Aula em inglês de Jason Leitch, diretor clínico da Unidade de Qualidade do Governo Escocês, durante o II Seminário Internacional sobre Qualidade em Saúde e Segurança do Paciente - evento do Qualisus - que ocorreu dias 13 e 14 de Agosto de 2013, no Ministério da Saúde, em Brasília.

1. Scotland’s Approach to
Safety and Quality
Jason Leitch
Clinical Director
The Quality Unit, Scottish Government
@jasonleitch

2. • 5 million people
• £12 billion
• 14 Health Boards
• 8 Support Boards
• Integrated delivery
• Moving towards
social care
integration

3. Public Finances
Fall in Government expenditure

4. Health Budget

5. 191119311951197119912011
Source: Scotland 2011 Census
Scotland’s Demographics 1911 - 2011

6. Projected % Change in Scotland’s Population
by age group 2006-2031
Source: GRO Scotland, 2007

8. Strategic Objectives

9. Aims:
To deliver the highest
quality healthcare services
to the people of Scotland
For NHSScotland to be
recognised as world-
leading in the quality of
healthcare it provides

10. The Healthcare Quality Strategy for Scotland
Person-Centred - Mutually beneficial partnerships between
patients, their families, and those delivering healthcare
services which respect individual needs and values, and which
demonstrate compassion, continuity, clear communication,
and shared decision making.
Effective - The most appropriate treatments, interventions,
support, and services will be provided at the right time to
everyone who will benefit, and wasteful or harmful variation
will be eradicated.
Safe - There will be no avoidable injury or harm to patients
from healthcare they receive, and an appropriate clean and
safe environment will be provided for the delivery of
healthcare services at all times.

11. Triple Aim
Health of the
Population
Experience of
Care
Best Value
for Money
The IHI Triple Aim

12. Evidence based discovery
Evidence based delivery
17 years to get 14% of evidence
into practice

13. Implementing at scale….
can it be done?

15. Improve Safety of
Healthcare
Services in
Scotland
(15% reduction in
HSMR by end of
2012)
Boards accept SPSP as a
key strategic priority for
effective governance
Scottish Government
sets SPSP as strategic
priority
Deliver the
programme
Build a sustainable
infrastructure for
improvement
Align SPSP with
national improvement
programmes
Primary Drivers
Demonstrable results
Clear, shared measurement set
Visible on all senior leader agendas
A cohesive and united programme
Secondary Drivers
Agreed set of outcomes
Review & address outcome delivery
Quality & safety on every agenda
Infrastructure supports
Involve patients
Clinical faculty expert at
improvement methods and coaching
Programme design and structure
BTS collaborative
Acceptance of pragmatic science
Royal Colleges support
Inventory of national programmes
Engage with national programmes
Harmonize metrics

16. By what method?
W. Edwards Deming

17. DESIGN DESIGN DESIGN DESIGN APPROVE
Conference Room
Real World
The Typical Approach…
IMPLEMENT

18. DESIGN
TEST &
MODIFY
TEST &
MODIFY
APPROVE
IF NECESSARY
Conference Room
Real World
TEST &
MODIFY
The Quality Improvement Approach
STARTTO
IMPLEMENT

19. Our change theory
 A clear and stretch goal
 A method
 Predictive, iterative testing

20. Breakthrough Series Collaborative

21. ‘This model is not magic, but it is
probably the most useful single
framework I have encountered in
twenty years of my own work on
quality improvement’
Dr Donald M. Berwick
Former Administrator of the Centres for Medicare &
Medicaid Services
Professor of Paediatrics and Health Care Policy
at the Harvard Medical School
The Model for
Improvement

22. NHSScotland Surgical Safety Briefings

23. 23% reduction from median
NHSScotland Surgical Mortality

24. Hospital Standardised Mortality Ratios
(Seasonally Adjusted) Scotland: Dec 2002 to Mar 2012
0.6
0.7
0.8
0.9
1.0
1.1
1.2
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
Quarters
Smoothed
SMR
average annual reduction
4.2%
(Apr 2010 to Mar 2012)
1.4%
average annual reduction
(Oct 2002 to Jan 2010)
SmoothedSMR

26. How has the frontline done it?
Get goals
Get bold
Get together
Get a model (and stick
with it)
Get patients and
families
Get the facts
Get to the field
Get a clock
Get the numbers
Get the stories

29. The Early Years Collaborative -
Ambition
To make Scotland the best place in the world to
grow up in by improving outcomes, and
reducing inequalities, for all babies, children,
mothers, fathers and families across Scotland to
ensure that all children have the best start in life
and are ready to succeed.

30. The Early Years Collaborative - Aims
1. To ensure that women experience positive pregnancies which result in the birth of
more healthy babies as evidenced by a reduction of 15% in the rates of
stillbirths (from 4.9 per 1,000 births in 2010 to 4.3 per 1,000 births in 2015) and
infant mortality (from 3.7 per 1,000 live births in 2010 to 3.1 per 1,000 live births in
2015).
2. To ensure that 85% of all children within each Community Planning
Partnership have reached all of the expected developmental
milestones at the time of the child’s 27-30 month child health review, by
end-2016.
3. To ensure that 90% of all children within each Community Planning Partnership
have reached all of the expected developmental milestones at the
time the child starts primary school, by end-2017.

32. Scotland’s 2020 Vision:
The Quality Strategy:
The Quality Improvement Hub:
Some Useful Links
Institute for Healthcare Improvement:

34. @jasonleitch