qi conference 2016
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Luton and BedfordshireQuality Improvement
LaunchJoin the online discussion and tweet your thoughts or ideas using the hashtag #QIConfFollow us on @ELFT_QI
• Fire Exits• Tea-break• Lunch• Slido
House-keeping
Welcome
John WilkinsDeputy CEO & Managing Director
for Bedfordshire and Luton
Dr. Richard EvansDeputy Medical Director
What’s coming up this morning?
All about
Let’s join the conference in East London
Back to Bedfordshire
What is QI?
Dr Zelpha KittlerClinical Director, Bedfordshire
Institute of Medicine, Crossing the Quality Chasm: A New Health
System for the 21st Century, 2001
What is Quality?
Why does Quality matter?
Our core purpose for existing
Of greatest importance to our patients, carers, staff, GPs and all our stakeholders
Poor quality costs
Provides a clear long-term focus – guiding decision-making, investment, organisation
Where do we want to get to?
Working in partnership with patients and carers to continuously improve
Empowering front-line staff to innovate and improve the care we
provide
Systematic ways of implementing change
and monitoring progress
Improve quality improvement capability
in our organisation
Continuous quality
improvement
Where do we want to get to?
How do we do QI?
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
The Culture we want to nurture
How are we planning to develop QI across
Luton & Bedfordshire?
Dr Farid JabbarClinical Director, Luton
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67.8
51.1
UCL
LCL
Incidents resulting in physical violence (Trust-wide, excluding Luton and Bedfordshire) - C Chart
No.
of Inc
iden
ts
TRUST WIDE VIOLENCE REDUCTION
25% reduction
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 & roadshows2. Microsite3. Using the power of narrative4. Celebrate successes5. Network of champions / ambassadors6. Learning events
1. Initial assessment of alignment & capability2. Recruiting central QI team3. Online training4. Face-to-face training5. Follow-up coaching on projects6. Develop in-house training for 2016 onwards
1. Align all projects with improvement aims2. Align team / service goals with improvement aims3. Align all corporate and support systems4. Patient and carer involvement in all improvement
work5. Embed improvement within management structures
Reducing Harm by 30% every year1. Reduce harm from inpatient violence2. Reduce harm from falls3. Reduce harm from pressure ulcers4. Reduce harm from medication errors5. Reduce harm from restraints
Right care, right place, right time1. Improving patient and carer experience2. Reliable delivery of evidence-based care3. Reducing delays and inefficiencies in the system4. Improving access to care at the right location
How do we drive improvement?
Culture change – from managing performance to supporting quality improvement
Leadership
Invest in our people - provide our staff with the skills and space to make improvements
Innovate - Small-scale change led by front-line staff with short cycles of change to keep momentum
Spread what works
How do we align QI projects to the overall Aims?
The Tennis Ball Game
Break out Exercise
At your table: How many people are at your table?
6, 7, 8, 9 or 10
Assign a time keeper
Assign a number to each of the other people at your table, starting with the number 1 and continuing until you run out of people
Break out Exercise
Your current process involves tossing a tennis ball from person to person, following the sequence provided on the next slide
Practise your process one time
Time keeper - please time how long the team takes to complete the process (in seconds)
6 people
7 people8 people
9 people
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5 people1
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5
Break out Exercise
Team Aim: To reduce the time taken for every person to touch the ballCome up with change ideas and try them out
Rules: • The initial sequence as provided must be adhered to• You may only test one change idea at a time• You have 4 minutes to test out different change ideas
to achieve your aim
6 people
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9 people
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Knew your aim and worked together to…• Think of a few different ways of doing it• Tested out the approaches• And you learned…
What worked well and perhaps what didn’t too!
You’ve just done some PDSAs!
