PERSON CENTRED, SAFE AND EFFECTIVE

HEALTHCARE

A QUALITY STRATEGY FOR NHSSCOTLAND

Purpose

• To inform you of the development of the quality strategy

• To work with you, sharing thinking and ideas

• To consider the ways in which the quality strategy will affect NHS Scotland and services

• To hear your thoughts on how to make it happen

PROPOSED AIMS FOR QUALITY STRATEGY?

1. To make NHS Scotland a world leader in healthcare quality.

2. To do so in a way that is meaningful to all.

KEY MESSAGES

• Not ‘just another strategy’• Not top down imposition• Integrated rather than additional• A development of Better Health

Better Care – not a replacement• Built on shared values • For the whole of the NHS, our

partners and for the public

WHAT PEOPLE SEE AS HIGH QUALITY HEALTHCARE?

• caring and compassionate health services;

• collaborating effectively with clinicians, patients and others;

• confidence and trust in health services;• providing a clean and safe care

environment;• improving the access to care and

continuity of care;• delivering clinical excellence

The aim is to get out in front;

Some foundations

Work to do…

Ageing Population

Health inequalities

Economic position

Changing expectations

THE CONTEXT

The Right Time?

• Everyone working in or with NHSScotland is already committed to providing high quality healthcare

• Demographic, resource and cultural context combine to create clear drivers and a unique challenge/opportunity

• We know that marginal changes will not create the scale of change required

• NHSScotland particularly well placed, through its structures, values and through the foundations already in place to take action and achieve these aims, positioning it amongst the best in the world.

The perfect storm? Where values and expectations align

THE QUALITY STRATEGYWhat people have said…

A unique and important opportunity for all of us to work together to make our NHS even better, for everyone.

We all need to understand what our respective expectations, roles and responsibilities are, and make a shared commitment to take the action required of each of us to make the changes needed to ensure that our NHS delivers the very best quality healthcare for us all, now and into the future.

How will we do it?

PROPOSED APPROACH

• Person-centred : beyond shared decision making – i.e. relationship-based care in the very fabric of every interaction (Every Person Every Time).

• Clinically effective : with a focus on reducing unnecessary variation in delivering care and treatment, and in support for managing long term conditions

• Safety : throughout primary, mental and acute services achieving significant reductions in adverse events

• Efficient, timely and equitable integrated

Aim Key Drivers Priority Areas For Action

Scotland is a World leader in

Healthcare Quality

Person Centred

Safe

Effective

1. Improve and embed patient reported outcomes and

experience across all NHS services

2. Support staff, patients and carers to create partnerships which

result in shared decision making

3, Inform and support people to manage and maintain their health,

and to manage ill health

1. Ensure continuity in all care pathways through implementation

of long term conditions action plan and other key opportunities

2. Apply information from quality data to drive consistently better

care across NHS

3. Promote culture of improvement in NHS at all levels

1. Establish appropriate governance arrangements2. Develop information to provide rapid feedback to identify and tackle risk3. Develop outcome measures to drive and monitor progress4. Develop data for improvement

Quality infrastructure

1. Secure the improvements which have been delivered through the success of the Patient Safety Programme, and2. Roll out across other areas of NHS activitysupport integrated programme of action to reduceoccurrence of HAI

IMPLEMENTATION - APPROACH

• Overarching and integrating approach – NOT additional

• Bottom up – will be achieved through the accumulation of ‘excellent’ interactions, every person every time

IMPLEMENTATION - ROLES

Patients, their families and carers and the public

• Mobilising and supporting public by Communicating expectations, responsibilities – building on mutuality

