ELFT Quality improvement roadshow - 2014

Quality Improvement Roadshow

Roadshow Video

Our quality improvement programme

Why?

The strategic case for change

Changing the culture through quality improvement

Involvement of service users and carers through every step of the journey

The culture we want to nurture

Our quality improvement programme

How?

Long-term mission and stretch aims

The mission

To provide the highest quality mental health

and community care in England

by 2020

Quality improvement strategy

Reduce harm by 30% every year

Right care, right place, right time

Two stretch aims

Long-term mission and stretch aims

How many incidents of harm were reported in 2013?

How much harm currently occurs in our care?

1. Under 100 6. 2000 – 30002. 100 – 250 7. 3000 – 40003. 250 – 500 8. 4000 – 50004. 500 – 1000 9. 5000 – 60005. 1000 - 2000 10. 6000 - 7000

How many incidents of harm were reported in 2013?

How much harm currently occurs in our care?

1. Under 100 6. 2000 – 30002. 100 – 250 7. 3000 – 40003. 250 – 500 8. 4000 – 50004. 500 – 1000 9. 5000 – 60005. 1000 - 2000 10. 6000 - 7000

Answer = 2881

Long-term mission and stretch aims

What proportion of our patients currently state they are extremely likely to recommend our services to their friends and family?

Patient experience?

1. Under 10%2. 10 – 20%3. 20 – 40%4. 40 – 60%5. 60 – 80%6. 80 – 100%

What proportion of our patients currently state they are extremely likely to recommend our services to their friends and family?

Patient experience?

1. Under 10%2. 10 – 20%3. 20 – 40%4. 40 – 60%5. 60 – 80%6. 80 – 100%

Long-term mission and stretch aims

Central QI team

Functions

Coordinate the programme

Improvement expertise to support frontline work

Learning and sharing – internally & externally

Make-up

Programme director (Medical Director)

Deputy programme director (Associate Medical Director)

Programme manager

Continuous improvement and measurement lead

2 x rotating clinical secondments

Programme support

Central QI team

Building the will

Long-term mission and stretch aims

Traditional engagement

Grassroots movement /

campaign

• Launch event & roadshows• Through formal directorate structures• Local champions

• Q30 (staff) and Q12 (service user) groups to shape our comms• Microsite – as a central resource• Branding & identity

Central QI team

Building the will

Long-term mission and stretch aims

Aligning our systems

Clinical auditReal-time patient experience feedbackLearning from

complaints

Datix improvements

Reviewing our inductions Integrated quality data

available to all

Embedding a structure for listening

Outcome measures

Influencing contracts and CQUINs

Financial measures

Stopping activity of lower value

Central QI team

Building the will

Long-term mission and stretch aims

Aligning our systems

Building improvement skills

Successful improvement

requires a specific set of skills

Most of us have not been trained in improvement

Improvement at scale needs a

consistent approach

Appointment of an external partner to build skills within our workforce at scale & pace

Methodology

How do we deliver a consistent approach to quality?

Introduction to our external partner

Independent, not-for-profit organisation

Based in Cambridge, Massachusetts

Leading innovator, convenor, partner and driver of results in health and healthcare worldwide

5 key areas of work

• Improvement capability• Patient and family-centred care• Patient safety• Quality, cost and value• Triple aim for populations (improving health

outcomes, experience and per capita cost)

A P

DS

Plan

DoStudy

Act

AIM: What are we trying to accomplish?

MEASURES: How will we know if achange is an improvement?

CHANGE: What changes can we makethat will result in improvement?

The Model for Improvement

Plan• Objective• Questions &

predictions• Plan to carry out:

Who?When?How? Where?

Do• Carry out plan• Document

problems• Begin data

analysis

Act• Ready to

implement?• Try something

else?• Next cycle

Study• Complete data

analysis• Compare to

predictions• Summarize

“What will happen if we try something different?”

“Let’s try it!”“Did it work?”

“What’s next? ”

The PDSA Cycle

Spread to other sites / groups / popn

Develop a change

Implement a change

Test a changeTheory and Prediction

Test under a variety of conditions

Make part of routine operations

`

A P

DS

The Steps to Change

Measurement and Using Data for Improvement

How Do ELFT Use Measurement?

