Quality Improvement in Social Work Regional Programme
Contents Foreword 1 Introduction 2 Programme Aims and Objectives 3 Content 3 Delivery 4 Expectations 5 Evaluation 5 Timetable 6 Outline 7 Appendices Section 1. Quality Improvement Methodology - The Model for Improvement 11 2. Guidance on selecting your Improvement Initiative 13 3. Reading materials & useful links 14 4. Who s who? 15 Speakers 15 Implementation Team 18 Mentors 19 Acknowledgements 20
Foreword I am delighted to welcome the development of a regional quality improvement learning programme for social work. This programme provides a unique opportunity for social work in Northern Ireland to lead improvement focused practice across the region using a set of techniques based on improvement and implementation science. Involvement of service users, carers and front line practitioners is essential if we are to see improvements that make a real difference to peoples experiences of our services. A greater focus on outcomes and measuring improvements will ensure that safety, quality and service user experience is at the heart of all we do. I would like to acknowledge all those who had the vision and foresight to commission this development and thank everyone whose dedication and commitment has made this programme possible. Sean Holland Chief Social Services Officer 1
Introduction The Strategy for Social Work in Northern Ireland, Improving and Safeguarding Social Wellbeing 2012-2022 outlines key strategic priorities for the delivery of safe, quality services. These need to be led by skilled professionals who can implement change and continuous improvement which will improve outcomes for service users. To support the social work profession to develop skills and knowledge in continuous quality improvement, a regional learning forum has been established and a quality improvement programme developed. This programme Quality Improvement in Social Work is based on the Institute of Health Care (IHI) Improvement Safety Framework which presents a model for examining the safety and quality of service delivery for patients and service users. IHI Safety Framework This programme will provide an opportunity for social work training/governance staff and operational leaders to develop a set of common techniques to achieve improvements in care and lead improvement focused practice across the five Trusts. The programme has been designed to meet the needs of social work professionals committed to leading continual quality improvement and is linked to The Attributes Framework: Supporting Leadership for Quality Improvement and Safety in Health and Social Care, which is informed by the principles and values within the Quality 2020strategy (DHSSPS 2011). 2
Programme Aim The overall aim of this pilot programme is to develop and strengthen social work practitioners and leaders by utilising quality improvement techniques and to contribute to the regional development of quality improvement in social work. Objectives To support the achievement of the overall aim and provide safer, better quality care for ALL service users, the programme will:- Increase the capability of participants in undertaking quality improvement initiatives that result in measurable and sustained improvements for service users receiving a social care service. Support participants to develop an understanding in the processes involved in improving quality, safety and service user experience Equip staff with skills in continuous quality improvement and sustainability Support the development of a regional learning community to share good practice. Content The programme will commence on Wednesday 2 December 2015 with a launch and participant induction, followed by a series of eight tutorial days commencing in January 2016. The programme will cover a range of topics based on the IHI Patient Safety Framework including:- Culture of Quality & Safety Model for Improvement Measurement for improvement Human factors in Quality & Safety Communication and teamwork Improving person centred care Sustaining improvement Leadership and managing change. 3
Delivery Programme delivery will be through a combination of learning techniques, multiple media activities and exercises, small group and plenary discussion. Coaching in improvement methodology and implementation will support participants throughout, alongside a range of other creative resources and activities. Tutorial days will present a range of topics from both internal and external speakers. Each afternoon will provide opportunity for meeting with mentors, project work, completion of IHI Open School modules and self-directed study. The programme consists of four compulsory components:- Attendance at all monthly tutorial days Completion of the Institute for Healthcare Improvement (IHI) Open School Modules with supplementary material and monthly tasks on Knowledge Exchange Discussion Forum Participation