Sustainability in quality improvement - CSH Networks · Sustainability in Quality Improvement...
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Sustainability in quality improvement Dr. Frances Mortimer Medical Director, Centre for Sustainable Healthcare, Oxford February 2017 Sustainability in Quality Improvement training materials, developed by the Centre for Sustainable Healthcare with grant funding from North Bristol NHS Trust.
Transcript of Sustainability in quality improvement - CSH Networks · Sustainability in Quality Improvement...
Sustainabilityinqualityimprovement
Dr.FrancesMortimerMedicalDirector,CentreforSustainableHealthcare,Oxford
February2017
SustainabilityinQualityImprovementtrainingmaterials,developedbytheCentreforSustainableHealthcarewithgrantfundingfromNorthBristolNHSTrust.
Aims– youshouldbeableto:
1. Recognise sustainabilityasadomainofqualityinhealthcareanddiscussitsrelationshiptootherdomains.
2. Reviewtheenvironmental,socialandeconomicinputstoagivenhealthsystem,andidentifyrelevantcarbonhotspots.
3. ApplytheprinciplesofsustainableclinicalpracticeinthedesignofaQIintervention.
4. Identifyoutcomeandactivitymeasuresinordertoevaluateimpactonsustainability/sustainablevalue.
“Ourvisionofsustainablehealthandcare:Asustainablehealthandcaresystemworkswithintheavailableenvironmentalandsocialresourcesprotectingandimprovinghealthnowandforfuturegenerations.”
Sustainabilityasadomainofquality
SustainablePatient CentredEquitable
Efficient
Effective
Timely
Safe
Dr Donal O’DonoghueNational Clinical Director for
Kidney Care 2007-13
Seealso:Atkinson,S.etal.Defining QualityandQualityImprovement.Clin Medvol.10,no.6537-539(2010)
SettingQIgoalsIncludingsustainabilitywithinyourprojectaims(howwillthisaffectengagementwithcolleaguesandwiderstakeholders?)
Sustainable value in healthcare:
Academy of Medical Royal Colleges, 2016 (with CSH)
(goods – harms)
Informedbypatientvalues
outcomesValue =
environmental + social + financial costs(the “triple bottom line”)
SustainableQI
StudyingthesystemUnderstandingenvironmental andsocialresourceuseandimpacts
Carbonhotspots
Socialimpacts– onwhom?
👤 Patient👥 Staff👥 Carers👥 Dependants👥 Localcommunity👥 Distantcommunities(e.g.supplychainworkers)
Socialimpactsondistantcommunities
“Labourers insurgicalinstrumentmanufactureareoftenpaidlessthanUS$1perday,havepoorjobsecurity,havewoefullyinadequateprotectionofhealthandsafety,andmanyemployeesarechildren,someasyoungassevenyearsold.”BMAMedicalFair&EthicalTradeGroup
Socialsustainability• Basicneeds,includinghousingandenvironmentalhealth• Educationandskills• Employment• Equity• Humanrightsandgender• Poverty• Socialjustice• Demographicchange(ageing,migrationandmobility)• Socialmixingandcohesion• Identity,senseofplaceandculture• Empowerment,participationandaccess• HealthandSafety• Socialcapital*• Wellbeing,HappinessandQualityofLife
*definedas“networkstogetherwithsharednorms,valuesandunderstandingsthatfacilitateco-operationwithinoramonggroups”(OECD)
Source:Colantonio,A.&Dixon,T.(2009)MeasuringSociallySustainableUrbanRegenerationinEurope.OxfordInstituteforSustainableDevelopment(OISD)
DesigningyourQIinterventionApplyingtheprinciplesofsustainableclinicalpractice
Howwill80%carbonreductionbeachieved?
Sustainableclinicalpractice:principles
Reducecarbonwithoutreducing
health
Reduceactivity
Prevention
Selfcare
Leanpathways
Reducecarbonintensity
Lowcarbonalternatives
Sustainableestates
Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11
Outcomeneeded
Secondarydrivers
Primarydriver
Primarydriver
CENTRE forSUSTAINABLEHEALTHCARE
Sustainableclinicalpractice:principles
Reducecarbonwithoutreducing
health
Reduceactivity
Prevention
Selfcare
Leanpathways
Reducecarbonintensity
Lowcarbonalternatives
Sustainableestates
Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11
Outcomeneeded
Secondarydrivers
Primarydriver
Primarydriver
CENTRE forSUSTAINABLEHEALTHCARE
Sustainableclinicalpractice:principles
Reducecarbonwithoutreducing
health
Reduceactivity
Prevention
Selfcare
Leanpathways
Reducecarbonintensity
Lowcarbonalternatives
Sustainableestates
Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11
Sustainableclinicalpractice
Outcomeneeded
Secondarydrivers
Primarydriver
Primarydriver
Infrastructure&processCENTRE for
SUSTAINABLEHEALTHCARE
e.g.drypowderinhalers(1/20xcarbonofMDI)
Improvesustainabilityofrespiratoryinhalerprescribing
1.Preventavoidablerespiratorydisease
Reducesmoking Reviewreferral ratestosmokingcessationservice
Reducecold/mould exposure Investigatehousingimprovementreferral scheme
ReduceairpollutantexposureInputtolocaltransportpolicy
Ensurepatientsreceiveairqualityhealthadvice
2.Empowerpatientstoimprovediseasemanagement
Co-production
Ensureyearlycareplanning
Rescue packsforacuteexacerbations
Socialprescribing Singing/pulmonaryrehabreferral forms
3.Ensureleanprescribinganddispensingsystems
Leancommunications Introducepaperlessprescribing/repeat requests
Highvalueprescribing Introduceannualinhalerreviews
4.Switch tolowercarbonalternatives Preferential useofDPIvsMDI inhalers
Updateprescribingguidelines
Writearticle forlocalGPnewsletter
5.ImproveoperationalresourceuseInhalerrecycling Signpostrecyclingpoints
Waste,energy,travel Relevantactions
Leansystems…spottingwaste
• Outofdatestock• Singleuseitems• Cancellation• Packaging• Standby• Noncompliance• Waitingtime• Commutingtime• …canyouadd2moreeuphemismsforwaste?
