1. Derek Feeley
Director-General Health and Social Care and Chief
Executive NHSScotland
Jason Leitch
Clinical Director, The Quality Unit, Scottish
Government

4. The Edge of Glory?

6. A legitimate Statement of Values
“The Lothian Way” has been developed within NHS Lothian
as a set of emergent values and associated behaviours
identified as vital elements of the culture that NHS
Lothian wants to build. Patients are first and foremost in
this set of values however staff motivation and
organisational reputation are central too. They are as
follows:
– Person Centred
– Partnership
– Integrity
– Accountability
– Innovation

7. Underlying cultural assumptions
(the unwritten rules)
Many organisations have unwritten rules which
describe ‘the way we do things around here’. In
NHS Lothian the following have been described
consistently to us in one-to-one interviews:
• Suppression of bad news – do not write it down
• Gloss
• You are on your own – ‘Just fix It’ “

8. Some less prominent headlines (in May alone…)

9. The real world?
• Performance continues to improve
• In many areas it is better than ever (and
world class)
• We can’t afford to stand still
• Attitudes, ethics and values are as
important as technical excellence
• Reliability just as important in these areas
– every person every time

10. We should choose to learn!
“What if we choose to change? Could we
craft joy from loss, pride from revision, and
excellence from invention?
Yes we can.”
Don Berwick; British Journal of General Practice; Feb 2009

11. To change and to persist!
“There were a number of
definitions of courage, but
now I was seeing it in its
simplest form: you do
what has to be done day
after day, and you never
quit.”
― Eric Greitens, The Heart
and the Fist: The Education
of a Humanitarian, the
Making of a Navy SEAL

12. To make the right thing easier to
do!

13. Tough Love?

14. So what if……?
• We had the courage to persist in our
pursuit of world-class care
• We continued to make care safer, more
effective and more person-centred
• We choose to learn together
• We share and renew our ethics and
values
• We make the right thing easier to do
• We get ready for the next curve

15. 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

16. 2020 Vision
Everyone is able to live longer
healthier lives at home, or in a
homely setting.

17. Getting to the third curve
Co-production
& assets
Performance
Improvement
Performance
Time

18. What will it take?
• Redesign, creativity and innovation
• New technologies and better use of
existing technology
• Prevention, assets and activation
• Up our game on person centred care
• Continued focus on performance and
improvement
• Shared and renewed ethics and values

19. JL

20. Getting to the third curve
Performance
s
il ie
d fam
s an
t
ti en
Pa
Time

21. Getting to the third curve
Performance
Performance
Time

23. Median and 90th percentile waits for IP/DC
Median (days) 90th percentile (days)
120
105
100
Wait (days)
80 63
60
35
40 25
20
0
Ju 8
Ju 9
Ju 0
Ju 1
2
M 8
M 0
M 9
M 1
N 8
N 0
N 1
N 9
-0
-1
-0
-1
-1
-0
-0
-1
-1
l-0
l-0
l-1
l-1
ar
ar
ar
ar
ar
ov
ov
ov
ov
M
Quarter ending

24. Patient journeys within 18 weeks
50%
60%
70%
80%
90%
100%
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Month
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
% of patient journeys within 18 weeks

25. “The overall financial
performance of the NHS is good”
Audit Scotland, 2011
good = euphoria

26. Getting to the third curve
Performance
Improvement
Performance
Time

28. “The Scottish Patient Safety Programme is without doubt one
of the most ambitious patient safety initiatives in the world –
national in scale, bold in aims, and disciplined in science. It
harnesses the energies and wisdom of Scotland’s health care
leaders –NHS executives, QIS experts, clinical professionals,
civil servants, and more – all aligned toward a common vision,
making Scotland the safest nation on earth from the viewpoint
o
of health care.”
Don Berwick

29. Ja
10
12
14
16
18
20
22
24
26
28
30
n-
08
Ap
r- 0
8
Ju
l-0
8
O
ct
-0
8
18.2%
Ja
n-
09
Ap
r- 0
9
Ju
l-0
9
O
ct
-0
9
Ja
n-
10
Ap
r- 1
0
Ju
l-1
0
O
ct
-1
0
Ja
% ICU mortality
n-
11
Ap
r- 1
1
Ju
l-1
1
O
ct
24% improvement
-1
1
13.9%

30. Surgical Mortality
28%

31. Scotland HSMR – 9.5% reduction
Standardised Mortality Ratio (SMR) Regression line
1.5
Standardised Mortality Ratio
1.0
0.5
Oct- Apr- Oct- Apr- Oct- Apr- Oct- Apr- Oct- Apr- Oct-
Dec Jun Dec Jun Dec Jun Dec Jun Dec Jun Dec
2006 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011p

