Learning from ELFT - Setting up an organisation wide QI programme
- 1. Our quality improvement programme web qi.elft.nhs.uk email qi@elft.nhs.uk @ELFT_QI Conflicts of interest: None
- 2. Mental health services Newham, Tower Hamlets, City & Hackney, Luton & Bedford Forensic services All above & Waltham Forest, Redbridge, Barking & Dagenham, Havering Child & Adolescent services, including tier 4 inpatient service Regional Mother & Baby unit Community health services Newham Urgent care centre Newham IAPT Newham, Richmond and Luton Speech & Language Barnet
- 5. The strategic case for change Make quality our absolute priority • Improving quality of care is our core purpose • Of greatest importance to all our stakeholders • Build on the excellent work already happening to improve quality National drivers • The need to focus on a more compassionate, caring service with patients first and foremost • More structured and bottom-up approach to improvement Enable our staff to lead change • The desire to engage, free and support our staff to innovate and drive change • Engaged and motivated staff leads to improved patient outcomes The economic climate • The need to do more with less – improving quality whilst reducing cost @ELFT_QI
- 6. The culture we want to nurture A listening and learning organisation Empowering staff to drive improvement Increasing transparency and openness Re-balancing quality control, assurance and improvement Patients, carers and families at the heart of all we do @ELFT_QI
- 8. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will Build improvement capability Alignment QI Projects 1. Launch event & roadshows 2. Microsite 3. Using the power of narrative 4. Celebrate successes 5. Network of champions / ambassadors 6. Learning events 1. Initial assessment of alignment & capability 2. Recruiting central QI team 3. Online training 4. Face-to-face training 5. Follow-up coaching on projects 6. Develop in-house training for 2016 onwards 1. Align all projects with improvement aims 2. Align team / service goals with improvement aims 3. Align all corporate and support systems 4. Patient and carer involvement in all improvement work 5. Embed improvement within management structures Reducing Harm by 30% every year 1. Reduce harm from inpatient violence 2. Reduce harm from falls 3. Reduce harm from pressure ulcers 4. Reduce harm from medication errors 5. Reduce harm from restraints Right care, right place, right time 1. Improving patient and carer experience 2. Reliable delivery of evidence-based care 3. Reducing delays and inefficiencies in the system 4. Improving access to care at the right location @ELFT_QI
- 9. STARTING TO BUILD THE WILL • The events led the trust to question whether it had the right processes in place to deliver quality care • Robust assurance • Staff and patient experience feedback not very good • Arrival of MD from NPSA who made a case for more co-ordinated and systemic trust wide approach.
- 10. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will QI microsite the online hub for the programme qi.eastlondon.nhs.uk Staff and service user newsletter reaches 4000 people every month QI launch event and roadshows attended by over 1000 staff, service users and carers Bespoke QI learning events for staff, service users, commissioners, governors @ELFT_QI
- 11. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will 35,000
- 12. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will 35,000page views of the QI microsite in the last year our one-stop shop for QI built and managed by the QI team, total cost £300 qi.elft.nhs.uk
- 14. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will Introducing microsite 2.0
- 15. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will 1,000
- 16. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will 1,000Staff, service users, carers, Governors, commissioners engaged in the first 4 months of the programme
- 17. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will Bespoke learning sessions Specialist services leadership Service users and carers Finance team Health visitors Nursing students Band 3 nursing staff Psychology trainees Trainee doctors External partners
- 18. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will 5,000
- 19. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will 5,000staff receiving the monthly QI e-newsletter
- 20. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will Percentage of staff opening the e-newsletter
- 21. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will 550
- 22. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will 550local services receiving the quarterly paper newsletter, including GP practices and voluntary sector organisations
