ELFT QI Conference
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Transcript of ELFT QI Conference
Quality improvement annual conference
Interact from your mobile deviceGo to slido.com and enter the code 6789
You’ll be able to see the slides we present, ask questions, take part in our polling, and tweet your thoughts using #QIConf
Welcome
Auzewell ChiteweQI Lead
“Wake and Shake”
Ged PattisonHead of Security for
Forensics
Let’s say hello to our colleagues in Bedfordshire
Marie Gabriel (Chair) and Mary Elford (Vice-Chair)
Messages from NHS Improvement &
Kaiser Permanente
Interact from your mobile device
You’ll be able to see the slides, ask questions, take part in polling, and tweet your thoughts using Slido
Introduction to the tech we’ll be using today…
Tim GillProgramme Manager
…ask questions during the
event
…vote in live polls
Use on your tablets and phones to…
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in real time
Ways you can contribute today
www.slido.com
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event code: 6789
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event code: 6789
Practice Live Poll
A look back at our first 2 years of QI…
Dr Amar ShahAssociate Medical
Director for QI
James InnesHead of 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. Newsletters (paper and electronic)2. Stories from QI projects - at Trust Board, newsletters3. Annual conference4. Celebrate successes – support submissions for awards5. Share externally – social media, Open mornings, visits,
microsite, engage key influencers and stakeholders
1. Build and develop central QI team capability2. Online learning options3. Pocket QI for those interested in QI4. Improvement Science in Action waves5. Develop cohort and pipeline of QI coaches6. Bespoke learning, including Board sessions & commissioners
1. Embed local directorate structures & processes to support QI
2. Align projects with directorate and Trust-wide priorities3. Support staff to find time and space for QI work4. Support deeper service user and carer involvement5. Support team managers and leaders to champion QI6. Align research, innovation, improvement and operations
Reducing Harm by 30% every year1. Reduce harm from inpatient violence2. Reduce harm from pressure ulcers3. Other harm reduction projects (not priority areas)
Right care, right place, right time1. Improving access to services2. Improving physical health 3. Other right care projects (not priority areas)
AIM:To provide the highest
quality mental
health and community
care in England by
2020
Build the will
QI Stories at Trust Board
QI Visibility Wall
Electronic & paper newsletters
12 projects published or submitted for
publication
qi.elft.nhs.uk
100,000
Open days
ELFT experience day
Jason Leitch
Jeremy Taylor Jocelyn Cornwall
Visits to see QI at ELFT
Influencing national policy and thinking
Influencing national policy and thinking
Influencing national policy and thinking
Influencing national policy and thinking
Video – Nigel Crisp & Jennifer Dixon
12Awards
Shortlisted
5
Staff experience and engagement
2010 2011 2012 2013 2014 20153.5
3.6
3.7
3.8
3.9
4
Overall Engagement Score
ELFT Score
National Median
Scor
e
2010 2011 2012 2013 2014 20153.5
3.6
3.7
3.8
3.9
4
4.1
4.2 Staff Motivation to Work
Scor
e
2010 2011 2012 2013 2014 20153.3
3.4
3.5
3.6
3.7
3.8
3.9
4
4.1 Staff job satisfaction
Scor
e
2010 2011 2012 2013 2014 201555
60
65
70
75
80
85
90 Staff able to contribute towards improvements at work
Scor
e (%
)
AIM:To provide the highest
quality mental
health and community
care in England by
2020
Build improvement
capability
Pocket QI commenced in October 2015. Aim to reach 200 people by
Dec 2016.All staff receive intro to QI at
induction
480 people have undertaken the ISIA so far. Wave 5 = Luton/Beds
(Sept 2016 – Feb 2017)
29 QI coaches graduated in January 2016. To identify and train
second cohort in mid-late 2016
Most Executives will have undertaken the ISIA.
Annual Board session with IHI & regular Board development
discussions on QI
Currently have 4 improvement advisors, with 1.5 wte deployed to QI. To increase to 8 IA’s in 2016/17
(6 wte).
Bespoke QI learning sessions for service users and carers. Over 40
attended in 2015. Build into recovery college syllabus, along with
confidence-building, presentation skills etc.
Estimated number needed to train = 5000Needs = introduction to quality
improvement, identifying problems, change ideas, testing and measuring change
Estimated number needed to train = 1000Needs = deeper understanding of
improvement methodology, measurement and using data, leading teams in QI
Estimated number needed to train = 40Needs = deeper understanding of
improvement methodology, understanding variation, coaching teams and individuals
Needs = setting direction and big goals, executive leadership, oversight of improvement, being a champion, understanding variation to lead
Estimated number needed to train = 11Needs = deep statistical process control,
deep improvement methods, effective plans for implementation & spread
Needs = introduction to quality improvement, how to get involved in improving a service, practical skills in
confidence-building, presentation, contributing ideas, support structure for
service user involvement
Experts by experience Expe
rts b
y exp
erie
nce
All staff
Staff involved in or leading QI projects
QI coaches
Board
Internal experts (QI
team)
Experts by experience
Prework Workshop9/29-10/1
Webex 110/14
Webex 211/2
Supports:• Listserve• Assignments
AP-1 AP-2Webex 3
11/30AP-3
ProjectPlanning Reliability Sustaining
Gains
Workshop
(3 days)
Webex #2Webex #1
• Faculty consults• Webex calls• Coaching calls
Webex #3 Learning Set 2 &
graduation
AP-5AP-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.
Improvement Science in Action
- 6 month learning path
Learning set 1
75 123
176 106
480
Workshop 1
Overview to using QI
Workshop 3
PDSAs and testing
Workshop 4
QI Tools
All 4 workshops are between 2-3 hours in a classroom format and rotate in location throughout the
geography of the Trust.
Workshop 2Using
measurement for improvement
Pocket QI- 2 month learning path
134
QI Coaches
29
Intro to QI - for service users & carers
40
Experts by experience Expe
rts b
y exp
erie
nce
All staff
Staff involved in or leading QI projects
QI coaches
Board
Internal experts (QI
team)
Experts by experience
So how are we doing so far?
