Improvement Fellows Spring Networking event

Improvement Fellows Spring Networking event Wednesday 1 st March 2017 Leeds e: academy@yhahsn.nhs.uk / t: 01274 383966 www.improvementacademy.org

Our # for the event #ImprovementFellows @improvementacademy

Housekeeping

Welcome and introduction Rebecca Lawton Academic Advisor & Professor, Psychology of Healthcare Improvement Academy / University of Leeds

Programme 13.15 Introduction to Q Clare Ashby & Georgina Denis 14.00 Learning Bites: sharing improvement Skype s the limit Implementing Safety Huddles in EOC Trust me I am your patient Reducing wait time from request for TTOs Facilitated by Clare Ashby Dr Angela O Donoghue Clare Ashby Graham Prestwich & Marilyn Foster Donald Richardson 14.45 Refreshments and Networking Georgina Denis available at the Health Foundation Q stand 15.15 Measuring safety culture in the Southwest Dr Matt Hill 15.45 Safety culture reflections and discussion Prof Mohammed A Mohammed 16.00 Finish

Improving patient care

The Yorkshire and Humber Patient Safety Translational Research Centre University of Leeds AND Bradford Teaching Hospital Foundation Trust

Who are we? 2016 3.2 million research funding secured by theme leads 2016-19 publications by theme leads, 7 with international collaborators

Where are we? 900 Serious events 153,000 Patient Safety Incidents Regional NIHR CLAHRC Regional AHSN Improvement Academy Regional Patient Safety Collaborative

What will we do? Increase funding for research in patient safety and implementation science Create centralized and coordinated oversight of patient safety Address safety across the entire care continuum Support the health care workforce Partner with patients and families for the safest care Ensure that technology is safe and optimized to improve patient safety Ensure that leaders establish and sustain a safety culture Create a common set of safety metrics that reflect meaningful outcomes Gandhi TK, Berwick DM, Shojania KG. Patient Safety at the Crossroads. JAMA. 2016;315(17):1829-1830. doi:10.1001/jama.2016.1759

Our ambition Research that makes healthcare safer

Thank you for listening

Q: connecting people across the UK Clare Ashby & Georgie Denis 1 March 2017

Contents 1. What Q is 2. What Q offers 3. How people can join 4. Q&A

What is Q? A connected community working together to improve health and care quality across the UK Supports people in their existing improvement work: making it easier to share ideas, enhance skills and make changes that benefit patients 15

Collaboratively designed Initial scoping: 300+ people fed in ideas Designed with 231 founding members diverse cross section of improvers from across the UK

What Q offers

Who can join Q? Anticipating 1000s of members from all backgrounds Applicants need to demonstrate: Experience and understanding of improvement Thoughtful commitment to Q Decision Tree - is Q for you?

Growing Q May 2015: 231 founding cohort Oct 2016: 216 pilot including: National organisations Patient leaders with national profile Phased opportunities to apply: November 2016 March 2017 May/August 2017

Recruitment in Yorkshire and Humber Applications open on 9-3-17 and close on 10-4-17 Suggesting all Improvement Fellows consider a Q application Application portal link: https://aims.health.org.uk/register/ AIMS user manual: https://q.health.org.uk/wpcontent/uploads/2016/11/aims-applicant-user-guide.pdf Not sure? Attend a Q drop in session with Clare Ashby on: 9 th March, 13 th March, 22 nd March, 28 th March, 6 th April in the Improvement Academy

Looking forward By 2020: Established large-scale, long-term home for improvers Connecting locally, regionally and nationally Vibrant community tackling local and cross-system priorities

Reactions? Questions?

Thank you Visit us online: http://q.health.org.uk Email the Health Foundation: Q@health.org.uk Follow us on Twitter: @theqcommunity #theqinitiative

Learning Bites Facilitated by Clare Ashby

Skype s the Limit: a digital solution to patient demand Dr Angela O Donoghue GP, Harrogate CCG

Small rural surgery: 5700 Patients

What is the demand?

