The UCLH Quality Improvement Framework Guy Young Head of Quality Improvement.

The UCLH Quality Improvement Framework

Guy YoungHead of Quality Improvement

What is quality?

• Excellence in meeting customers’ expectations

• In healthcare 3 components:– Is it safe?– Is it effective?– Is the experience good for the patient?

Why do we need a quality improvement programme?

Falls with harm 2010-2011

0

5

10

15

20

25

30

April

May

June Ju

ly

Augus

t

Septe

mbe

r

Octob

er

Novem

ber

Decem

ber

Janu

ary

Febr

uary

Mar

chApr

ilM

ay

June Ju

ly

Augus

tSep

tOct

NovDec Ja

nFe

b

Mar

ch

Nu

mb

er

Moderate +

All harm

Target

Composite patient experience scores 2010/11

80

81

82

83

84

85

86

87

88

89

90

Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11

%

Wardreception

desk

Midwives station

Midwives stationDischarge

lounge

Clean utility

Treatment room

Dirty utility

Patient bathroom

Patient board

Patie

nt

bo

ard

2.

36

3.

1.

4

5.

6.

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

242526

27

28

29

30

31

32

33

34

35

Paeds room

37

38

39

40

41

42

SPAGHETTI DIAGRAM OF ONE MIDWIVES’S TRAVEL ON POSTNATAL WARD

Key Findings:•In one hour, one midwife in charge of discharging women from the ward had 62 different stop offs•Clusters of stop offs at patient boards, midwives stations, bays of women being discharged and in the clean utility room•Midwife was interrupted twelve times with questions and queries from colleagues, women and their partners•Difficult to identify which woman to discharge next because of information on the patient white boards.•Ward environment increases hunting and gathering time.

43

44

45

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4849

50

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54

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57

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61

62

The UCLH Quality Improvement Framework

• A way of delivering continuous quality improvement at ward/unit level driven by frontline staff– Draws on:

• Transforming Care at the Bedside• Productive Ward• Lean

• Aligns well with HIAs and Energising for Excellence

Key themes

• Transformational Leadership

• Safe and Reliable Care

• Vitality and Teamwork

• Patient-Centered Care

• Value-added Care Processes

Cross cutting interventions

• Intentional rounding

• Patient status boards

• SBAR

• The Well Organised Ward (5S)

• Care bundles

How it is done?

• Change driven by frontline staff

• Staff agree areas for improvement and identify potential solutions (snorkel)

• Small tests of change

• Adoption and spread

Results of a snorkel

Small tests of change

• Small means small!– One nurse– One patient– One time/one shift

The PDSA Model Components

• Plan an activity or improvement test

• Do the activity (implement the improvement plan)

• Study the Impact of the improvement plan (what was learned)

• Act determine what changes are to be made in light of what you have learned.

Measures Display Boards

Patient status board

Environments after 5s

Situation to date• 8 pathfinder wards

– 4 TCAB– 4 Productive ward

• 6 new wards this year

• From May onwards 4 wards to join every 2 months

• 1 full day start up training required (5 staff)