session 1a - building organisational and system-wide ... · 2. sharing stories t newsletters,...

Q community event 2019Session 1A - Building organisational and system-wide

approaches to improvement

13 November 2019

Agenda

1. Chair’s welcome - Tim Horton, Assistant Director, The Health Foundation

2. The Improvement Journey report - Bryan Jones, Improvement Fellow, The Health Foundation

3. The ELFT approach to quality - Amar Shah, Chief Quality Officer, East London NHS FT

4. GSTT’s improvement journey - Neil Goulbourne, Deputy Director of Improvement, Guy’s & St.

Thomas’ NHS Foundation Trust

5. Rapid responses

• Erin Payne, Head of QI, Yorkshire Ambulance Service NHS Trust

• Frances Wiseman, Head of Transformation and Delivery, Portsmouth Hospitals NHS Trust

6. Comments and questions from the floor

13.11.19 Building organisational and system wide approaches to improvement

Key questions for this session• What is an organisational approach to improvement, and why do they matter?

• What is involved in planning, implementing and sustaining an organisational approach to

improvement?

• What capabilities and capacity do organisations need to embark on their journey?

• How should organisations assess their ‘readiness to improve’?

• To what extent do organisations’ size, location, care sector and ‘improvement maturity’

matter when it comes to deciding the pace, shape and direction of their approach to

improvement?

• How do organisational level approaches to improvement relate to system level

improvement approaches?

• What external support do organisations and systems need on their improvement journey?


The Improvement JourneyBryan Jones, Improvement Fellow, The Health Foundation


Health Foundation learning on organisational and system wide improvement

What is an organisational approach to improvement?

A long-term initiative to embed a culture of continuous improvement across an

organisation, involving:

• an improvement vision supported at all levels, which is realised through;

• a coordinated programme of interventions to improve care pathways and systems


What are the key enablers?

• Leadership and governance: visible board leadership; improvement activity

aligned with organisational strategy

• Infrastructure and resources: data, equipment and resources available at team

level to plan and deliver improvement

• Skills and workforce: improvement capability

building programme open to all staff

• Culture and workforce: supportive, collaborative

and inclusive workplace culture


Why does it matter?

A coordinated, aligned organisational

improvement approach:

• Avoids safety risks of siloed microsystem

level improvement

• Enables efficient use of staff time and

resources

• Provides means to tackle ‘big hairy’

systemic problems

• Enables creation of a workplace culture

conducive to improvement


Why does it matter?NHS Long Term Plan

‘A programme to build improvement capability exists in 80% of the trusts rated ‘outstanding’

NHS Trust quality strategies – three examples

‘Our ambition is to maintain our outstanding grading and our focus on continuous QI will help us

achieve this aim.’

‘Outstanding trusts have one thing in common; a well-led, embedded, staff and patient driven QI

approach. This trust has committed to this QI agenda.’

‘A large scale, integrated improvement programme, encompassing strategic change, population

health, digital transformation, service and productivity improvement, workforce redesign, OD, QI

and patient involvement is being proposed to drive the trust’s actions over the next 3 years.’


Characteristics of organisations struggling to improve quality


Systematic

review by

Vaughn and

Saint et al

BMJ Qual Saf

2019

Assessing readiness

1 Securing board support

2

Sustaining an organisation-wide approach

6Aligning activity5

Developing improvement skills and infrastructure

4

Securing wider organisationalbuy-in

3

The improvement journey

The ELFT approach to quality

Dr Amar Shah, Chief Quality Officer

DrAmarShah

Mental health servicesNewham, Tower Hamlets, City & Hackney, Luton & Bedfordshire