75%Estimated number needed to train = 800
134 people trained in Pocket QI
467 people have undertaken the ISIA so
farExperts by experience Expe
rts b
y exp
erie
nce
All staff
Staff involved in or leading QI projects
QI coaches
Board
Internal experts (QI
team)
Experts by experienceACHIEVED
So how are we doing so far?
Band 3 Band 4 Band 5 Band 6 Band 7 Band 8a Band 8b Band 8c Band 8d Band 9 Doctor0%
10%
20%
30%
40%
50%
60%
70%
80%
90%0.
31%
1.82
%
2.62
%
5.85
%
14.6
3%
33.5
6%
34.6
9%
51.8
5%
80.9
5%
73.6
8%
30.0
3%
1.88
%
1.82
%
1.89
%
2.00
%
0.95
%
2.71
%
2.04
%
3.70
%
0.00
%
0.00
%
1.86
%
% of staff trained across the trust (excluding Luton and Bedfordshire)
ISIA Pocket QI
% o
f sta
ff tr
aine
d
75%97%
Estimated number needed to train = 800
Estimated number needed to train = 30
134 people trained in Pocket QI
467 people have undertaken the ISIA so
far
29 QI coaches graduated
Experts by experience Expe
rts b
y exp
erie
nce
All staff
Staff involved in or leading QI projects
QI coaches
Board
Internal experts (QI
team)
Experts by experienceACHIEVED
So how are we doing so far?
75%97%57%
Estimated number needed to train = 800
Estimated number needed to train = 30
Estimated number needed to train = 7
134 people trained in Pocket QI
467 people have undertaken the ISIA so
far
29 QI coaches graduated
Currently have 4 improvement advisors
Experts by experience Expe
rts b
y exp
erie
nce
All staff
Staff involved in or leading QI projects
QI coaches
Board
Internal experts (QI
team)
Experts by experienceACHIEVED
So how are we doing so far?
5 Executives have undertaken the ISIA course.
75%97%57%
Estimated number needed to train = 800
Estimated number needed to train = 30
Estimated number needed to train = 7
134 people trained in Pocket QI
467 people have undertaken the ISIA so
far
29 QI coaches graduated
Currently have 4 improvement advisors
Experts by experience Expe
rts b
y exp
erie
nce
All staff
Staff involved in or leading QI projects
QI coaches
Board
Internal experts (QI
team)
Experts by experienceACHIEVED
So how are we doing so far?
Estimated number needed to train = 7 71%
5 Executives have undertaken the ISIA course.
75%97%57%
Estimated number needed to train = 800
Estimated number needed to train = 30
Estimated number needed to train = 7
134 people trained in Pocket QI
467 people have undertaken the ISIA so
far
29 QI coaches graduated
Currently have 4 improvement advisors
Experts by experience Expe
rts b
y exp
erie
nce
All staff
Staff involved in or leading QI projects
QI coaches
Board
Internal experts (QI
team)
Experts by experienceACHIEVED
So how are we doing so far?
Estimated number needed to train = 7
Annual Board session with IHI & regular Board
development discussions on QI
Estimated number needed to train = 15 100%
71%
AIM:To provide the highest
quality mental
health and community
care in England by
2020
Alignment
QI ResourcesService User Input
Support around every team
Project Sponsor QI Coach
QI Forums
QI Team
Little i Regularly
consulted during lifetime of the
project
Big I Act as a full member
of the QI project team
Surveys
Focus groups
Community meetings
Service user
forum
Service user input in projects
QI ResourcesService User Input
Support around every team
Project Sponsor QI Coach
QI Forums
QI Team
See and search for other QI work in the Trust
Taking data to the next level
Data at Trust, directorate or team level
AIM:To provide the highest
quality mental
health and community
care in England by
2020
QI Projects
155Active
Projects
Our QI Projects
155Active
Projects
REDUCE HARM BY 30% EVERY YEAR
26RIGHT CARE, RIGHT PLACE, RIGHT TIME
129
Our QI Projects
155Active
Projects
REDUCE HARM BY 30% EVERY YEAR
9
PHYSICAL HEALTH
ACCESS TO SERVICES
PRESSURE
ULCERS
VIOLENCE REDUCTION
3 19 18
26RIGHT CARE, RIGHT PLACE, RIGHT TIME
129
Our QI Projects
Our QI Projects
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15Fe
b-15
Mar-15
Apr-15
May-15
Jun-15Jul-1
5
Aug-15Se
p-15Oct-
15
Nov-15
Dec-15
Jan-16Fe
b-1660
70
80
90
100
110
120
130
140
150
No. of active projects per month
No.
of n
ew p
roje
cts
Our QI Projects
16-Mar-15 30-Mar-15 13-Apr-15 27-Apr-15 19-May-15 28-May-15 15-Jun-15 07-Jul-15 13-Aug-15 02-Sep-15 07-Oct-15 03-Nov-15 01-Dec-15 12-Jan-16 02-Feb-16 08-Mar-16
14 12 11 11 15 11
60
25 22 24 2213 9 9 11 9
16 17 17 18 1515
15
3128 29
2329
28
47 46 45
31 29 25 23 2522
21
35 44 41
3631
31
28 2825
19 1920 20
2426
25 29 29 32
3134
32
30 2523
9 9 13 13
1716
15 15 1415
1414
13
14 18
17
97 10 10
1217
17 19 1918
1917
21
20 24
25
2 67 7
9 9
10 8 7 7
67
7
77
7
3 32 2
4 3
3 4 45
34
4
44
5
1 1 2 2
5 7
7 10 89
44
3
45
6
44
1112
15
1514
14
06-J
an-1
4
20-J
an-1
4
03-F
eb-1
4
17-F
eb-1
4
03-M
ar-1
4
17-M
ar-1
4
31-M
ar-1
4
14-A
pr-1
4
28-A
pr-1
4
12-M
ay-1
4
26-M
ay-1
4
09-J
un-1
4
23-J
un-1
4
07-J
ul-1
4
21-J
ul-1
4
04-A
ug-1
4
18-A
ug-1
4
01-S
ep-1
4
15-S
ep-1
4
29-S
ep-1
4
13-O
ct-1
4
27-O
ct-1
4
10-N
ov-1
4
24-N
ov-1
4
08-D
ec-1
4
22-D
ec-1
4
05-J
an-1
5
19-J
an-1
5
02-F
eb-1
5
16-F
eb-1
5
02-M
ar-1
5
16-M
ar-1
5
30-M
ar-1
5
13-A
pr-1
5
27-A
pr-1
5
11-M
ay-1
5
25-M
ay-1
5
08-J
un-1
5
22-J
un-1
5
06-J
ul-1
5
20-J
ul-1
5
03-A
ug-1
5
17-A
ug-1
5
31-A
ug-1
5
14-S
ep-1
5
28-S
ep-1
5
12-O
ct-1
5
26-O
ct-1
5
09-N
ov-1
5
23-N
ov-1
5
07-D
ec-1
5
21-D
ec-1
5
04-J
an-1
6
18-J
an-1
6
01-F
eb-1
6
25
35
45
55
65
75
85
95
67.8
51.1
UCL
LCL
Incidents resulting in physical violence (Trust-wide) - C Chart
No.