in a service improvement initiative with the support of an experienced mentor Sharing the learning with managers and leaders at the final session. Participants will be required to register with IHI Open School and Knowledge Exchange at HSC Leadership Centre, completing identified modules and tasks in preparation for each tutorial day. Support will be available from Julie Hall, Patient Safety Support Officer, and Eileen McKay, Learning, Development and Research Team julie.hall@setrust.hscni.net eileen.mckay@setrust.hscni.net. The programme will be linked to the Attributes Framework (Quality 2020) which identifies the quality improvement and safety attributes needed by staff to deliver and lead improvement. PiP Accreditation On completion of the programme, participants may claim three requirements of the NI PiP Leadership and Strategic Award. Participants will be assessed through completion of the following:- Completion of IHI modules Participation in Knowledge Exchange Discussion Forum Attendance at taught days Sessions with mentors Contribution to Service Improvement Initiative Final Presentation. 4
Expectations It is a non-negotiable expectation that participants attend all learning sessions and actively participate in all the required activities associated with the programme. Each participant will be expected to undertake a quality improvement initiative within the timeframe of the programme (9 months), which will enable them to directly apply the new knowledge and skills acquired in practice as the programme progresses. Participants will decide on a specific topic area /improvement initiative in their area of responsibility and discuss this with their manager and Trust representative prior to commencing the programme. On the last day of the programme, senior leaders and managers will be invited to join the final event to hear participants present their projects and share their learning. This will be an opportunity for discussions regarding sustaining and spreading the learning from the projects. Evaluation This pilot programme will be evaluated throughout, with a pre programme knowledge and skills evaluation by each participant, followed up by a mid and post programme evaluation. All feedback from participants will be analysed and a report provided to all Trusts and the Social Work Strategy programme. 5
Launch of Programme The Quality Street - Setting the Scene The Heart of Improvement - The Model Counting Along the Way - Measurement We are all Human! - Human Factors Working Together - Teamwork Listen to Me! - Person Centred Care Rocking the Boat - Leading Change After 8 What? - Keeping on going Sharing the Learning Regional Programme 2016 Programme Launch Wednesday 2 December 2015 Venue: Dunsilly Hotel, Antrim Day 1 Thursday 21 January 2016 Venue: QIIC, Trust HQ, Ulster Hospital Day 2 Tuesday 23 February 2016 Venue: QIIC, Trust HQ, Ulster Hospital Day 3 Tuesday 23 March 2016 Venue: QIIC, Trust HQ, Ulster Hospital Day 4 Tuesday 19 April 2016 Venue: QIIC, Trust HQ, Ulster Hospital Day 5 Tuesday 17 May 2016 Venue: QIIC, Trust HQ, Ulster Hospital Day 6 Tuesday 21 June 2016 Venue: QIIC, Trust HQ, Ulster Hospital Day 7 Tuesday 23 August 2016 Venue: QIIC, Trust HQ, Ulster Hospital Day 8 Tuesday 27 September 2016 Venue: QIIC, Trust HQ, Ulster Hospital Final Event Friday 21 October 2016 Venue: TBC 6
Programme outline Session 1: Thursday 21 January 2016 The Quality Street! - Setting the Scene IHI Module: PS 106 Introduction to quality improvement and culture of safety To introduce participants to the key concepts of quality improvement To provide participants with the knowledge to identify and improve a quality culture within health & social care organisations. Morning session: 10.00am Framework for Quality and Safety The Science of Improvement The QI Journey A Culture of Quality and Safety Barbara Campbell Brenda Carson Jocelyn Harpur Hugh McCaughey Afternoon session: 2.00pm Open school modules & key learning Eileen McKay Meet your mentor and self-directed study time. Objectives:- Session 2: Tuesday 23 February 2016 The Heart of Improvement - The Model IHI Module: Q102 The Model for Improvement, your engine for change Objectives:- To introduce participants to the model for improvement and small tests of change. Morning session: 10.00am Quality Improvement - A Regional Perspective Model for Improvement & PDSA cycle: A QI Journey in Children s Services Gavin Lavery Brenda Carson & Dr David Hill Marie Kehoe O Sullivan Improvement initiative: Improving staff reporting in regulated facilities Norma Jeffers Afternoon session: 2.00pm Meet your mentor and self-directed study time. 7
