Quality MK - an introduction 240609
- 1. QUALITY: MK A whole system approach to quality improvement Milton Keynes, June 2009 Sue Lacey Bryant, Programme Manager Sue.Lacey-Bryant@mkpct.nhs.uk health:mk
- 2. Working in partnership health:mk NHS Milton Keynes LINKs-MK Centre for Evidence Based Medicine health:mk
- 3. Our aim Create a self-improving system to make a reality of three widely used slogans… • Evidence based • Primary care led • Patient engagement health:mk
- 4. How are we going about it? Repeated cycles of learning from projects Create relevant… •Culture and values •Skills and capacity •Systems & processes health:mk
- 5. Commissioning for improvement: Service review and redesign •Smoking cessation: revised pathway •Alcohol introduction of brief interventions •Weight management new service for children •Diabetes: care planning approach community based service •Mild/moderate depression user designed service …. At varying stages of progress, all based on evidence with clinicians on each group & combinations of public engagement and user involvement in service design health:mk
- 6. In practice and across primary care evidence-based discussion groups Share and spread – inc. supporting 3 prescribing projects •E-B skills training & toolkit •Librarian support IMPACTE groups Improving Medical Practice by •Pharmacist support Assessing CurrentT Evidence inc. toolkits health:mk
- 7. Patient and public engagement • Two PPE representatives on each TaF • Training workshops for commissioners • Learning from experience • Appropriate approaches • Rules of engagement • Patient empowerment • Embedding patient and through information public involvement in the • Patient participation planning process groups health:mk
- 8. Building a self-improving system Multiple channels for innovation and improvement; Mainstreaming a systematic approach to service review and redesign Clinical effectiveness; Map of Medicine as default Defining, documenting: tools & templates communications, engagement, evidence, prescribing Assuring information data flows System and process inc. PEC, HR Learning culture Public and patient engagement Seeing it through; supporting the change leads Making it easier to work with these values, than not to .. health:mk
- 9. What have we learned? Lead with values Embed change into the Listen; trust patients and system. Change: service users values Support skill development agenda setting consistent with values and planning process identify QI skills as core decision criteria Be prepared to make, resource allocation admit and align organisational & learn from mistakes processes with values Be persistent Tighten programme mgt health:mk
- 10. Things to do sooner ... or differently Recruit clinical champions Strengthen channels for Worry less about QI engagement and inviting process techniques local expertise Use data persuasively: Offer better information & Generate light, not heat support for PPE Pay more attention to Clearer terms of reference how to implement change Explicit accountability Diagnose barriers health:mk
- 11. ... and from the project leads Use the evidence Prioritise “Raise the flag” Importance of leadership Clear objectives Focus on outcomes Nurture the partnerships Build the team Challenge assumptions Reflect health:mk
- 12. How are we getting on? “A dynamic & organic shift” “The success of this programme can be seen in the high level of patient and clinician involvement” “... with greater use of evidence” “There is an explosion of patient involvement” health:mk
- 13. Roadmap to quality improvement Explaining the Setting out the system process Tools, Best practice techniques to deliver Quality Guidance on Improvement “how to” health:mk
Editor's Notes
- #2: Thank you; delighted to be asked to share our experience. Quality:MK is one of nine projects comprising a national scheme Engaging with Quality in Primary Care (funded by The Health Foundation. The aim is to establish a whole system approach to improving health care that is driven by primary care, patient engagement and evidence-based practice. So – this is not a victory narrative, and there are parallels with my experience of driving around MK – where I get caught out by a mismatch between the map and the road ahead, and take many a second tour of a roundabout, quality improvement is an iterative, messy yet very worthwhile journey On a journey – starting from a position where could already see all sorts of good practice – yet room for improvement, closer relationships, and not a strong culture of PPE or evidence-based practice
- #3: – 26 of 27general practices formerly Patient and Public Involvement Forum --- Local Involvement Network NHS Milton Keynes – initiated within the Public Health Directorate of the PCT, sit within the commissioning arm Colleagues in the audience from each of the 3 local partners
- #4: What are we trying to do? Placing evidence, service users and primary care right at the heart of decision making and the quality improvement agenda - and keeping them there Building our knowledge and understanding of how to deliver and sustain improvement, using the lessons learned through an ambitious programme of Quality:MK projects to help line up the ‘cogs and wheels’ needed to build a self-improving system Explicit focus on learning and improvement process; ongoing process of continual, self-conscious change. The application of best evidence to healthcare will yield quality improvements;
- #5: Using repeated cycles of learning from projects to design and implement changes in system & organisational process Establish multiple channels for innovation and improvement; Mix of large-scale service review and redesign projects AND Projects initiated by practices – either as “bright ideas” or deriving from discussions of the evidence
- #6: Mainstreaming a systematic approach to service review and redesign Adopting Map of Medicine 12 task and finish groups: 100+ participants
- #7: 14 groups in all: 7 for practice staff: 5 in practice – 4 meeting regularly for some time now, plus two new groups 1 IMPACTE central and 1 IMPACTE online – 7 meeting in community services, most on an occasional basis. Well over a 100 participants, over 10 topics discussed Brought in a clinical effectiveness pharmacist to develop projects and toolkits, to to build up a network, to attract change, and support wider adoption of changes in practice All the CATs are listed on our website pages, currently on PCT website Back in Jan 09 - 55 topics discussed across all journal clubs. 36 of these within 5 GP practices. Of these 36 topics, 32 have been followed up with further investigation 4 have led to an actual change in practice: 1. Delayed prescribing as strategy to reduce antibiotic use 2. Interventions for alcohol misuse 3. Fever in under 5s 4. Lipid Modification hot on the heels of preparation of the first 3 implementation toolkits for prescribing projects, steering group will choose their next 3 topics in July.
- #8: As the current LITs are revamped; guidance on patient and public engagement to be prepared and issued to each LIT Chair on ensuring active involvement. This guidance to model the health:mk approach (whereby there is always some form of patient engagement but it takes different forms eg. perhaps commenting on a specification rather than helping to devise it). Develop a joint statement on the benefits of public and patient engagement, the benefits of partnership working and the “Golden Rules”, to be taken forward by NHS Milton Keynes, health:mk and LINk:MK as local partners PPI in planning process includes – enabling patients and the public to place issues on the agenda New guide for PPGs
- #9: Changes in system and process for service planning: patient engagement, clinical engagement, evidence-based inc. decision-makers need to demonstrate their use of evidence
- #10: Lessons taken from a presentation that Nick gave in Berlin about the emerging lessons from our work
- #11: from the Programme Manager These are some the things I wish I had done sooner or differently - - Paul Plsek - Engaging Physicians in a Shared Quality Agenda. IHI
- #12: These are some of the things the project leads have said: Inc believe the evidence of change management
- #13: From independent qualitative evaluation by PHRU showing evidence of a positive impact. Focus is on embedding the work, holding the gains and pushing on with the journey.
- #14: “ Continual improvement is an unending journey.” As first tranche of projects draw to a close over next year, already shaping Quality:MK Mark3 to continue after the close of HF funding – pleased to be asked to support work on review of stroke services, looking to develop a project on Domestic violence, assimilating the learning from another HF project Aim of microsite - to support the integration and ‘embedding’ of the Quality:MK principles into commissioning, planning and delivery. Mid-october If of any use to you in your mission - please make free use of any of the resources there - summaries of keynote papers on QI, current awareness services – new one on cost and quality – Learn from your experience as fellow travellers .. Thank you for yourtime-