plenary 1 driving quality through innovation

Derek Feeley

Director-General Health and Social Care and Chief Executive NHSScotland

Jason Leitch

Clinical Director, The Quality Unit, Scottish Government

The Edge of Glory?

A legitimate Statement of Values

“The Lothian Way” has been developed within NHS Lothian as a set of emergent values and associated behaviours identified as vital elements of the culture that NHS Lothian wants to build. Patients are first and foremost in this set of values however staff motivation and organisational reputation are central too. They are as follows: – Person Centred – Partnership – Integrity – Accountability – Innovation

Many organisations have unwritten rules which

describe ‘the way we do things around here’. In

NHS Lothian the following have been described

consistently to us in one-to-one interviews: • Suppression of bad news – do not write it down • Gloss • You are on your own – ‘Just fix It’ “

Underlying cultural assumptions (the unwritten rules)

Some less prominent headlines (in May alone…)

The real world?

• Performance continues to improve

• In many areas it is better than ever (and world class)

• We can’t afford to stand still

• Attitudes, ethics and values are as important as technical excellence

• Reliability just as important in these areas – every person every time

We should choose to learn!

“What if we choose to change? Could we

craft joy from loss, pride from revision, and

excellence from invention?

Yes we can.”

Don Berwick; British Journal of General Practice; Feb 2009

To change and to persist!

“There were a number of definitions of courage, but now I was seeing it in its simplest form: you do what has to be done day after day, and you never quit.” ― Eric Greitens, The Heart and the Fist: The Education of a Humanitarian, the Making of a Navy SEAL

To make the right thing easier to do!

Tough Love?

So what if……?

• We had the courage to persist in our pursuit of world-class care

• We continued to make care safer, more effective and more person-centred

• We choose to learn together

• We share and renew our ethics and values

• We make the right thing easier to do

• We get ready for the next curve

Aims

To deliver the highest quality healthcare

services to the people of Scotland

For NHSScotland to be recognised as world-leading in the quality

of healthcare it provides

2020 Vision Everyone is able to live longer healthier lives at home, or in a

homely setting.

Getting to the third curve

Time

Perform

ance

Performance

Improvement

Co-production& assets

What will it take?

• Redesign, creativity and innovation

• New technologies and better use of existing technology

• Prevention, assets and activation

• Up our game on person centred care

• Continued focus on performance and improvement

• Shared and renewed ethics and values

JL

Getting to the third curve

Time

Perform

ance

Patients and fa

milies

Getting to the third curve

Time

Perform

ance

Performance

0

20

40

60

80

100

120

Mar

-08

Jul-0

8

Nov-08

Mar

-09

Jul-0

9

Nov-09

Mar

-10

Jul-1

0

Nov-10

Mar

-11

Jul-1

1

Nov-11

Mar

-12

Quarter ending

Wai

t (d

ays)

Median (days) 90th percentile (days)

Median and 90th percentile waits for IP/DC

3525

105

63

50%

60%

70%

80%

90%

100%

Jan

-11

Feb

-11

Mar

-11

Ap

r-11

May

-11

Jun

-11

Jul-

11

Au

g-1

1

Sep

-11

Oct

-11

No

v-11

Dec

-11

Jan

-12

Feb

-12

Mar

-12

Month

Pat

ien

t jo

urn

eys

wit

hin

18

wee

ks% of patient journeys within 18 weeks

“The overall financial performance of the NHS is good”

