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Plenary 1 Driving Quality Through Innovation
1. Derek Feeley
Director-General Health and Social Care and Chief
Executive NHSScotland
Jason Leitch
Clinical Director, The Quality Unit, Scottish
Government
6. A legitimate Statement of Values
âThe Lothian Wayâ has been developed within NHS Lothian
as a set of emergent values and associated behaviours
identified as vital elements of the culture that NHS
Lothian wants to build. Patients are first and foremost in
this set of values however staff motivation and
organisational reputation are central too. They are as
follows:
â Person Centred
â Partnership
â Integrity
â Accountability
â Innovation
7. Underlying cultural assumptions
(the unwritten rules)
Many organisations have unwritten rules which
describe âthe way we do things around hereâ. In
NHS Lothian the following have been described
consistently to us in one-to-one interviews:
⢠Suppression of bad news â do not write it down
⢠Gloss
⢠You are on your own â âJust fix Itâ â
9. The real world?
⢠Performance continues to improve
⢠In many areas it is better than ever (and
world class)
⢠We canât afford to stand still
⢠Attitudes, ethics and values are as
important as technical excellence
⢠Reliability just as important in these areas
â every person every time
10. We should choose to learn!
âWhat if we choose to change? Could we
craft joy from loss, pride from revision, and
excellence from invention?
Yes we can.â
Don Berwick; British Journal of General Practice; Feb 2009
11. To change and to persist!
âThere were a number of
definitions of courage, but
now I was seeing it in its
simplest form: you do
what has to be done day
after day, and you never
quit.â
â Eric Greitens, The Heart
and the Fist: The Education
of a Humanitarian, the
Making of a Navy SEAL
14. So what ifâŚâŚ?
⢠We had the courage to persist in our
pursuit of world-class care
⢠We continued to make care safer, more
effective and more person-centred
⢠We choose to learn together
⢠We share and renew our ethics and
values
⢠We make the right thing easier to do
⢠We get ready for the next curve
15. 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
16. 2020 Vision
Everyone is able to live longer
healthier lives at home, or in a
homely setting.
17. Getting to the third curve
Co-production
& assets
Performance
Improvement
Performance
Time
18. What will it take?
⢠Redesign, creativity and innovation
⢠New technologies and better use of
existing technology
⢠Prevention, assets and activation
⢠Up our game on person centred care
⢠Continued focus on performance and
improvement
⢠Shared and renewed ethics and values
23. Median and 90th percentile waits for IP/DC
Median (days) 90th percentile (days)
120
105
100
Wait (days)
80 63
60
35
40 25
20
0
Ju 8
Ju 9
Ju 0
Ju 1
2
M 8
M 0
M 9
M 1
N 8
N 0
N 1
N 9
-0
-1
-0
-1
-1
-0
-0
-1
-1
l-0
l-0
l-1
l-1
ar
ar
ar
ar
ar
ov
ov
ov
ov
M
Quarter ending
26. Getting to the third curve
Performance
Improvement
Performance
Time
27.