MMSE

CQUINS & KPIs

Clinical Trials and Research

Service user outcomes

Service user experience

Waiting lists

BPRS

Blood results

• Research (efficacy)

• Improvement (efficiency and effectiveness)

• Accountability (reassurance, comparison)

The Three Faces of Measurement

ResearchAim New Knowledge (efficacy)

Methods:Test observability

Tests are blinded or controlled

Bias Designed to eliminate bias

Sample size ‘Just in case data’ (very large data sets)

Flexibility of hypothesis

Fixed hypothesis

Testing Strategy One large test

Determining if a change is an improvement

Enumerative Statistics (t-test, p-values)

ImprovementAim Improvement of care

(efficiency and effectiveness)

Methods:Test observability

Tests are observable

Bias Accept consistent bias

Sample size ‘Just enough data’, small sequential samples

Flexibility of hypothesis

Flexible and changes as learning takes place

Testing Strategy Sequential test over time

Determining if a change is an improvement

Analytical statistics. Run and Control charts

AccountabilityAim Comparison, choice,

reassurance, motivation for change

Methods:Test observability

No test, evaluate current performance

Bias Measure and adjust to reduce bias

Sample size Obtain 100% of available, relevant data

Flexibility of hypothesis

No hypothesis

Testing Strategy No tests

Determining if a change is an improvement

No change focus

• Research (efficacy)

• Improvement (efficiency and effectiveness)

• Accountability (reassurance, comparison)

The Three Faces of Measurement

Does this represent improvement?

1.Yes 2. No

• How can you tell if you are improving?

• Data collection and analysis are central to QI• Helps identify quality problems but also opportunities

for improvement• Allows us to track improvement over time• Success of programme will hinge on the

measurements we put in place

Why Measure?

Training Plan for the Organisation

• IHI Open School programme available to all staff

• Face to face training for 200 staff in next year

• Learning Events (Autumn 2014)

Training Plan for the Organisation

“I’m In” Video

Break

Starting an Improvement Project

qi.eastlondon.nhs.uk

Key Ingredients for Success

And why is this important?(the strategic and business case)

What are We Trying to Accomplish?

• Involve members familiar with all different parts of the process

• Effective teams require three kinds of expertise– System leadership– Improvement advice– Day to day leadership - Project leader

• Aim to meet every 1-2 weeks for 30-45 minutes• How will you communicate?• How to bring data to meeting?

Choose your team

The Driver Diagram is a tool to help us understand the system, its outcomes and the processes that drive the outcomes

Defining your messy system

AIM

Primary driver

Primary driver

Secondary driver

Secondary driver

Secondary driver

Secondary driver

Secondary driver

Change 1

Change 2

Change 3

AIM:Lose 5kg

in 3 months

Calories in

Calories out

Limit daily intake

Substitute low calorie

food

Avoid alcohol

Exercise

Fidgeting

Track calories

Plan meals

Drink water, not Coke

Work out 3 times a week

Cycle to work

Hacky sack in office

AIM PRIMARY DRIVERS SECONDARY DRIVERS

CHANGE IDEAS

Improving quality of care on an inpatient female psychiatric ward

Draw a Driver Diagram

A P

DS

Plan

DoStudy

Act

AIM: What are we trying to accomplish?

MEASURES: How will we know if achange is an improvement?

CHANGE: What changes can we makethat will result in improvement?

The Model for Improvement

Video: Overview of the model for improvement

• A strong, measurable aim with a clear time frame will help keep your project on course

• It has to be important to those involved A P

DS

Plan

DoStudy

Act

AIM: What are we trying to accomplish?

MEASURES: How will we know if achange is an improvement?

CHANGE: What changes can we makethat will result in improvement?

The Aim

• Be creative

A P

DS

Plan

DoStudy

Act

AIM: What are we trying to accomplish?

MEASURES: How will we know if achange is an improvement?

CHANGE: What changes can we makethat will result in improvement?

Developing Changes

• Measurement is critical for testing and implementing changes

• Different from measurement for research A P

DS

Plan

DoStudy

Act

AIM: What are we trying to accomplish?

MEASURES: How will we know if achange is an improvement?

CHANGE: What changes can we makethat will result in improvement?

Measurement

Video: The Model for Improvement, Developing Changes and Measurement

The PDSA Cycle

Plan• Objective• Questions &

predictions• Plan to carry out:

Who?When?How? Where?

Do• Carry out plan• Document

problems• Begin data

analysis

Act• Ready to

implement?• Try something

else?• Next cycle

Study• Complete data

analysis• Compare to

predictions• Summarize

“What will happen if we try something different?”

“Let’s try it!”“Did it work?”

“What’s next? ”

Video: The PDSA Cycle

Complete Project Charter

• Email to QI team • qi@eastlondon.nhs.uk• QI team will get in contact in a few days

• Make sure you have right ingredients for success• Help finalise charter• Make sure your project aligns with programme

aims• Link you with support on project and

methodology• Provide support and access to BMJ Quality

platform

The QI Team Will…

Draft Measurement Framework

Mission and AimsMission: Highest Quality Mental Health and Community Care in England

Stretch Aim 1: Right care, Right Time

Stretch Aim 2: Reduce Harm

Improved Patient Experience

Summary and Close