Session 3: Wednesday 23 March 2016 Counting along the way - Measurement IHI Module: QI103 Measuring for Improvement & QI 104 The life cycle of a project To provide participants with a practical understanding of data collection and analysis To provide an understanding of measurement for improvement in social care interventions/ settings. Morning session: 10.00am Measuring for improvement: Measuring in Triple Aim Improvement initiative: Conducting Hope Jocelyn Harpur & Conor Campbell Pedro Delgado Lindsay Grierson Afternoon session: 2.00pm Meet your mentor and self-directed study time. Objectives:- Session 4: Tuesday 19 April 2016 We are all just human! - Human Factors Training NB 9.3am - 4.30pm IHI Module: PS 102: Human Factors and Safety Objectives:- To provide an understanding of human factor principles in health and social caresettings. Morning session: 9.45am Human Factors in Safety and Quality Captain Philip Higton,Terema, UK Afternoon session: 1.45pm Human Factors in Safety and Quality (continued) 4.30pm Close 8
Session 5: Tuesday 17 May 2016 Working together - Team work IHI Module: PS 103 Team Work and Communication To provide participants with the knowledge of the link between engaged staff and quality of care To provide an understanding of how to identify, engage and communicate effectively with key stakeholders To provide an understanding of how to manage transitions and resistance to change in order to improve the outcomes and sustainability of improvement initiatives. Morning session: 10.00am Working Together Improvement Initiative: Financial Independence for service users Annette Bartley Aoife O Hanlon Afternoon session: 2.00pm Meet your mentor and self-directed study time. Objectives:- Session 6: Tuesday 21 June 2016 Listen to me - Person Centred Care IHI Module: QI 105 The Human Side of Quality Improvement Objectives:- To provide participants with an understanding of what is patient/client centred care To provide participants with the knowledge and skills in measuring person centred care. Morning session: 10.00am Person Centred Care Measuring Person Centeredness Improvement Initiative: Listening to the voice of young people in care Shaun Maher & Tommy Whitelaw Shaun Maher David Hamilton Afternoon session: 2.00pm Meet your mentor and self-directed study time. 9
Session 7: Tuesday 23 August 2016 Rocking the Boat - Leading change IHI Module: L101 - Becoming a leader in Health Care To provide participants with a greater knowledge of leading improvement in their organisation To identify the successful factors to leading improvement To identify key qualities needed for service improvement leaders to lead change. Morning session: 10.00am Rocking the Boat - Leading change Improvement Initiative To be confirmed Nial Leonard Afternoon session: 2.00pm Meet your mentor and self-directed study time. Session 8: Tuesday 27 September 2016 After 8 what? - Keeping on going All IHI Module: Should be completed Objectives:- Objectives:- To provide participants with an understanding of the factors effecting spread and sustainability of improvement initiatives Identify with participants what can be done to ensure sustainability of their improvement initiative To provide opportunity for participants to present their improvement work. Morning session: 10.00am Seven Spreadly Sins! To be confirmed Afternoon session: 2.00pm Meet your mentor and self-directed study time. Final Event: Sharing the Learning Friday 21 October 2016 10
Appendices section Appendix 1 Quality Improvement Methodology -The Model for Improvement A range of traditional quality improvement principles and methods will underpin this programme of work. A principle feature will be the use of the Model for Improvement. A key feature of improvement methodology is the Model for Improvement developed by Associates in Process Improvement (USA) to provide the best chance of achieving goals and adopting ideas. The model provides a framework to structure improvement. This simple yet powerful tool enables staff to test ideas for change drawn from a change package or via a process of innovation on a small scale and to learn from these tests and build upon them, testing ideas in practice before implementing and spreading them. 11
The Model for Improvement is based on three simple key questions, which should form the basis for every improvement effort. 1. What are we trying to accomplish? In order to improve, it is important to be clear about what exactly you are trying to improve/ accomplish. By focusing on a specific aim it helps to draws individual to a common purpose or vision. An aim needs to be specific, realistic and should indicate how good you want to be and by when. The aim should be ambitious but achievable. Your aim should be SMART. Specific Measurable Achievable Realistic Timely. 2. How will we know that change is an improvement? It is crucial to be able to test changes in practice prior to full-scale implementation in order to measure whether or not they are actually making a difference and positively impacting on the outcome we are seeking. In order to measure the impact of change, a balanced set of baseline and on-going process, outcome and balancing measures is required. These should include the vital few measures, which will tell you whether or not things are improving, or if adaptations need to be made to the process. If changes have already been successfully tested elsewhere, care should still be taken to ensure that the new process/intervention meets or is adapted to the new context/local needs. 