28. âThe Scottish Patient Safety Programme is without doubt one
of the most ambitious patient safety initiatives in the world â
national in scale, bold in aims, and disciplined in science. It
harnesses the energies and wisdom of Scotlandâs health care
leaders âNHS executives, QIS experts, clinical professionals,
civil servants, and more â all aligned toward a common vision,
making Scotland the safest nation on earth from the viewpoint
o
of health care.â
Don Berwick
29. Ja
10
12
14
16
18
20
22
24
26
28
30
n-
08
Ap
r- 0
8
Ju
l-0
8
O
ct
-0
8
18.2%
Ja
n-
09
Ap
r- 0
9
Ju
l-0
9
O
ct
-0
9
Ja
n-
10
Ap
r- 1
0
Ju
l-1
0
O
ct
-1
0
Ja
% ICU mortality
n-
11
Ap
r- 1
1
Ju
l-1
1
O
ct
24% improvement
-1
1
13.9%
31. Scotland HSMR â 9.5% reduction
Standardised Mortality Ratio (SMR) Regression line
1.5
Standardised Mortality Ratio
1.0
0.5
Oct- Apr- Oct- Apr- Oct- Apr- Oct- Apr- Oct- Apr- Oct-
Dec Jun Dec Jun Dec Jun Dec Jun Dec Jun Dec
2006 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011p
37. Katy: Zero Pressure
Ulcers Stages 3 & 4
To: Memorial Hermann Katy Hospital
Zero Pressure Ulcers for 36 Months
January 1, 2008 to December 31, 2010
Zero Pressure Ulcers x 36 Months
38. Northwest: Zero Retained
Foreign Bodies
To: Memorial Hermann Northwest Hospital
Zero Retained Foreign Bodies for 24 Months
January 1, 2010 to December 31, 2010
Zero Retained Foreign Bodies x 24 Months
39. Sugar Land: Zero Central
Line Blood Stream Infections
To: Memorial Hermann Sugar Land Hospital
Zero Central Line Associated Blood Stream
Infections for 36 Months
February 1, 2008 to January 31, 2011
Zero CLABSIs x 36 Months
40. High Reliability
Certified Zero Hospitals
Central Line Associated Bloodstream Infections (4)
Ventilator Associated Pneumonias (7)
2012 Surgical Site Infections
40
Awards
Retained Foreign Bodies (9)
Iatrogenic Pneumothorax (4)
Accidental Punctures and Lacerations
Pressure Ulcers Stages III & IV (8)
Hospital Associated Injuries (2)
Deep Vein Thrombosis and/or Pulmonary Embolism (1)
Deaths Among Surgical Inpatients with
Serious Treatable Complications
Birth Traumas (4)
Serious Safety Events (1)
41. "Quality is never an accident;
it is always the result of high
intention, sincere effort,
intelligent direction and
skillful execution; it
represents the wise choice of
many alternatives.â
1941, William A. Foster
42. Getting to the third curve
Co-production
& assets
Performance
Improvement
Performance
Time
54. Assets vs Deficits
Assets thinking Deficit thinking
â˘Strengths based â˘Problem orientated
â˘How can we create â˘How to fix this problem?
community spirit? â˘Someone needs to sort this
â˘What can I do? â˘Us versus them
â˘Weâre all in this together â˘Problems are embedded
â˘Weâre getting there â˘Do things to people
â˘Work with engaged people â˘People are a problem
â˘People have the answers â˘People canât be trusted to
â˘People control their lives decide/be in control
64. Ethics and Glory
âGlory, built on selfish principles, is shame and
guiltâ
William Cowper
âGlory follows virtue as if it were its shadowâ
Cicero
âGlory lies in the attempt to reach oneâs goal and
not in reaching itâ
Mahatma Ghandi
65. So are you ready toâŚâŚ?
⢠Show the courage to persist in our pursuit
of world-class care
⢠Continue to make care safer, more
effective and more person-centred
⢠Choose to learn together
⢠Share and renew our ethics and values
⢠Make the right thing easier to do
⢠Get ready for the next curve
A quick reminder of the differences. Assets based and deficit based approaches take policies and services down radically different routes, radically different ways of thinking and going about the business Christie and others link many of our current intractable problems in policies and services which define people by what they canât do or their problems, treat them as passive recipients incapable of and not to be trusted with determining their own lives and so further disempowering and alienating them. They argue that doing things to people has been ineffective and resource intensive. Structural inequalities reinforce powerlessness and hopelessness and create barriers to self fulfillment and realisation of assets allowing inequalities in outcomes such as health to flourish. A lack of assets creates and sustains transient and troubled communities which are disconnected, powerless and passive. Lacking connections, self worth and empathy, they are riven by prejudice, intolerance. Sectarianism, anti social behavior, hate crimes and disrespect thrive in weak and threatened communities and on poverty and inequality.