of I
ncid
ents
VIOLENCE REDUCTION
2013 2014 2015150
200
250
300
350
400
450
500
550Physical violence to patients (per 100,000
occupied bed days)
No.
of I
ncid
ents
2013 2014 2015300
400
500
600
700
800
900Physical violence to staff (per 100,000
occupied bed days)
No.
of I
ncid
ents
25% reduction
Tower Hamlets Violence Reduction Collaborative
57% reduction
Tower Hamlets Violence Reduction Collaborative
57% reduction
14% reduction
Cedar Ward, MHCOP
Mar
-14
Apr-
14
May
-14
Jun-
14
Jul-1
4
Aug-
14
Sep-
14
Oct
-14
Nov-
14
Dec-
14
Jan-
15
Feb-
15
Mar
-15
Apr-1
5
May
-15
Jun-
15
Jul-1
5
Aug
-15
Sep-
15
Oct
-15
Nov-
15
Dec-
15
Jan-
16
0
2
4
6
8
10
12
14
16
5.4
2.8
UCL
LCL
Incidents resulting in physical violence (Clerkenwell ward, Forensics) - C Chart
No.
of I
ncid
ents
48% reduction
Tower Hamlets Violence Reduction Collaborative
57% reduction
14% reduction
Cedar Ward, MHCOP
Clerkenwell Ward, Forensics
PRESSURE ULCERS
228 Pressure Ulcers
healed in 2015 !28
-Apr
-14
19-M
ay-1
409
-Jun
-14
30-J
un-1
421
-Jul
-14
11-A
ug-1
401
-Sep
-14
22-S
ep-1
413
-Oct
-14
03-N
ov-1
424
-Nov
-14
15-D
ec-1
405
-Jan
-15
26-J
an-1
516
-Feb
-15
16-M
ar-0
006
-Apr
-15
27-A
pr-1
518
-May
-15
08-J
un-1
529
-Jun
-15
20-J
ul-1
510
-Aug
-15
31-A
ug-1
521
-Sep
-15
12-O
ct-1
502
-Nov
-15
11-J
an-1
60%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
57.30%
73.10%
92.01%
UCL
LCL
Waterlow Completion Rate - P Chart
Com
plet
ion
Rat
e / %
07-A
pr-1
428
-Apr
-14
19-M
ay-1
409
-Jun
-14
30-J
un-1
421
-Jul-1
411
-Aug
-14
01-S
ep-1
422
-Sep
-14
13-O
ct-1
403
-Nov
-14
24-N
ov-1
415
-Dec
-14
05-J
an-1
526
-Jan
-15
16-F
eb-1
509
-Mar
-15
30-M
ar-1
520
-Apr
-15
11-M
ay-1
501
-Jun
-15
22-J
un-1
513
-Jul-1
503
-Aug
-15
24-A
ug-1
514
-Sep
-15
05-O
ct-1
526
-Oct
-15
16-N
ov-1
507
-Dec
-15
0
1
2
3
4
5
6
7
8
9
10
3.5
2.5
UCL
LCL
Grade 2 Pressure Ulcers - C Chart
No. of P
ress
ure Ulcers
61% increase
29% decrease
ACCE
SS T
O S
ERVI
CES
COLL
ABO
RATI
VE
- Baseline data
Jan-
14Feb
-14
Mar
-14
Apr
-14
May
-14
Jun-
14Ju
l-14
Aug
-14
Sep
-14
Oct
-14
Nov
-14
Dec
-14
Jan-
15Feb
-15
Mar
-15
Apr
-15
May
-15
Jun-
15Ju
l-15
Aug
-15
Sep
-15
Oct
-15
Nov
-15
Dec
-15
Jan-
16Feb
-16
19%
24%
29%
34%
39%
32.21%25.23%
UCL
LCL
Non-attendance at first face to face appt - P Chart
DNA /
%
Jan-
14F
eb-1
4M
ar-1
4A
pr-1
4M
ay-1
4Ju
n-14
Jul-1
4A
ug-1
4S
ep-1
4O
ct-1
4N
ov-1
4D
ec-1
4Ja
n-15
Feb
-15
Mar
-15
Apr
-15
May
-15
Jun-
15Ju
l-15
Aug
-15
Sep
-15
Oct
-15
Nov
-15
Dec
-15
Jan-
16F
eb-1
6
700
800
900
1000
1100
1200
1300
1400
1500
1600
1700
1021.71213.1
UCL
LCL
No. of referrals received - I Chart
No.