3. What changes can we make that will result in improvement? Many of the change initiatives undertaken within healthcare in the past have not always resulted in actual improvements in care despite significant efforts, input and resources. This constant climate of change within healthcare with little evidence of sustained improvement has meant that many healthcare professionals have become disillusioned with change. Often the reason for the failure of such initiatives is due to the fact many good ideas have not been based on best-known science or tested in practice to allow for variations in culture and context prior to full-scale implementation. So it important to ensure that you generate a theory or prediction as to how a particular change will impact in practice and that you allow time to test this in your own practice and learn using the iterative Plan Do Study Act (PDSA) cycle. 12
Appendix 2 Quality Improvement in Social Work Guidance on selecting your improvement initiative: Please note participants will be working in pairs. What not to choose. Large scale projects, for example re-design of a service A project without the support of the leadership within your organisation. What to choose The improvement initiative should be focused on a small area of practice You must have the support of the senior leadership team within your organisation The improvement initiative should have a team as opposed to an individual working on it Small system and process changes should be within the control of the relevant organisation and are more likely to succeed Improvement initiative should focus on safety, quality and improving the service user experience. In identifying and developing an improvement initiative, ask yourself: 1. What are we trying to accomplish? 2. How will we know that a change is an improvement? 3. What changes can we make that will result in an improvement? 13
Appendix 3 Reading materials and useful links The Institute for Healthcare Improvement (IHI). www.ihi.org. Scottish Quality Improvement Hub http://www.qihub.scot.nhs.uk/home.aspx The Health Foundation http://www.health.org.uk Health Foundation Patient Safety Resource http://patientsafety.health.org.uk/ The Clinical Human Factors Group http://www.chfg.org.uk The Improvement Guide: A Practical Approach to Enhancing Organizational Performance [Hardcover]. Gerald J. Langley (Author), Ronald Moen (Author), Kevin M. Nolan (Author), Thomas W. Nolan (Author), Clifford L. Norman (Author), Lloyd P. Provost (Author) NHS Improving Quality radicles@nhsiq.nhs.uk The Essential of Patient Safety Charles Vincent (Author) c.vincent@imperial.ac.uk Organizational Culture A Review of the Literature (2013), Quality 2020. Dr Rachel Doherty, Dr Claire Loughrey and Ms Patricia Higgins. Social Care Governance; A Practice Workbook SCIE www.iriss.org.uk. 14
Appendix 4 Who s who? Speakers Annette is a registered nurse with over 30 years of experience in healthcare. She has held leadership roles in frontline clinical care, management and at director level. In 2006 she was awarded a Health Foundation Quality Improvement Fellowship spent at the US Institute for Healthcare Improvement (IHI), during which time she also completed a Masters in Public Health at Harvard University. Annette J Bartley Annette has been an Independent Quality Improvement Consultant for the last six years and has been responsible for developing, supporting and leading a wide range of highly successful quality improvement and patient safety initiatives across the UK at regional, national and international level. Barbara works as Assistant Director of Social Work and Social Care Governance in South Eastern Health & Social Care Trust. In 2013 Barbara undertook the Patient Safety Executive Programme awarded by the Institute of Health Improvement, Boston and continues to take a lead role inpromoting quality improvement across the region. Barbara Campbell Conor is the Governance and Patient Involvement Lead in South Eastern Health & Social Care Trust, having previously held posts of safety & quality information senior manager and safer 10 years experience in quality improvement during a 25 year NHS career to date. Conor Campbell Brenda Carson Pedro Delgado Brenda is Head of Patient Safety and Improvement for South Eastern Health & Social Care Trust, leading the organisation through a number of collaborative improvement programmes, empowering teamwork, driving and developing practice and improving Patient Safety throughout the organisation. She worked as registered nurse before