
Sep-1
3
Oct-
13
No
v-1
3
De
c-1
3
Jan-1
4
Feb
-14
Ma
r-1
4
Apr-
14
Ma
y-1
4
Jun-1
4
Jul-
14
Aug-1
4
Sep-1
4
Oct-
14
No
v-1
4
De
c-1
4
Jan-1
5
No
. o
f In
cid
en
ts
Incidents resulting in the use of Restraint (C Chart)
68 per month
30 per month
56% reduction
134 per month
112 per month
16% reduction
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UCL
LCL 0
1
2
3
4
5
6
7
8
07 A
pr
21 A
pr
05 M
ay
19 M
ay
02 J
un
16 J
un
30 J
un
14 J
ul
28 J
ul
11 A
ug
25 A
ug
08 S
ep
22 S
ep
06 O
ct
20 O
ct
03 N
ov
17 N
ov
01 D
ec
15 D
ec
29 D
ec
12 J
an
26 J
an
09 F
eb
23 F
eb
09 M
ar
23 M
ar
06 A
pr
Grade 3-4 Pressure Ulcers - C Chart Number
UCL
LCL 0
2
4
6
8
10
12
14
16
24 M
ar
31 M
ar
07 A
pr
14 A
pr
21 A
pr
28 A
pr
05 M
ay
12 M
ay
19 M
ay
26 M
ay
02 J
un
09 J
un
16 J
un
23 J
un
30 J
un
07 J
ul
14 J
ul
21 J
ul
28 J
ul
04 A
ug
11 A
ug
18 A
ug
25 A
ug
01 S
ep
08 S
ep
15 S
ep
22 S
ep
29 S
ep
06 O
ct
13 O
ct
20 O
ct
27 O
ct
03 N
ov
10 N
ov
17 N
ov
24 N
ov
01 D
ec
08 D
ec
15 D
ec
22 D
ec
29 D
ec
05 J
an
12 J
an
19 J
an
26 J
an
02 F
eb
09 F
eb
16 F
eb
23 F
eb
02 M
ar
09 M
ar
16 M
ar
23 M
ar
30 M
ar
06 A
pr
Grade 2 Pressure Ulcers - C Chart Number
6.4 per week
2.8 per week
56% reduction
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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
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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
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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
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Organisational culture is created by what leaders pay attention to
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web qi.elft.nhs.uk email [email protected] @ELFT_QI