Slides from the East London NHS Foundation Trust roadshow on quality improvement

1. Quality Improvement
Roadshow

2. Roadshow Video

3. Our quality
improvement programme
Why?

4. The strategic case for change

5. Changing the culture through quality improvement
Involvement of service users and carers through every step of the journey

6. The culture we want to nurture

8. Our quality
improvement programme
How?

9. 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

10. Long-term
mission and
stretch aims

11. How many incidents of harm were reported in 2013?
How much harm currently occurs in our care?
1. Under 100 6. 2000 – 3000
2. 100 – 250 7. 3000 – 4000
3. 250 – 500 8. 4000 – 5000
4. 500 – 1000 9. 5000 – 6000
5. 1000 - 2000 10. 6000 - 7000

12. How many incidents of harm were reported in 2013?
How much harm currently occurs in our care?
1. Under 100 6. 2000 – 3000
2. 100 – 250 7. 3000 – 4000
3. 250 – 500 8. 4000 – 5000
4. 500 – 1000 9. 5000 – 6000
5. 1000 - 2000 10. 6000 - 7000
Answer = 2881

13. Long-term
mission and
stretch aims

14. 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%

15. 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%

16. 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

17. 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

18. Central QI
team
Building the
will
Long-term
mission and
stretch aims
Aligning our
systems
Clinical audit
Real-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

19. 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

20. Methodology
How do we deliver a consistent approach to quality?

21. Introduction to our external partner

22. 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)

23. The Model for Improvement

24. “What will happen if
we try something
different?”
“Let’s try it!”“Did it work?”
“What’s next? ”
The PDSA Cycle

25. 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
The Steps to Change

26. Measurement and
Using Data for
Improvement

27. How Do ELFT Use Measurement?
MMSE
CQUINS & KPIs
Clinical Trials and Research
Service user outcomes
Service user experience
Waiting lists
BPRS
Blood results

28. • Research (efficacy)
• Improvement (efficiency and effectiveness)
• Accountability (reassurance, comparison)
The Three Faces of Measurement

29. Research
Aim 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)

30. Improvement
Aim 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

31. Accountability
Aim 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

32. • Research (efficacy)
• Improvement (efficiency and effectiveness)
• Accountability (reassurance, comparison)
The Three Faces of Measurement

34. Does this represent improvement?
1.Yes 2. No

36. • 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?

37. Training Plan for the Organisation

38. • 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

39. “I’m In” Video

40. Break

41. Starting an
Improvement Project

42. qi.eastlondon.nhs.uk

44. Key Ingredients for Success

45. And why is this important?
(the strategic and business case)
What are We Trying to Accomplish?

46. • 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

47. 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

48. AIM
Primary
driver
Primary
driver
Secondary
driver
Secondary
driver
Secondary
driver
Secondary
driver
Secondary
driver
Change
1
Change
2
Change
3

49. 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

50. AIM PRIMARY DRIVERS SECONDARY
DRIVERS
CHANGE IDEAS
Improving quality of care on an inpatient female
psychiatric ward

52. Draw a Driver Diagram

53. The Model for Improvement

54. Video: Overview of the model for
improvement

55. • A strong, measurable
aim with a clear time
frame will help keep
your project on course
• It has to be important to
those involved
The Aim

56. • Be creative
Developing Changes

57. • Measurement is critical
for testing and
implementing changes
• Different from
measurement for
research
Measurement

58. Video: The Model for Improvement,
Developing Changes and Measurement

59. The PDSA Cycle
“What will happen if
we try something
different?”
“Let’s try it!”
“Did it work?”
“What’s next? ”

60. Video: The PDSA Cycle

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

62. • 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…

63. Draft Measurement
Framework

64. Mission and Aims
Mission: Highest Quality Mental Health and Community Care in England
Stretch Aim 1: Right care, Right Time
Stretch Aim 2: Reduce Harm

65. Improved Patient Experience

66. Summary and Close