Yourservice- sustainableclinicalpractice
Principle Opportunities?
1.Prevention
2.Patientempowermentandselfcare
3.Leansystems
4.Lowcarbonalternatives
Yourservice- sustainableresourceuseResourceuse Opportunities?
Energy
Travel(staff,patients)
Medicalsupplies
Non-medicalsupplies
Water
Waste
Prioritise
Opportunity Impact(1-3) Feasibility(1-3)
Measuringenvironmentalandsocialcosts/impacts
Sustainable value in healthcare:
Academy of Medical Royal Colleges, 2016 (with CSH)
(goods – harms)
Informedbypatientvalues
outcomesValue =
environmental + social + financial costs(the “triple bottom line”)
EnvironmentalCosts
Carbonfootprint- thesumofgreenhousegasemissionsreleasedinrelationtoanorganisation,productorservice,expressedascarbondioxideequivalents(CO2e).
Carbonfootprint:whatisincluded?(operationalboundaries)
Scope3:Indirectemissions
(other)
Scope2:Indirectemissions
(electricity)
Scope1:Direct emissions
• Supplychain• Travel• Wastedisposal
• Electricityuse
• Energygeneration• Vehicleemissions• HFCs,N2O,etc.
Topdowninput-output
Bottomupprocess-based
Emissionsfactorsappliedtocomponentsofaprocessorproduct,e.g.materials,energyuse
Emissionsfactorsappliedtospendindifferenteconomicsectors
Hybrid
Methods
Availablefromhttp://www.ukconversionfactorscarbonsmart.co.uk/
Greenhousegasemissionsfactors– UKGovt
Goodsandservicescarbonhotspots, NHSSustainableDevelopmentUnit(2013)
Care Pathways Guidance on Appraising Sustainability (SDU, 2015)
Carbonbyunitsofhealthcareactivity
Measuringenvironmentalcosts- exampleAprimarycareteamnoticedthatsomepatientswhowerereferredforhipandkneereplacementswerebeing
referredbacktotheGPsurgeryafterpre-operativeassessmentatthelocalhospital.Thiswasbecauseparameters,suchasbloodpressure,wereeitheroutsidethetargetrangeorwerenotcommunicatedproperly
inthereferralinformation.Anauditrevealedthat1in6patientsloopedthroughthesystem– 10/year.
Activity Outcome £’s CO2e Social
ExtraGPconsult [delaytosurgery]
£451 18kg2 Patient&carertime/stress
ExtraHospitalconsult [delaytosurgery]
£1121 23kg2 Patient&carertime/stress(parking…)
Total (for 10loops) £1570 410kg
1. UnitCostsofHealthandCare,PSSRU,December2015.Availableat:http://www.pssru.ac.uk/project-pages/unit-costs/2015/index.php2. CarbonHotspotsupdateforthehealthandcaresectorinEngland2015,SustainableDevelopmentUnit,January2016.
CharlieKenward,SevernGPST3SustainabilityScholar2014-15
Measuringsocialimpacts?
Patients Carers Community Supplychain Staff
Housing
Poverty
Health
Education
Employment
Safety/security
Satisfaction
Participation
Socialgradient
Canyouidentifyoutcomeandactivitymeasurestoevaluatesustainabilityimpactof…?
• Introducingone-stopservice,e.g.• Breastlumpassessment• Peripheralvasculardisease• Backpain
• Integratingpreventativeservices,e.g.• Vascularclinic– smokingcessationetc• Gallstonespathway- dietetics
• Overnight>daycasesurgery,e.g.• Laparoscopiccholecystectomy• Roboticprostatectomy
ThinkingsustainablywithinaQIproject
1. ApplysustainabilityapproachatthedifferentstagesofANYproject
2. Chooseaprojectareathatrelatescloselytosustainability,e.g.a. Prevention,patientempowerment,etc.b. Reducingpharmaceuticalwastec. Reducingover-investigation/over-treatment
http://sustainablehealthcare.org.ukfrances.mortimer@sustainablehealthcare.org.uk
