Developing a Patient Safety Culture within NHS Scotland

Tuesday 20th September 2011

Unlocking the Potential

The Healthcare Improvement Programme for Foundation Doctors at Salisbury NHS Foundation

Trust (HImP)

Peter WilcockFormer Director of Service Improvement

Outline of presentation

• Context and overview of programme

• Brief introduction to some of the projects

• Some practical thoughts

• Work with junior doctors on improving safety – 2002/04

• New Modernising Medical Careers curriculum 2004- weak links to healthcare improvement per se but:

- opportunities

• Decision to use these as a springboard by Foundation Programme Director, Director of Medical Education, Director of Service Improvement

• First cohort began 2005

Background to the Programme

Broad learning aims

• Transferable knowledge and skills in healthcare improvement through undertaking an improvement project

• Legacy of real improvement

• Experience of interprofessional team working and broader organisational systems

Key programme elements

• Maintaining a patient focus

• Methods to learn about the current situation and identify priorities for improvement

• A practical framework to turn ideas into actions

• Using PDSA cycles to undertake small tests of change with simple feedback measures

The learning process (1)

Choosing topics- early experiences of poor quality or safety

- October brainstorming meeting

- involvement of senior Trust managers

- forming project groups

The learning process (2)

Implementing the programme

• Four core sessions spread over 9 months – bleep free

• Three bleep free hours in between

• Facilitated action learning groups – hospital consultant with another senior member of staff

• Peer facilitation

• HImP dedicated website on Trust intranet

• July presentation to hospital Clinical Governance Core session

Programme evaluationSelf reported learning

0% 20% 40% 60% 80% 100%

Managing risk and improving patient safety

Involving patients and carers in service development and projects

Inter-professional working

Inter-professional learning

Using the principles of ‘continuous quality improvement’ to improve care

Use of any specific methods such as: process mapping; fishbone

diagrams; root cause analysis, pareto principle, others? Please specify

Designing and contributing to clinical (other) audits?

Designing service improvements and testing them in practice (eg: using

Plan-Do-Study-Act cycles)Using recorded data in graphical form to display results and analyse

impacts of changes

Using reflective approaches such as diaries/logs to record own learning

a.b

.c.

d.e.

f.g

.h.

i.j.

Have not heard of the approach

Have heard of the approach but have no experience of its application

Have observed it at work but not been directly involved

Have been actively engaged in using this at work

Pre

Programme evaluationSelf reported learning

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Managing risk and improving patient safety

Involving patients and carers in service development and projects

Inter-professional working

Inter-professional learning

Using the principles of ‘continuous quality improvement’ to improve care

Use of any specific methods such as: process mapping; fishbone

diagrams; root cause analysis, pareto principle, others? Please specify

Designing and contributing to clinical (other) audits?

Designing service improvements and testing them in practice (eg: using

Plan-Do-Study-Act cycles)Using recorded data in graphical form to display results and analyse

impacts of changes

Using reflective approaches such as diaries/logs to record own learning

a.b.

c.d.

e.f.

g.

h.

i.j.

Have not heard of the approach

Have heard of the approach but have no experience in its application

Have observed it at w ork but have not been directly involved

Have been actively engaged in using this at w ork

Post

Programme evaluationQualitative feedback

• Brilliant idea – gets you involved in the healthcare system

• Sometimes frustrating

• Learned new ways of thinking and analysing

• Education isn’t the only thing we need to implement change

• We have worked well as a team

• Would encourage more MDT members to take part

Final comments

• F1 doctor“It made me feel worthwhile”

• Facilitator“It is the highlight of my week”

Some projects• Improving process for DVT risk assessment

• Finding urgently needed equipment in treatment rooms

• Locating patient notes and request forms on wards

• Improving weekend handovers

• Improving reliable access to notes and test results for newly admitted patients on MAU

• Speeding up internal consultant to consultant referrals

Results

• Drug chart

• Focus group

• Assessment tool trial

Before

After

Re-audit and Results• Implementation of

design to another treatment room

• Re-audit of times taken

• Reduction in times taken

• No difference between standardised rooms

• Faster times when unfamiliar room is standardised

Time taken to prepare for simple procedures in an unfamiliar treatment room.