Better continuity, better capacity

Reduced waiting times in Mins

Patients driving QI: Continual Feedback

INSTAGRAM BUSINESS CARD

Instagram

Social Media Strategy Joe Blunden- NHS elect

Shine studies

North Yorkshire GPs to offer digital appointments

Human Factors Analysis and Safety Huddles March 2017 Clare Ashby, Head of Safety Yorkshire Ambulance Service

What are human factors? Human factors is the science of understanding human performance within a given system. Translated into a healthcare context, human factors has been defined as: Enhancing clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture, organization on human behaviour and abilities, and application of that knowledge in clinical settings. Catchpole, 2011 Human factors are found in design, in teamwork, in incident investigations and in working in the real world.

Human factors benefits Reduction of harm through better design of healthcare systems and equipment Understanding why healthcare staff make errors and how systems factors threaten patient safety Improving the safety culture of teams and organisations Enhancing teamwork and improving communication between healthcare staff Improving how we learn when things go wrong Predicting what could go wrong Working together to make things better

Human factors EOC analysis Human factor category Number of incidents Situational 83 1 awareness Communications 57 5 Decision making 136 28 Team Working 125 1 Leadership 13 0 Managing stress 7 3 Coping with fatigue 1 0 Total Working for year together 459 to make things 38 better Number of complaints

Human factor examples DESCISION MAKING EMD - Fast, time pressured, reliant on what they tell you, what you hear spell street wrong, spell medication wrong, = wrong address or wrong drug noted - possible patient harm TEAM WORKING Dispatcher under pressure, many jobs at once, not up to date with SOP, bariatric case, can t identify ISU, can t identify staff to assist possible patient harm COMMUNICATION EMD or Dispatcher fail to pass on information about scene safety unwarranted stand off possible patient harm

Human factors & safety huddles

Safety huddles - ignite a spirit of learning Making measurement visible Addressing Teamwork+Safety Culture Celebrating success We are achieving results now, that none of us thought were possible 12 months ago Consultant Medicine for Older People, LTHT

Safety Culture improved

Safety Huddle key characteristics Focused meeting about one or more agreed harm/s Informed by QI tools and visual feedback Senior clinical leadership Agreed actions - set of team/individual actions (aimed at reducing risk of patient harm) Daily (Monday - Friday as minimum) - same time and place Brief (5-15 minutes) Multidisciplinary ALL the frontline team Celebration, celebration, celebration!!

Safety Huddle EOC feedback It s a step forward I was initially sceptical, however now feel they are invaluable Many issues were discussed and ideas/solutions taken away from this Great for brainstorming ideas, concerns and expectations Good to get point of view of other disciplines in relaxed atmosphere. Feel more valued and part of bigger team I think it is a good to discuss things in this way and get everyone's in put Yes, as patient safety should always be a concern I felt included in the discussions

Safety Huddle EOC characteristics Were there any safety events or significant near misses in the last 12/24 hours? Have there been any threats to patient safety recently and are there any safety issues that may impact on our ability to provide safe care today? Are we dealing with any situations that detract from our ability to focus on safe care delivery to patients? Do we have any high-risk procedures or deficiencies in equipment supplies, staffing or skill mix that may act as a barrier to safe delivery of care?

Safety Huddle EOC communication Potential items of discussion may include; Incidents staffing levels (CMS/Dispatch/Operational) performance (EOC & Operational) skill mix, sickness absence & RTWs traffic reports & weather vehicle availability & shortfalls staff welfare issues hospital & on scene delays equipment availability/reliability (including IT) newly implemented/recently updated procedures

Safety Huddle important elements Informed by QI tools and visual feedback Celebration, celebration, celebration???? Ideas for what is possible in EOC? What measurements can we use? How can we display them easily? How do we celebrate our success?

EOC the next steps Spread of safety huddles and human factor work to continue Think about how you can get involved! Displays of measurement, learning and celebration How do you work as a team? How do you learn as a team? Is patient safety central to all you do?

