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WELCOME TO THIS SIGN UP TO SAFETY WEBINAR
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An organisation wide approach to
quality and safety improvement in
Mental Health
Mental health servicesNewham, Tower Hamlets, City & Hackney, Luton & Bedford
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 in East London
Cultural diversity
Social deprivation
Geographical diversity
Commissioning
arrangements
Financial stability and
strong assurance systems
@ELFT_QI
Our quality
improvement programme
Why?
@ELFT_QI
The strategic case for change
Make quality our absolute priority
• Improving quality of care is our core purpose
• Of greatest importance to all our stakeholders
• Build on the excellent work already happening to improve quality
National drivers
• The need to focus on a more compassionate, caring service with patients first and foremost
• More structured and bottom-up approach to improvement
Enable our staff to lead change
• The desire to engage, free and support our staff to innovate and drive change
• Engaged and motivated staff leads to improved patient outcomes
The economic climate
• The need to do more with less
– improving
quality whilst
reducing cost
@ELFT_QI
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
Our quality
improvement programme
How?
@ELFT_QI
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. Launch event & roadshows
2. Microsite
3. Using the power of narrative
4. Celebrate successes
5. Network of champions / ambassadors
6. Learning events
1. Initial assessment of alignment & capability
2. Recruiting central QI team
3. Online training
4. Face-to-face training
5. Follow-up coaching on projects
6. Develop in-house training for 2016 onwards
1. Align all projects with improvement aims
2. Align team / service goals with improvement aims
3. Align all corporate and support systems
4. Patient and carer involvement in all improvement
work
5. Embed improvement within management structures
Reducing Harm by 30% every year
1. Reduce harm from inpatient violence
2. Reduce harm from falls
3. Reduce harm from pressure ulcers
4. Reduce harm from medication errors
5. Reduce harm from restraints
Right care, right place, right time
1. Improving patient and carer experience
2. Reliable delivery of evidence-based care
3. Reducing delays and inefficiencies in the system
4. Improving access to care at the right location
@ELFT_QI
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build the
will
QI microsite the online
hub for the
programme
qi.eastlondon.nhs.uk
Staff and service
user newsletter
reaches 4000
people every
month
QI launch event and roadshows
attended by over 1000 staff,
service users and carers
Bespoke QI learning
events for staff, service
users, commissioners,
governors
@ELFT_QI
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
35,000
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
35,000page views of the QI microsite in the last year
our one-stop shop for QI
built and managed by
the QI team, total cost
£300
qi.eastlondon.nhs.uk
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
Introducing microsite 2.0
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
1,000
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
1,000Staff, service users, carers, Governors,
commissioners engaged in the first 4 months of
the programme
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
Bespoke learning sessions
Specialist
services
leadership
Service users
and carersFinance team
Health visitorsNursing
students
Band 3 nursing
staff
Psychology
trainees
Trainee
doctors
External
partners
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
4,000
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
4,000staff receiving the monthly QI e-newsletter
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
Percentage of staff opening the e-newsletter
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
550
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
550local services receiving the quarterly paper
newsletter, including GP practices and voluntary
sector organisations
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will 6projects shortlisted
for regional or
national awards
1regional award
7projects being
written up for
publication with BMJ
6teams presenting
their work to the Trust
board each year
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020 Build
improvement
capability
Face to face improvement training
- hundreds of staff, services users,
Governors to be trained over the
next few years
Support for
improvement work from
the Trust’s QI team
IHI Open School
available to all
Strategic
partnership
with IHI
Board
sessions
@ELFT_QI
Experts
Front line staff
Clinical leaders
Directorate
improvement
leads
Board
Estimated number = 3300
Requirement = introduction to quality
improvement, identifying problems,
change ideas, testing and measuring
change
Time-frame = train 10-20% in 2 years
Estimated number = 250
Requirement = deeper understanding
of improvement methodology,
measurement and using data, leading
teams in QI
Time-frame = train 30-50% in 2 years
Estimated number = 30
Requirement = deeper understanding
of improvement methodology,
understanding variation, coaching
teams and individuals
Time-frame = train 100% in 2 years
Estimated number = 10
Requirement = setting direction and
big goals, executive leadership,
oversight of improvement, being a
champion, understanding variation to
lead
Time-frame = train 100% in 2 years
Estimated number = 5
Requirement = deep statistical process
control, deep improvement methods,
effective plans for implementation &
spread
Time-frame = train 100% in 2 years
Where are we?