- 23. AIM: To provide the highest quality mental health and community care in England by 2020 Build the will 6projects shortlisted for regional or national awards 1regional award 7projects being written up for publication with BMJ 6teams presenting their work to the Trust board each year
- 24. 1. How would you rate the will to undertake a QI programme in your organisation? 2. What are the barriers stopping you from undertaking this work? 3. In light of what you heard today, will you be doing anything differently in order to make a case for change? Building the Will Table Discussion
- 25. AIM: To provide the highest quality mental health and community care in England by 2020 Build improvement capability Face to face improvement training - hundreds of staff, services users, Governors to be trained over the next few years Support for improvement work from the Trust’s QI team IHI Open School available to all Strategic partnership with IHI Board sessions @ELFT_QI
- 26. Experts Front line staff Clinical leaders Directorate improvement leads Board Estimated number = 3300 Requirement = introduction to quality improvement, identifying problems, change ideas, testing and measuring change Time-frame = train 10-20% in 2 years Estimated number = 250 Requirement = deeper understanding of improvement methodology, measurement and using data, leading teams in QI Time-frame = train 30-50% in 2 years Estimated number = 30 Requirement = deeper understanding of improvement methodology, understanding variation, coaching teams and individuals Time-frame = train 100% in 2 years Estimated number = 10 Requirement = setting direction and big goals, executive leadership, oversight of improvement, being a champion, understanding variation to lead Time-frame = train 100% in 2 years Estimated number = 5 Requirement = deep statistical process control, deep improvement methods, effective plans for implementation & spread Time-frame = train 100% in 2 years Where are we? On track to train over 500 people through 5 six-month waves of learning between 2014-16. First 3 waves delivered with the IHI On track. All senior staff being encouraged to join QI training over next 2 years New need recognised. Developing improvement coaches programme will train 30 QI coaches in 2015 On track. Most Executives will have undertaken the ISIA, and Board training has been delivered in 2015. Currently have 3 improvement advisors, with 1.5wte deployed to QI. Will need to build more capacity at this level.
- 27. AIM: To provide the highest quality mental health and community care in England by 2020 1,100 Build improvement capability
- 28. AIM: To provide the highest quality mental health and community care in England by 2020 1,100Open School lessons completed Build improvement capability
- 29. AIM: To provide the highest quality mental health and community care in England by 2020 Build improvement capability Recruited a central QI team Board sessions Developed 3 improvement advisors
- 30. Coaching teams from the very start Success Form a team Agree the quality issue to be tackled Ensure patient (and carer) involvement Find time to meet @ELFT_QI
- 31. Prework Workshop 9/29-10/1 Webex 1 10/14 Webex 2 11/2 Supports: • Listserve • Assignments AP-1 AP-2 Webex 3 11/30 AP-3 Project Planning Reliability Sustaining Gains Workshop (3 days) Webex #2Webex #1 • Faculty consults • Webex calls • Coaching calls Webex #3 Learning Set 2 & graduation AP-5AP-4 The two learning sets will be focused on sharing the participants’ work on their projects and learning from each other. These sessions also will reinforce the content from the Webex calls and the ISIA workshop. Learning set 1 @ELFT_QI Learning and coaching over 6 months
- 32. 1. What improvement capability exists in your organisation? 2. How could you shuffle existing resources to create some capacity to start improvement work? 3. How would you build a business case and convince your leadership team about the need to invest in building capability and capacity for improvement? Building Capability Table Discussion
- 33. AIM: To provide the highest quality mental health and community care in England by 2020 Alignment
- 34. AIM: To provide the highest quality mental health and community care in England by 2020 Alignment
- 35. AIM: To provide the highest quality mental health and community care in England by 2020 Alignment
- 36. 1. What would you have to change to produce alignment in your organisation? 2. How do you look at data, and talk about improvement and safety at every level? 3. What can you change, stop or review to create space for improvement? What are the structures in place to support improvement? Alignment Table Discussion
- 37. AIM: To provide the highest quality mental health and community care in England by 2020 QI Projects How have our projects developed over time?
