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
46
47
4849
50
51
52
53
54
55
56
57
58
59
60
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)