YASC-15-057-10 Questions

Trust me I am your patient Establishing a movement of Lay fellows Graham Prestwich & Marilyn Foster Lay Improvement Fellows/ Patient experts

Graham Prestwich Lay Member Leeds Area Prescribing Committee Achieving desired outcomes of care is far more important and far more valuable than just delivering processes of care. Patients and carers make a critical contribution to achieving the desired and expected outcomes from medicines Patient led initiative sponsored by The Leeds Area Prescribing Committee

@MrGPrestwich Patients identified the problem unresolved issues Patient focus groups identified what is important Patients in partnership are part of the solution (innovation) x (n) x (effective communications) = Likelihood of making a real difference

Marilyn Importance of Self Care & Prevention Self Care Patient involvement Move from Crisis Care to Prevention - breaking the cycle Difficult but essential to achieve How I personally contribute.

Questions? Thoughts / feedback to: Claire.marsh@bthft.nhs.uk

Reducing the wait time from request for TTOs Dr Donald Richardson York Hospitals NHSFT

Problem

Improvement in a complex system is complicated!

Pharmacy Audit -2015? Patient informed of discharge Doctor prescribes TTOs Pharmacy informed of discharge Discharge received in pharmacy Patients planned discharge time 0 hours 1 2 3 4 5 6hours Discharge validated by pharmacy Discharge completed by pharmacy

Actions Planning more discharges in advance so that more patients can be discharged before 11am Communicating discharges to pharmacy more effectively Reducing the gap between patients being informed about their discharge, pharmacy being informed and the discharge prescription being written Actions in parallel are much better Developing a discharge pledge about the completion time for discharge prescriptions received by pharmacy and responsibilities of all staff.

Highlighting the planned discharge date for all patients

Validated by pharmacist to ensure accuracy of information allows the pharmacist to review the patient s drug chart and medical notes and speak to the patient

Reconcile medications

Access to pharmacist Ensuring wards are informed each day who their ward pharmacist is How to contact them when discharge prescriptions are required. All staff urged to contact pharmacists asap For urgent discharge prescriptions, the pharmacy discharge team can also be contacted within pharmacy opening hours

Remove reliance on in hours pharmacy Making pre-packs of commonly prescribed medicines available. These can be supplied directly from the ward on discharge Outsourced dispensing partner in York To validate and dispense discharge prescriptions after the hospital pharmacy has closed

Reviewing and monitoring workflow in the pharmacy dept (inc dispensary) Patient boards for TTOs Symbol for TTOs Colour coding for pharmacy action Pharmacy discharge teams Second team geographically based

Highlighting the planned discharge date for all patients

Discharge TTOs process Planning discharges Doctors ordering TTOs Communicating required order to pharmacist Validating Order Processing order Dispensing prescription

All for a purple tick! 7 minutes reduction

Thanks to NATALIE BRYERS, ALAYA KHATUN GARY HARDCASTLE

Discharge prescriptions Highlighting the planned discharge date for all patients on the Core Patient Database (CPD) so this can be worked towards by all healthcare professionals. Producing an accurate list of all the medicines a patient is taking on discharge, including medicines that have been stopped and the reasons for this. This is produced electronically to ensure that the information is clear and is supplied to the GP in a timely way. Ensuring that discharge prescriptions are validated by a pharmacist at ward level prior to them being dispensed. This is to ensure accuracy of information and allows the pharmacist to review the patient s drug chart and medical notes and speak to the patient. It also ensures that patient s own medicines and medicines supplied for them during their admission are checked and used wherever possible. Ensuring wards are informed each day who their ward pharmacist in and how to contact them when discharge prescriptions are required. For urgent discharge prescriptions, the pharmacy discharge team can also be contacted within pharmacy opening hours. Making pre-packs of commonly prescribed medicines available. These can be supplied directly from the ward on discharge. Enabling Healthcare at Home, the outsourcing dispensing partner in York to validate and dispense discharge prescriptions after the hospital pharmacy has closed. This service is available until 8pm for wards in York that have been identified as having high numbers of admissions and discharges. Reviewing and monitoring workflow in the pharmacy dispensary to ensure efficiency and continual service improvement.

Refreshments and Networking Georgina Denis available at Q stand #ImprovementFellows

Safety Culture Where are we now? Matt Hill, Consultant Anaesthetist & Regional Patient Safety Lead 1 st March 2017

3/7/2017 Where I started

Why measure safety culture?

