The Scottish Patient Safety Programme

• Scotland at the forefront - a whole healthcare system approach

• A strategic development priority for NHS Scotland

• An explicit and tested approach to improving patient safety

• Build on foundations laid through audit, clinical effectiveness and clinical governance

• Alignment with wider NHS QIS Patient Safety work

The vision – Scotland leading the way in patient safety

• 3.7% Harvard 1991• 16.6% Australia 1995• 10.8% London 2001

• 3 million bed days in UK• £1 billion per annum in UK

• 50% PREVENTABLE

Adverse Events in Hospital

• McGlynn, et al: The quality of health care delivered to adults in the United States. NEJM 2003; 348: 2635-2645 (June 26, 2003)– 439 indicators of clinical quality of care– 30 acute and chronic conditions– Medical records for 6712 patients– Participants had received 54.9% of scientifically indicated

care (Acute: 53.5%; Chronic 56.1%; Preventative 54.9%)

• Conclusion: The Defect Rate in technical quality of American health care is approximately

• 45%

Reliability

17 years to apply 14% of research knowledge to

patient care.

Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yrbk of Med Informatics

2000; 65-70

• Launched 2007 by the CMO

• Aims to strategically improve safety for Scotland’s hospital patients

• SPSP is the first programme of work of SPSA

• Brings key healthcare organisations together

Scottish Patient Safety Alliance (SPSA)

• The Scottish Government• NHS Scotland• NHS QIS• Royal Colleges and Professional bodies• World leading experts on patient safety• Patients• NHS Education for Scotland• Health Protection Scotland

Scottish Patient Safety Alliance Key Partners

• Led by National Co-ordinator Jane Murkin, and the National Co-ordinating Team, based within NHS Quality Improvement Scotland (NHS QIS)

• Jason Leitch, National Clinical Lead for Safety & Improvement• Ros Gray, Wendy Sayan and Jane Ross, National Facilitators• Technical partner: the Institute for Healthcare Improvement (IHI)• Pat O’Connor, National Patient Safety Development Advisor• Scottish faculty• NHS boards

Delivery

• Build a compelling case for change• Work on processes and outcomes that engage hearts

& minds• Reduce waste and redundancy• Work at the coal face and at the executive level• Data feedback, data feedback, data feedback• Set the tempo!• Changes in process and outcomes are directly

connected• The changes being tested, when fully implemented,

will lead to large system aims

Our Theory

Inventory national programmes and measurementsMeet with programme leader to understand programme intent, audience, historyHarmonize our metrics

Improve Safety of Hospital Healthcare Services in Scotland

Scottish Government Sets Patient Safety as Strategic Priority

Boards Accept Safety as Key Strategic

Priority for Effective Governance

Robust, evidence

based proven clinical changes

IHI/QIS Team Expert at Content, Coaching

and Programme Management

Align SPSP with national improvement

programmes and measures

Primary DriversDemonstrable results to communityClear, shared measurement setVisible on all senior leader agendaPSA represents & demonstrates cohesive, united programmeNational Policy alignment

Secondary Drivers

Ownership of agreed upon set of outcomesReview of outcomes at each meetingQuality and safety comprises 25% of agendaRecovery plans for unmet outcomesInfrastructure supports improvement and measurementInvolve patients in safety

Scottish Patient Safety Programme

Driver Diagram

International expert clinical facultyFaculty expert at improvement methods and coachingProgramme design and structure

Acceptance of pragmatic scienceRoyal College Supports PSA Programme

• 15% reduction in mortality• 30% reduction in adverse events• Reduce healthcare associated infections• Reduce adverse surgical incidents• Reduce adverse drug events• Improve critical care outcomes• Data for improvement• Develop and build a quality improvement and

patient safety culture in our hospitals • Build in long term sustainability and capability

to drive this approach at all levels

Aims

• Leadership

• Critical care

• General ward

• Medicines management

• Peri-operative

Workstreams

Key objectives

Work Area Change Package ElementCritical Care Establish infrastructure

–Daily goal sheets–Daily multi-disciplinary rounds

Infection Prevention–Ventilator bundle–Central line bundle–General infection prevention practices–Glucose control (ITU then to HDU)

General Ward Risk Identification and Response–Rapid response (Outreach) teams–Early warning system

Infection Prevention -MRSA

Reliable care for Congestive heart failure

Communication and Teamwork–Safety briefings–Communication tools (e.g. SBAR)–Prevention pressure ulcers

Leadership Infrastructure to support safety

Walkrounds

Safety a strategic priority

Medicines Management Reconciliation

Anticoagulation , Insulin,

Conduct an FMEA on a high risk medication process

Perioperative DVT Prophylaxis

Continuity of Beta blockers

SSI bundle

Team culture - briefings

SPSP Engine and Timeline

2 day LS

Alignment with national

work SupportExpert clinical faculty Site Visit

Networking events Phone conf

Listserv Assessments

Monthly Reports via web

2 dayLS

A

P

D

S

A D

P

S

2 day Kickoff

D

S

P

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2 dayLS

Key Changes

Improvement

Measures

Jun 08 Jun 09Jan 09Jan 08

OrganisationalSelf Assessment

Oct 07

Continued Support

Jan 11

• Learning sessions

• National capacity and capability events

• Patient Safety Officer

• Fellowship programme

• Developing Scottish Faculty

• Improvement Advisors

Building a sustainable infrastructure for improvement

• Over 600 Leadership walkrounds have now taken place throughout Scotland.

• 52 pilot wards throughout Scotland have implemented daily safety briefings as a routine part of their work.

• Critical Care teams are able to demonstrate significant periods of time without central line infection in ITU.

Progress so far

• Reductions in length of stay

• Reduction in complaints

• Cost benefits

• Care is given in the right place at the right time and in the right way

• Increased improvement capability amongst staff

Benefits

“The Scottish Patient Safety Programme is without doubt one of the most ambitious patient safety initiatives in the world – national in scale, bold in aims, and disciplined in science.  It harnesses the energies and wisdom of Scotland’s health care leaders –NHS executives, QIS experts, clinical professionals, civil servants, and more – all aligned toward a common vision, making Scotland the safest nation on earth from the viewpoint of health care.”

Don Berwick, IHI