setting up an organisation wide qi programme.pdf

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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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  • Our quality

    improvement programme

    web qi.elft.nhs.uk email [email protected] @ELFT_QI Conflicts of interest: None

  • 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

  • Challenges and

    opportunities in East London

    Cultural diversity

    Social deprivation

    Geographical diversity

    Commissioning arrangements

    Financial stability and

    strong assurance systems

    @ELFT_QI

  • Our quality

    improvement programme

    Why?

    @ELFT_QI

  • 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

  • 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

  • Our quality

    improvement programme

    How?

    @ELFT_QI

  • 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

  • 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.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

  • AIM: To provide the highest

    quality mental

    health and community

    care in England by

    2020

    Build the will

    35,000

  • 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

  • AIM: To provide the highest

    quality mental

    health and community

    care in England by

    2020

    Build the will

    Introducing microsite 2.0

  • 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 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

    Table Discussion

  • AIM: To provide the highest

    quality mental

    health and community

    care in England by

    2020

    QI Projects

    How have our projects developed

    over time?

  • AIM: To provide the highest

    quality mental

    health and community

    care in England by

    2020

    QI Projects

    September 2014

  • AIM: To provide the highest

    quality mental

    health and community

    care in England by

    2020

    QI Projects

    October 2014

  • AIM: To provide the highest

    quality mental

    health and community

    care in England by

    2020

    QI Projects

    November 2014

  • AIM: To provide the highest

    quality mental

    health and community

    care in England by

    2020

    QI Projects

    December 2014

  • AIM: To provide the highest

    quality mental

    health and community

    care in England by

    2020

    QI Projects

    January 2015

  • AIM: To provide the highest

    quality mental

    health and community

    care in England by

    2020

    QI Projects

    February 2015

  • 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

  • Is it making a difference?

    @ELFT_QI

  • 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

  • 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

  • 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

  • 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