On track to train over 500
people through 5 six-month
waves of learning between
2014-16. First 3 waves
delivered with the IHI
On track. All senior staff
being encouraged to join QI
training over next 2 years
New need recognised.
Developing improvement
coaches programme will train
30 QI coaches in 2015
On track. Most Executives
will have undertaken the
ISIA, and Board training has
been delivered in 2015.
Currently have 3
improvement advisors, with
1.5wte deployed to QI.
Will need to build more
capacity at this level.
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
1,000Build
improvement
capability
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
1,000Open School lessons completed
Build
improvement
capability
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
improvement
capability
Recruited a central QI team
Board sessions
Developed 3
improvement advisors
Coaching teams from the very start
Success
Form a team
Agree the quality issue to be tackled
Ensure patient (and
carer) involvement
Find time to meet
@ELFT_QI
Workshop
(3 days)
Webex #2Webex #1
• Faculty consults
• Webex calls
• Coaching calls
Webex #3 Learning Set
2 &
graduation
AP-5AP-4
The two learning sets will be focused on sharing the participants’ work on their
projects and learning from each other. These sessions also will reinforce the
content from the Webex calls and the ISIA workshop.
Learning
set 1
@ELFT_QILearning and coaching over 6 months
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Alignment
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Alignment
QI Team
QI Resources
Project Sponsor
QI Forums
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
How have our
projects developed
over time?
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
September 2014
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
October 2014
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
November 2014
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
December 2014
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
January 2015
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
February 2015
Right Care, Right
Place, Right Time
TH CollaborativeRoman, Globe, Bricklane, Lea,
Millharbour, Rosebank
MHCOPLarch Lodge, Cedar Lodge,
Sally Sherman Ward
CHNEPCS Teams (North East,
North West, Central, South)
Multiple I/P Wards
C&HRehab, AOS, Connolly, Bevan
NewhamMultiple I/P wards
NewhamPsychology
MHCOPTraining Lodge
Children’sCDC x2
CAMHS x3
MHCOPMemory Service
C&HAll CMHTS
ForensicsClerkenwell
REDUCE HARM
BY 30% EVERY
YEAR
RIGHT CARE,
RIGHT PLACE,
RIGHT TIME
VIOLENCE
REDUCTIONPHYSICAL
HEALTHACCESS
PRESSURE
ULCERS
@ELFT_QI
Is it making a difference?
