Open Day August 2015.pdf
Transcript of Open Day August 2015.pdf
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qi.elft.nhs.uk [email protected]
@ELFT_QI
Welcome to the ELFT QI
open morning
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Our focus on Quality Improvement
with Dr Kevin Cleary (Medical Director)
Professor Jonathan Warren (Director of Nursing)
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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
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Challenges and
opportunities in East London
Cultural diversity
Social deprivation
Geographical diversity
Commissioning arrangements
Financial stability and
strong assurance systems
@ELFT_QI
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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
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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
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Research & innovation
Quality improvement
Assurance, control &
performance managament
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A perspective from a non-executive
member of our Board
with Jennifer Kay
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Our quality
improvement programme
with Dr Amar Shah (Associate Medical Director for QI)
James Innes (Head of Quality Improvement)
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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
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@ELFT_QI
Trust board bespoke learning sessions
Visiting other organisations that successfully implemented QI
Sentinel event
Focus groups
Building the will for change
Early small scale tests of QI methodology
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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 has 50,000 page views to date qi.elft.nhs.uk
Staff and service user newsletter reaches 5000 people every month
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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 has 60,000 page views to date qi.elft.nhs.uk
Staff and service user newsletter reaches 5000 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
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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 has 50,000 page views to date qi.elft.nhs.uk
Staff and service user newsletter reaches 5000 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
Annual QI conference attended by over 270 staff, patients and external partners
ELFT experience day attended by over 70 international delegates
QI visibility wall to describe programme & update on progress
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AIM: To provide the highest
quality mental
health and community
care in England by
2020 Build improvement
capability
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Experts
Front line staff
Clinical leaders
Directorate improvement
leads
Executives
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 = 25 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 clinical and service leads to have
completed the ISIA training within 2 years
Leading & Facilitating change programme will train 30 QI
coaches in 2015
On track. Most Executives will have undertaken the
ISIA, and all will have received Board training with
the non-Executives
Currently have 3 improvement advisors, with
1.5wte deployed to QI. To develop 5 more in 2015.
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AIM: To provide the highest
quality mental
health and community
care in England by
2020 Build improvement
capability
Support for improvement work from the Trusts QI
team
Partnership with IHI on delivery of QI training to
staff and Trust Board, and strategic guidance from IHI
executive team
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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
IHI Open School online training resource available to all. Providing essential skills to support people leading quality improvement.
Support for improvement work from the Trusts QI
team
Partnership with IHI on delivery of QI training to
staff and Trust Board, and strategic guidance from IHI
executive team
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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.
Improvement Science in Action - 6 month learning path
Learning set 1
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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
QI coaches- 30 staff to become coaches, spending 1 day/week
supporting local QI projects
IHI Open School online training resource available to all. Providing essential skills to support people leading quality improvement.
Support for improvement work from the Trusts QI
team
Working upstream with external partners to build capability around continuous improvement
Partnership with IHI on delivery of QI training to
staff and Trust Board, and strategic guidance from IHI
executive team
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Time for a video
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
Alignment
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Starting an
Improvement Project
At ELFT
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qi.elft.nhs.uk
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28
To assist in this process we
have a Project Charter form that defines
what we want to accomplish.
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Driver Diagrams
Support and resources available on microsite: http://qi.elft.nhs.uk/driver-diagrams/
http://qi.eastlondon.nhs.uk/driver-diagrams/http://qi.eastlondon.nhs.uk/driver-diagrams/http://qi.eastlondon.nhs.uk/driver-diagrams/http://qi.eastlondon.nhs.uk/driver-diagrams/http://qi.eastlondon.nhs.uk/driver-diagrams/http://qi.eastlondon.nhs.uk/driver-diagrams/ -
Complete Your Charter and Driver Diagram!
Email to QI team
QI team or QI coach will get in contact in a few days
mailto:[email protected] -
QI Resources
Project Sponsor
QI Forums
QI Coach
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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
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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
Learning and coaching over 6 months
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
A process is in place for teams to submit project ideas to the QI team, who will help with planning, structure and measurement, and ensure projects are aligned with our high-level aims.