32. 20%

34. 11.5%

35. Median Time to IV Fluids Percentage Oxygen Complance
Sepsis bundle compliance
120%
02:09
01:55 100%
01:40
80%
01:26
01:12 60%
00:57
40%
00:43 100
00:28 20%
00:14 90 0%
00:00 02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
02/04/12 80
09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
70 Median Time to Blood Cultures Percentage Compliance IV Fluids
120%
02:52
02:24 60 100%
80%
01:55
50 60%
01:26
00:57 40 40%
20%
00:28
30 0%
00:00
02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
20
Median Time to Lactate
02:52
10 Percentage Compliance of Blood Cultures
45%
40%
02:24 0 35%
01:55 02/04/12 09/04/12 16/04/12 23/04/12 30/04/12
30% 07/05/12 14/05/12
25%
01:26 20%
15%
00:57
10%
5%
00:28
0%
00:00 02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12
02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12

36. Harm-free care

37. Katy: Zero Pressure
Ulcers Stages 3 & 4
To: Memorial Hermann Katy Hospital
Zero Pressure Ulcers for 36 Months
January 1, 2008 to December 31, 2010
Zero Pressure Ulcers x 36 Months

38. Northwest: Zero Retained
Foreign Bodies
To: Memorial Hermann Northwest Hospital
Zero Retained Foreign Bodies for 24 Months
January 1, 2010 to December 31, 2010
Zero Retained Foreign Bodies x 24 Months

39. Sugar Land: Zero Central
Line Blood Stream Infections
To: Memorial Hermann Sugar Land Hospital
Zero Central Line Associated Blood Stream
Infections for 36 Months
February 1, 2008 to January 31, 2011
Zero CLABSIs x 36 Months

40. High Reliability
Certified Zero Hospitals
Central Line Associated Bloodstream Infections (4)
Ventilator Associated Pneumonias (7)
2012 Surgical Site Infections
40
Awards
Retained Foreign Bodies (9)
Iatrogenic Pneumothorax (4)
Accidental Punctures and Lacerations
Pressure Ulcers Stages III & IV (8)
Hospital Associated Injuries (2)
Deep Vein Thrombosis and/or Pulmonary Embolism (1)
Deaths Among Surgical Inpatients with
Serious Treatable Complications
Birth Traumas (4)
Serious Safety Events (1)

41. "Quality is never an accident;
it is always the result of high
intention, sincere effort,
intelligent direction and
skillful execution; it
represents the wise choice of
many alternatives.”
1941, William A. Foster

42. Getting to the third curve
Co-production
& assets
Performance
Improvement
Performance
Time

44. ~6500
people

45. Bedday rate for patients aged 75+,
emergency admissions
6500
Bedday rate per 1000 aged 75+
6000
Borders
Lothian
5500
~550 beds
Board
average
5000
Highland
Ayrshire &
Arran
4500 Tayside
Re-shaping Care
Prog/LTC Prog
4000
0 6 0 7 0 8 0 9 1 0 1 1
M ar- M ar- M ar- M ar- M ar- M ar- Sept-11
Year ending
Prepared by Peter Knight JIT June12

46. Doors

52. Person centred health and
care programme
Coming soon

53. DF

54. Assets vs Deficits
Assets thinking Deficit thinking
•Strengths based •Problem orientated
•How can we create •How to fix this problem?
community spirit? •Someone needs to sort this
•What can I do? •Us versus them
•We’re all in this together •Problems are embedded
•We’re getting there •Do things to people
•Work with engaged people •People are a problem
•People have the answers •People can’t be trusted to
•People control their lives decide/be in control

56. Values on the way to work

57. Derek’s Values
• Advocacy
• Accessibility
• Ambition
• Authenticity

58. Jason’s values
• Person-centred
• Pioneering
• Restless
• Aspiring

63. The Edge of Glory
Please complete your cards

64. Ethics and Glory
“Glory, built on selfish principles, is shame and
guilt”
William Cowper
“Glory follows virtue as if it were its shadow”
Cicero
“Glory lies in the attempt to reach one’s goal and
not in reaching it”
Mahatma Ghandi

65. So are you ready to……?
• Show the courage to persist in our pursuit
of world-class care
• Continue to make care safer, more
effective and more person-centred
• Choose to learn together
• Share and renew our ethics and values
• Make the right thing easier to do
• Get ready for the next curve

66. The Edge of Glory!