Improving health outcomes across England by providing improvement and change expertise

Supporting and Delivering Patient Safety Collaboratives

Fiona Thow Phil Duncan

Responding to Francis and Berwick

“The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end.”

Berwick Report, August 2013

A Different kind of Collaborative

• Locally driven

• Designed in partnership

• Provide support, co-ordination & rapid spread and adoption

• Developing capacity & capability for QI & Safety

For NHS staff and clinicians:

• Participate actively in the improvement of

systems of care

• Acquire the skills to do so

• Speak up when things go wrong

• Involve patients as active partners and co-

producers in their own care

Patients as leaders and true partners

Co- producing the safety programme

Framework for Operational Excellence

©Alan Frankel and IHI 2013

A system devoted to continual learning and improvement

A clear and practical framework made up of two “organ systems” - culture and learning process, if the culture isn’t right there will be no learning. The learning system is underpinned by culture, the foundation for the delivery of safe, high quality care

©Alan Frankel and IHI 2013

Underpinning improvement : the Framework for Operational Excellence

Culture – the foundations

• Culture is uniquely local - the social glue in an organisation, ‘the way we do things round here’

• High performing teams have clearly agreed norms of behaviour and structures that support behaviours that create value for the patient, staff and the organisation.

• Measuring culture provides valuable (personal) insights into what it really feels like to work in that environment in a particular role

• Insights can be quite disparate - "the doctors or managers think it's fine, and no one else does"

• Evidence on culture - perceptions about teamwork, safety, and leadership correlate with the quality of care and ‘excellence’

Critical components of culture in healthcare are Leadership, Psychological Safety and Teamwork

©Alan Frankel and IHI 2013

Learning – a system

Every day skilled healthcare professionals face challenges with basic defects and flaws that make it difficult to deliver high quality care • A learning system provides a methodical way to

visibly capture concerns, act on them, introducing a cycle of learning and improvement

• This is an essential component of high performing

organisation

Critical components of a learning system are

Reliability, Improvement and Measurement and Continuous Learning Processes

©Alan Frankel and IHI 2013

Using the principles of the Safety Framework

• Patients, families and carers involved in agreeing and designing priorities

• Focusing on creating the right culture

• Creating a system that continues to learn

• Using appropriate quality and safety improvement methodology

• Measurement & Leadership are key !

Programme Aim

Improve safety by working in

partnership to create the conditions

for a safer culture and enabling

continuous learning

What are the conditions?

• Patient Safety Collaboratives – co-ordinate and

connect 15 patient safety collaboratives as an enabler

for safety improvement

• Leadership – build on existing leadership capability to

support a safer culture, at all levels in the system

• Measurement – improve the measurement of safety by

co-ordinating and supporting the development of

measurement capability – “How much, by when?”

The conditions… • Patients as partners – Involve patients and carers as

active partners to co-produce the programme

• Large scale change – connect improvement ideas and innovation, building momentum for change, embracing new methods to share key learning for spread. Building sustainability.

• Capability and capacity – build on existing knowledge and skills, identifying where resource is in the current system and developing new knowledge to support improvement action

What have we heard to date?

• Locally led collaborative programmes • Build on pockets of excellence and communities

of interest • Help with capability building, metric

development and national aggregation / ROI • QI and programme advice and guidance • Co-produce - avoid duplication and share best

practice and resources • Challenge the system - critical friend • Help align work and join up the dots nationally

Quality improvement approach

• Patient focussed - experience of care expertise

• Focus on practical delivery and implementation – the ‘how to do it’

• Empower all staff to make a change

• Avoid duplication and re-inventing the wheel

• Use improvement methods that fit the task in hand

• Aim for large scale and transformational change

• Capture learning that can be adopted and improvements that can be sustained

The ‘operational model’ National Patient Safety Collaborative Programme - Operational Model

Pressure Ulcers VTE

Medication

Errors HCAI Maternity Falls

AHSN

1 x x x

2 x x x

3 x x x

4 x x

5 x x

6 x x x

7 x x

8 x x

9 x x

10 x x x

11 x x x

12 x

13 x x x

14 x x

15 x x

Leadership and Measurement

NHS IQAcceleratedLearning Groups

EvidenceToolkitsSocial mediaCampaignsSpread

Cluster groups

• Primary focus: leadership, measurement and

quality improvement and safety capability

• Medicines, AKI, Mental Health, Pressure Ulcers…

• Group focus on topic specific improvement

• Bringing expertise together with practical

application

• Peer support and problem solving

• Accelerate and share learning across the NHS

Key principles

• Build on existing good work

• Establish ‘how’ to implement current evidence

• Test and refine new ways of working – where evidence

may be lacking

• Influence levers and drivers in the system to support safer

care

• Align initiatives – making safety everyone’s business

• Staff and patients – tools, skills and support

• Share learning across the NHS

#saferNHS

enquiries@nhsiq.nhs.uk

www.nhsiq.nhs.uk

Improving health outcomes across England

by providing improvement and change expertise.