Reducing Harm and Developing the Right Care in
Right Place at the Right TimeQI In Luton & Bedfordshire
Ishrat Love-ChowdhuryQI Lead
“…Using data, we can determine what care is working well and what needs to be improved, allowing patients, clinicians and commissioners to <see>
the quality and efficiency of care…”
Chief Data OfficerNHS England
0
100
200
300
400
500
600
700
800
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
669
283
182 168133 128
89 86 80 80 6949 46 45 42 35 26 25 21 17 15 14 13 12 12 9 9 9 4 3 2 1 1 1
80%
Frequency
%Pareto Analysis Luton & Bedfordshire
incidents
Violence
or Agg
ressio
n
Absence
without le
ave
Clinica
l condition or P
hysical
Frailt
y
Treatm
ent /
Procedure
Breach of S
ecurity
Propoert
y Dam
age
Medica
tion Error
Unexpect
ed Dete
riorati
on
Health an
d Safet
y
Dange
rence
Occurre
nce
Informati
on Governan
ce
Access
or Tran
sition
Clinica
l Risk
Assessm
ent is
sue
HR / Comms /
Estat
esLeg
al
Death of S
ervice
User
Finan
cial
Psychologic
al
Acciden
t
Governan
ce
Safeg
uarding
Pressure
Ulcers
Occupati
onal Hea
lth
Investiga
tions / Te
sts
Medica
l Devi
ce / E
quipment
Neglect
Death of C
hild
Diagnosti
c issue
Domestic V
iolence
Instituitional
0
100
200
300
400
500
600
0%
20%
40%
60%
80%
100%
120%
551
125
9078
58 5746 44
31 26 24 23 20 20 20 17 11 11 9 8 7 5 4 2 2 2 1 1 1 1
80%
Frequency
%
Pareto Analysis Luton incidents
0
50
100
150
200
250
300
350
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
325
127
96
6355
43 40 3831 26 23 23 22 20 19 18 17 17 15 14 12 12 11 5 4 4 1 1 1
80%
Frequency %
Pareto Analysis Bedfordshire incidents
REDUCE HARM BY 30%
EVERY YEAR
RIGHT CARE, RIGHT PLACE, RIGHT TIME
QI Work in East London on
Violence and aggression
Globe ward
Designed and developed the Safety Culture Bundle of interventions throughout 2015Used on 4 acute wards with some success on PICUsShared bundle includes:• Safety huddles• Broset Violence Checklist• Safety Crosses• Safety discussion in ward
community meetings
Tower Hamlets Violence Collaborative
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0
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UCLLCL
Tim
e be
twee
n ev
ents
/ da
ys
3 days
8 days
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-14
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-14
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-14
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-15
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-Feb
-15
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-Mar
-15
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-15
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-15
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-15
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-15
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-15
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-Aug
-15
0
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5.8 2.4
UCL
LCL
No.
of I
ncid
ents
per
100
0 O
BD
MHCOP service
Tower Hamlets collaborative
REDUCE HARM BY 30%
EVERY YEAR
RIGHT CARE, RIGHT PLACE, RIGHT TIME
QI Work in East London on
Improving Access
Newham Child and Family Consultant Service
Front Door QI Project
Driver diagram
To reduce waiting times for CFCS from 11weeks to 9 weeks
by April 2015 and improve the patient
experience of referral to CFCS as demonstrated by
increased attendance at first
appointment
Referral Processes
Define Admin process for handling referrals
Define standards from CAMHS clinicians in liaison
activity with referrers
Streamlining referral processes
Identify and use onward pathways for cases diverted
from CFCS
Demand Management
Information provided to referrers about CFCS
Checklists/ Screening tools for referrers
Awareness events
Signposting to alternative services
Limited Capacity
Increase proportion of telephone consultation time
Workload balancing
Broaden interventions Develop self help materials
Standardise liaison activity with referrers
Develop telephone screening protocol for families
Develop welcome call to families accepted to CAMHS prior to
appt
Develop library of easily accessible self-help materials
Screening checklists for GPs/referrers
Review and rationalise info sent to families
Develop knowledge about alternative services in
community / ‘secret shopper’ users.
Review and develop administrative systems for
referrals
AIM PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS
A PS D
A PS D
A PS DD S
P A
DATA
FEEDBACK
TO FRONTLINE
STAFF:
Compliance
w PVC check
D SP A
Cycle 1: Collect baseline data on current referral process
Cycle 2: Standardize triage assessment script
Cycle 4: Pilot triage (‘Front door’) service
Cycle 3: Develop self-help library and local service database
Sequence of PDSA’s – for one change idea or secondary driver
Cycle 5: Using interpreters
A PS D
A PS D
A PS DD S
P A
DATA
FEEDBACK
TO FRONTLINE
STAFF:
Compliance
w PVC check
Cycle 6: : Drop-in appointments
Cycle 7: Pilot combined DLC & ‘front door’ role
Cycle 9:Implement the full ‘front door’ service
Cycle 8: Align referral admin with ‘front door’ service
Sequence of PDSA’s – for one change idea or secondary driver
(cont.)
