The Scottish Approach to Reforming Healthcare – Quality, Efficiency and Productivity

National Healthcare Conference, 22 March 2012

Frances Elliot | Chief Executive

The Scottish national context for quality in healthcare

My organisation

Our activity

What can you learn?

THE PRESENTATION

NHS SCOTLAND • 5.1 million population• One integrated NHS system• £10.3 billion• Integrated health and social care• 14 territorial boards• Special boards

– Healthcare Improvement Scotland– NHS Education for Scotland– NHS Health Scotland– NHS National Services Scotland– Scottish Ambulance Service– State Hospital– Golden Jubilee National Hospital– NHS 24

THE SCOTTISH CONTEXT

Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.

There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times.

 

The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.

QUALITY AMBITIONS

QUALITY AND EFFICIENCY – GETTING THE BALANCE RIGHT

NATIONAL PERFORMANCE FRAMEWORK 2011

Healthcare experience

Staff engagement and potential

Healthcare associated infection

Emergency admission rate/bed days

Adverse events

Hospital standardised mortality ratio

Under 75 mortality rate

Patient/user reported outcome measures

Self-assessed general health

Percentage of time in last 6 months of life spent at home or in a community setting

Early years indicator

Resource use indicator

QUALITY OUTCOME INDICATORS

TRANSPARENCY

Definition of transparent: allowing light to pass through so that objects behind can be easily seen; easily understood; of such a kind that the truth behind it is easily perceived; clear and unmistakeable

Often described in terms of how individuals behave and organisations function e.g. with candour, integrity, honesty, ethics, clarity, full disclosure, legal compliance

The aim: to allow us to deal fairly with each other and those we serve.

HEALTHCARE IMPROVEMENT SCOTLAND

Set up by an Act of Scottish Parliament on 1 April 2011.

Two key functions:Enhancing and protecting the safety and wellbeing of all persons who use services provided under the national health service and independent health care services.

Uniquely in the United Kingdom we fulfil both an improvement and scrutiny role with regard to health services.

VISION

To deliver excellence in improving the quality of the care and experience of every person in Scotland every time they access healthcare.

INTEGRATED CYCLE OF IMPROVEMENT

IMPROVEMENT

“The combined and unceasing efforts of everyone – healthcare professionals, patients and their families, researchers, payers, planners, administrators, educators – to make changes that will lead to better patient outcome, better system performance, and better professional development.”

 

Batalden P, Davidoff F. Qual. Saf. Health Care 2007;16;2-3

IMPROVEMENT

We run the Scottish Patient Safety Programme, a Paediatric Safety Patient Programme and are developing new national programmes for primary care, mental health, maternity services and person centred care

We also have a number of other improvement programmes, for example Healthcare Associated Infection (HAI), cardiovascular disease, neurological conditions

The Scottish Quality Improvement Hub

We support national initiatives such as Releasing Time to Care.

The Improvement Guide, API

SIX QUESTIONS FOR HEALTHCARE PROVIDERSDoes everyone in the system know what we are trying to achieve?Are we prioritising the improvements likely to have the biggest impact on the aim and stopping those that have little impact?Is everyone clear about the means of securing improvements towards our aim?Are we able to measure and report progress on our aim?Do we know how and where to deploy resources when improvement is slower than required?Do we have a way of testing and innovating and then spreading new learning?

Having to redo operations and interventions

Readmissions – initial problem not fixed

Healthcare associated infection

Delayed discharges

Poor communication

Drug interactions and reactions

Poor patient flow along care pathways

Complaints and litigation.

THE COST OF QUALITY

TRUST

Trust and transparency are always linked

The unimpeded flow of information is essential for healthy relationships and for organisational health

Ibsen defines “vital lies” as the operative fictions that cover a more disturbing truth in troubled families

In organisations they play a role in attempting to keep embarrassing truths from surfacing.

SCOTTISH PATIENT SAFETY PROGRAMME

SPSP WORKSTREAMS

Critical Care– Ventilator acquired pneumonia bundle, central line

bundleGeneral Ward

– Early rescue – Communication

Medicines Management– Medicines reconciliation

Perioperative– Surgical pause, surgical checklist– Infection prevention/control, prevention of venous

thromboembolismLeadership

– Safety walkrounds– Executive leadership, board patient safety profile

MEASUREMENT AND DATA

To end of 2011:

• 61% reduction in Ventilator Associated Pneumonia rate

• 70% reduction in Central Line Bloodstream Infection rate

• There were 14 central line infections in intensive care units in Scotland in 2011

• There were zero central line infections in intensive care units in March, June and December 2011

• 19% improvement in compliance with critical care multidisciplinary rounds and daily goals

• 24% improvement in critical care mortality

• 0.5 day reduction in ICU length of stay

• 90% reduction in ward C. difficile rate

• 40% reduction in ward Staph aureus bacteraemia rate

• 20% improvement in compliance with surgical briefing

• 18% improvement in medicines reconciliation

HSMR – up to end of September 2011 improved by 9.3%

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VAP RATE (PER THOUSAND VENTILATOR DAYS)

9.11

3.54

61% reduction

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VAP BUNDLE COMPLIANCE

85%

92%

7% improvement

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CENTRAL LINE INFECTION RATE (PER THOUSAND LINE DAYS)

2.8

0.84

70% reduction

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CENTRAL LINE BUNDLE COMPLIANCE

89%

94%

5% improvement

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% COMPLIANCE WITH MULTI-DISCIPLINARY ROUNDS AND DAILY GOALS

74%

93%

19% improvement

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% ICU MORTALITY

18.2%

13.9%

24% improvement

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ICU AVERAGE LENGTH OF STAY

4.8

4.3

½ day improvement

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GENERAL WARD C.DIFFICILE RATE(PER THOUSAND PATIENT DAYS)

1.15

0.12

90% reduction

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GENERAL WARD SAB RATE(PER THOUSAND OCCUPIED BED DAYS)

0.35

0.21

40% reduction

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PERCENTAGE COMPLIANCE WITH EWS

92%

95%

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PERCENTAGE COMPLIANCE WITH SURGICAL BRIEFING

74%

94%

20% improvement

PERCENTAGE COMPLIANCE WITH PERI-OP BRIEFINGS

92%

95%

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PERCENTAGE COMPLIANCE WITH MEDICINES RECONCILIATION

64%

82%18% improvement

THE NEW TRANSPARENCY

In everyday life we live in a globally networked society

The mobile phone equipped with a camera, and CCTV, means that each of us is, more or less, always under scrutiny and on display

This new, involuntary transparency recognises that there is no such thing as secrecy

It calls for a new code of behaviour, one dictated by the reality that we can never assume we are alone or unaccountable for our actions.

RECOMMENDED READING FOR BOARD MEMBERSHow well does your organisation measure up in terms of transparency?

Do you have a mechanism to encourage difficult conversations in your senior management team, in governance committees and at the board level?

How do your staff raise sensitive and difficult issues?

What support do they receive when they do?

“Do not be content with mediocrity. Do your job so well that nobody could do it better.”

Martin Luther King

KEY MESSAGE

www.healthcareimprovementscotland.org

www.scotlandperforms.com

www.scottishpatientsafety.programme.scot.nhs.uk

USEFUL WEBSITES