1. QUALITY: MK
A whole system approach to quality improvement
Milton Keynes, June 2009
Sue Lacey Bryant, Programme Manager
Sue.Lacey-Bryant@mkpct.nhs.uk
health:mk
2. Working in partnership
health:mk
NHS Milton Keynes
LINKs-MK
Centre for Evidence
Based Medicine
health:mk
3. Our aim
Create a self-improving system to make a
reality of three widely used slogans…
• Evidence based
• Primary care led
• Patient engagement
health:mk
4. How are we going about it?
Repeated cycles of
learning from projects
Create relevant…
•Culture and values
•Skills and capacity
•Systems & processes
health:mk
5. Commissioning for improvement:
Service review and redesign
•Smoking cessation: revised pathway
•Alcohol introduction of brief interventions
•Weight management new service for children
•Diabetes: care planning approach
community based service
•Mild/moderate depression user designed service
…. At varying stages of progress, all based on evidence with
clinicians on each group & combinations of public engagement
and user involvement in service design
health:mk
6. In practice and across primary care
evidence-based
discussion groups
Share and spread –
inc. supporting 3
prescribing projects
•E-B skills training & toolkit
•Librarian support IMPACTE groups
Improving Medical Practice by
•Pharmacist support Assessing CurrentT Evidence
inc. toolkits
health:mk
7. Patient and public engagement
• Two PPE representatives
on each TaF
• Training workshops for
commissioners
• Learning from experience
• Appropriate approaches
• Rules of engagement • Patient empowerment
• Embedding patient and through information
public involvement in the • Patient participation
planning process groups
health:mk
8. Building a self-improving system
Multiple channels for innovation and improvement;
Mainstreaming a systematic approach to service review
and redesign
Clinical effectiveness; Map of Medicine as default
Defining, documenting: tools & templates
communications, engagement, evidence, prescribing
Assuring information data flows
System and process inc. PEC, HR
Learning culture
Public and patient engagement
Seeing it through; supporting the change leads
Making it easier to work with these values, than not to ..
health:mk
9. What have we learned?
Lead with values Embed change into the
Listen; trust patients and system. Change:
service users values
Support skill development agenda setting
consistent with values and planning process
identify QI skills as core decision criteria
Be prepared to make, resource allocation
admit and align organisational
& learn from mistakes processes with values
Be persistent
Tighten programme mgt
health:mk
10. Things to do sooner ... or differently
Recruit clinical
champions
Strengthen channels for Worry less about QI
engagement and inviting process techniques
local expertise Use data persuasively:
Offer better information & Generate light, not heat
support for PPE Pay more attention to
Clearer terms of reference
how to implement change
Explicit accountability Diagnose barriers
health:mk
11. ... and from the project leads
Use the evidence
Prioritise
“Raise the flag”
Importance of leadership
Clear objectives
Focus on outcomes
Nurture the partnerships
Build the team
Challenge assumptions
Reflect
health:mk
12. How are we getting on?
“A dynamic & organic shift”
“The success of this programme can be seen in
the high level of patient and clinician
involvement”
“... with greater use of evidence”
“There is an explosion of patient involvement”
health:mk
13. Roadmap to quality improvement
Explaining the Setting out the
system process
Tools, Best practice
techniques to
deliver Quality Guidance on
Improvement “how to”
health:mk
Notas do Editor
Thank you; delighted to be asked to share our experience. Quality:MK is one of nine projects comprising a national scheme Engaging with Quality in Primary Care (funded by The Health Foundation. The aim is to establish a whole system approach to improving health care that is driven by primary care, patient engagement and evidence-based practice. So – this is not a victory narrative, and there are parallels with my experience of driving around MK – where I get caught out by a mismatch between the map and the road ahead, and take many a second tour of a roundabout, quality improvement is an iterative, messy yet very worthwhile journey On a journey – starting from a position where could already see all sorts of good practice – yet room for improvement, closer relationships, and not a strong culture of PPE or evidence-based practice
– 26 of 27general practices formerly Patient and Public Involvement Forum --- Local Involvement Network NHS Milton Keynes – initiated within the Public Health Directorate of the PCT, sit within the commissioning arm Colleagues in the audience from each of the 3 local partners
What are we trying to do? Placing evidence, service users and primary care right at the heart of decision making and the quality improvement agenda - and keeping them there Building our knowledge and understanding of how to deliver and sustain improvement, using the lessons learned through an ambitious programme of Quality:MK projects to help line up the ‘cogs and wheels’ needed to build a self-improving system Explicit focus on learning and improvement process; ongoing process of continual, self-conscious change. The application of best evidence to healthcare will yield quality improvements;
Using repeated cycles of learning from projects to design and implement changes in system & organisational process Establish multiple channels for innovation and improvement; Mix of large-scale service review and redesign projects AND Projects initiated by practices – either as “bright ideas” or deriving from discussions of the evidence
Mainstreaming a systematic approach to service review and redesign Adopting Map of Medicine 12 task and finish groups: 100+ participants
14 groups in all: 7 for practice staff: 5 in practice – 4 meeting regularly for some time now, plus two new groups 1 IMPACTE central and 1 IMPACTE online – 7 meeting in community services, most on an occasional basis. Well over a 100 participants, over 10 topics discussed Brought in a clinical effectiveness pharmacist to develop projects and toolkits, to to build up a network, to attract change, and support wider adoption of changes in practice All the CATs are listed on our website pages, currently on PCT website Back in Jan 09 - 55 topics discussed across all journal clubs. 36 of these within 5 GP practices. Of these 36 topics, 32 have been followed up with further investigation 4 have led to an actual change in practice: 1. Delayed prescribing as strategy to reduce antibiotic use 2. Interventions for alcohol misuse 3. Fever in under 5s 4. Lipid Modification hot on the heels of preparation of the first 3 implementation toolkits for prescribing projects, steering group will choose their next 3 topics in July.
As the current LITs are revamped; guidance on patient and public engagement to be prepared and issued to each LIT Chair on ensuring active involvement. This guidance to model the health:mk approach (whereby there is always some form of patient engagement but it takes different forms eg. perhaps commenting on a specification rather than helping to devise it). Develop a joint statement on the benefits of public and patient engagement, the benefits of partnership working and the “Golden Rules”, to be taken forward by NHS Milton Keynes, health:mk and LINk:MK as local partners PPI in planning process includes – enabling patients and the public to place issues on the agenda New guide for PPGs
Changes in system and process for service planning: patient engagement, clinical engagement, evidence-based inc. decision-makers need to demonstrate their use of evidence
Lessons taken from a presentation that Nick gave in Berlin about the emerging lessons from our work
from the Programme Manager These are some the things I wish I had done sooner or differently - - Paul Plsek - Engaging Physicians in a Shared Quality Agenda. IHI
These are some of the things the project leads have said: Inc believe the evidence of change management
From independent qualitative evaluation by PHRU showing evidence of a positive impact. Focus is on embedding the work, holding the gains and pushing on with the journey.
“ Continual improvement is an unending journey.” As first tranche of projects draw to a close over next year, already shaping Quality:MK Mark3 to continue after the close of HF funding – pleased to be asked to support work on review of stroke services, looking to develop a project on Domestic violence, assimilating the learning from another HF project Aim of microsite - to support the integration and ‘embedding’ of the Quality:MK principles into commissioning, planning and delivery. Mid-october If of any use to you in your mission - please make free use of any of the resources there - summaries of keynote papers on QI, current awareness services – new one on cost and quality – Learn from your experience as fellow travellers .. Thank you for yourtime-
