Sarah Leng

Jo Wookey Programme Managers

KSS AHSN

What has the AHSN got to offer?

• Introduction to the KSS Academic Health Science Network (AHSN) and Quality & Patient Safety Collaborative (QPSC)

• QI Capability

• Peer Support

• PDSA – Tennis balls

• Model for Improvement

• Life Platform

• Communities of Practice

• Patients as Partners for Improvement

• Improvers Network

• Q

• Measurement for Improvement •

Presentation covers:

Can improving safety culture improve outcomes for patients?

QI Capability

What support is there?

• Breakthrough series – support with the QI methodology available to increase QI capability (this is the first of 4 sessions and QI will be drip fed through).

• This session is the introduction to QI capability building

• 492 joined the Improvers Network

• Bronze QI training (on-line training)

• LIFE Platform

• Networking events

• Peer Support

• Q

Peer Support

• Networking

• Problem solving

• Sharing learning and best practice

Can improving safety culture improve outcomes for patients?

Touching tennis ball An introduction to PDSA

Tennis Ball

• Aim is for every person on the table to touch each ball with both hands in the quickest time.

• You can only touch 1 ball at a time!

• DOCUMENT your Theories, Predictions, Results

Please choose individuals:

• 1. Note taker

To fill out your sheet

• 2. Timekeeper

Need a watch with a second hand (or phone)

Making a Prediction

• What is your theory? –What process will you use to improve time?

• What do you think will happen? –What is your prediction about time?

• Think ahead to future tests –….and how they might be shaped by the current small test.

Getting the Most out of the Exercise

• This exercise is designed to teach how to perform a test of change.

• During the simulations, observe – the conversations that occur

– the generation of ideas

– any disagreements

– the team dynamics

– the interactions between individuals.

• Think about what is happening and how it might apply in a clinical setting.

Reflection

Take a moment to reflect on your own work. What will you incorporate from this session into your plans?

An introduction to QI

Why study Quality Improvement?

• Based on Institute for Healthcare Improvement (IHI) Model for Improvement

Aim – Getting it right!

What is a Driver Diagram?

What is a Driver Diagram?

Aim: What, how much and by when? (Me, Size smaller/1 stone lighter - by summer holiday!)

What to measure?

Outcome Measures The impact/result of the work you are trying to achieve – (my final weight/dress size)Mortality Process Measures Are the processes performing as planned ?– (eating less/exercising more)Use of NEWS Balancing Measures Are the changes designed to improve causing new problems? (am I starving myself and fainting/feeling ill?) Staffing workload shifted? (outreach excess calls) Use a balanced set of measures for all improvement efforts.

What is a PDSA cycle?

Reflections from the ball exercise and PDSA cycles?

We are great at planning and doing – but sometimes the study and act are missing! This should be quick easy small tests of change – don’t invest too long in each PDSA Seek Usefulness Not Perfection Aim – if you knew the best time at the start of the exercise– would your original aim/time have been different?

How does it all fit together?

Why start small?

• Experience tells us that not all situations are the same

• One standardised process will not work for all

• Design a process to deliver reliable care for a group that is easiest to work with

• Learn from that group and spread to others

Why Some Improvement Efforts Fail?

• We do not get to the root of the problem • We do not understand human factors and engineer

systems to deal with the human condition • We do not simplify • We add steps to the processes that result in increased

work and complexity • We do not engage everyone at the right time

• Goal posts change

Choluteca River Bridge

Choluteca Bridge after Hurricane Mitch

An introduction to the Life Platform

What is the LIFE platform?

• Bespoke QI platform developed by SW AHSN

• Based on IHI model for improvement

• Allows for collaborative learning

• Covers all aspects of project development

– Driver diagrams

– PDSA cycles

– SPC charts

• Project library / Resources section

• Asset mapping capability

How can we use it?

• Free to all healthcare workers in KSS

• Register through site https://life.seedata.co.uk/login/signup/

• User guide– look in resources in LIFE

Why have we got it?

• Increase visibility of improvement

• Improve collaborative working

• Improvers network

• Tracking of collaborative improvement

Life demonstration

Demonstration Home Page

Demonstration Learning Centre

Demonstration Learning Centre

Demonstration Resources

Demonstration Connect

Demonstration – good example

Demonstration Driver Diagram

Demonstration Charts

Communities of Practice

CoP – Mortality and Serious Incidents

• Communities of Practice are groups of people who share a concern or passion for something they do and learn how to do it better as they voluntarily interact regularly……

Myron Rogers

CoP – Mortality and Serious Incidents

What we care

about DOMAIN

What and how we do things

together about it

PRACTICE

Who cares about it

COMMUNITY

CoP – Mortality and Serious Incidents

• Our ambition for the CoP:

• Building relationships between organisations to improve reviews and so enrich learning for safer care.