of R
efer
rals
Jan-
14
Feb
-14
Mar
-14
Apr
-14
May
-14
Jun-
14
Jul-1
4
Aug
-14
Sep
-14
Oct
-14
Nov
-14
Dec
-14
Jan-
15
Feb
-15
Mar
-15
Apr
-15
May
-15
Jun-
15
Jul-1
5
Aug
-15
Sep
-15
Oct
-15
Nov
-15
Dec
-15
Jan-
16
Feb
-16
40
45
50
55
60
65
70
60.7
51.0
UCL
LCL
Average waiting time from referral to 1st face to face appt - X-bar Chart
Ave
rage
Wai
ting
Tim
e / D
ays
ACCESS TO SERVICES
16% reduction
19% increase22% decrease
67
MSK Therapy Team, CHN
41% reduction
Newham Borough-wide, Psychological Services
80% reduction
68
MSK Therapy Team, CHN
41% reduction
Newham CFCS, Children’s
19% reduction
Newham Borough-wide, Psychological Services
80% reduction
PHYSICAL HEALTH
Professor Jason Leitch
National Clinical Director, Scottish Government
Senior fellow, Institute for Healthcare Improvement
Pose your questions to Jason from your mobile deviceGo to slido.com and enter the code 6789
Tweet your thoughts using #QIConf
Sustaining Large Scale Change
Professor Jason LeitchNational Clinical Director
Scottish Government
@jasonleitch
• 5 million people• £12 billion• 14 Health Boards• 8 Support Boards• Integrated delivery• Moving towards
social care integration
% 30 day Mortality of ICD 10 A40/A41
21 % Reduction
% 30 day Mortality of ICD 10 A40/A41
NHS Greater Glasgodw & Clyde PICUVAP Rate per 1000 Ventilation Days
Jan 2013 – Sep 2015
48 % Reduction
NHS Greater Glasgodw & Clyde PICUVAP Rate per 1000 Ventilation Days
Jan 2013 – Sep 2015
Median: 5.3
Scottish Stillbirth Rate (per 1000 births)2000 - 2014
Median: 5.3
15 % Reduction
Scottish Stillbirth Rate (per 1000 births)2000 - 2014
General Medical Services
Pharmacy
Community Nursing Dentistry
Policy & Politics
Learning System
Communications
Policy & Politics
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
Learning System
Learning System
System level measures
Explicit theory or rationale for
system changes
Segmentation of the
population
Learn by testing
changes sequentially“Act for the
individual learn for the population”
Learning during scale-up and spread & plan to go to
scale
Periodic review
People to manage &
oversee the learning system
Source: Tom Nolan
Improvement Science Leadership for Improvement
IntroductoryKnowledge
AdvancedKnowledge
AdvancedKnowledge
Improvement Capacity Building:Scotland’s Approach
Improvement Science Leadership for Improvement
IHI Improvement Advisor Waves
IntroductoryKnowledge
AdvancedKnowledge
AdvancedKnowledge
Improvement Capacity Building:Scotland’s Approach
Scottish Improvement Leader (ScIL)
Improvement Science Leadership for Improvement
IHI Improvement Advisor Waves
Quality Improvement Fellowship
IntroductoryKnowledge
AdvancedKnowledge
AdvancedKnowledge
Improvement Capacity Building:Scotland’s Approach
Scottish Improvement Leader (ScIL)
Improvement Science Leadership for Improvement
IHI Improvement Advisor Waves
Quality Improvement Fellowship
IntroductoryKnowledge
AdvancedKnowledge
AdvancedKnowledge
Improvement Capacity Building:Scotland’s Approach
Scottish Improvement Leader (ScIL)
Impr Science in Action
Improvement Science Leadership for Improvement
IHI Improvement Advisor Waves
Quality Improvement Fellowship
IntroductoryKnowledge
AdvancedKnowledge
AdvancedKnowledge
Improvement Capacity Building:Scotland’s Approach
Scottish Improvement Leader (ScIL)
Impr Science in Action
Boards on Board
Improvement Science Leadership for Improvement
IHI Improvement Advisor Waves
Quality Improvement Fellowship
IntroductoryKnowledge
AdvancedKnowledge
AdvancedKnowledge
Improvement Capacity Building:Scotland’s Approach
Scottish Improvement Leader (ScIL)
Impr Science in Action
Boards on Board
Improvement Collaboratives
Communications
Policy & Politics
Learning System
Communications
@jasonleitch
Legends A Suite Legends B Suite
Break-out sessions
Session A Session B
World café session where you will hear
from 3 project teams
Physical health & panel discussion
At 11am there will be time for a 15 minute coffee break before we swap round
Take a look at your lanyard…
Take a look at your lanyard…
Rooms
World Café Physical health and Panel discussion
Take a look at your lanyard…Table cloth colour and table number
Two different breakout sessions:
Breakout session 1 -09:55-11:00Tea break 11:00-11:20
Breakout session 2 -11:20-12:25
Break-out sessions
Time per session: 65 minutes per session
Legends A Suite Legends B Suite
Break-out sessions
Session A Session B
Move into Legends A – table colour and number
on lanyard
Come into the central section as we’ll have a more informal
panel discussion
After tea break - swap round into other room
Time for the breakout Sessions
Breakout Session B
Physical Health and Panel Discussion
1. Physical health as a priority area
2. Service user experience of QI
3. Physical activity session
4. Panel discussion
Structure of the session
Emma Binley Darzi Fellow in QI
Our QI work on physical health
with Dr Kevin Cleary (Medical Director)
Why did ELFT make physical health a priority area?
