Supporting and developing patient safety collaboratives - Phil Duncan and Fiona Thow, Patient safety collaborative delivery leads, NHS Improving Quality Presentation from the Patient Safety Collaborative launch event held in London on 14 October 2014 More information at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/patient-safety-collaboratives.aspx

1. Improving health outcomes across England by providing improvement and change expertise
Supporting and Delivering Patient Safety Collaboratives
Fiona Thow
Phil Duncan

2. Responding to Francis and Berwick
“The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end.” Berwick Report, August 2013

3. A Different kind of Collaborative
•Locally driven
•Designed in partnership
•Provide support, co-ordination & rapid spread and adoption
•Developing capacity & capability for QI & Safety

4. For NHS staff and clinicians:
•Participate actively in the improvement of systems of care
•Acquire the skills to do so
•Speak up when things go wrong
•Involve patients as active partners and co- producers in their own care

5. Patients as leaders and true partners
Co- producing the safety programme

6. Framework for Operational Excellence
©Alan Frankel and IHI 2013
A system devoted to continual learning and improvement

7. A clear and practical framework made up of two “organ systems” - culture and learning process, if the culture isn’t right there will be no learning. The learning system is underpinned by culture, the foundation for the delivery of safe, high quality care
©Alan Frankel and IHI 2013
Underpinning improvement : the Framework for Operational Excellence

8. Culture – the foundations
•Culture is uniquely local - the social glue in an organisation, ‘the way we do things round here’
•High performing teams have clearly agreed norms of behaviour and structures that support behaviours that create value for the patient, staff and the organisation.
•Measuring culture provides valuable (personal) insights into what it really feels like to work in that environment in a particular role
•Insights can be quite disparate - "the doctors or managers think it's fine, and no one else does"
•Evidence on culture - perceptions about teamwork, safety, and leadership correlate with the quality of care and ‘excellence’
Critical components of culture in healthcare are Leadership, Psychological Safety and Teamwork
©Alan Frankel and IHI 2013

9. Learning – a system
Every day skilled healthcare professionals face challenges with basic defects and flaws that make it difficult to deliver high quality care
•A learning system provides a methodical way to visibly capture concerns, act on them, introducing a cycle of learning and improvement
•This is an essential component of high performing organisation
Critical components of a learning system are Reliability, Improvement and Measurement and Continuous Learning Processes
©Alan Frankel and IHI 2013

10. Using the principles of the Safety Framework
•Patients, families and carers involved in agreeing and designing priorities
•Focusing on creating the right culture
•Creating a system that continues to learn
•Using appropriate quality and safety improvement methodology
•Measurement & Leadership are key !

11. Programme Aim
Improve safety by working in partnership to create the conditions for a safer culture and enabling continuous learning

12. What are the conditions?
•Patient Safety Collaboratives – co-ordinate and connect 15 patient safety collaboratives as an enabler for safety improvement
•Leadership – build on existing leadership capability to support a safer culture, at all levels in the system
•Measurement – improve the measurement of safety by co-ordinating and supporting the development of measurement capability – “How much, by when?”

13. The conditions…
•Patients as partners – Involve patients and carers as active partners to co-produce the programme
•Large scale change – connect improvement ideas and innovation, building momentum for change, embracing new methods to share key learning for spread. Building sustainability.
•Capability and capacity – build on existing knowledge and skills, identifying where resource is in the current system and developing new knowledge to support improvement action

15. What have we heard to date?
•Locally led collaborative programmes
•Build on pockets of excellence and communities of interest
•Help with capability building, metric development and national aggregation / ROI
•QI and programme advice and guidance
•Co-produce - avoid duplication and share best practice and resources
•Challenge the system - critical friend
•Help align work and join up the dots nationally

16. Quality improvement approach
•Patient focussed - experience of care expertise
•Focus on practical delivery and implementation – the ‘how to do it’
•Empower all staff to make a change
•Avoid duplication and re-inventing the wheel
•Use improvement methods that fit the task in hand
•Aim for large scale and transformational change
•Capture learning that can be adopted and improvements that can be sustained

17. The ‘operational model’
National Patient Safety Collaborative Programme - Operational Model
Pressure Ulcers VTE
Medication
Errors HCAI Maternity Falls
AHSN
1 x x x
2 x x x
3 x x x
4 x x
5 x x
6 x x x
7 x x
8 x x
9 x x
10 x x x
11 x x x
12 x
13 x x x
14 x x
15 x x
Leadership and Measurement
NHS IQ
Accelerated
Learning Groups
Evidence
Toolkits
Social media
Campaigns
Spread

18. Cluster groups
•Primary focus: leadership, measurement and quality improvement and safety capability
•Medicines, AKI, Mental Health, Pressure Ulcers…
•Group focus on topic specific improvement
•Bringing expertise together with practical application
•Peer support and problem solving
•Accelerate and share learning across the NHS

19. Key principles
•Build on existing good work
•Establish ‘how’ to implement current evidence
•Test and refine new ways of working – where evidence may be lacking
•Influence levers and drivers in the system to support safer care
•Align initiatives – making safety everyone’s business
•Staff and patients – tools, skills and support
•Share learning across the NHS

20. #saferNHS
enquiries@nhsiq.nhs.uk
www.nhsiq.nhs.uk
Improving health outcomes across England
by providing improvement and change expertise.