qi.elft.nhs.uk @elft qiænder.dk/media/2006/ls1_internationalt... · 2. stories from qi projects -...
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The presenters have nothing to disclose@ELFT_QIqi.elft.nhs.uk
Mental health servicesNewham, Tower Hamlets, City & Hackney
Forensic servicesAll above & Waltham Forest, Redbridge, Barking & Dagenham, Havering
Child & Adolescent services, including tier 4 inpatient service
Regional Mother & Baby unit
Community health services Newham
Urgent care centre Newham
IAPTNewham, Richmond and Luton
Speech & LanguageBarnet
Challenges and
opportunities
Cultural diversity
Social deprivation
Geographical diversity
Commissioningarrangements
Financial stability and
strong assurance systems
QualityBetter
Reject defectives
Requirement,Specification or Threshold
No action taken here
Worse
The old or only way we knew (Quality Assurance)
Performing well?
The culture we want to nurture
A listening and learning organisation
Empowering staff to drive improvement
Increasing transparency and openness
Re-balancing quality control, assurance and
improvement
Patients, carers and families at the heart of all
we do
@ELFT_QI
Trust board bespoke learning sessions
Visits to other organisationsSentinel event
Developing the strategy through engagement
Building the case for change
Early small scale tests
Long-term business case approved
Assess readiness for change
Identify strategic partner
AIM:To provide the highest
quality mental
health and community
care in England by
2020
Build the will
Build improvement
capability
Alignment
QI Projects
1. Newsletters (paper and electronic)2. Stories from QI projects - at Trust Board, newsletters3. Annual conference4. Celebrate successes – support submissions for awards5. Share externally – social media, Open mornings, visits,
microsite, engage key influencers and stakeholders
1. Build and develop central QI team capability2. Online learning options3. Pocket QI for those interested in QI4. Improvement Science in Action waves5. Develop cohort and pipeline of QI coaches6. Bespoke learning, including Board sessions & commissioners
1. Embed local directorate structures & processes to support QI
2. Align projects with directorate and Trust-wide priorities3. Support staff to find time and space for QI work4. Support deeper service user and carer involvement5. Support team managers and leaders to champion QI6. Align research, innovation, improvement and operations
Reducing Harm by 30% every year1. Reduce harm from inpatient violence2. Reduce harm from pressure ulcers
3. Other harm reduction projects (not priority areas)
Right care, right place, right time1. Improving access to services2. Improving physical health 3. Other right care projects (not priority areas)
QI Stories at Trust Board
QI Visibility Wall
Electronic & paper newsletters
http://qi.elft.nhs.uk
12 QI projects published or submitted for publication
Shortlisted for 12 national awards, won 5
Pocket QI commenced in October 2015. Aim to reach 200 people by
Dec 2016.All staff receive intro to QI at
induction
600 staff have completed the ISIA
67 QI Coaches by end of 2016
Most Executives will have undertaken the ISIA.
Annual Board session with IHI & regular Board development
discussions on QI
7 Improvement Advisors
Bespoke QI learning sessions for service users and carers. Over 40
attended in 2015. Build into recovery college syllabus, along with
confidence-building, presentation skills etc.
Estimated number needed to train = 5000Needs = introduction to quality
improvement, identifying problems, change ideas, testing and measuring change
Estimated number needed to train = 1000Needs = deeper understanding of
improvement methodology, measurement and using data, leading teams in QI
Estimated number needed to train = 40Needs = deeper understanding of
improvement methodology, understanding variation, coaching teams and individuals
Needs = setting direction and big goals, executive leadership, oversight of improvement, being a champion, understanding variation to lead
Estimated number needed to train = 11Needs = deep statistical process control,
deep improvement methods, effective plans for implementation & spread
Needs = introduction to quality improvement, how to get involved in improving a service, practical skills in
confidence-building, presentation, contributing ideas, support structure for
service user involvement
All staff
Staff involved in or leading QI projects
QI coaches
Board
Internal experts (QI
team)
Experts by experience
QI ResourcesService User Input
Support around every team
Project Sponsor QI Coach
QI Forums
QI Team
Governance Improvement
Little i Big I
Surveys
Focus groups
Community meetings
Service user
forum
Portfolio thinking
67,8
51,1
UCL
LCL
25
35
45
55
65
75
85
95
06
-Jan-1
4
20
-Jan-1
4
03
-Feb
-14
17
-Feb
-14
03
-Mar-
14
17
-Mar-
14
31
-Mar-
14
14
-Ap
r-14
28
-Ap
r-14
12
-May-1
4
26
-May-1
4
09
-Jun-1
4
23
-Jun-1
4
07
-Jul-1
4
21
-Jul-1
4
04
-Au
g-1
4
18
-Au
g-1
4
01
-Se
p-1
4
15
-Se
p-1
4
29
-Se
p-1
4
13
-Oct-
14
27
-Oct-
14
10
-No
v-1
4
24
-No
v-1
4
08
-De
c-1
4
22
-De
c-1
4
05
-Jan-1
5
19
-Jan-1
5
02
-Feb
-15
16
-Feb
-15
02
-Mar-
15
16
-Mar-
15
30
-Mar-
15
13
-Ap
r-15
27
-Ap
r-15
11
-May-1
5
25
-May-1
5
08
-Jun-1
5
22
-Jun-1
5
06
-Jul-1
5
20
-Jul-1
5
03
-Au
g-1
5
17
-Au
g-1
5
31
-Au
g-1
5
14
-Se
p-1
5
28
-Se
p-1
5
12
-Oct-
15
26
-Oct-
15
09
-No
v-1
5
23
-No
v-1
5
07
-De
c-1
5
21
-De
c-1
5
04
-Jan-1
6
18
-Jan-1
6
01
-Feb
-16
No.