AIM:
Reduce cardiovascular
risk for all adults and children for
whom we initiate or change
psychotropic medication
Information provision
Minimum standards & checks
Pods for community settings
Assessment
Health promotion (exercise, diet, education)
Smoking cessation
Involvement in all QI areas
Monitoring
Communication between services
Improving physical health
collaborative;Driver Diagram
Overview
Leadership
Prescribing
3. Measuring and Reporting• Template development: define
scope, data, spec• Reports & dashboards
1. Equipment
2. Assessment & monitoring
3. Intervention
4. Service user & staff
engagement
Infrastructure
AIM:
Reduce cardiovascular
risk for all adults and children for
whom we initiate or change
psychotropic medication
Minimum standards & checks
Pods for community settings
Assessment
Monitoring
Improving physical health
collaborative;Driver Diagram
Overview
3. Measuring and Reporting• Template development: define
scope, data, spec• Reports & dashboards
1. Equipment
2. Assessment & monitoring
AOS
SCMHT
NCMHT
EQUIP
AIM:
Reduce cardiovascular
risk for all adults and children for
whom we initiate or change
psychotropic medication Health promotion (exercise, diet,
education)
Smoking cessation
Communication between services
Improving physical health
collaborative;Driver Diagram
Overview
Prescribing
3. Intervention
Our QI work on Health Promotion
Physical activity
Behavioural interventions, e.g. motivational interviewing
Informal and formal support; professional and family/peer
Diet and nutrition
Education and information
Communication /pathway between
services
Smoking cessationIn
terv
entio
n Prescribing
Health promotion
Steve Yarnold(Matron & QI Coach)
Sapphire ward
Sapphire ward
What’s next…
Health Promotion QI projects
Wolfson House
John Howard Centre
Newham centre for
Mental Health
AIM:
Reduce cardiovascular
risk for all adults and children for
whom we initiate or change
psychotropic medication
Information provision
Involvement in all QI areas
Improving physical health
collaborative;Driver Diagram
Overview
Leadership
4. Service user & staff
engagement
Infrastructure
Service user’s perspective of QI
What do you think of Bridge Club?
Service user’s perspective of QI
“Thank you for sponsoring the
bridge club”
“I think it’s really good, for health-wise; fitness and stuff like that”” “It’s a good
look, yeah!”
“It’s good to be with my
friends”
James Cook (MBE)
British & European Super-Middleweight
Champion
Boxercise
Boxercise with James Cook
Butabika Link
Moses Wasswa Mulimira(Co-Founder of Uganda Diaspora Health
Foundation)
Olivia Carmichael Butabika Link Coordinator
Be Inspired, Be activeEnhancing physical activity, recovery and reducing mental health stigma through
football at butabika Hospital, kick started the visit
Opening the training workshops
Cohort one
Cohort Two
Ward visits
Key stakeholder engagement
To Summarise…
Jen Taylor-WattQI Lead
Panel discussion
Pose your own questions from your mobile device
Go to slido.com and enter the code 6789
Tweet your thoughts using #QIConf
Let’s Introduce Our Panel
Dr Navina Evans
Dr David Bridle
Dr Paul Gilluley
Prof Jonathan Warren
Paul Binfield
Picture to be added
Time for a break
Breakout Session B
Physical Health and Panel Discussion
1. Physical health as a priority area
2. Service user experience of QI
3. Physical activity session
4. Panel discussion
Structure of the session
Emma Binley Darzi Fellow in QI
Our QI work on physical health
with Dr Kevin Cleary (Medical Director)
Why did ELFT make physical health a priority area?
AIM:
Reduce cardiovascular
risk for all adults and children for
whom we initiate or change
psychotropic medication
Information provision
Minimum standards & checks
Pods for community settings
Assessment
Health promotion (exercise, diet, education)
Smoking cessation
Involvement in all QI areas
Monitoring
Communication between services
Improving physical health
collaborative;Driver Diagram
Overview
Leadership
Prescribing
3. Measuring and Reporting• Template development: define
scope, data, spec• Reports & dashboards
1. Equipment
2. Assessment & monitoring
3. Intervention
4. Service user & staff
engagement
Infrastructure
AIM:
Reduce cardiovascular
risk for all adults and children for
whom we initiate or change
psychotropic medication
Minimum standards & checks
Pods for community settings
Assessment
Monitoring
Improving physical health
collaborative;Driver Diagram
Overview
3. Measuring and Reporting• Template development: define
scope, data, spec• Reports & dashboards
1. Equipment
2. Assessment & monitoring
AOS
SCMHT
NCMHT
EQUIP
AIM:
Reduce cardiovascular
risk for all adults and children for
whom we initiate or change
psychotropic medication Health promotion (exercise, diet,
education)
Smoking cessation
Communication between services
Improving physical health
collaborative;Driver Diagram
Overview
Prescribing
3. Intervention
Our QI work on Health Promotion
Physical activity
Behavioural interventions, e.g. motivational interviewing
Informal and formal support; professional and family/peer
Diet and nutrition
Education and information
Communication /pathway between
services
Smoking cessationIn
terv
entio
n Prescribing
Health promotion
Steve Yarnold(Matron & QI Coach)
Sapphire ward
Sapphire ward
What’s next…
Health Promotion QI projects
Wolfson House
John Howard Centre
Newham centre for
Mental Health
AIM:
Reduce cardiovascular
risk for all adults and children for
whom we initiate or change
psychotropic medication
Information provision
Involvement in all QI areas
Improving physical health
collaborative;Driver Diagram
Overview
Leadership
4. Service user & staff
engagement
Infrastructure
Service user’s perspective of QI
What do you think of Bridge Club?
Service user’s perspective of QI
“Thank you for sponsoring the
bridge club”
“I think it’s really good, for health-wise; fitness and stuff like that”” “It’s a good
look, yeah!”