Performance = capability x behaviour

3/7/2017 Surveying Paper & manual entry Paper and scanning Web-based Automatic analysis Safe and Reliable Healthcare

The Bidet effect Phil Hammond

SAQ v SCORE SAQ Job Satisfaction Working Conditions Stress recognition Perception of Management Teamwork Safety Climate SCORE Work/life Balance Learning Environment Resilience Local leadership/management Teamwork Safety Climate

Teamwork Climate

Safety Climate

Survey Domains Domain Learning Environment Local Leadership Burnout and Resilience Definition Learning measures the ability of a work setting to selfreflect, identify problems and solve them Measures the level of confidence that respondents have in the support they receive from their local leaders including positive feedback Measures the degree of cynicism that respondents feel and is linked to absenteeism, poor staff retention, low staff morale, poor performance, disturbed sleep and all cause mortality for the respondent, but also the clinical outcomes of their patients Teamwork Safety Measures how effectively different disciplines coordinate their efforts and whether they work in a psychologically safe environment Measures the degree to which mindfulness and psychological safety exist in the work setting

3/7/2017 Value SCORE has given us a valuable way of delving down into a deeper layer of understanding and insight...and to continue to develop, grow and thrive but in a more healthy and sustainable way! Sometimes, we are so service focussed that we forget that we are people staff health and wellbeing is as important as the care we provide it is crucial to build resilience and sustainability. Associate Director, Mental Health Trust

Teamwork

Local Leadership Domain In this work setting, local leadership... is available at predictable times. 100 %...communicates their expectations to me about my performance. 69 % 80 % 60 %...regularly makes time to provide positive feedback to me about how I am doing. 48 % 40 % 38 % 20 % 37 % 0 % 34 %...provides meaningful feedback to people about their performance. 39 % 34 %...regularly makes time to pause and reflect with me about my work....provides useful feedback about my performance....provides frequent feedback about my performance. Safe and Reliable Healthcare

Teamwork Domain Disagreements in this work setting are appropriately resolved ie not who is right but what is best for the patient 100 % Communication breakdowns are NOT common when this work setting interacts with other work settings 63 % 80 % 60 % 73 % In this work setting, it is NOT difficult to speak up if I perceive a problem with patient care. 40 % 17 % 20 % 0 % 33 % Communication breakdowns are NOT common in this work setting. 37 % 91 % It is easy for personnel here to ask questions when there is something that they do not understand. 84 % Dealing with difficult colleagues is NOT consistently a challenging part of my job The people here from different disciplines/backgrounds work together as a well co-ordinated team Safe and Reliable Healthcare

Safety Climate Domain My suggestions about quality would be acted upon if I expressed them to management 100 % The values of the organisations leadership are the same values that people in this work setting think are important. 50 % 80 % 60 % 68 % Errors are handled appropriately in this work setting 46 % 40 % 20 % 0 % 60 % 36 % In this work setting, it is NOT difficult to discuss errors I receive appropriate feedback about my performance 58 % 85 % I would feel safe being treated here as a patient. The culture in this work setting makes it easy to learn from the errors of others Safe and Reliable Healthcare

matt.hill1@nhs.net

Safety culture reflections and discussion Prof. Mohammed Amin Mohammed Professor of Healthcare, Quality & Effectiveness, University of Bradford

Questions? #ImprovementFellows

Forthcoming Improvement Academy Events 15 th Mar 2017 Problem Structuring Masterclass, The Studio, Leeds 21 st Apr 2017 Achieving Behaviour Change (Leadership Fellows), The Studio, Leeds 26 th Apr 2017 Silver Quality Improvement Training, Principal York Hotel, York 13 th Jul 2017 Silver Quality Improvement Training, Cedar Court Hotel, Wakefield 26 th May 2017 Achieving Behaviour Change (open to all), The Studio, Leeds www.improvementacademy.org

Thank you for attending #ImprovementFellows e: academy@yhahsn.nhs.uk / t: 01274 383966 www.improvementacademy.org