- 38. AIM: To provide the highest quality mental health and community care in England by 2020 QI Projects September 2014
- 39. AIM: To provide the highest quality mental health and community care in England by 2020 QI Projects October 2014
- 40. AIM: To provide the highest quality mental health and community care in England by 2020 QI Projects November 2014
- 41. AIM: To provide the highest quality mental health and community care in England by 2020 QI Projects December 2014
- 42. AIM: To provide the highest quality mental health and community care in England by 2020 QI Projects January 2015
- 43. AIM: To provide the highest quality mental health and community care in England by 2020 QI Projects February 2015
- 44. Right Care, Right Place, Right Time TH Collaborative Roman, Globe, Bricklane, Lea, Millharbour, Rosebank MHCOP Larch Lodge, Cedar Lodge, Sally Sherman Ward CHN EPCS Teams (North East, North West, Central, South) Multiple I/P Wards C&H Rehab, AOS, Connolly, Bevan Newham Multiple I/P wards Newham Psychology MHCOP Training Lodge Children’s CDC x2 CAMHS x3 MHCOP Memory Service C&H All CMHTS Forensics Clerkenwell REDUCE HARM BY 30% EVERY YEAR RIGHT CARE, RIGHT PLACE, RIGHT TIME VIOLENCE REDUCTION PHYSICAL HEALTH ACCESS PRESSURE ULCERS @ELFT_QI
- 45. Is it making a difference? @ELFT_QI
- 46. UCL LCL 50 70 90 110 130 150 170 190 210 230 Dec12 Jan13 Feb13 Mar13 Apr13 May13 Jun13 Jul13 Aug13 Sep13 Oct13 Nov13 Dec13 Jan14 Feb14 Mar14 Apr14 May14 Jun14 Jul14 Aug14 Sep14 Oct14 Nov14 Dec14 Jan15 Feb15 Incidentseachmonth Month Incidents of physical violence across the Trust (C Chart) 179 per month 145 per month 19% reduction across the Trust Datix incident reporting @ELFT_QI
- 47. UCL LCL 10 20 30 40 50 60 70 80 90 100 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 No.ofRestraints Episodes of Restraint in Prone Position - C Chart UCL LCL 50 70 90 110 130 150 170 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 No.ofIncidents Incidents resulting in the use of Restraint (C Chart) 68 per month 30 per month 56% reduction 134 per month 112 per month 16% reduction
- 48. UCL LCL0 1 2 3 4 5 6 7 8 07Apr 21Apr 05May 19May 02Jun 16Jun 30Jun 14Jul 28Jul 11Aug 25Aug 08Sep 22Sep 06Oct 20Oct 03Nov 17Nov 01Dec 15Dec 29Dec 12Jan 26Jan 09Feb 23Feb 09Mar 23Mar 06Apr Grade 3-4 Pressure Ulcers - C ChartNumber UCL LCL0 2 4 6 8 10 12 14 16 24Mar 31Mar 07Apr 14Apr 21Apr 28Apr 05May 12May 19May 26May 02Jun 09Jun 16Jun 23Jun 30Jun 07Jul 14Jul 21Jul 28Jul 04Aug 11Aug 18Aug 25Aug 01Sep 08Sep 15Sep 22Sep 29Sep 06Oct 13Oct 20Oct 27Oct 03Nov 10Nov 17Nov 24Nov 01Dec 08Dec 15Dec 22Dec 29Dec 05Jan 12Jan 19Jan 26Jan 02Feb 09Feb 16Feb 23Feb 02Mar 09Mar 16Mar 23Mar 30Mar 06Apr Grade 2 Pressure Ulcers - C ChartNumber 6.4 per week 2.8 per week 56% reduction
- 49. Buildingwill Build a broad coalition for change Take time to bring people with you Shift decision- making to the edge Develop a compelling narrative Find some clear signals of change Use the power of stories Take every opportunity to celebrate
- 50. Buildingcapability& capacity Be prepared to invest Train all levels and across disciplines Realign existing resources Stop lower value work
- 51. Alignment&integration Start at the top Create a support structure Build a learning system Ensure patients and carers are integral Ensure the context is ripe Line of sight from team to system goals
- 53. Organisational culture is created by what leaders pay attention to…