“It’s good to be with my
friends”
James Cook (MBE)
British & European Super-Middleweight
Champion
Boxercise
Boxercise with James Cook
Butabika Link
Moses Wasswa Mulimira(Co-Founder of Uganda Diaspora Health
Foundation)
Olivia Carmichael Butabika Link Coordinator
Be Inspired, Be activeEnhancing physical activity, recovery and reducing mental health stigma through
football at butabika Hospital, kick started the visit
Opening the training workshops
Cohort one
Cohort Two
Ward visits
Key stakeholder engagement
To Summarise…
Jen Taylor-WattQI Lead
Panel discussion
Pose your own questions from your mobile device
Go to slido.com and enter the code 6789
Tweet your thoughts using #QIconf
Let’s Introduce Our Panel
Dr Navina Evans
Dr David Bridle
Dr Paul Gilluley
Prof Jonathan Warren
Paul Binfield
Picture to be added
Legends A joins Legends B
Poster Competition
And the winner is…
Let’s hear from…
Dr Robert Dolan (Chief Executive)
Dr Kevin Cleary (Medical Director)
Let’s hear from the IHI…
Derek Feeley, Chief Executive
Dr Robert Lloyd, Vice President
Andy Cruickshank(Associate Clinical
Director, Borough Lead Nurse & Head of Nursing
for QI)
Professor Michael West
Professor of Work and Organisational psychology, Lancaster University Management
School
Head of Thought Leadership, The King’s Fund
Pose your own questions from your mobile deviceGo to slido.com and enter the code 6789
Tweet your thoughts using #QIConf
Leadership for Continually Improving and Compassionate Care
Michael WestThe King’s Fund,
Lancaster University Management School
178
Leading cultures for high quality care
1. Prioritising an inspirational vision and narrative – focused on quality
2. Clear aligned goals and objectives at every level
3. Good people management and employee engagement
4. Continuous learning and quality improvement
5. Team-working, cooperation and integration
6. Via a values-based, collective leadership strategy
1. Vision, values and strategyVision sets out clear ambition for the future, to guide and inspire the whole organisation1. It is forward looking2. Makes clear commitments3. Is inspiring to and welcomed by stakeholders
‘To deliver continuously improving, high quality and compassionate care to all in our community’‘To be the safest hospital in England’
2. Clear aligned goals at every level• Clear objectives linked to quality improvement• Aligned, measureable and challenging … at every level and feedback on performance
BMJ Quality and Safety, Sept 2013
http://www.lums.lancs.ac.uk/nhs-quality
3. People management and engagement for high quality care
• Patient/service user satisfaction highest where staff have clear goals
• Staff views of leaders linked to patients views of care quality
• Staff satisfaction/commitment predicts patient/service user satisfaction
• High work pressure - patients/service users report too few staff, insufficient support, privacy, respect.• Poor staff health and well-being, high injury rates, audit ratings• Good HRM practices - low patient mortality http://www.dh.gov.uk/health/2011/08/nhs-staff-management/
3. Employee engagement success factors www.kingsfund.org.uk/publications/staff-engagement
A compelling strategic narrative
Inclusive leadership and management styles
Putting staff in charge of service change
• Successful Trusts develop a clear narrative on their purpose and aims
• Salford aimed to be the safest hospital in England
• The happiness of all our staff, through their worthwhile, satisfying employment in a successful business
Values and Integrity
• Successful Trusts have invested in retraining staff to adopt inclusive management styles
• For example, Oxleas has introduced a substantial programme to retrain middle managers in facilitative leadership
• Notts Healthcare NHS FT develops leadership aligned around strategy and values
• Successful Trusts give staff responsibility for leading service change
• Wrightington, Wigan and Leigh works with Unipart to support staff-led change
• Salford’s quality directorate supports teams of frontline staff in testing improvements
• Staff survey evidence highlights importance of values and trust in senior leadership
• Perceptions of unfairness are our best predictor of intention to leave
• In particular, fairness of procedures, bullying and discrimination.
Stable senior leadership
Many of the Trusts with highest levels of engagement have had the same senior leaders for over a decade: CEO of Oxleas in post since 2002, CEO of Salford in post since 2002, CEO of Frimley Park in post since 1998, in comparison
with an average CEO tenure of less than two years.
184
Positive emotion and culture
• Leader positive affect, climate and performance• Processing negative emotion – ‘affective shift’• Dealing with intimidating or disruptive behavior
and poor performance
4. Learning and innovation
A promise to learn – A commitment to act• Staff focused on continually improving patient care and on
ensuring zero harm• Reflective practice and learning endemic• Team learning and cross boundary cooperation, trust, and
openness • High levels of dialogue and discussion end to end and top to
bottom• Effective schemes to promote responsible, safe innovation –
lean, QI
Chassin & Loeb (2013). High reliability health care. Millbank Quarterly, 91, 459-490.
5. Team working, cooperation and integration
Team Leadership
• Offer an inspiring vision and clear direction• Ensure regular and positive team meetings• Encourage positive, supportive relationships• Resolve and prevent intense conflicts• Positive group attitudes towards diversity • Be attentive and listen carefully to the team• Lead inter-team cooperation• Nurture team learning, improvement & innovation
Teams are more effective and innovative to the extent that they routinely take time out to reflect upon their objectives, strategies, processes and environments and make changes accordingly.
Reflexivity
Schippers, West & Dawson, 2012 Journal of Management
6. Collective Leadership
• Leadership the responsibility of all - anyone with expertise taking responsibility when appropriate
• Shared leadership in teams• Interdependent, collaborative leadership - working together to
ensure high quality health and social care• Leaders and teams prioritising quality of care across the
system/organisation • Shared approach to leadership within the leadership community
http://www.kingsfund.org.uk/publications/developing-collective-leadership-health-care West, M. A., Lyubovnikova, J., Eckert, R., & Denis, J.L. , (2014),Collective leadership for cultures of high quality health care. Journal of Organizational Effectiveness: People and Performance, 1, 240 – 260. http://dx.doi.org/10.1108/JOEPP-07-2014-0039
Leadership Typologies
West, Armit, Loewenthal, Eckert, West, & Lee (2015) Leadership and Leadership Development in Health Care: The Evidence Base. London: Faculty of Medical Management and Leadership/The King’s Fund.
How will the organisation ensure the creation of leadership capabilities?
The challenges
health care is facing require
new strategies
New strategies imply new leadership capabilities
These are both
individual and collective leadership capabilities
This requires new and
collective leadership
cultures
Must Deliver These
© Center for Creative Leadership, 2014. Used with permission.
A Leadership Strategy
e.mail [email protected] @westm61
What is compassionate leadership?
What’s coming up in the next year…
Dr Amar ShahAssociate Medical
Director for QI
James InnesHead of QI
Constantly evolving, constantly iterating
Embedding QI in directorates
Making QI work easier
Scale up and spread
Increasing service user, carer or
customer involvement
Linking quality and cost
Our areas of focus
Embedding QI in directorates
Work currently underway
• Developing clear improvement priorities
• Second cohort of QI coaches
• Redesigning recruitment, performance appraisal & leadership strategy
Making QI work easier
Quality and Performance Dashboard
Access Dashboard
Violence Reduction Dashboard
KPIs
Our New QI Web Platform
Project tabs – all elements of a QI project in one place
Project landing page
Driver Diagram page
Example PDSA
Statistical Process Control (SPC) page
- This is being updated for ELFT
SPC Charts – showing
• Special cause variation• Notes• Linked PDSA’s
Example charts from the Analytics area
Scale up and spread
31
S + P+ C = OStructure + Process + Culture = Outcomes
Source: Donabedian, A. Explorations in Quality Assessment and Monitoring. Volume I: The Definition of Quality and Approaches To Its Assessment. Ann Arbor,
MI, Health Administration Press, 1980.
