Healthcare quality lessons from the best small country in the world

Transcription

1 Healthcare quality lessons from the best small country in the world

2 Scotland and Canada

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5 Scotland

6 5.5 Million people

7 Scottish Politics

8 Scottish Politics Devolution Scottish National Party minority Government Devolved powers Health Education Criminal justice Agriculture Transport

9 NHS Scotland 10.3 billion Integrated health and social care 14 territorial boards Special boards NHS Education for Scotland NHS Quality Improvement Scotland NHS Health Scotland NHS National Services Scotland National Waiting Times Centre Scottish Ambulance Service State Hospital

10 NHS Boards Responsible for individual and population health Acute hospitals - 15,000 beds in 37 hospitals Rural General Hospitals Community Hospitals Community Health Partnerships Primary healthcare and social care

11 NHS Scotland Leadership Board Chairs meet with Cabinet Secretary monthly Board Chief Execs meet with NHS Scotland Chief Exec monthly Medical Directors meet monthly Finance Directors meet monthly Nurse Directors meet monthly

12 All cause mortality: Males 0-64, 2001 Glasgow

13 Male alcohol-related deaths in Scotland

14 4 ways to deliver public services (LeGrand 2007)

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16 The NHS No cannula in ambulance Nurse handwashing in A&E X-ray in an hour Admitted in two hours Medicines reconciliation Operated next day HDU recovery Stroke assessment

17 The NHS A&E consultant hand washing Ward information leaflet No surgical review in HDU Nutrition Water Milkshakes Wound sores National Clinical Lead and medical records!

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20 Outcome Aims Mortality: 15% reduction Adverse Events: 30% reduction Ventilator Associated Pneumonia: 0 or 300 days between Central Line Bloodstream Infection: 0 or 300 days between Blood Sugars w/in Range (ITU/HDU): 80% or > w/in range MRSA Bloodstream Infection: 30% reduction Crash Calls: 30% reduction

21 Primary Outcomes Develop and build a quality improvement and patient safety culture in our hospitals Build in long term sustainability and capability to drive this approach at all levels

22 Interventions Critical Care Ventilator acquired pneumonia bundle, central line Ward Early rescue Communication Medicines Medicines reconciliation Theatres Surgical pause Infection prevention/control Leadership Safety walkrounds Executive leadership board patient safety profile

23 The Improvement Guide, API

24 Rapid Cycle Change with PDSA What does this mean? Plan, Do, Study, Act Rapid cycle starts with e.g. One doctor, one nurse, one patient Moving to All These changes happen in hours and days not weeks and months

25 Ventilator Care bundle Head of bed elevation 30 degrees Sedation vacation PUD prophylaxis DVT prophylaxis Multi Disciplinary Rounds Daily goals

26 Reality! Measurement of the ventilator bundle elements for 8 patients Head of Bed > 30 degrees = 35% Sedation Hold = 50% PUD prophylaxis = 85% DVT prophylaxis = 100% Bundle All or nothing concept 0% compliance to the ventilator bundle

27 Aim: Reduce VAP rates by 30% by Oct 2006 by implementing the VAP care bundle in Intensive care Measures Cycle 1e: Test sedation hold on all patients with completion of a ventilator bundle sticker Cycle 1a: Test sedation hold element of bundle on one patient with one nurse and one anaesthetist Cycle 1d: Test sedation hold guideline with exclusions five patients with five nurses and one anaesthetist Cycle 1c: Test sedation hold element of bundle on three patients with three nurses and one anaesthetist using feedback from first test Cycle 1b:Test repeated with another patient with different nurse and anesthetist Process Change: Testing the sedation hold element of the ventilator bundle with frontline staff

28 NHS Tayside Ninewells, ventilator associated pneumonia Implementation of daily goals TREND Oral hygiene element of VAP bundle implemented SHIFT

29 Number of Boards - Met Programme Goals Mortality: 15% reduction Adverse Events: 30% reduction Ventilator Associated Pneumonia: 0 or 300 days between Central Line Bloodstream Infection: 0 or 300 days between Blood Sugars w/in Range (ITU/HDU): 80% or >w/in range Staph aureus bacteraemias: 30% reduction Crash Calls: 30% reduction Harm from Anti-coagulation: 30% reduction in INRs> 6 Surgical Site Infections: 50% reduction in population of choice

30 Number of Boards - Statistically Significant Improvements Mortality: 15% reduction Adverse Events: 30% reduction Ventilator Associated Pneumonia: 0 or 300 days between Central Line Bloodstream Infection: 0 or 300 days between Blood Sugars w/in Range (ITU/HDU): 80% or >w/in range Staph aureus bacteraemias: 30% reduction Crash Calls: 30% reduction Harm from Anti-coagulation: 30% reduction in INRs> 6 Surgical Site Infections: 50% reduction in population of choice

31 Forth Valley - mortality

32 100% Daily Goals Set and Reviewed > 1 time in the day Aim #1 >80% by March 2009, Aim #2 >95% by June 2009 GRI ICU Percentage had Daily Goals Set and Reviewed > 1 time 90% 80% 100% 70% 60% 50% 80% 60% 40% 30% 20% 40% 20% 10% 0% Jun-08 Aug-08 Oct-08 Dec-08 Feb-09 Apr-09 Jun-09 Aug-09 Oct-09 Dec-09 0% Jul-08 Sep-08 Nov-08 Jan-09 Mar-09 May-09 Jul-09 Sep-09 Nov-09 Days GRI ICU Monthly Average Length of Stay (days) Jan-03 Jul-03 Jan-04 Jul-04 Jan-05 Jul-05 Jan-06 Jul-06 Jan-07 Jul-07 Jan-08 Jul-08 Jan-09 Jul-09 UCL LCL Process Avg Daily Goals & VAP Prevention bundle start Jan-10

33 NHS Lothian Central line infection

34 A&A VAP rate

35 NHS Fife 24 wards, peripheral vascular catheter bundle compliance

36 NHS Highland Raigmore medical receiving unit

37 NHS Borders pilot ward c-diff

38 NHS Lanarkshire C.Diff in each hospital

39 D&G Early Warning Scoring

40 D&G Crash Call Rate

41 NHS Grampian theatre briefings

42 NHS Grampian DVT prophylaxis

43 NHS Orkney Hand hygiene

44 NHS Scotland Hand hygiene

45 Future Developments Paediatric Primary care Mental health Heart failure Pressure ulcers

46 Leadership Driver Diagram Develop the infrastructure to support quality and safety improvement Provide the leadership system to support the implementation of safety and quality outcomes in your NHS Board Provide oversight to programme Promote the position of safety and Quality in the organisation

47 Highest Performing Boards See extranet data regularly Discuss HSMR and question executive team about it Receive reports on extent of harm in hospital and see a plan to reduce it Board members on walkarounds Have safety and quality as first board agenda item

48 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 of health care. Don Berwick, CEO and President, Institute for Healthcare Improvement

49 Patient Centred Healthcare Our new approach to achieving world-leading Healthcare Quality

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51 Proposed New Quality Aims 1. To make NHS Scotland a world leader in healthcare quality improvement. 2. To do so in a way that is meaningful to all.

52 Key messages Focus on results Build capability quickly Rationalise measurement All improvement is local Build a guiding coalition in your context Patient voice Enjoy the work

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54 We look to Scotland for all our ideas of civilisation. Voltaire (Francois Marie Arouet, )