Reaching Tipping Point

Strategies for building QI capability at

scale across healthcare organisations

1.30-4.30pm, Wednesday 22 April 2015

Conflicts of Interest

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Jo Bibby, Bryan Jones and Penny Pereira are Health Foundation

employees and, as such, are paid to attend this conference and lead this

workshop

Tricia Woodhead is a Health Foundation Quality Improvement Fellow who

was contracted by the Health Foundation to help produce the report on

which this workshop is based: Building the foundations for improvement

Building the foundations for improvement was funded and published by

the Health Foundation. It is available free to the public

Session One

1.30 – 2.30pm

Introduction

Dr. Jo Bibby, Director of Strategy and Innovation,

The Health Foundation, UK

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Icebreaker exercise

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1. Think of a new skill you learnt recently and now use regularly

– either in your professional or personal life

2. Think about how and why you learnt it, and how you found

the learning process

3. Share your thoughts with people at your table

4. Be ready to feed back to the whole room

Our role in developing improvement capability

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• Funding leadership and quality improvement fellowship programmes:

GenerationQ; Q initiative

• Funding small scale innovation and demonstration at scale projects

• Developing tools and resources for improvement practitioners

• Influencing national policy to create a climate ready for improvement

• Understanding how organisations in UK and abroad are developing

improvement capability Building the Foundations for Improvement

Purpose of this event

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• Provide overview of improvement capability building

programmes developed by 5 UK health & social care trusts

• Enable you to identify your improvement capability

strengths and weaknesses

• Give you an opportunity to talk about improvement

capability building with key people from the 5 trusts

Running order for this afternoon

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Session 1: 1.30 - 2.30pm

• Welcome

• Overview of Building the Foundations for Improvement case study report

• Table Exercise: Identifying your main capability building challenges

• Panel discussion with key people from the case study sites

Session 2: 2.30 - 3pm

• Workshop 1: Mapping your improvement capability strengths and weaknesses

BREAK: 3- 3.15pm

Session 3: 3.15 - 4.15pm

• Workshop 2: Table discussion with key people from the case study sites

Session 4: 4.15 - 4.30pm

• Wrap up panel discussion

Building the Foundations for

Improvement: An overview

Dr. Bryan Jones, Policy Manager, The Health Foundation, UK

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Aims of our report

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• A number of UK health and social care providers have built and

sustained improvement capability at scale over the past decade

• We have produced case studies of 5 such providers

• Through desk based research and interviews with executives and QI

leads in each trust we aimed to understand:

• how and why the trusts embarked on their improvement journeys;

• the steps they took at each stage;

• the impact they achieved;

• the challenges they encountered along the way

The 5 case study sites

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South Eastern Health

and Social Care Trust

Salford Royal NHS

Foundation Trust

Sheffield Teaching Hospitals

NHS Foundation Trust

East London NHS

Foundation TrustRoyal Devon and Exeter

NHS Foundation Trust

Key statistics on 5 case study sites

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East London NHS Foundation Trust

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Why did they do it?

• QI programme inspired to a large extent by two ‘sentinel events’

What did they do?

• Built the will

• Built improvement capability

• QI projects

• Alignment

What impact has it had?

• Now in top 10 health care employers in the UK

• Early QI project to address violence on wards has led to 20% reduction across trust

East London QI programme driver diagram

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South Eastern HSC

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Why did they do it?

• Quality and safety made organisational priority following trust merger

What did they do?

• Ensured organisation aligned with the safety, quality and experience approach

• Secured staff support for the new approach

• Developed an improvement capability building programme

• Created a physical hub for improvement activity

What impact has it had?

• Increase in staff perceptions of the trust’s commitment to improving quality and safety

• Multiple service improvements – such as reduction in post-partum haemorrhage rates following childbirth and falls among older people

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Service improvement projects Year 3 - 2013/14

Medicine Surgery Woman & Child Health

Post Ward Checklist

Oxygen Prescribing & Monitoring

Reducing the incidence of missing

and illegible patient identification

wristbands within the Ulster Hospital

Pain App

Recording of Intra-Operative

Distention Fluid

Pain Assessment and Management

Introduction of a Safety Huddle for

Nurses in CCU

Improving the performance of the

Safer Surgical Checklist

Promoting Safety in Research

Medicines Management

Early Pregnancy Clinic

Medication Reconciliation

Allied Health Professionals Social Work Nursing, Primary Care & Older People

Community Physio Follow up

Improving Client Participation in

Goal Planning in Community Brain

Injury Service

Permanence Planning for Children

in Trust Care

Promoting Meaningful Engagement

of Looked after Children in LAC

Reviews

Accurately Recognising and Grading

Pressure Ulcers

Post Cardiac Arrest

Emergency Response Number

Bereavement, Best Practice Made

Easy

Adult Services Elderly Services Hospital Services

To improve the level of financial

independence for Tenants that line

in a Mental Health supported living

facility

Improving Communication with the

Formalisation of Handover

Processes

Not all bugs need drugs

Improve the process for collating

carer assessment data

Improving the experience for carers'

at Domiciliary Care reviews

AWARE (Awareness why

anticipating and responding is

essential)

Incomplete Inpatient E-referrals for

CT and MRI Scans

If you are Sick, call us Quick, it could

be an Emergency

Key lessons for providers

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• Get early board-level support

• Think about how you will fund your programme

• Free up staff time to participate

• Make sure participants ‘learn by doing’ through QI projects

• Align QI work with other priorities

Table Exercise

What are your main improvement capability

building challenges?