being appointed as Patient Safety at Leeds University, a Post-Grad Diploma in Health and Social Care Management at the HSC Leadership Centre and is a Clinical Microsystems Coach trained through Dartmouth Institute, Pedro Delgado, Executive Director, IHI, works with large-scale health system improvement efforts in Europe and Latin America. Currently, his work includes existing programs throughout the UK and emerging initiatives throughout Latin America. Before joining IHI, he worked for the UK National Health Service leading pioneering large-scale improvement efforts in Northern Ireland. This involved working with partners (providers, policy makers, patient representatives, commissioners, and regulators) to design, develop, and deliver a comprehensive country-wide program of work focused on generating sustainable, transformational health, social care, patient safety, and quality improvement initiatives. 15
Jocelyn Harpur Jocelyn is a Speech and Language Therapist in Adult Services in South Eastern Health and Social Care Trust. She completed the Trust s Leading in Safety, Quality and Experience programme in 2014 and was inspired to undertake the Safety Forum Scottish Fellowship, which she completed in 2015. Jocelyn is currently undertaking a safety and quality improvement coaching programme with the Dartmouth Institute Microsystems Academy. Phil has been a commercial pilot for 34 years with British Airways and as part of Terema for the last eleven years has extensive experience in transferring learning between his former and current worlds. He was instrumental in introducing Lean techniques into the process of pilot majority of his career involved with training and examining fellow pilots under delegated authority from the Civil Aviation Authority (CAA). Since joiningterema eleven years ago he has applied these skills and insights to a wide range of NHS and other healthcare issues. Captain Philip Higton - Terema UK Phil is now Director of Training for Terema, responsible for the preparation and delivery of programmes for more than 10,000 Health care professionals. His role means he is actively engaged in projects with both primary and acute healthcare across the United Kingdom and overseas, working with a wide range of professional and teams. A frequent contributor to both National and International Forums on safety and quality in healthcare and other major conferences, and has been involved with the Safer Clinical Systems project sponsored by the UK Health foundation. David has worked as a Consultant in pain management since 1996 in the South Eastern Health and Social Care Trust. From 2009 he has been Associate Medical Director working in the areas of clinical governance, patient safety and improvement and research and innovation. He is currently involved in the leadership team for patient safety within the Trust and promoting clinical engagement in improvement. David Hill Gavin Lavery Dr Gavin Lavery is Clinical Director of the HSC Safety Forum and a consultant in Critical Care Medicine at Belfast HSC Trust. The Safety Forum s remit is to provide Leadership in Quality Improvement and Patient Safety and currently facilitates seven improvement programmes across Health & Social Care. Dr Lavery is a graduate of the Advanced Training Programme at Intermountain Healthcare and is a member of the Health Foundation s College of Assessors. He is a standing member (Patient Safety) on Quality Standards Advisory Committee (#2) at NICE College of Physicians in Ireland. Niall is a consultant nephrologist in South Eastern Health & Social Care Trust, and sub dean for Queen s University.He has helped to successfully incorporate Quality Improvement into both undergraduate and post graduate medical education. Nial Leonard 16
Shaun is Strategic Advisor, Planning and Quality Division, Scottish Government. The main focus of Shaun s current role is to advise and support the development of policy, practice and measurement of person centred approached to care, including the on-going development and Shaun Maher Shaun has more than 23 years clinical experience across diverse healthcare settings in primary and secondary care and still manages a small amount of clinical practice. He is a Scottish Patient Safety Improvement Fellow and has a particular interest in developing person-centred approached to improving safety and effectiveness. Hugh McCaughey Hugh McCaughey is the Chief Executive of the South Eastern Health and Social Care Trust. He is chair of the Patient Safety Forum, the Northern Ireland Cancer Network and a Non-Executive member of the Skills for Health Board. Hugh is a Board Member of the Chief Executives Forum and a member of the Business Committee of CEF. Hugh has wide experience in a range of Health and Social Care leadership positions and has a particular interest and passion in quality improvement and promoting safer care. Pat O Connor National