of In
cid
en
ts
Incidents resulting in physical violence (Trust-wide) - C Chart
VIOLENCE REDUCTION
150
200
250
300
350
400
450
500
550
2013 2014 2015
No
. of
Inci
de
nts
Physical violence to patients (per 100,000 occupied bed days)
300
400
500
600
700
800
900
2013 2014 2015
No
. of
Inci
de
nts
Physical violence to staff (per 100,000 occupied bed days)
25% reduction
16.9
7.9
3.5
UCL
LCL
0
5
10
15
20
25
30
35
40
13-A
pr-
16
16-A
pr-
16
19-A
pr-
16
22-A
pr-
16
25-A
pr-
16
28-A
pr-
16
01-M
ay-1
60
4-M
ay-1
60
7-M
ay-1
61
0-M
ay-1
61
3-M
ay-1
61
6-M
ay-1
61
9-M
ay-1
62
2-M
ay-1
62
5-M
ay-1
62
8-M
ay-1
63
1-M
ay-1
60
3-J
un-1
60
6-J
un-1
60
9-J
un-1
61
2-J
un-1
61
5-J
un-1
61
8-J
un-1
62
1-J
un-1
62
4-J
un-1
62
7-J
un-1
63
0-J
un-1
60
3-J
ul-1
60
6-J
ul-1
60
9-J
ul-1
61
2-J
ul-1
61
5-J
ul-1
61
8-J
ul-1
62
1-J
ul-1
62
4-J
ul-1
62
7-J
ul-1
63
0-J
ul-1
60
2-A
ug
-16
05-A
ug
-16
08-A
ug
-16
11-A
ug
-16
14-A
ug
-16
17-A
ug
-16
20-A
ug
-16
23-A
ug
-16
26-A
ug
-16
29-A
ug
-16
01-S
ep
-16
04-S
ep
-16
07-S
ep
-16
10-S
ep
-16
13-S
ep
-16
16-S
ep
-16
19-S
ep
-16
22-S
ep
-16
25-S
ep
-16
28-S
ep
-16
01-O
ct-
16
04-O
ct-
16
07-O
ct-
16
10-O
ct-
16
13-O
ct-
16
16-O
ct-
16
19-O
ct-
16
22-O
ct-
16
25-O
ct-
16
28-O
ct-
16
Control Chart: Number of recorded red incidents (physical violence) every 3 days on Safety Cross - Conolly, Gardner, Joshua, Ruth Seifert
& Brett
Red IncidentsW
ho
le C
olla
bo
rative
Me
asu
res fro
m S
afe
ty C
ross
01/04: Testing started on all wards except
Conolly
01/04: CHVRC* 2
13/04: Testing started Conolly
24/06: CHVRC* 4
*CHRVC = Meetings of the “City and Hackney Violence Reduction Collaborative”
13/05: CHVRC* 3
01/08: CHVRC* 5
30/09: CHVRC* 6
79%
^ 05/09
X transferred
Please note, some of this reduction is due to changes in patient mix on Brett Ward. Please see the next chart for the reduction, excluding Brett Ward
PRESSURE ULCERS
57,30%
73,10%
92,01%
UCL
LCL
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
28-A
pr-
14
19-M
ay-1
4
09-J
un-1
4
30-J
un-1
4
21-J
ul-1
4
11-A
ug
-14
01-S
ep
-14
22-S
ep
-14
13-O
ct-
14
03-N
ov-1
4
24-N
ov-1
4
15-D
ec-1
4
05-J
an-1
5
26-J
an-1
5
16-F
eb
-15
16-M
ar-
00
06-A
pr-
15
27-A
pr-
15
18-M
ay-1
5
08-J
un-1
5
29-J
un-1
5
20-J
ul-1
5
10-A
ug
-15
31-A
ug
-15
21-S
ep
-15
12-O
ct-
15
02-N
ov-1
5
11-J
an-1
6
Com
ple
tion R
ate
/ %
Waterlow Completion Rate - P Chart
3,5
2,5
UCL
LCL0
1
2
3
4
5
6
7
8
9
10
07
-Ap
r-14
28
-Ap
r-14
19-…
09
-Jun-1
4
30
-Jun-1
4
21
-Jul-1
4
11-…
01-…
22-…
13
-Oct-
14
03-…
24-…
15-…
05
-Jan-1
5
26
-Jan-1
5
16-Feb-…
09-M
ar-…
30-M
ar-…
20
-Ap
r-15
11-…
01
-Jun-1
5
22
-Jun-1
5
13
-Jul-1
5
03-…
24-…
14-…
05
-Oct-
15
26
-Oct-
15
16-…
07-…
No.
