Local Improvement following National Clinical Audit Linda Chadburn, Governance Manager, Mersey Care NHS Trust July 2012.

Local Improvement following

National Clinical Audit

Linda Chadburn, Governance Manager, Mersey Care NHS Trust

July 2012

Me

Context

• Experiences of the Trust

• Using national audit results

• Practical steps taken to make change happen

Case Studies

• National Audit of Falls and Bone Health (Round Three)

• National Audit of Schizophrenia (Round One)

• 2 NCAs = 2 models

Model one• NCA: Falls and bone health

– Stakeholders involved: Senior Physiotherapist and me

– College Liaison: me– Data collection: Senior Physiotherapist– Considered results: together– Identified issues: together– Developed action plan: together

Lone working• Owned the action plan

– Senior Physiotherapist

• Implemented action plan – Senior Physiotherapist

• Develop policy, changes in process, introduce new assessments, and…. – Senior Physiotherapist

• Report progress to me: – Senior Physiotherapist

Experiences

• Using NCA results to make improvements: – Isolated– No-one knows you’re doing it at all– Ineffective

• Lessons learnt

• Time to test out another model

Model two

• NCA: Schizophrenia– Increased number of stakeholders:

consultants, service users, carers, audit team and me– Pilot: service users, carers, PALS, RCPSYCH, audit

team and me – Three aspects of main audit:

• Service user: own survey form• Carer: own survey form• Consultants: own audit tool• Audit team: upload consultant data

The continuum

• Lots of activity

• Wait for report

• Risk of inertia

• Options

Analysing the options

Sit and wait for the report

Plan strategically

Just go for it

Benefit:

Real results

Benefit:

Maintain momentum

Risk:Break the rules

Risk:Inertia

Risk:Low risk

Benefit:

Make best-fit

The strategic option

FrameworkStep One Step Two Step Three Step Four Step Five Step Six

Benefits:Making use of national audit data

Improves patient care

Provide high quality service

Coalition:Stakeholder discussion

Knowledge base

Influence and power

Strategy:Shared aims & objectives

Ownership

Champions

Work group

Barriers:Conflicting priorities

Power struggles

Accepting responsibility

Methodology:Sharing event

Gain perspectives of stakeholders

Identify areas for improvement

Develop action plan

Momentum:Maintain enthusiasm

Maintain stakeholder involvement

Share successes

The session

Aim

To understand the audit results and engage in discussion, giving own perspective; encouraging the identification of areas for improvement and consideration of ‘CLEVER’ actions.

Involvement & engagement• Encourage participation• Issues identified in writing• Discussed as a group• Recommendations for improvement identified• Recommendations turned into actions• Actions tested

Are the actions CLEVER?C what costs are predicted to implement the

action?L who will lead the action?E what evidence will confirm implementation of

the action?V will the action add value to the service?E what is the predicted end date?R are sufficient resources in place to implement

the action?

Template action plan

Recommendation:

Action Costs Lead Evidence Value End date Resources Progress

1.

2.

3.

Resistance

Ownership

• Identify champions• Maintain momentum and engagement• Engagement = motivation• NAS Champion Group formed

– Monitor action plan– Call upon resources

Model of achievement

Share successes

Maintain involvement