Transcript The new driving force for improvement in the NHS

The Patient Safety
Collaborative Programme
2014-2019
World Stop Pressure Ulcers
Day
Fiona Thow
20 November 2014Network
Responding to Francis and Berwick
“The most important single change in the
NHS in response to this report would be for
it to become, more than ever before, a
system devoted to continual learning and
improvement of patient care, top to bottom
and end to end.”
Berwick Report, August 2013
For NHS staff and clinicians:
• Participate actively in the improvement of
systems of care
• Acquire the skills to do so
• Speak up when things go wrong
• Involve patients as active partners and coproducers in their own care
Patients as leaders and true partners
Co- producing the safety programme
Responding to Francis and Berwick
“Following Don Berwick’s recommendation, NHS
England will establish a new Patient Safety
Collaborative Programme across England to spread
best practice, build skills and capabilities in patient
safety and improvement science, and to focus on
actions that can make the biggest difference to
patients in every part of the country. They will be
supported to systematically tackle the leading causes
of harm to patients. The programme will start in April
2014.”
The government’s response to Francis, November
2013
Patient safety collaboratives
•
•
•
•
AHSN footprint
2-5m population
Locally owned and run
Majority of funding devolved
to support local improvement
programme activity
• National support for;
• change packages/
interventions;
• knowledge sharing;
• consistent measurement;
• networks/communities.
#saferNHS
A Different kind of Collaborative
• Locally driven and led
• Designed in partnership
• Provide support, co-ordination & rapid
spread and adoption
• Developing capacity & capability for QI &
Safety
A system devoted to continual learning
and improvement
Framework for Operational Excellence
©Alan Frankel and IHI 2013
Using the principles of the Safety
Framework
• Patients, families and carers involved in
agreeing and designing priorities
• Focusing on creating the right culture
• Creating a system that continues to learn
• Using appropriate quality and safety
improvement methodology
• Measurement & Leadership are key !
Progress to date
• NHS England Public Board signalled support for the
programme
• Design Day held for 120 experts on 15 January 2014
• NHS England funding allocation process finalised
• Governance structures and processes agreed with AHSNs
• Collaborative Programme Board established
• Patient Safety Leads group convened
• 1:1 meetings with AHSN’s
• Baseline data packs in development
• Establishing links to other initiatives
• National Launch Day - 14th October
• Operational model & initial “cluster groups” agreed
Collaborative priorities - proposals
Topic area
Patient Safety Topic
The
‘essentials’
NHS
Outcomes
Framework
improvement
areas
Measurement
Leadership
Venous
Thromboembolism
Other major
sources of
death and
severe harm
Falls
Vulnerable
groups for
whom
improving
safety is a
priority
People with
Mental Health
needs
Healthcare
Associated
Infections
Handover
and
Discharge
Nutrition and
hydration
People with
Learning
Disabilities
Pressure
Ulcers
Maternity
Acute
Kidney
Injury
Missed and
delayed
diagnosis
Children
Offenders
Medication
Errors
Deterioration
of patients
Deterioration in
children
Medical
Device
Errors
Acutely ill older
people
Sepsis
Transition
between
paediatric and
adult care
The ‘operational model’
National Patient Safety Collaborative Programme - Operational Model
Pressure Ulcers
VTE
x
x
x
x
x
Medication
Errors
HCAI
Maternity
Falls
AHSN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
NHS IQ
Accelerated
Learning Groups
x
x
x
x
x
x
x
x
Leadership and Measurement
x
x
x
x
x
x
Evidence
Toolkits
Social media
Campaigns
Spread
Cluster groups
• Primary focus: leadership, measurement and quality
improvement and safety capability
• Medicines Optimisation, AKI, Mental Health, Pressure
Ulcers, deterioration of the patient (Incl. sepsis)
• Group focus on topic specific improvement
• Bringing expertise together with practical application
• Peer support and problem solving
• Accelerate and share learning across the NHS
Pressure Ulcers
• 5 AHSNs have identified it as a priority area
• Interest in working in care homes, community
and supporting people in their own homes
• Developing skills and training resources for care
homes
• Linking it to work on hydration, falls and AKI
• Plans are still being developed – cluster group
input, master classes, sharing good practice,
resources
Key principles
• Build on existing good work
• Establish ‘how’ to implement current evidence
• Test and refine new ways of working – where evidence
may be lacking
• Influence levers and drivers in the system to support safer
care
• Align initiatives – making safety everyone’s business
• Staff and patients – tools, skills and support
• Aim for large scale and transformational change
• Share learning across the NHS
NHS IQ Role – what we have heard
• A small national supporting / coordinating function
• Build on pockets of excellence and communities of interest
• Developing joint approaches with partners to:
• Measurement - expert group, baseline metric development and
national aggregation
• Leadership & Culture - expert group
• Capability building programme - workshops
• Programme evaluation & ROI
• Partner with patients and carers
• Provide QI and programme support materials and guidance
• Co-produce - avoid duplication and share best practice and
resources
• Do only what adds value nationally - help align work, connect and
join up the dots
#saferNHS
[email protected]
www.nhsiq.nhs.uk
Improving health outcomes across England
by providing improvement and change expertise.