M16 Is there a perfect system? Scotland s Quality Journey 1
NHSScotland 5 million people 12 billion 14 Health Boards 8 Support Boards Integrated delivery Moving towards social care integration Public Finances Fall in Government expenditure 2
Population of Scotland All cause mortality males 15-44 3
Cirrhosis mortality males 15-44 4
The Angel s Share 24 th European Congress of Pathology Prague 11th September 2012 5
What patients see as high quality healthcare? caring and compassionate health services; collaborating effectively with clinicians, patients and others; confidence and trust in health services; providing a clean care environment; improving access and the continuity of care; delivering clinical excellence 6
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. quality improvement The combined and unceasing efforts of everyone professionals, patients and their families, researchers, payers, planners, administrators, educators to make changes that will lead to better patient outcome, better system performance, and better professional development. Batalden P, Davidoff F. Qual. Saf. Health Care 2007;16;2-3 7
4 ways to deliver public services (LeGrand 2007) What s our job? Headquarters of the NHS and 11 billion Support to ministers Leadership of 400 staff 8
"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 Triple Aim The IHI Triple Aim Health of the Population Experience of Care Best Value for Money 9
2009-2011 TACTICAL STRATEGIC PRODUCTIVITY & EFFICIENCY SERVICE OPTIMISATION CRES TRANSFORMATION DEALING WITH THE 3% SPENDING THE 97% BETTER 2010-2013 TACTICAL STRATEGIC PRODUCTIVITY & EFFICIENCY SERVICE OPTIMISATION CRES TRANSFORMATION DEALING WITH THE 3% SPENDING THE 97% BETTER 10
By what method? W.Edwards Deming A Breakthrough Series Collaborative underpinned by the Model for Improvement A clear aim Over 40 measures Five change packages Site visits, a listserve, learning sessions 11
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 HSMR Hospital Standardised Mortality Ratio 12
NHSScotland HSMR; Jan 2008 June 2012 1.03 7521 less than expected deaths 0.88 Hospital Standardised Mortality Ratios (Seasonally Adjusted) Scotland: Oct-Dec 2002 to Jan-Mar 2012 1.4% 4.2% (Oct 2002 to Jan 2010) (Apr 2010 to Mar 2012) 13
NHSScotland Surgical Mortality 23% reduction from median ICU Mortality (%) 20% reduction 18.2% 14.5% Compiled from reported data by Jason Leitch September 2012 14
Adverse event rate - Raigmore 62% reduction 37.59 14.18 Ventilator Associated pneumonia Forth Valley ICU 15
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 16
Afternon 17
~6500 people ~550 beds Prepared by Peter Knight JIT June12 18
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Having the best professionals in the world is no longer enough Our change theory A clear and stretch goal A method Predictive, iterative testing 21
The Scottish Early Years Collaborative Aim: Scotland is the best place to grow up 22
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Challenges How do we design for multi-agency improvement? Should we attempt to combine the cultures? How should we measure? What about leadership? 24
@jasonleitch 25