Quality of life

Changing complex systems• Complex systems seek stability• People living in complex systems take comfort

from stability and fear change• Attempts to change them often result in

unanticipated consequences • Those trying for change get the blame whatever

the outcome• We tend, therefore to tinker round the edges

rather than trying for transformational change

Complex adaptive systems

• Not machines so no traditional forms of control• Leadership is distributed. The boss can’t control

everything• Small changes in one area might have large

impacts elsewhere and vice versa• Outcomes are unpredictable so continual

monitoring and learning and chage is part of the process of change

Changing complex systems

• Challenge the stability of existing behaviours and structure

• Set simple, order generating rules• Expect new insights and ideas to emerge• Have an open, learning attitude, using plan,

do, study act cycles• Keep calm and carry on!

Albert Einstein

• Insanity “is doing the same thing over and over again and expecting different results”

Improvement science

• W Edwards Deming (1900-1993)– “In God we trust, all others must bring data”– “By what method? Only the method counts.”

• Don Berwick– “Some is not a number. Soon is not a time.”

• Scottish Patient Safety Programme– “By how much and by what method?”

Hospital SMR – 9.3% reduction

0.5

1.0

1.5

Oct-Dec2006

Jan-Mar2007

Apr-Jun

2007

Jul-Sep2007

Oct-Dec2007

Jan-Mar2008

Apr-Jun

2008

Jul-Sep2008

Oct-Dec2008

Jan-Mar2009

Apr-Jun

2009

Jul-Sep2009

Oct-Dec2009

Jan-Mar2010

Apr-Jun

2010

Jul-Sep2010

Oct-Dec2010

Jan-Mar

2011p

Apr-Jun

2011p

Jul-Sep

2011p

Sta

ndar

dise

d M

orta

lity

Rat

io

Standardised Mortality Ratio (SMR) Regression line

0

0.5

1

1.5

2

2.5

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

General ward C.Difficile rate(per thousand patient days)

1.15

0.12

90% reduction

0

0.5

1

1.5

2

2.5

3

3.5

4

Jan-

08

Mar

-08

May

-08

Jul-0

8

Sep

-08

Nov

-08

Jan-

09

Mar

-09

May

-09

Jul-0

9

Sep

-09

Nov

-09

Jan-

10

Mar

-10

May

-10

Jul-1

0

Sep

-10

Nov

-10

Jan-

11

Mar

-11

May

-11

Jul-1

1

Sep

-11

Nov

-11

Central line infection rate (per thousand line days)

2.8

0.84

70% reduction

Life expectancy trendsLife expectancy: Scotland & other Western European Countries, 1851-2005

Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Portugal

Scotland

Life expectancy trends

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Walsh, D. et al. Eur J Public Health 2010 20:58-64; doi:10.1093/eurpub/ckp063

Male life expectancy at birth West Central Scotland and 10 post-industrial regions

Post industrial regions of Europe

Male mortality 15-75Scotland and 15 other European countries

Female mortality 15-75Scotland and 15 European countries

Attention to detail

Suggestions for collaborative working

• Early years and children• Young persons offending• Physical activity across the population• Planning and design of communities• Entrepreneurship

Adverse childhood events risk of alcoholismAdverse childhood events risk of alcoholism

Hillis et al 2011

Adverse childhood eventsAdverse childhood eventsrisk of perpetrating violencerisk of perpetrating violenceBoys experiencing physical abuseBoys experiencing physical abuse

Duke et al 2010

Risk of heart disease and early adversityRisk of heart disease and early adversity

Social connectedness

• 148 studies comprising 308,849 participants, high levels of social integration conferred a 50% increased likelihood of survival.

• Complex patterns of social integration conferred a 90% increase in survival.

• Simple connections such as living with others versus living alone conferred a survival benefit of 19%.

SGLAsNHS3rd

Sector

Enhancing social connectedness

1. Light the fire

2. Build communitie

s

Help to connect peopleCoproduction

Risk Factors- mortality Blair et al BJSM 2009

Risk reduction associated with physical activity

Chronic condition Risk reductionAll cause mortality 30% risk reductionCVD, stroke 20-35% reductionDiabetes 30-40% reductionHip fractures 36-68% reductionColon cancer 30% reductionBreast cancer 20% reductionLoss of function 30% reductionDepression/dementia 20-30% reduction