Improving Quality of Care

How do we address the implementation challenge?

Iain WallaceInterim Medical Director

NHS Quality Improvement Scotland

An expert is somebody who is more than 50 miles from home, has no responsibility for implementing the advice he gives, and shows slides.

Edwin Meese III

……first something about NHS QIS

NHSQISNHSQIS

Excellence in leading the use of knowledge

to improve the quality of

healthcare for

the people of Scotland

Dimensions of Dimensions of Quality inQuality in Health Care Health Care

Effective Safe Patient Centered Timely Efficient Equitable

Institute of Medicine 2004

QIS, QI and QA

NHS QIS Key Activity

Advice, guidance and standards

Implementation and improvement support

Assessment, measurement and

reporting

Local improvement

cycles

AssuranceAccountability

Advice and guidanceAdvice and guidance

SIGN guidelines

Standards

Assessment of clinical and cost-

effectiveness of health interventions

Health technology assessments

Evidence notes

NICE advice

Implementation

Scottish Patient Safety Programme

Infection Improvement and Implementation

Programme

SIGN Rockets

QOF & SPICE pc

Assessment and Assessment and measurementmeasurement

Performance assessment against

standards

National audits

External quality assurance

Healthcare Environment

Inspectorate

But………But………

How can we do things better?

A systematic narrative review of quality improvement models in health care

AE Powell, RK Rushmer, HTO Davies

How to do it…….

Factors for successful implementation of QI

Apply method consistently

over a sufficiently long timescale with sustained commitment and support

Factors for successful implementation of QI

Involve doctors and other health professionals in a wide team effort while providing adequate training and development

Factors for successful implementation of QI

Integrate quality improvement into other activities and tailor methods to local circumstances

Factors for successful implementation of QI

Good information systems to enable measurement of processes and impact

Factors for successful implementation of QI

Acknowledge and ameliorate as far as possible the impact of competing activities and changes

Adoption/spread

Easier where an improvement initiative offers:Relative advantageCompatibility SimplicityTrialabilityObservability

HIT implications……….

Improve the system then add IT

“We know that if you try to apply IT to

something that is fundamentally screwed up it doesn’t help very

much!”

Prof. Michael PorterHarvard Business School

MIT Symposium on Healthcare IT July 2006

HIT and QI

Information for decision-makingPortalPoint of care decision support

e Care bundlesRelevant real time feedback

HIT and QI

Computers really can improve your health,

or at least make your doctor less likely to kill you.

The Guardian, Jan 2006

QIS Support for QIS Support for ImplementationImplementation

Training in improvement methods measurement

Development of care bundles Enhancing leadership capacity Supporting clinical teams through

learning events

The future

Integrated approach across primary and secondary care

Improvement ‘bundles’ as the main currency

Measurement of change/ improvement at local level

Learning from others Building on an effective e health

platform