The Scottish Early YearsCollaborative

1941, William A. Foster

"Quality is never an accident; it is always the result of high

intention, sincere effort, intelligent direction and

skillful execution; it represents the wise choice of

many alternatives.”

Quality planning

Quality assurance Quality improvement

Juran’s trilogy

Quality Improvement

• “Quality Improvement is a broad range of activities of varying degrees of complexity and methodological and statistical rigor through which … providers develop, implement and assess small-scale interventions and identify those that work well and implement them more broadly in order to improve clinical practice.”

Mary Ann Bailey, The Hastings Center

Implementing at scale….can it be done?

WillIdeas

Execution

Evidence based discovery Evidence based delivery

17 years to get 14% of evidence into practice

25.1 harms per 100 admissions

Our change theory

• A clear and stretch goal

• A method

• Predictive, iterative testing

“By what method?”

W.Edwards Deming

A Breakthrough Series Collaborative underpinned by the Model for Improvement

•A clear aim•Over 40 measures

•Five change packages•Site visits, a listserve, learning sessions

IHI Breakthrough Series Collaborative

Select Topic

(develop mission)

Planning Group

Develop Framework & Changes

Participants (10-100 teams)

Prework

LS 1

P

S

A D

P

S

A D

LS 3LS 2

Supports

Email (listserv) Phone Conferences

Visits Assessments

Monthly Team Reports

A D

P

SExpert Meetings

AP1 AP2 AP3

LS – Learning Session

AP – Action Period

Holding the Gains

IHI Breakthrough Series Collaborative

Select Topic

(develop mission)

Planning Group

Develop Framework & Changes

Participants (10-100 teams)

Prework

LS 1

P

S

A D

P

S

A D

LS 3LS 2

Supports

Email (listserv) Phone Conferences

Visits Assessments

Monthly Team Reports

A D

P

SExpert Meetings

AP1 AP2 AP3

LS – Learning Session

AP – Action Period

Holding the Gains

What did the teams achieve?

HSMR – Jan. – Mar. 2012

• Deaths and discharges = 221,674

• Observed deaths = 6401

• Expected deaths = 7167

• HSMR = 6401/7176 = 0.89

9902 fewer than expected deaths since January 2008

902 in this quarter alone

Compiled from reported data by Jason Leitch – September 2012

HSMR: Scotland Jan. ’08 Mar. ‘12

0.80

0.85

0.90

0.95

1.00

1.05

Jan-M

ar 2

008

Apr-Jun 2

008

Jul-S

ep 2

008

Oct-D

ec 2

008

Jan-M

ar 2

009

Apr-Jun 2

009

Jul-S

ep 2

009

Oct-D

ec 2

009

Jan-M

ar 2

010

Apr-Jun 2

010

Jul-S

ep 2

010

Oct-D

ec 2

010

Jan-M

ar 2

011

Apr-Jun 2

011

Jul-S

ep 2

011

Oct-D

ec 2

011

Jan-M

ar 2

012p

HS

MR

1.03

0.89

10.6% reduction

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1981/8

2

1982/8

3

1983/8

4

1984/8

5

1985/8

6

1986/8

7

1987/8

8

1988/8

9

1989/9

0

1990/9

1

1991/9

2

1992/9

3

1993/9

4

1994/9

5

1995/9

6

1996/9

7

1997/9

8

1998/9

9

1999/0

0

2000/0

1

2001/0

2

2002/0

3

2003/0

4

2004/0

5

2005/0

6

2006/0

7

2007/0

8

2008/0

9*

2009/1

0*

2010/1

1*

2011/1

2*,

p

Year of discharge

% M

ort

ali

ty o

n D

isch

arg

e

Surgical Mortality

35%

0.51%

0.78%

Prepared 1st March 2012

0

0.5

1

1.5

2

2.5

Jan-

08

Apr-0

8

Jul-0

8

Oct-08

Jan-

09

Apr-0

9

Jul-0

9

Oct-09

Jan-

10

Apr-1

0

Jul-1

0

Oct-10

Jan-

11

Apr-1

1

Jul-1

1

Oct-11

General ward C.Difficile rate(per thousand patient days)

1.15

0.12

90% reduction

~6500 people

Act your way into culture change

Communities

The Improvement Guide, API

Aim

Measures

Changes

Execution

New measurement skills

• Run charts

• Transparency

• All-or none measurement

You can only learn as quickly as you test.

Having the best professionals in the world

is no longer enough

@jasonleitch