Dr. Avedis Donabedian(1919-2000)
Classic approach to delivering outcomes
1. A system for identifying those projects that are starting to produce results
2. A process to help projects think about scale up or spread
3. Ensuring support of local DMT or wider management team
• Treat as new project
• Will this involve scale up or spread within a directorate or across the Trust?
• Assign relevant sponsors and support
AP D
S
AP
D S
APD
S
A P
DS
Learning from data
4. Use QI methodology to scale & spread
Violence reduction on acute wards and Psychiatric Intensive Care Units (PICUs)Orchestrated Testing
Brick Lane Ward
Mill harbour
Rosebank
Lea Ward
Globe Ward
Roman Ward
Ruth Seifert Ward
Brett Ward
Joshua Ward
Gardner Ward
Bevan PICU
Mother and Baby
Unit
Conolly Ward
Topaz Ward
Opal Ward
Emerald Ward
Sapphire Ward
Jade Ward
Ruby Triage
Crystal PICU
City and Hackney
Newham
Provisional agreement by Borough QI Sponsors and
DMT to scale-up from February 2016
First sta
ge of successfu
l scale-up
Current test-b
ed
2012 -2013
2014-2015
2016 >
Tower Hamlets
Globe Ward
Next stage: Planned
experimentation
Shoreditch(For)
Clerkenwell(For)
PICUs/Forensic learning system
Jan-
12
Feb-
12
Mar
-12
Apr
-12
May
-12
Jun-
12
Jul-1
2
Aug
-12
Sep
-12
Oct
-12
Nov-
12
Dec
-12
Jan-
13
Feb-
13
Mar
-13
Apr
-13
May
-13
Jun-
13
Jul-1
3
Aug
-13
Sep
-13
Oct
-13
Nov
-13
Dec
-13
Jan-
14
Feb-
14
Mar
-14
Apr
-14
May
-14
Jun-
14
Jul-1
4
Aug
-14
Sep
-14
Oct
-14
Nov
-14
Dec
-14
Jan-
15
Feb-
15
Mar
-15
Apr-1
5
May
-15
Jun-
15
Jul-1
5
Aug
-15
Sep
-15
Oct
-15
Nov
-15
Dec
-15
Jan-
16
0
1
2
3
4
5
6
7
8
4.0
0.5
Incidents resulting in physical violence - Run Chart
No.
of
Inci
dent
s
PDSA 1 BVC PDSA 2 BVC + Safety Huddles
87% reduction4 per month
0.5 per month
Violence reduction on acute wards and Psychiatric Intensive Care Units (PICUs)Orchestrated Testing
Brick Lane Ward
Mill harbour
Rosebank
Lea Ward
Globe Ward
Roman Ward
Ruth Seifert Ward
Brett Ward
Joshua Ward
Gardner Ward
Bevan PICU
Mother and Baby
Unit
Conolly Ward
Topaz Ward
Opal Ward
Emerald Ward
Sapphire Ward
Jade Ward
Ruby Triage
Crystal PICU
City and Hackney
Newham
Provisional agreement by Borough QI Sponsors and
DMT to scale-up from February 2016
First sta
ge of successfu
l scale-up
Current test-b
ed
2012 -2013
2014-2015
2016 >
Tower Hamlets
Globe Ward
Next stage: Planned
experimentation
Shoreditch(For)
Clerkenwell(For)
PICUs/Forensic learning system
0
2
4
6
8
10
12
14
16
5.8
2.5
UCL
LCL
Incidents resulting in physical violence per 1000 occupied bed days (OBD) - U Chart
No.
of I
ncid
ents
per
100
0 O
BD
5.8 per month
2.5 per month
57% reduction
Violence reduction on acute wards and Psychiatric Intensive Care Units (PICUs)Orchestrated Testing
Brick Lane Ward
Mill harbour
Rosebank
Lea Ward
Globe Ward
Roman Ward
Ruth Seifert Ward
Brett Ward
Joshua Ward
Gardner Ward
Bevan PICU
Mother and Baby
Unit
Conolly Ward
Topaz Ward
Opal Ward
Emerald Ward
Sapphire Ward
Jade Ward
Ruby Triage
Crystal PICU
City and Hackney
Newham
Provisional agreement by Borough QI Sponsors and
DMT to scale-up from February 2016
First sta
ge of successfu
l scale-up
Current test-b
ed
2012 -2013
2014-2015
2016 >
Tower Hamlets
Globe Ward
Next stage: Planned
experimentation
Shoreditch(For)
Clerkenwell(For)
PICUs/Forensic learning system
Increasing service user, carer or
customer involvement
Service User & Carer QI Steering Group
To a
chie
ve %
serv
ice
user
/car
er in
volv
emen
t in
QI
acro
ss E
LFT
Communication (in and out)
Advertising
Access to information
Support structure
Big I
Service user/carer specific role in project team
Training
Structure/process outlining how service users/carers get involved
Payment
Service user/carer led or co-led projects
Little I
Service user/carer feedback
Partnership working between Quality team and QI Team
Overview of service user/carer
involvement
Monitoring & reporting
Regular Reviews
• Booklet outlining all information about involvement in QI
• Clear structure outlining different levels of support and outlining responsibilities
• Service user/carer involvement in QI forum
• Service user/carer lead in QI central team and each project team
• Role descriptions and contracts • Incorporate QI into recovery syllabus • Buddying up • Regular support sessions for service
users/carers similar to coaches. • Training – not focused on methodology
– more focus communication skills and role plays.
• Service user/carer bespoke group – similar to support QI coaches receive.
• Induction to team and/or trust induction.