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, Tower Hamlets &

Bedfordshire

IAPTNewham, Tower Hamlets,

Richmond and Bedfordshire

Primary care

AIMTo provide the

highest quality

mental health and

community care in

England by 2020

Engaging, encouraging &

inspiring

Developing improvement

skills

Embedding into daily work

QI Projects

1. Targeting / segmenting communication for different groups (community- based staff, Bedfordshire & Luton staff)

2. Sharing stories – newsletters, microsite, presenting internally3. Celebration – awards, conferences, publications, internal

presentations4. Share externally – social media, Open mornings, visits, microsite5. Work upstream – trainees, regional partners, key national and

international influencers

1. Pocket QI for anyone interested, extended to Beds & Luton2. Refresher training for all ISIA graduates3. Improvement Science in Action waves4. Online learning options5. Develop cohort and pipeline of improvement coaches6. Leadership and scale-up workshops for sponsors7. Bespoke learning, including Board sessions & commissioners

1. Learning system: QI Life, quality dashboards, microsite2. Standard work as part of a holistic quality system3. Job descriptions, recruitment process, appraisal process4. Annual cycle of improvement: planning, prioritising, design and

resourcing projects5. Support staff to find time and space to improve things6. Support deeper service user and carer involvement

Directorate-level priorities- Defined through annual cycle of planning- Most local projects aligned to directorate priorities

Trust-wide strategic priorities1. Reducing inpatient physical violence2. Improving access to community services3. Enjoying work4. Shaping recover in the community5. Value for money

Experts by experience

All staff

Staff involved in or leading QI projects

Sponsors

Board

Estimated number needed to train = 4000Needs = introduction to QI & systems thinking,

identifying problems, how to get involved

Estimated number needed to train = 1000Needs = Model for improvement, PDSA,

measurement and using data, leading teams

Estimated number needed = 50Needs = deep understanding of method & tools,

understanding variation, coaching teams

Needs = setting direction and big goals, executive leadership, oversight of improvement,

understanding variation

Estimated number needed to train = 10Needs = deep statistical process control, deep

improvement methods, effective plans for implementation & spread

477 completed Pocket QI so far. All staff receive intro to QI at

induction

690 graduated from ISIA in 6 waves. Wave 7 in 2017-18.

Refresher training for ISIA grads.

53 QI coaches trained so far, with 35 currently active. Third cohort of

20 to be trained in 2017

All Executives have completed ISIA. Annual Board session with IHI &

regular Board development

Currently have 6 improvement advisors, with 3 further QI leads in

training

Internal experts (QI

leads)

Bespoke QI learning sessions for service users and carers. Over 95

attended so far. Build into recovery college syllabus

Needs = introduction to QI, how to get involved in improving a service, practical skills in

confidence-building, presentation, contributing ideas

QI coaches

Needs = Model for improvement, PDSA, measurement & variation, scale-up and spread,

leadership for improvement

58 current sponsors. All completed ISIA. Leadership, scale-up & refresher QI training in 2017

Psychology trainees – Pocket QI, embedded into QI project teams with 4 bespoke learning sessions

Nursing students – Intro to QI delivered within undergraduate and postgrad syllabus, embedded into QI project teams during student placements

Wor

king

upst

ream

qi.elft.nhs.uk

Change in leadershipbehaviours

“Go see”“Gemba”Executive WalkRounds

Use of data to guide decision-making

Stop solving problems at the top

Give people time and space to solve complex problems

Manage the expectationsPaying

personal attention

QI ResourcesService User Input

Support around every team

Project Sponsor QI Coach

QI Forums

QI Team

UCL

175.462

102.625

LCL

60

80

100

120

140

160

180

200

220

Jan-

13Fe

b-13

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-13

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ay-1

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No. o

f Inc

iden

tsIncidents resulting in physical violence (ELFT excluding Luton and Bedfordshire) - C Chart

150

250

350

450

550

650

750

850

2013 2014 2015 2016

No. o

f Inc

iden

ts

Physical violence to staff (per 100,000 occupied bed days)

150

250

350

450

550

650

750

850

2013 2014 2015 2016

No. o

f Inc

iden

ts

Physical violence to patients (per 100,000 occupied bed days)