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Table exercise instructions

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1. Think about the main improvement capability building

challenges which you would like this event to examine

2. Discuss your challenges with other people at your table

3. Be ready to feed back to the whole room

Panel discussion with key

figures from the case study sites

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Panel members

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Dr Tom Downes, Consultant Physician and Geriatrician, Clinical Lead for

QI, Sheffield Teaching Hospitals NHS Foundation Trust; Health Foundation QI

Fellow

Bernadette George, Lead Nurse Patient Safety and Risk, Royal Devon and

Exeter NHS Foundation Trust

Linda Kelly, Assistant Director for Safe and Effective Care, South Eastern Health

and Social Care Trust

Siobhan Moran, Assistant Director of QI, Salford Royal NHS Foundation Trust

Penny Pereira, Assistant Director, The Health Foundation (Panel Chair)

Session 2

2.30 – 3pm

Workshop 1

Building improvement capability:

What are your strengths and weaknesses?

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Four key stages

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Stage 1: Testing the Water

Financial and organisational stability

Board and executive level support

Governance and performance

structure

Existing QI capacity or partner

Stage 2: Building the right

foundations

Business case

QI team

Alignment with other goals

Engaged workforce and users

Stage 3: Getting started

Learning by doing

Training appropriate for all

Time and space to take part in

training

Deliver some ‘early wins’

Stage 4: Once the programme is

underway

Evaluation process in place

Knowledge of range of QI methods

Graduates share their knowledge

Service managers supportive

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Take 15 minutes to complete the sheet individually or in groups at your table.

Use the building improvement capability checklist on your table to guide to you

Workshop 2 table plan

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Table Trust Topic Table Trust Topic

1 East London Getting buy in from boards and

management?10 Salford Building capability across your

organisation: steps to achieving

your vision

2 East London Building the will across your

organisation as a whole11 Salford Integrating improvement activities

in a busy clinical environment

3 East London Building the will across your

organisation as a whole12 Sheffield Creating the right conditions and

promoting continuous innovation

4 East London Building a convincing business case 13 Sheffield Creating the right conditions and

promoting continuous innovation

5 East London Aligning QI work with wider corporate

objectives and philosophy14 South Eastern Aligning QI work with wider

corporate objectives and

philosophy

6 East London Developing a training programme

tailored to your needs15 South Eastern Developing a training programme

tailored to your needs

7 East London Measuring and understanding impact 16 South Eastern Involving a social care workforce in

a QI programme

8 East London Measuring and understanding impact 17 Health

Foundation

Emerging issues

9 Royal Devon and

Exeter

Empowering and equipping frontline

teams to surface and tackle problems 18 Health

Foundation

Emerging issues

After the break, choose one of the following tables

BREAK

3 – 3.15pm

Session 3

3.15 – 4.15pm

Workshop 2

Facilitated table discussion with staff

from 5 case study sites

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Workshop 2 table plan

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Choose one of the following tables

Table Trust Topic Table Trust Topic

1 East London Getting buy in from boards and

management?10 Salford Building capability across your

organisation: steps to achieving

your vision

2 East London Building the will across your

organisation as a whole11 Salford Integrating improvement activities in

a busy clinical environment

3 East London Building the will across your

organisation as a whole12 Sheffield Creating the right conditions and

promoting continuous innovation

4 East London Building a convincing business case 13 Sheffield Creating the right conditions and

promoting continuous innovation

5 East London Aligning QI work with wider corporate

objectives and philosophy14 South Eastern Aligning QI work with wider

corporate objectives and philosophy

6 East London Developing a training programme

tailored to your needs15 South Eastern Developing a training programme

tailored to your needs

7 East London Measuring and understanding impact 16 South Eastern Involving a social care workforce in

a QI programme

8 East London Measuring and understanding impact 17 Health

Foundation

Emerging issues

9 Royal Devon and

Exeter

Empowering and equipping frontline

teams to surface and tackle problems 18 Health

Foundation

Emerging issues

Session 4

4.15 – 4.30pm

Final panel discussion

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Panel members

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Dr Amar Shah, Associate Director for QI and Consultant Forensic

Psychiatrist, East London NHS Foundation Trust

Dr Tricia Woodhead, Associate Clinical Director for Patient Safety at the

West of England Academic Health Science Network; Health Foundation

QI Fellow (Chair)

Over to you…

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Decide what your follow up action will be when you return home, then fill

in a post-card and leave it on your table. We will send it back to you in a

few weeks.

Keep in touchFor all the latest news and developments from the Health Foundation:

Visit our website at www.health.org.uk

Subscribe to our monthly email newsletter at

www.health.org.uk/newsletter

Register for email alerts to be notified about our latest work at

www.health.org.uk/updates

Take part in conversation and debate about current healthcare

issues on our blog

Follow us on Twitter, Facebook or LinkedIn.

Keep in touchFor all the latest news and developments from the Health Foundation:

Visit our website at www.health.org.uk

Subscribe to our monthly email newsletter at

www.health.org.uk/newsletter

Register for email alerts to be notified about our latest work at

www.health.org.uk/updates

Take part in conversation and debate about current healthcare

issues on our blog

Follow us on Twitter, Facebook or LinkedIn.

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