Audit Scotland, 2011

good = euphoria

Getting to the third curve

Time

Perform

ance

Performance

Improvement

“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

1012141618202224262830

Jan-

08

Apr-0

8

Jul-0

8

Oct-08

Jan-

09

Apr-0

9

Jul-0

9

Oct-09

Jan-

10

Apr-1

0

Jul-1

0

Oct-10

Jan-

11

Apr-1

1

Jul-1

1

Oct-11

% ICU mortality

18.2%

13.9%

24% improvement

Surgical Mortality

28%

Scotland HSMR – 9.5% reduction

0.5

1.0

1.5

Oct-Dec2006

Apr-Jun

2007

Oct-Dec2007

Apr-Jun

2008

Oct-Dec2008

Apr-Jun

2009

Oct-Dec2009

Apr-Jun

2010

Oct-Dec2010

Apr-Jun

2011

Oct-Dec

2011p

Sta

ndar

dise

d M

orta

lity

Rat

io

Standardised Mortality Ratio (SMR) Regression line

20%

11.5%

Percentage Oxygen Complance

0%

20%

40%

60%

80%

100%

120%

02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12

Median Time to IV Fluids

00:00

00:14

00:28

00:43

00:57

01:12

01:26

01:40

01:55

02:09

02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12

Percentage Compliance IV Fluids

0%

20%

40%

60%

80%

100%

120%

02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12

Median Time to Blood Cultures

00:00

00:28

00:57

01:26

01:55

02:24

02:52

02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12

Percentage Compliance of Blood Cultures

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12

Median Time to Lactate

00:00

00:28

00:57

01:26

01:55

02:24

02:52

02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12

0

10

20

30

40

50

60

70

80

90

100

02/04/12 09/04/12 16/04/12 23/04/12 30/04/12 07/05/12 14/05/12

Sepsis bundle compliance

Harm-free care

Katy: Zero Pressure Ulcers Stages 3 & 4

To: Memorial Hermann Katy HospitalZero Pressure Ulcers for 36 Months

January 1, 2008 to December 31, 2010

Zero Pressure Ulcers x 36 Months

Northwest: Zero Retained Foreign Bodies

To: Memorial Hermann Northwest HospitalZero Retained Foreign Bodies for 24 Months

January 1, 2010 to December 31, 2010

Zero Retained Foreign Bodies x 24 Months

Sugar Land: Zero Central Line Blood Stream Infections

To: Memorial Hermann Sugar Land Hospital

February 1, 2008 to January 31, 2011

Zero Central Line Associated Blood Stream Infections for 36 Months

Zero CLABSIs x 36 Months

High ReliabilityCertified Zero Hospitals

Central Line Associated Bloodstream Infections (4) Ventilator Associated Pneumonias (7)

Surgical Site Infections Retained Foreign Bodies (9) Iatrogenic Pneumothorax (4)

Accidental Punctures and LacerationsPressure Ulcers Stages III & IV (8)

Hospital Associated Injuries (2)Deep Vein Thrombosis and/or Pulmonary Embolism (1)

Deaths Among Surgical Inpatients with Serious Treatable Complications

Birth Traumas (4)Serious Safety Events (1)

2012

Awards40

1941, William A. Foster

"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.”

Getting to the third curve

Time

Perform

ance

Performance

Improvement

Co-production& assets

~6500 people

Prepared by Peter Knight JIT June12

Bedday rate for patients aged 75+, emergency admissions

4000

4500

5000

5500

6000

6500

Year ending

Bed

day r

ate

per

1000 a

ged

75+

Borders

Lothian

BoardaverageHighland

Ayrshire &ArranTayside

Sept-11

Re-shaping Care Prog/LTC Prog

~550 beds

Doors

Person centred health and care programme

Coming soon

DF

Assets vs Deficits

Assets thinking•Strengths based•How can we create community spirit?•What can I do?•We’re all in this together•We’re getting there•Work with engaged people•People have the answers•People control their lives

Deficit thinking•Problem orientated•How to fix this problem?•Someone needs to sort this•Us versus them•Problems are embedded•Do things to people •People are a problem•People can’t be trusted to decide/be in control

Values on the way to work

Derek’s Values

• Advocacy

• Accessibility

• Ambition

• Authenticity

Jason’s values

• Person-centred

• Pioneering

• Restless

• Aspiring

The Edge of Glory

Please complete your cards

Ethics and Glory

“Glory, built on selfish principles, is shame and guilt”

William Cowper

“Glory follows virtue as if it were its shadow”Cicero

“Glory lies in the attempt to reach one’s goal and not in reaching it”

Mahatma Ghandi

So are you ready to……?

• Show the courage to persist in our pursuit of world-class care

• Continue to make care safer, more effective and more person-centred

• Choose to learn together

• Share and renew our ethics and values

• Make the right thing easier to do

• Get ready for the next curve

The Edge of Glory!