Quality improvement programme-project support structures
Alignment
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
Alignment
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AIM: To provide the highest
quality mental
health and community
care in England by
2020
QI projects
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Our QI Projects
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Trust project status over time
14 12 11 11 15 11
60
16 17 17 1815
15
15
31 2925 23 25
22
21
1919
20 2024
26
25
99 13 13
1716
15
97 10 10
1217
17
26
7 7
9 9
10
3 32 2
4 3
3
1 1 2 2
5 7
7
16-Mar-15 30-Mar-15 13-Apr-15 27-Apr-15 19-May-15 28-May-15 15-Jun-15
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May
-
June
-
July
1
7
0 0 1
5 63
11
4
33
2 1
0
9
4
33
2
4
2
6
3
3
2
3
62
4
3
2
6
2
1
1
2 3
1
2
2
1
7
7
1
1
3
2
1
3
0
12
5
2
1
Addictions Children'sServices
CommunityHealth Newham
MHCOP City and HackneyMental Health
Corporate Forensics Newham MentalHealth
PsychologicalServices &LearningDisability
Tower HamletsMental Health
5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5
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Right Care, Right Place, Right Time
MHCOP Larch Lodge, Cedar Lodge, Sally Sherman Ward
CHN EPCS Teams (North East, North
West, Central, South) Multiple I/P Wards (Cazebon, Sally
Sherman and Fothergaile)
City & Hackney Adult Psychiatry CMHT, All CMHTs, Assertive Outreach, Rehab, Joshua, Conolly
Newham CMHTs, Newham Centre for Mental Health
CHN / MHCOP Urgent Care Centre
Childrens Newham CFCS, CDC West Ham
Lane, Community CAMHS TH, OT, Health Visiting
CHN / MHCOP Newham Memory Service
C&H South CMHT, AOS & CRRT, North
Team 1 Recovery/Primary Care
Forensics Clerkenwell, West Ferry Ward
REDUCE HARM BY 30% EVERY
YEAR
RIGHT CARE, RIGHT PLACE, RIGHT TIME
VIOLENCE REDUCTION
PHYSICAL HEALTH
ACCESS TO SERVICES
PRESSURE ULCERS
TH Collaborative Roman, Globe, Bricklane, Lea, Millharbour, Rosebank
Childrens All Community CAMHS, Adolescent MHT
Forensics Woodberry, Victoria, Limehouse, Morrison
Psychological / LD Community Learning Disability Service
Smoking Forensics, Millharbour
Psychological Older People Richmond /
Newham, City and Hackney, Newham
CAMHS Coborn Unit
Tower Hamlets
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Time to meet some of our
projects
Rooms:
4 (lower ground floor) 5 (lower ground floor) Training room (ground floor) 9 (4th floor)
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Is it making a difference?
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Datix incident reporting 40% reduction across the Trust
170.9
103.1
UCL
LCL
70
90
110
130
150
170
190
210
230
Jan
-13
Fe
b-1
3
Ma
r-1
3
Ap
r-13
Ma
y-1
3
Jun
-13
Jul-
13
Au
g-1
3
Se
p-1
3
Oct-
13
Nov-1
3
Dec-1
3
Jan
-14
Fe
b-1
4
Ma
r-1
4
Ap
r-14
Ma
y-1
4
Jun
-14
Jul-
14
Au
g-1
4
Se
p-1
4
Oct-
14
Nov-1
4
Dec-1
4
Jan
-15
Fe
b-1
5
Ma
r-1
5
Ap
r-15
Ma
y-1
5
No
. o
f In
cid
en
ts
Number of Incidents resulting in Physical Violence (Trust-wide) - C Chart
171 per month
103 per month