Patient Safety Agency (NHS), Tayside. Pat is a clinical nurse and midwife by background with a passion for patient centred care. For the past 10 years she has been leading improvement in patient safety and quality improvement in health care at national, regional and local hospital level with demonstrable results. She loves working with teams to improve care. Marie Kehoe O Sullivan Marie began her nursing career at Ardkeen Hospital in Waterford before moving to the USA where she completed her Bachelor and Master Degrees in Nursing. She also obtained her Improvement Faculty for the NHS Institute for Innovation and Improvement. She is currently undertaking her PhD in Trinity College Dublin. She has lectured on Quality Improvement and was appointed to the Medical Council in 2012 and was appointed Director of Safety and Quality Improvement with HIQA in July 2012. In 2011 Tommy undertook a walk around Scotland s towns and cities to collect hundreds of life story letters detailing the experiences of individuals caring for a loved one living with dementia. Since then, he has engaged with thousands of carers through his Tommy on Tour blog and as Project Engagement Lead with the Health and Social Care Alliance s Dementia Carer Voices Project. Thomas Whitelaw Most recently, in January 2015, Tommy was awarded the British Citizen s Award for Services to Healthcare in recognition of his work to raise awareness of dementia and promote a fuller understanding of the carer journey. 17
Programme Implementation Team Pat McAuley Pat has worked as a social worker within Social Services throughout her career and more recently, as Social Care Governance Facilitator in South Eastern Health & Social Care Trust. Since completing ILM Level 5 in Coaching & Mentoring in 2011 and the Trust s programme in Leading Safety, Quality & Experience in 2012, Pat has been involved in quality improvement work, coaching and mentoring social workers as they strive to take forward best practice and quality improvement initiatives. adult services with a particular interest in dementia and mental health. Eileen works in the South Team and completed the Trust s Leading Safety, Quality and Experience programme in 2013. As a mentor on the programme, she is excited about the opportunity to develop and deliver a quality improvement programme for social work. Eileen McKay Pauline Thompson Pauline s practice experience as a social worker has mainly been in Children s Services with a special interest in children with a disability.pauline has completed the ILM Level 5 in Coaching and Mentoring, and the Trust s Leading in Safety, Quality and Experience programme in 2012. As a mentor on the SQE programme. Pauline was delighted to have the opportunity to undertake the Patient Safety Executive programme awarded by the Institute of Health Improvement, Boston in 2013 and has since taken a lead role in promoting quality improvement within social work. 18
Programme Mentors Brenda Carson Julie Hall David Hamilton Aoife O Hanlon Jocelyn Harpur Campbell Killick Marita Magennis Pat McAuley Eileen McKay Pamela Smyth Pauline Thompson Sharon Thompson 19
Acknowledgements Thank you to all those who contributed to making this programme happen. Marie-Kehoe O Sullivan, Director Health, Information and Quality Authority (HIQA) Dublin Northern Ireland Regional HSC Safety Forum Pedro Delgado, Executive Director, Institute of Health Improvement Regional Quality Improvement Forum for Social Work Regional Social Work Strategy Programme Programme Planning Group, South Eastern HSC Trust Quality Improvement & Innovation Centre, South Eastern HSC Trust Safe & Effective Care Department, South Eastern HSC Trust Social Care Governance Team, South Eastern HSC Trust Social Services Learning, Development & Research Team, South Eastern HSC Trust Regional Quality Improvement Forum for Social Work Caroline Brogan Barbara Campbell Barbara Gillen Pat McAuley Caroline McGonigle Eileen McKay Christine McLaughlin Marita Magennis Ethna Scallon Maria Sommerville Belfast HSC Trust South Eastern HSC Trust Northern HSC Trust South Eastern HSC Trust Northern HSC Trust South Eastern HSC Trust Western HSC Trust Southern HSC Trust Marie-Curie Service User Representative Programme Planning Group - South Eastern HSC Trust Brenda Carson Julie Hall David Hamilton Jocelyn Harpur Campbell Killick Pat McAuley Eileen McKay Aoife O Hanlon Pauline Thompson Pauline Thompson South Eastern HSC Trust 20
For further information on the Regional Quality Improvement Programme for Social Work Contact Programme Implementation Team:- Pat McAuley, Eileen McKay or Pauline Thompson, South Eastern Health & Social Care Trust Downshire Hospital, Ardglass Road, Downpatrick BT30 6RA Telephone: (028) 4483 8329 Email: pat.mcauley@setrust.hscni.net eileen.mckay@setrust.hscni.net pauline.thompson@setrust.hscni.net Designed by Communications Department, South Eastern HSC Trust