@ELFT_QI
UCL
LCL
50
70
90
110
130
150
170
190
210
230
Dec 1
2
Jan 1
3
Feb 1
3
Mar
13
Apr
13
May 1
3
Jun 1
3
Jul 13
Aug 1
3
Sep 1
3
Oct 13
Nov 1
3
Dec 1
3
Jan 1
4
Feb 1
4
Mar
14
Apr
14
May 1
4
Jun 1
4
Jul 14
Aug 1
4
Sep 1
4
Oct 14
Nov 1
4
Dec 1
4
Jan 1
5
Feb 1
5
Incid
ents
each m
onth
Month
Incidents of physical violence across the Trust (C Chart)
179 per
month
145 per
month
19% reduction across the TrustDatix incident reporting
@ELFT_QI
150
200
250
300
350
400
450
500
550
2013 2014
Inci
de
nts
pe
r 1
00
,00
0 b
ed
da
ys
Physical violence to patients (per
100,000 occupied bed days)
250
350
450
550
650
750
850
2013 2014
Inci
de
nts
pe
r 1
00
,00
0 b
ed
da
ys
Physical violence to staff (per
100,000 occupied bed days)
NHS benchmarking club – mental health services
ELFT Score
@ELFT_QI
0
10
20
30
40
50
2010 2011 2012 2013 2014
Sco
re (
%)
Staff experiencing physical violence from
patients, relatives or the public in last 12 months
NHS staff survey
@ELFT_QI
UCL
LCL
10
20
30
40
50
60
70
80
90
100
Jan-1
2
Feb
-12
Ma
r-1
2
Apr-
12
Ma
y-1
2
Jun-1
2
Jul-1
2
Aug-1
2
Sep-1
2
Oct-
12
No
v-1
2
De
c-1
2
Jan-1
3
Feb
-13
Ma
r-1
3
Apr-
13
Ma
y-1
3
Jun-1
3
Jul-1
3
Aug-1
3
Sep-1
3
Oct-
13
No
v-1
3
De
c-1
3
Jan-1
4
Feb
-14
Ma
r-1
4
Apr-
14
Ma
y-1
4
Jun-1
4
Jul-1
4
Aug-1
4
Sep-1
4
Oct-
14
No
v-1
4
De
c-1
4
Jan-1
5
No
. o
f R
estr
ain
ts
Episodes of Restraint in Prone Position - C Chart
UCL
LCL
50
70
90
110
130
150
170
Jan-1
2
Feb
-12
Ma
r-1
2
Apr-
12
Ma
y-1
2
Jun-1
2
Jul-1
2
Aug-1
2
Sep-1
2
Oct-
12
No
v-1
2
De
c-1
2
Jan-1
3
Feb
-13
Ma
r-1
3
Apr-
13
Ma
y-1
3
Jun-1
3
Jul-1
3
Aug-1
3
Sep-1
3
Oct-
13
No
v-1
3
De
c-1
3
Jan-1
4
Feb
-14
Ma
r-1
4
Apr-
14
Ma
y-1
4
Jun-1
4
Jul-1
4
Aug-1
4
Sep-1
4
Oct-
14
No
v-1
4
De
c-1
4
Jan-1
5
No
. o
f In
cid
en
ts
Incidents resulting in the use of Restraint (C Chart)
68 per month
30 per month
56% reduction
134 per month
112 per month
16% reduction
250
450
650
850
1050
1250
1450
2013 2014
Re
stra
ints
pe
r 1
00
,00
0 b
ed
da
ys
Use of restraint (per 100,000
occupied bed days)
NHS benchmarking club – mental health services
@ELFT_QI
NE team tests new
documentation pack
NW team tests
documentation
pack
NW team tests
band 6
coordination of
assessments
6 per week
3 per week
50% reduction
57%
93%
36% increase
in reliability
Grade 3-4 PUs Acquired in EPCT Grade 2 PUs
Acquired in EPCT
5
25
45
65
85
105
125
145
165
2013 2014
Serious incidents per 100,000 occupied bed
days in adult mental health
@ELFT_QI
50
70
90
110
130
150
170
190
210
230
2013 2014
Err
ors
pe
r 1
00
,00
0 o
ccu
pie
d b
ed
da
ys
Drug administration errors
10
20
30
40
50
60
70
80
90
2013 2014
Err
ors
pe
r 1
00
,00
0 o
ccu
pie
d b
ed
da
ys
Prescribing errors
NHS benchmarking club – mental health services
@ELFT_QI
Bu
ild
ing
wil
l
Build a broad coalition for
change
Take time to bring people
with you
Shift decision-making to the
edge
Develop a compelling narrative
Find some clear signals
of change
Use the power of stories
Take every opportunity to
celebrate
Bu
ild
ing
ca
pa
bil
ity
&
cap
aci
ty
Be prepared to invest
Train all levels and across disciplines
Realign existing
resources
Stop lower value work
Ali
gn
me
nt
& i
nte
gra
tio
n
Start at the topCreate a support
structure
Build a learning system
Ensure patients and carers are
integral
Ensure the context is ripe
Line of sight from team to system goals
Organisational culture is created by what
leaders pay attention to…
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