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Prior to change

After change

Before… & …After

The Handover!

HANT computer system

CLINICAL GOVERNANCE - HALF DAY Tuesday 19 th July 2011

1:30pm – 5pm

All staff / disciplines are requested to attend whe re possible

Lecture Theatre, Level 5 Post Grad Centre

CORE SESSION 1:30 – 3:15pm

Service Improvement - Health Improvement Projects

1:45 Introduction – Dr Claire Page, Director, Foundation Prog.

2:00 “This season’s guide to side room standardisation: fashion for the future” - Hand Hygiene (Georgina Wood, Emma Grimshaw & Clare Rivers) Standardising and simplifying side room policy to avoid confusion and lower transmission of infection.

2:15 “Oxygen – a breath of fresh air” - Oxygen prescribing (Dan O’Shea, Sam Leach, Panos Prevezanos, Cath Roels) Junior doctors to champion the improvement of oxygen prescribing at SDH.

2:30 “Keeping Track of our patients” - Escalation practice (Theo Delisle, Claire Sethu, Steven Lester, Michele Giorg i & Christopher John) When patients move wards, they can be “lost” due to inappropriate or incomplete update of Consultant lists. We’ve looked at ways to standardise this process to prevent this from happening.

3:00 “Improving weekend ward work” - Bleeps at weekend (Nicola Amos, Kirsty Jenner & Moira Graham) Reducing the number of non-urgent bleeps to the ward cover F1 to prioritise acutely unwell patients, aid teamwork between healthcare professionals and improve patient care

3:15 Medicine, Madness & Money - Service improvements in Clinical Psychology (Kate Jenkins) Cognitive stimulation activities with elderly patients - helping to reduce length of stay

5:00pm Directorate / Department sessions � These are arranged separately by individual Directorates and departments. � Most departments have a lead clinician that arranges the agendas for the

half-day sessions. � If you are unsure of structure/venue please contact your Senior Nurse or

Clinical Director

Learning outcomes

• Small change = BIG DIFFERENCE

• Our project- negotiation- resistance to change- champions- meetings are key

• Success of healthcare improvement in a DGH

Learning points

� Principles of service improvement

� Collaborative working and good communication is essential

� Learning about and interacting with different professionals in the trust

� Improvements to the Trust which will benefit patients as well as staff

What we’ve learnt

• Teamwork• Time management• Developing an understanding of audits

and how the hospital system works.

What have we learnt about the Improvement Process?

• Liaising with numerous different committees, each with a slightly different role, and co-ordinating their input

• Difficult to navigate the system– Need somebody with insight into various boards

and their roles• Involves effective teamwork and

communication to co-ordinate project work around our rotas

• Need an aim that gains the support of colleagues and maintains our own interest and motivation

Dissemination

Foundation Doctors’ Presentations

• National Association of Clinical Tutors (2008, 2009, 2010)

• UK Office for the Foundation Programme Conference (2009)

• International Forum for Quality and Safety in Healthcare (Berlin 2009, Nice 2010, Amsterdam 2011)

• International Patient Safety Congress 2009

Some practical tips (1)

Provide clear benefits for:

(i) Patients – projects close to patient care

(ii) Learners – relevance to own practice, innovative way to address curriculum; strengthen CV

(iii) Facilitators – influence the future, satisfaction

(iv) Trust – real, important, improvements to care

Some practical tips (2)

Learning

i.Involve FY Docs in project choice

ii.Be clear what the core learning outcomes are

iii.Match educational/coaching approaches to context

iv.Encourage reflection on experience, organisational and personal. NB Team dynamics.

v.Be clear about purpose of assessment - beware burden

Some practical tips (3)

Time

i. Prepare a broad timeline with key milestones

ii. Have a clear end of project event – eg presentation/dragons den

iii. Consider protected time for learners and facilitators

iv. Identify someone to act as central contact point and provide administrative support

Some practical tips (4)

Support

i. Encourage senior doctors to allow F1s to attend sessions

ii. Create links with interprofessional clinical teams - avoid ‘orphan’ projects

iii. Keep in touch with progress – link-in with facilitators

iv.Consider post-project sustainability

v. Provide high profile leadership and support