of P
ressure
Ulc
ers
Grade 2 Pressure Ulcers - C Chart
Outcome Measure 2: Total Grade 2 PUs, Acquired in EPCS, On a Weekly Basis
14/03EPCT Consultation
Launched
12/04EPCT Consultation
Concluded
06/06Senior staff on late/evening
shift
04/07New structure implemented
UCL
4,537
2,375
1,3…
0
2
4
6
8
10
12
07
-Ap
r-1
4
28
-Ap
r-1
4
19
-May
-14
09
-Ju
n-1
4
30
-Ju
n-1
4
21
-Ju
l-1
4
11
-Au
g-1
4
01
-Sep
-14
22
-Sep
-14
13
-Oct
-14
03
-No
v-1
4
24
-No
v-1
4
15
-Dec
-14
05
-Jan
-15
26
-Jan
-15
16
-Feb
-15
09
-Mar
-15
30
-Mar
-15
20
-Ap
r-1
5
11
-May
-15
01
-Ju
n-1
5
22
-Ju
n-1
5
13
-Ju
l-1
5
03
-Au
g-1
5
24
-Au
g-1
5
14
-Sep
-15
05
-Oct
-15
26
-Oct
-15
16
-No
v-1
5
07
-Dec
-15
28
-Dec
-15
18
-Jan
-16
08
-Feb
-16
29
-Feb
-16
21
-Mar
-16
11
-Ap
r-1
6
02
-May
-16
23
-May
-16
13
-Ju
n-1
6
04
-Ju
l-1
6
25
-Ju
l-1
6
15
-Au
g-1
6
05
-Sep
-16
26
-Sep
-16
17
-Oct
-16
No
. of
Pre
ssu
re U
lce
rs
Grade 2 Pressure Ulcers - C Chart
70%
2 new teams join
collaborative
AV
ERA
GE
WA
ITIN
G T
IME
October 2016 1- Baseline data
Child and Adolescent Mental Health Service (Tower Hamlets) Community Mental Health Teams (City and Hackney & Tower Hamlets)
Average Waiting Time from Referral to 1st face to face appointment – I Chart
51.52
45.56
57.46
36.45
31.44
16/02Learning
Set 1
10/05Learning
Set 9Test
ing
be
gin
s
28/03Learning
Set 2
27/07Learning
Set 3
03/09Learning
Set 4
01/10Learning
Set 5
25/11Learning
Set 6
05/01Learning
Set 7
16/02Learning
Set 8
3 teams leave collaborative
39.85
60,66
53,17
44,51
51,23
UCL
LCL
35
40
45
50
55
60
65
70
Ja
n-1
4
Feb
-14
Mar-
14
Apr-
14
May-1
4
Ju
n-1
4
Ju
l-14
Aug
-14
Sep
-14
Oct-
14
No
v-1
4
De
c-1
4
Ja
n-1
5
Feb
-15
Mar-
15
Apr-
15
May-1
5
Ju
n-1
5
Ju
l-15
Aug
-15
Sep
-15
Oct-
15
No
v-1
5
De
c-1
5
Ja
n-1
6
Feb
-16
Mar-
16
Apr-
16
May-1
6
Ju
n-1
6
Ju
l-16
Aug
-16
Sep
-16
Avera
ge W
aitin
g T
ime / D
ays
Average waiting time from referral to 1st face to face appt (Collaborative, 10/12 teams) - X-bar Chart
ACCESS TO SERVICES
Staff experience and engagement
3,5
3,6
3,7
3,8
3,9
4
2010 2011 2012 2013 2014 2015
Sco
re
Overall Engagement Score
ELFT Score
National Median
3,5
3,6
3,7
3,8
3,9
4
4,1
4,2
2010 2011 2012 2013 2014 2015
Sco
re
Staff Motivation to Work
3,3
3,4
3,5
3,6
3,7
3,8
3,9
4
4,1
2010 2011 2012 2013 2014 2015
Sco
re
Staff job satisfaction
55
60
65
70
75
80
85
90
2010 2011 2012 2013 2014 2015
Sco
re (
%)
Staff able to contribute towards improvements at work
Make it feel meaningful
Make it feel possible
Make it feel valued and permanent
Provide skills and support
@ELFT_QIqi.elft.nhs.uk [email protected]