Everyone delivering healthcare services for NHS• Mobilising and supporting Staff through

development, KSF, revalidation, assessment reshaping etc

NHS management and Scottish Government• Making whole system changes – alignment

in governance, measurement/performance targets, and policy development etc

Key Drivers Priority Areas For Action Specific Improvement Interventions

Person Centred

Safe

Effective

1. Improve and embed patient reported

outcomes and experience across all NHS services

2. Support staff, patients and carers to create

partnerships which result in shared decision making

3, Inform and support people to manage and maintain

their health, and to manage ill health

1. Ensure continuity in all care pathways through

implementation of long term conditions action plan

and other key opportunities

2. Apply information from quality data to drive

consistently better care across NHS

3. Promote culture of improvement in NHS at all levels

1. Secure the improvements which have been delivered through the success of the Patient Safety Programme, and2. Roll out across other areas of NHS activitysupport integrated programme of action to reduceoccurrence of HAI

1. Establish appropriate governance arrangements2. Develop information to provide rapid feedback to identify and tackle risk3. Develop outcome measures to drive and monitor progress4. Develop data for improvement

1. Develop and introduce patient reported experience andoutcome measures2. Establish CARE measures in all clinical appraisal andIn revalidation3. Develop and introduce collaborative decision-making through relationship-based care reflecting individual circumstance

Quality infrastructure

1. Ensure Anticipatory Care Plan in placeof the 5% population most at risk (SPARRA)2. Shift the balance of care and reduce variation3. Reduce re-admission4. Implement long term condition action plan5. Ensure alignment of GP enhanced services

1.Accelerate spread of Scottish Patient Safety Programme (SPSP) throughout acute care2. Develop approaches to improve patient safety inPrimary Care and Mental Health3. Make the Electronic Care Summary widely available4. Integrate the work of the HAI taskforce with the SPSP

1. Establish Quality Alliance2. Develop ‘Quality Dashboard’3. Develop Quality Measures and align with HEAT4. NHS: QIS and NHS;NSS;ISD to establish appropriatedata to support continuous improvement

3-TIERS OF MEASURES?

• High level outcomes• Intermediate Outputs• Local/short term actions/outputs

and at each level – appropriate measures/targets/indicators…

POTENTIAL AREAS FOR MEASUREMENT ?

Patient Staff System

Person-centred

experience satisfaction Anticipatory care

Effective outcome capability and capacity

Re-admission

Safe cleanliness cleanlinessadverse events

HAIHSMR

It can be done…

“NHS Scotland has undertaken a bold, comprehensive, and scientifically grounded programme to improve patient safety.  The dedication of NHS leadership at all levels to this endeavor is apparent to me, and bodes well for success.  In its scale and ambition, the Scottish Patient Safety Programme marks Scotland as leader – second to no nation on earth – in its commitment to  reducing harm to patients dramatically and continually.”

Don Berwick June 2008

Will people say the same about our Quality Strategy?

NEXT STEPS

• Launch draft Strategy Document – Oct ‘09• Engage in discussion/consultation - Oct/Nov ‘09

(NHS events 19/21)• Launch Quality Strategy Jan’10• Detailed collaboration and consultation about

‘bottom-up’ implementation, building on successful local and national approaches – Jan’10 onwards

• Launch Communications Strategy – Jan ’10 • Establish approach to ensuring alignment in

workforce development, policy, governance, measurement etc

QUESTIONS• Do you agree that this is the right thing to do - why?

• How would you describe high quality healthcare ?

• Do you think these are the right drivers to use and initial areas to focus on?

• What are the hurdles/risks, how do we mitigate against them and what do we need to stop doing?

• What do we need to do first?

• What do you think success would look like, and what measures should we pursue to report progress?

• Do we need to be explicit about the need to embed efficiency, equity and access, and how do we achieve this?

Questions for Quality measures • What do you think about this general 3-tier approach

to measures of quality (person-centred, safe, effective from patient, staff and system perspective)?

• What type of measures should we use to report progress at the high/outcome level? How should they relate to the National Outcomes/Government Purpose

• What type of measures are appropriate at the Intermediate/output level? For improvement? How should they relate to HEAT targets?

• Do we need to agree a core set of local/short term activity/output measures, or should these be for local determination?

• Do we have the information required to inform these measures/targets and indicators? If not – how do we establish it? Do we need to stop collecting other data?

• Do we need to be explicit about the need to embed efficiency, equity and access in the Quality Strategy by developing appropriate measures at each level? How do we achieve this?