• Our community:

• A community from Kent, Surrey and Sussex closely involved in mortality/SI reviews and management and committed to making a difference.

Patients as Partners for Improvement

PAPfI

• We are developing this pilot training in partnership with HW East Sussex and HW Surrey, Mark Doughty, Senior Consultant, Leadership Development – The Kings Fund (and founder of the Centre for Patient Leadership) and the KSS leadership academy.

• Patients will have 4 learning sets over 1 year

• Patients aligned to QPSC projects including the deteriorating patient

PAPfI Skills Mind Map

An introduction to the Improvers Network

Improvers Network

• 492 joined “I’m IN”

• LIFE Platform

• Networking events

• Local Chapter meetings

• Stepping stone to Q

• Communities of Practice – Mortality and Serious Incidents

Improvers Network – Why join IN?

• Q is an initiative connecting people who have health and care improvement expertise across the UK.

• Q is led by the Health Foundation and supported and co-funded by NHS Improvement.

• The Q community is made up of a diverse range of people including those at the front line of health and social care, patient leaders, managers, commissioners, researchers, policymakers, and others.

• Next stage – growing Q (May / June 2017)

Q is not a taught programme, but a network of support for those already knowledgeable in undertaking improvement.

Can improving safety culture improve outcomes for patients?

Measurement for Improvement Making the data work for you!

Thank you – any questions?

BREAK REMEMBER TO APPLY TO BE PART OF THE

Q COMMUNITY

Primary Drivers Secondary Drivers

Recognition Improved

assessment and

monitoring in all care settings

Communication/safety netting Improve safety

within the healthcare

system

Management Improve timely treatment and

management of deteriorating

patients

Escalation improved

response to deteriorating patients in all

settings

1.Patients to have accurate NEWs scores whilst in inpatient and urgent care

2. NEWS calculated at emergency by community staff

3. Emergency GP referrals to have an accurate full set of observations and NEWS score ( including out of hours)

4. Care homes to use and calculate NEWS and benchmark

5. Education in all care settings re NEWs and recognising deterioration

6. Agreed escalation policies and trigger in all care settings

7. Patients with NEWS score of >5 to have a rapid assessment according to the escalation plan by an appropriate team

8. Patients with NEWS >5 to have screening for Sepsis/AKI ( Sepsis 6 within 1 hour of trigger)

9. ? Use of escalation plans – involve patients, family and carers

10. Ensure all patients have medications review

11. Use of checklist, agreed bundles, sepsis 6

12

13. Education of all staff in all care settings

14. Patients to have accurate NEWS score communicated at all referral points

15. Use of structured communication/common language

16. Patient information and discharge summaries containing adequate information/plans

Aim of the Programme

To improve the recognition, escalation,

management of the

deteriorating patient whilst

improving communication

and safety netting to

ensure improved

safety across the healthcare

system

By April 2018, use of NEWS in all

care settings ,

Reduction in transfer

to ICU within 24

hours of ED admission,

reduction in mortality,

reduction in cardiac

arrest calls, reduce LOS, ( ???? Need

to agree)

17.

18. Develop teams improvement science knowledge and capability

19. Develop dashboard and use of measurement for improvement

Improve Improvement capability and culture

Possible Measures Do these work? Are there additional measures which would be better suited to your setting? Which are your top 5 or do we need more?

Process measures Outcome measures Balancing measures

NEWS score documented Critical care admission Staff satisfaction

Accuracy of NEWs score (Proportion

accurately recorded)

Rate of inappropriate admission to

hospital

Outreach staff workloads

Proportion of high/changing NEWs that

elicit an appropriate response

Cardiac arrest (In/out hospital)

Proportion of communications including

last NEWS score

Deaths associated with coding for sepsis

Time to review -medical review/GP

discussion/paramedic review

Length of stay

Time to escalation decision OR senior

review

MET calls

Time to or proportion with documented

medication review

RRT for AKI

Time to screening tool completion

(Sepsis, AKI, delirium)

Proportion where timely and

appropriate EoL review undertaken

Measures

Type of measure:

Outcome Measures The impact/result of the work you are trying to achieve – (my final weight/dress size) Process Measures Are the processes performing as planned ?– (eating less/exercising more) Balancing Measures Are the changes designed to improve causing new problems? (am I starving myself and fainting/feeling ill?)

Things to think about:

• Not sector specific

• Important to clinicians

• Practical (can be elicited with available resources)

• Purposeful