• A trust wide survey service users/carers can complete about quality of service and/or QI project on that ward/in that team – similar to friends and family test.
Change Ideas – from strategy meeting 29/10/15
• Regular steering group/oversight meeting.
• Monitoring informatics system that reviews service user/carer involvement at all different stages of the QI project.
• Dashboards
Little i Regularly
consulted during lifetime of the
project
Big I Act as a full member
of the QI project team
Surveys
Focus groups
Community meetings
Service user
forum
Service user input in projects
• Add any questions related to QI work you are undertaking
• Up to date data can then be sent to you
Little i: use existing patient experience feedback systems
• ‘Introduction to QI’ now in Recovery College syllabus
• Other courses useful for those wanting to take part in QI highlighted
• Working with OT to create more opportunities to get service users & carers involved
Big I: Linking QI & Recovery
Linking quality and cost
Improved service user and carer
outcomes
Improved service user and carer
outcomes
More efficient, productive and effective teams
Improved service user and carer
outcomes
More efficient, productive and effective teams
Intangible benefits
Improved service user and carer
outcomes
More efficient, productive and effective teams
Intangible benefitsCash releasing savings
05-A
pr-1
319
-Apr
-13
23-M
ay-1
307
-Jun
-13
16-J
un-1
310
-Jul
-13
11-J
ul-1
321
-Jul
-13
31-J
ul-1
318
-Aug
-13
09-S
ep-1
324
-Sep
-13
18-O
ct-1
324
-Oct
-13
04-N
ov-1
311
-Nov
-13
29-N
ov-1
313
-Jan
-14
11-F
eb-1
425
-Mar
-14
04-A
pr-1
422
-May
-14
06-J
un-1
426
-Jun
-14
12-J
ul-1
422
-Aug
-14
18-N
ov-1
414
-Jan
-15
30-J
an-1
517
-Feb
-15
23-A
pr-1
520
-Jun
-15
09-A
ug-1
5
0
10
20
30
40
50
60
UCLLCL
Days between incidents of physical violence - T Chart
Tim
e be
twee
n ev
ents
/ da
ys
03-N
ov-1
2
26-N
ov-1
2
10-D
ec-1
2
04-J
an-1
3
12-J
an-1
3
29-J
an-1
3
01-F
eb-1
3
28-F
eb-1
3
05-A
pr-1
3
19-A
pr-1
3
13-J
un-1
3
22-A
ug-1
3
24-S
ep-1
3
15-O
ct-1
3
22-O
ct-1
3
03-F
eb-1
4
07-M
ar-1
4
30-A
pr-1
4
28-J
un-1
4
01-N
ov-1
4
22-J
an-1
5
30-J
an-1
5
02-M
ar-1
5
31-M
ar-1
5
21-J
ul-1
5
0
20
40
60
80
100
UCLLCL
Days between staff injury due to physical violence - T Chart
Tim
e be
twee
n ev
ents
/ da
ys
3 days
8 days
8 days
23 days
Apr-13 to Dec-14 Oct-13 to Mar-14 Apr-14 to Dec-14
Number of incidents 44 34 28
Cost attributable to violence £119,988 £72,230 £61,376
Violence ReductionViolence Reduction on older adult wards
Grade 2 Grade 3 Grade 4Pay costs of managing £684 £4530 £17545Non pay costs of managing £129 £945 £8669
Pressure Ulcer Reduction in the community
Apr
-14
May
-14
Jun-
14Ju
l-14
Aug
-14
Sep
-14
Oct
-14
Nov
-14
Dec
-14 .
Sat
07
Mar
15
Sat
14
Mar
15
Sat
21
Mar
15
Sat
28
Mar
15
Sat
04
Apr
15
Sat
11
Apr
15
Sat
18
Apr
15
Sat
25
Apr
15
Sat
02
May
15
Sat
09
May
15
Sat
16
May
15
Sat
23
May
15
Sat
30
May
15
Sat
06
Jun
15S
at 1
3 Ju
n 15
Sat
20
Jun
15S
at 2
7 Ju
n 15
Sat
04
Jul 1
5S
at 1
1 Ju
l 15
Sat
18
Jul 1
5S
at 2
5 Ju
l 15
Sat
01
Aug
15
Sat
08
Aug
15
Sat
15
Aug
15
Sat
22
Aug
15
Sat
29
Aug
15
Sat
05
Sep
15
Sat
12
Sep
15
Sat
19
Sep
15
Sat
26
Sep
15
Sat
03
Oct
15
Sat
10
Oct
15
Sat
17
Oct
15
Sat
24
Oct
15
Sat
31
Oct
15
Sat
07
Nov
15
Sat
14
Nov
15
Sat
21
Nov
15
0%
20%
40%
60%
80%
100%
120%
UCL
LCL
Ivory Ward Bed Occupancy: P Chart
Perc
ent
88%79%
57%
= Baseline dataTarget = 70%
Finance team building a cost model for this work
Looking to spread from Newham to single ward for Hackney/Tower Hamlets
Reducing bed occupancy on older adult functional ward in Newham
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 66 68 70 72 75 77 79 81 84 86 88 93 96 99 101
106
109
112
116
119
0
50
100
150
200
250
300
350
400
450
UCL
Total number of working days from start to finish (I chart)
Case number
Day
s
Implemented new documents and offered two hearing dates
at case number 108
107 days52 days
Data for 14-15
Total cost £892,341
Number of cases 29
Average cost per case £30,770
Average number of days suspended 104
Average cost per day of suspension £296
If we can reduce length of suspension by 50 days, we would save £429,200 per annum
Reducing length of the disciplinary process
Your work is having an impact nationally and globally…
We’re Quality Improving
Stephen SandfordLead for Arts Therapies
Dr Stuart WoodMusic Therapy Research Lead, ELFT / Guildhall School of Music and Drama
Vocals and Lyrics: Von-de-viel NetteyRecording: Camilo Tirado
Music Video: Salem Hanna Music & Video content: ELFT staff
Emma Binley Darzi Fellow in QI
Presents
“We’re Quality Improving”
@ELFT_QIqi.elft.nhs.uk [email protected]