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Aula em inglês de Jason Leitch, diretor clínico da Unidade de Qualidade do Governo Escocês, durante o II Seminário Internacional sobre Qualidade em Saúde e Segurança do Paciente - evento do Qualisus - que ocorreu dias 13 e 14 de Agosto de 2013, no Ministério da Saúde, em Brasília.
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Scotland’s Approach to Safety and Quality
Jason LeitchClinical Director
The Quality Unit, Scottish Government
@jasonleitch
• 5 million people• £12 billion• 14 Health Boards• 8 Support Boards• Integrated delivery• Moving towards
social care integration
Public Finances Fall in Government expenditure
Health Budget
191119311951197119912011
Source: Scotland 2011 Census
Scotland’s Demographics 1911 - 2011
Projected % Change in Scotland’s Population by age group 2006-2031
Source: GRO Scotland, 2007
Strategic Objectives
Aims:To deliver the highest quality healthcare services to the people of Scotland
For NHSScotland to be recognised as world-leading in the quality of healthcare it provides
The Healthcare Quality Strategy for Scotland
Person-Centred - Mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision making.
Effective - The most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.
Safe - There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.
Triple Aim
Health of the
Population
Experience of Care
Best Value for Money
The IHI Triple Aim
Evidence based discovery
Evidence based delivery
17 years to get 14% of evidence into practice
Implementing at scale….can it be done?
WillIdeas
Execution
Improve Safety of Healthcare Services in Scotland
(15% reduction in HSMR by end of
2012)
Boards accept SPSP as a key strategic priority for
effective governance
Scottish Government sets SPSP as strategic
priority
Deliver the programme
Build a sustainable infrastructure for
improvement
Align SPSP with national improvement
programmes
Primary Drivers
Demonstrable results Clear, shared measurement setVisible on all senior leader agendasA cohesive and united programme
Secondary DriversAgreed set of outcomesReview & address outcome deliveryQuality & safety on every agendaInfrastructure supports Involve patients
Clinical faculty expert at improvement methods and coachingProgramme design and structure
BTS collaborativeAcceptance of pragmatic scienceRoyal Colleges support
Inventory of national programmes Engage with national programmesHarmonize metrics
By what method?
W. Edwards Deming
DESIGN DESIGN DESIGN DESIGN APPROVE
Conference Room
Real World
The Typical Approach…
IMPLEMENT
DESIGN
TEST & MODIFY
TEST & MODIFY
APPROVEIF
NECESSARY
Conference Room
Real WorldTEST & MODIFY
The Quality Improvement Approach
START TO IMPLEMENT
Our change theory
A clear and stretch goal A method Predictive, iterative testing
Breakthrough Series Collaborative
‘This model is not magic, but it is probably the most useful single
framework I have encountered in twenty years of my own work on
quality improvement’
Dr Donald M. BerwickFormer Administrator of the Centres for Medicare &
Medicaid Services Professor of Paediatrics and Health Care Policy
at the Harvard Medical School
The Model for Improvement
NHSScotland Surgical Safety Briefings
23% reduction from median
NHSScotland Surgical Mortality
Hospital Standardised Mortality Ratios (Seasonally Adjusted) Scotland: Dec 2002 to Mar 2012
0.6
0.7
0.8
0.9
1.0
1.1
1.2
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
Quarters
Sm
oo
thed
S
MR
average annual reduction 4.2%
(Apr 2010 to Mar 2012)
1.4% average annual reduction
(Oct 2002 to Jan 2010)
Smoo
thed
SM
R
How has the frontline done it?
Get goalsGet boldGet togetherGet a model (and stick
with it)Get patients and
families
Get the factsGet to the fieldGet a clockGet the numbersGet the stories
The Early Years Collaborative - Ambition
To make Scotland the best place in the world to grow up in by improving outcomes, and reducing inequalities, for all babies, children, mothers, fathers and families across Scotland to ensure that all children have the best start in life and are ready to succeed.
The Early Years Collaborative - Aims1. To ensure that women experience positive pregnancies which result in the birth of
more healthy babies as evidenced by a reduction of 15% in the rates of stillbirths (from 4.9 per 1,000 births in 2010 to 4.3 per 1,000 births in 2015) and infant mortality (from 3.7 per 1,000 live births in 2010 to 3.1 per 1,000 live births in 2015).
2. To ensure that 85% of all children within each Community Planning
Partnership have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review, by end-2016.
3. To ensure that 90% of all children within each Community Planning Partnership
have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017.
www.scotland.gov.uk/Topics/Health/Policy/2020-Vision/Strategic-NarrativeScotland’s 2020 Vision:
www.scotland.gov.uk/Topics/Health/Policy/2020-Vision/Quality-StrategyThe Quality Strategy:
The Quality Improvement Hub:www.qihub.scot.nhs.uk
Some Useful Links
Institute for Healthcare Improvement:www.ihi.org.uk
@jasonleitch