OU
TCO
ME
MEA
SURE
SImproving Access Collaborative – CAMHS Newham CFCS Front Door ServiceMarch 2016
BALA
NCI
NG
MEA
SURE
S- Baseline data
Jan-
14
Feb-
14
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-14
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-14
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-14
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4
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-14
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-14
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-14
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-14
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-14
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-15
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-15
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-15
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5
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-15
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-15
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-15
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-15
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-15
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Feb-
16
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75
85
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48.8
UCL
LCL
Average waiting time from referral to 1st face to face appt (NH CAMHS) - X-bar ChartA
vera
ge W
aitin
g Ti
me
/ Day
s
Jan-
14Fe
b-14
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-14
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-14
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-14
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l-14
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-14
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-14
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-14
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-14
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-15
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b-16
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UCL
LCL
No. of referrals received (NH CAMHS) - I Chart
No.
of R
efer
rals
Jan-
14Fe
b-14
Mar
-14
Apr
-14
May
-14
Jun-
14Ju
l-14
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-14
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-14
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-14
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-14
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-14
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b-15
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-15
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-15
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-15
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15Ju
l-15
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-15
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-15
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-15
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-15
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-15
Jan-
16Fe
b-16
5%
10%
15%
20%
25%
30%
35%
40%
45%
28.54%
20.58%
UCL
LCL
% of 1st face to face appt DNAs (NH CAMHS) - P Chart
DN
A /
%
REDUCE HARM BY 30%
EVERY YEAR
RIGHT CARE, RIGHT PLACE, RIGHT TIME
QI Work in East London on
Improving Physical Health
AIM:
Reduce cardiovascular
risk for all adults and children for
whom we initiate or change
psychotropic medication
Information provision
Minimum standards & checks
Pods for community settings
Assessment
Health promotion (exercise, diet, education)
Smoking cessation
Involvement in all QI areas
Monitoring
Communication between services
Improving physical health
collaborative;Driver Diagram
Overview
Leadership
Prescribing
3. Measuring and Reporting• Template development: define
scope, data, spec• Reports & dashboards
1. Equipment
2. Assessment & monitoring
3. Intervention
4. Service user & staff engagement
Infrastructure
AOS
Sapphire ward
Luton & Bedfordshire Looking at data over time…
How has QI impacted on staff?
2010 2011 2012 2013 2014 201555
60
65
70
75
80
85
90 Staff able to contribute towards improvements at work
Scor
e (%
)
2010 2011 2012 2013 2014 20153.5
3.6
3.7
3.8
3.9
4
4.1
4.2 Staff Motivation to Work
Scor
e
2010 2011 2012 2013 2014 20153.3
3.4
3.5
3.6
3.7
3.8
3.9
4
4.1 Staff job satisfaction
Scor
e
2010 2011 2012 2013 2014 20153.5
3.6
3.7
3.8
3.9
4
Overall Engagement ScoreELFT ScoreNational Median
Scor
e
Let’s hear from some of the staff and patients in East London about what kind of impact QI has made…
Tea break15mins
…Take a look at the posters on display
Running QI Projects within a supported
environment
Running a QI Project
Neil LadStaff Nurse, Onyx ward
Being a QI Coach and supporting projects
Jamie StaffordClinical Nurse Manager
Jade ward PICU
Next up for QI Luton & Beds
Ishrat Love-ChowdhuryQI Lead
Area Project
Luton To ensure Physical Health Needs & Risk Assessment are completed for all admissions
Luton To improve Patient Safety and Follow-up discharge
Bedfordshire Reducing waiting times in Bedfordshire’s East and West CMHTs
Bedfordshire Improving Outcomes
Bedfordshire Embedding a system of practice audit
Bedfordshire Provision of synchronised and high quality reporting
Other initial QI Projects
Learn more about QI April – August 2016
• General QI Roadshows• Service / Team sessions• Preparatory Workshops
All the details will be on the Microsite as more dates are confirmed www.qi.elft.nhs.uk
Date: Service:23rd March 2016 Ash Ward Away-day30th March 2016 Keats Ward Away-day25th April 2016 General QI Roadshow 127th April 2016 Coral Ward Away-day27th April 2016 Fountains Court Away-day26th May 2016 General QI Roadshow 24th July 2016 General QI Roadshow 3July 2016 Psychiatric Liaison ServicesJuly 2016 Jade Ward PICUJuly 2016 Older People’s Services July 2016 Bedfordshire All Community Services Away-day6th Sept 2016 Bedfordshire Well-being Service Away-DayEarly July 2016 CAMHS August 2016 Learning Disabilities
And we’ll be coming to meet your teams..Please check on www.qi.elft.nhs.uk for all confirmed dates and venues…
Prework Workshop9/29-10/1
Webex 110/14
Webex 211/2
Supports:• Listserve• Assignments
AP-1 AP-2Webex 3
11/30AP-3
ProjectPlanning 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
Improvement Science in Action6 Month Learning Path
Service User Input
Support around every team
Project Sponsor QI Coach
QI Forums
QI Team
www.qi.elft.nhs.uk
qi@eastlondon.nhs.uk
@ELFT_QI
Let’s re-join the conference inEast London
Back to Bedfordshire
We’re Quality Improving…”
• Lunch available• Posters• Drop-in session
Wrap up
The ELFT
Has now launched in Luton and Bedfordshire!
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