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0
5
10
15
20
25
30
35
Jan
-13
Feb
-13
Mar
-13
Ap
r-1
3
May
-13
Jun
-13
Jul-
13
Au
g-1
3
Sep
-13
Oct
-13
No
v-1
3
Dec
-13
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
No
. o
f In
cid
en
ts p
er
10
00 O
BD
Incidents of physical violence per 1000 occupied bed days (OBD)
Participating wards
Non-Participating wards
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UCL
LCL
10
20
30
40
50
60
70
80
90
Jan
-13
Fe
b-1
3
Ma
r-1
3
Ap
r-13
Ma
y-1
3
Jun
-13
Jul-
13
Au
g-1
3
Se
p-1
3
Oct-
13
Nov-1
3
Dec-1
3
Jan
-14
Fe
b-1
4
Ma
r-1
4
Ap
r-14
Ma
y-1
4
Jun
-14
Jul-
14
Au
g-1
4
Se
p-1
4
Oct-
14
Nov-1
4
Dec-1
4
Jan
-15
Fe
b-1
5
Ma
r-1
5
Ap
r-15
Ma
y-1
5
No
. o
f In
cid
en
ts
Incidents resulting in restraint in prone position at ELFT - C Chart
59 per month
33 per month
44% reduction
UCL
LCL
70
80
90
100
110
120
130
140
150
160
170
Jan
-13
Fe
b-1
3
Ma
r-1
3
Ap
r-13
Ma
y-1
3
Jun
-13
Jul-
13
Au
g-1
3
Se
p-1
3
Oct-
13
Nov-1
3
Dec-1
3
Jan
-14
Fe
b-1
4
Ma
r-1
4
Ap
r-14
Ma
y-1
4
Jun
-14
Jul-
14
Au
g-1
4
Se
p-1
4
Oct-
14
Nov-1
4
Dec-1
4
Jan
-15
Fe
b-1
5
Ma
r-1
5
Ap
r-15
Ma
y-1
5
No
. o
f In
cid
en
ts
Incidents resulting in Restraint at ELFT - C Chart 134 per month
114 per month
15% reduction
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UCL
LCL 0
1
2
3
4
5
6
7
8
9
10
Ap
r-14
Ap
r-14
Ma
y-1
4
Ma
y-1
4
Jun
-14
Jun
-14
Jun
-14
Jul-
14
Jul-
14
Au
g-1
4
Au
g-1
4
Se
p-1
4
Se
p-1
4
Oct-
14
Oct-
14
Nov-1
4
Nov-1
4
Dec-1
4
Dec-1
4
Dec-1
4
Jan
-15
Jan
-15
Fe
b-1
5
Fe
b-1
5
Ma
r-1
5
Ma
r-1
5
Ap
r-15
Ap
r-15
Ma
y-1
5
Ma
y-1
5
Jun
-15
Jun
-15
Jun
-15
Grade 3-4 Pressure Ulcers - C Chart
6.4 per month
3.2 per month
50% reduction
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Series3
Series4
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%2
8-A
pr-
14
05-M
ay-1
41
2-M
ay-1
41
9-M
ay-1
42
6-M
ay-1
40
2-J
un-1
40
9-J
un-1
41
6-J
un-1
42
3-J
un-1
43
0-J
un-1
40
7-J
ul-1
41
4-J
ul-1
42
1-J
ul-1
42
8-J
ul-1
40
4-A
ug
-14
11-A
ug
-14
18-A
ug
-14
25-A
ug
-14
01-S
ep
-14
08-S
ep
-14
15-S
ep
-14
22-S
ep
-14
29-S
ep
-14
06-O
ct-
14
13-O
ct-
14
20-O
ct-
14
27-O
ct-
14
03-N
ov-1
41
0-N
ov-1
41
7-N
ov-1
42
4-N
ov-1
40
1-D
ec-1
40
8-D
ec-1
41
5-D
ec-1
42
2-D
ec-1
42
9-D
ec-1
40
5-J
an-1
51
2-J
an-1
51
9-J
an-1
52
6-J
an-1
50
2-F
eb
-15
09-F
eb
-15
16-F
eb
-15
23-F
eb
-15
02-M
ar-
15
16-M
ar-
00
23-M
ar-
15
30-M
ar-
15
06-A
pr-
15
13-A
pr-
15
20-A
pr-
15
27-A
pr-
15
04-M
ay-1
51
1-M
ay-1
51
8-M
ay-1
52
5-M
ay-1
50
1-J
un-1
50
8-J
un-1
51
5-J
un-1
52
2-J
un-1
52
9-J
un-1
50
6-J
ul-1
51
3-J
ul-1
5
Overall Waterlow Completion Rate in EPCT - P Chart
57%
97%
40% increase in reliability
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Leading cultural
transformation through QI
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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
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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
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qi.elft.nhs.uk [email protected] @ELFT_QI