The Boards Role in Leading for

Quality and Safety - A Regional Approach

Lesley Massey, Director

14.10.2014

• Established in 2010

• 70 Members

• 2 AHSNs –

GM ASHN

NW AHSN

Key Partnerships

- NW LA

- Haelo

- Health Foundation - The King’s Fund

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“AQuA’s mission is to support our members and customers to improve the quality of healthcare”

Our vision is that over the next decade we will support AQuA’s members to

transform the health and quality of healthcare of people living in the North West.

We will use learning from this to inspire and help all those working in healthcare… in the NHS and beyond.

We will do this by Supporting all of our members to build

their own culture and system for improvement.

Helping our members to work collaboratively to share good ideas and learn from each other.

Working with partners to align our collective efforts to support improvement.

Spreading learning from our work.

We will work outside AQuA to Spread what we are learning and to gain new

knowledge ourselves. We will do this if:- It fits with our capabilities and our priorities

(we must be able to make a difference). We can generate a financial return to invest

back into our membership. We have the capacity to do this work

without compromising the service to our members.

Our Priorities for 2014/15

Our proposed priorities are based on:

• What the data says about where our members most need to improve. • The big issues identified in the Francis, Keogh and Berwick reports. • Our understanding of our strengths and capabilities relative to those of other

partners

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Don’t hurt or harm me

Improving safety of care and reducing mortality

Provide me with the best care every time Evidence of the consistency and reliability of care

Be kind to me and involve me in decisions about my care

Improving patient experience

Join things up and work as a team for me

Integration and system leadership for service transformation

Give staff the skills to improve my care

Building capability

The Improvement Capability

and Leadership Framework

Novice to expert (Benner 1982)

Kn

ow

led

ge s

kil

ls &

att

itu

de

s (

Blo

om

19

56

)

Commit to Improve Lead to Improve

*Quality Improvement

Basics (previously QI

Fundamentals)

*Introduction to

Improvement

Methodologies

(previously AIM)

*Improvement

Practitioner

*Advanced Team

Training Programme

*Introduction to Lean

*Advanced

Improvement

Practitioner

*Board Development

*Improvement Science

Fellowships

Level 1

Foundation

(Novice)

Level 2

Practitioner

Level 3 Advanced

Practitioner

(Expert)

Leader

The Best Boards

1. Focus their time and attention on quality and safety and get to the heart of the real issues

2. Set ambitious aims which are translated into measurable goals

3. Use data and intelligence wisely to identify problems and to measure progress

4. Deeply engage patients and families in their work

5. Work effectively together as a Board balancing support and challenge, continuously improving, and managing tough conversations well

6. Engage everyone in the organisation in the drive to improve quality and build supportive relationships with external stakeholders – Building a quality improvement Culture

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The ‘Big Ticket’ Quality issues

• Mortality – HSMR, SHMI, RAMI crude

• HCAIs – MRSA, Cdiff, other

• Avoidable Harm – Safety Thermometer

– Patient safety incidents

• Staff Experience – Survey, Absence, Appraisals

• Patient Experience – Friends and Family Test

– Complaints

– Patient survey

• The quality impact of cost savings plans

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• How well are you doing?

• How do you know?

• What’s the plan to improve?

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The Quality Curve

Spread to move the curve to the right

Minimum standard

Support innovation amongst the leading

edge performers

Support to those with the most challenges

The Comparison Dashboard

• How do we compare to…

– Other hospitals?

– Regulatory standards?

– Targets?

– Pay for performance

thresholds?

• Hundreds of measures

– Processes

• Measures are typically

– Externally defined

– risk-adjusted

– apples to apples (rates per

procedure e.g.)

– Slow

– Tinged with fear

The Strategic Dashboard

• Are we on track to

achieve our aims?

– Reduce harm

– Improve outcomes

– Improve satisfaction

– Reduce costs

• A few key measures

– Outcomes, Drivers

• Measures are typically

– Internally defined

– Close to real time

– “Good enough”

Compliance Transformation

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Testing the Plan 4 Questions?

• Do you know how good you are?

o Qualitative and quantitative

o How and what is reported

o How do you know what patients think

• Do you know where your variation exists?

• Do you know where you stand relative to the best?

o Looking across the system building will to learn from the best

• Do you know your rate of improvement over time?

The Healthy NHS Board 2013 Principles for Good Governance

The Measurement and Monitoring of Safety (April 2013)

Taking safety on board: the board’s role in patient safety (October 2013)

Board, Governing Body

and Senior Leader Development

Economy-wide led improvement, oversight and governance of quality & patient safety

Provider and Commissioners

Board, governing body and senior leader development programme

Consolidation & further development for providers,

introduce commissioner provision

Boards on Board in partnership with NWLA

Provider organisations

29 Boards completed

2009/13

2014/15

2015/16

Next Phase

New programme design, pilot and test

phase

Aligned to the ‘Sign Up to Safety’ Campaign

2- day advanced board programme on quality and safety

for provider trusts

Masterclass on Human Factors aimed at Exec teams &

senior leaders

Clinical Leaders development day. Scenario based

AQuA faculty development

Cont’d

• Addressing needs of the ‘safe’ domain - CQC

How Safe is your organisation’s care?

• Content covering:

Track record on safety “past harm”- (Lagging Indicators)

Lessons learnt, and improved safety standards adopted

Reliable systems, processes and practices

Assessing and monitoring safety in real time

Risk anticipation and advanced planning (Leading

Indicators)

• Coming away with new or improved safety strategy (Measurement and Monitoring of Safety Framework

Charles Vincent et al.)