The Not-So-Secret Ingredients for Scotland’s Health Care Transformation

Professor Jason Leitch Clinical Director

The Quality Unit, Scottish Government

@jasonleitch

Lucy and Lewis

• 5 million people • £12 billion • 14 Health Boards • 8 Support Boards • Integrated delivery • Moving towards

social care integration

Public Finances Fall in Government expenditure

1911 1931 1951 1971 1991 2011

Source: Scotland 2011 Census

Scotland’s Demographics 1911 - 2011

Alcohol Related Mortality UK Countries 1990-2005

Source: Office for National Statistics 2007

People living in more deprived areas in Scotland develop multimorbidity 10 years

before those living in the most affluent areas

Scotland’s approach

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

2020 Vision/Quality Ambitions

“Safe, effective and person-centred care

which supports people to live as long as possible at

home or in a homely setting.”

Quality of Care

Primary Care

Integrated Care

Safe Care

Unscheduled and Emergency Care

Person Centred Care

Care for Multiple and Chronic Illnesses

Health of the Population

Early Years

Health Inequalities

Prevention

Value & Financial

Sustainability

Innovation

Efficiency & Productivity

Workforce

12 Priority Areas for Action

ROUTE MAP TO THE 20:20 VISION

NEW PUBLIC MANAGEMENT Targets, sanctions, inspections

QUALITY IMPROVEMENT

MOBILISING SOCIAL ACTION

Outcom

es

Time

Getting to the Third Curve

Sharing power

Keeping power

Ceding power

Implementing at scale…. can it be done?

Execution

Ideas

Will

“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

APPROVE IF NECESSARY

Conference Room

Real World TEST &

MODIFY

The Quality Improvement Approach

START TO IMPLEMENT

Large scale change….. developing our thinking over time

From the industrial era - doing

To the social era - connecting

Large scale change….. developing our thinking over time

Our change theory

A clear and stretch goal

A method

Predictive, iterative testing

Aims To Further Improve the Safety of People in Acute Adult

Healthcare

1. Reduce Harm 95% of people in acute adult health care free from harms in the Scottish Patient Safety Index by 2015: Cardiac Arrest Catheter Acquired Urinary Tract Infections Pressure Ulcers Falls

2. Reduce Hospital Associated Mortality Reduce HSMR by 20% by 2015.

NHSScotland Surgical Safety Briefings

NHSScotland Surgical Mortality

Rate of staphylococcus aureus bacteraemia (including MRSA) cases across NHSScotland was 0.30 per 1,000

acute occupied bed days (2006–2013)

Rate of identifications of CDI across NHSScotland was 0.37 per 1,000 occupied bed days among patients aged 65 & over

(2008 – 2013)

Hospital Standardised Mortality Ratio Scotland: 2006 to Sep 2013

The Early Years Collaborative - Ambition

“To make Scotland the best place in the world to grow up.”

Provide the Leadership System to

support quality improvement across

the Early Years Collaborative

90% of children at Grassmarket nursery school will receive a bedtime story

“Now he wants to sit with me.

He didn’t do that before, he just ran

around...”

“He wants me to do stuff with him like his garage. Now he

takes my hand.”

“He sits and cuddles in.

He’s bonding with me. He is listening

to me.”

“He is starting to turn the pages by himself and he is noticing if I miss a

page.”

Mental Models for Leadership

Volume Value

High Impact Leadership Behaviours

High Impact Leadership Framework

Engage Across Boundaries

Engage Across Boundaries

Shape Culture

Create Vision and Build

Will

Deliver Results

Develop Capability

Driven by People and Community

@jasonleitch