42%

31.73%24.38%

23.52%

20.32%

UCL

LCL

15%

17%

19%

21%

23%

25%

27%

29%

31%

33%

35%

37%

39%

Jan-

14

Feb-

14

Mar

-14

Apr-

14

May

-14

Jun-

14

Jul-1

4

Aug-

14

Sep-

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DN

A %

1st face to face appointments non-attendance (10/13 teams) - P Chart

UCL

1,021.711,213.13

1,284.57

LCL

700

800

900

1000

1100

1200

1300

1400

1500

1600

1700

Jan-

14

Feb-

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Mar

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Dec-

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Jan-

15

Feb-

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Mar

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Nov

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Dec-

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Jan-

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No.

of R

efer

rals

No. of referrals received (10/13 teams) - I Chart

60.66

53.17

44.51

49.42

UCL

LCL

35

40

45

50

55

60

65

70

Jan-

14

Feb-

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Mar

-14

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Aver

age

Wai

ting

Tim

e /

Day

s

Average waiting time from referral to 1st face to face appointment (10/13 teams) - X-bar Chart

- Testing begins - 3 teams leave the collaborative- 2 new teams join the collaborative - New DNA operational definition

Legend

Access to Services Collaborative

19%

36%26%

Periodic checks to ensure

the service is meeting the

needs of the customer/population

Actions to address gaps

identified

Identify clear measures of quality for the service,

and monitor these over time.

Take corrective action when

appropriate

Internal vigilance to hold

gains made through improvement

Identify the needs of the customer/ population

Develop service models to meet

the needs

Put in place structures and

processes to manage the

service

Identify what matters

most

Design project and bring

together a diverse team

Discover solutions through involving

those closest to the work, test ideas,

implement and then scale up

GSTT’s Improvement JourneyNeil Goulbourne, Deputy Director of Improvement,

Guy’s & St. Thomas’ NHS Foundation Trust

About GSTT

• 800 years old

• 17,000 staff

• 1,334 beds

• 2.6 million patient contacts

• 6,492 babies

• 796,000 patient contacts in community

services.

• 50 outreach clinic locations

Improvement and transformation at GSTT

+

• Evelina improvement

team

• Community transformation

team

• CLIMP Siemens

• Design thinking

• Patient safety and QI team

• 75 audit leads

• …

+

We knew we could do better

Confusion

for staff

CQC

guidance

QI not most

people’s ‘go

to’

Dwindling

impact

Our QI task and finish group

Strategy

• 14 teams

• 8 weeks

• Appreciative enquiry

• 3 workshops

• Desktop research

• Interviews

Implementation

plan

• 8 weeks

• 3 workshops

• More

interviews!

The GSTT QI System

Implementation plan

• Two model directorates – co-design

• Spread in pairs and triplets ahead of EHR

• Build corporate team including expertise

• QI coaches will lead EHR implementation

• Look for opportunities to spread faster

• Get external support but using our materials

Where are we now?

What have we learnt?

A movement for change in a complex environment

Relationship between corporate and local teams

Make the most of existing assets

Expertise into the corporate team

Avoid copying anatomy of exemplars

Make it practical

Rapid responses from Q members• Erin Payne, Head of QI, Yorkshire Ambulance Service NHS Trust

• Frances Wiseman, Head of Transformation and Delivery,

Portsmouth Hospitals NHS Trust

Key questions for this session• What is an organisational approach to improvement, and why do they matter?

• What is involved in planning, implementing and sustaining an organisational approach to

improvement?

• What capabilities and capacity do organisations need to embark on their journey?

• How should organisations assess their ‘readiness to improve’?

• To what extent do organisations’ size, location, care sector and ‘improvement maturity’

matter when it comes to deciding the pace, shape and direction of their approach to

improvement?

• How do organisational level approaches to improvement relate to system level

improvement approaches?

• What external support do organisations and systems need on their improvement journey?


Thank you

session 1a - building organisational and system-wide ... · 2. sharing stories t newsletters,...

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