Transcript Healthcare Standard 8.3

Integrating clinical audit with
quality improvement
- a model of delivery from
Aneurin Bevan University Health Board
Rachel Fletcher MSc
ABCi Lead – Project Support Team
15th October 2013
HQIP ‘Ensuring Safety, Driving Improving’ Conference
Two journeys meet in the middle
Top down
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1000 Lives Campaign
1000 Lives Plus
Programme
Learning from Jonkoping,
Ko Awatea, Kaiser
Permanente etc
Building Capacity for
Quality Improvement
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Bottom Up
IQT
Health Board Faculties
ABUHB commitment to QI
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Clinical Audit
Safer Patients Initiative
1000 Lives Campaign
1000 Lives Plus Programme
Shift away from Clinical
Audit towards Quality
Improvement
What did we learn?
Evidence based introduction of change - not
Spray’n’Pray!
Effective way to measure improvement realtime – SPC
Need to support clinicians to measure process/outcome
2009/10 ABHB Clinical Audit Annual Report
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248 Clinical Audits
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61% Audits led to agreed actions/shared learning
28% re-audits – difficult to assess actual improvements
1000 Lives - 143 series of data
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61% statistical improvement in outcome measures
64% statistical improvement in process measure
Model for
Improvement
Measurement
The Model for Improvement
What are we trying to
Accomplish?
How will we know that a
change is an improvement?
What change can we make
that will result in
improvement?
• Measurement a key
component
• Employs Statistical Process
Control Techniques
Act
Plan
Study
Do
Audit
Posters
International
Forum for
Quality &
Patient Safety
2013
Process &
System
Improvement
Posters
International Forum
for Quality & Patient
Safety 2013
Clinical Audit often aggregates data
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Before
and
After
SPC plots data over
time as Runcharts
or Control Charts
What did we do?
ABUHB Board Q&PS
Committee development
session – priorities set
 National priorities
 1000 Lives Plus
 Divisional priorities
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highest risks,
patient experience,
focus on
demonstrable
improvement
Staff engagement
workshops
Visits to all Audit Leads
Restructured workloads
New job descriptions
Staff training
National Clinical Audit and Outcome
Review Plan – ABHB progress
Clinical Effectiveness Group
chaired by Medical Director
responsible for ensuring:
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Overview of NCA&OR Plan at ABHB
Clinical Lead for each audit
Register of National Audits
Feedback re: each audit to CEG
 Priority audits full presentation
 Other audits via feedback
template
 Timetable of feedback devised
Learning and Action as a result of
audit
Annual Report 2012/13
Welsh Government NCA&OR
Advisory
Group visit
1000 Lives Plus
Coordinators supporting teams:
Through:
Acute Stroke
Care Metrics & Fundamentals of
Care
Stroke Rehabilitation
Supporting clinicians in gathering,
Life After Stroke
collation, analysis, interpretation,
Chronic Heart Failure (CHF)
reporting and feeding of progress
Hospital Acquired Thrombosis (HAT)
and data
Leadership Walkrounds
Liaising with agencies to gather
Transforming Maternity Services
routine data eg. WHAIP, 1000
Mouthcare
Lives central team
Enhanced Recovery After Surgery
Regular feedback to clinical teams
(ERAS)
High Level Data to Board as part
Catheter Associated Urinary Tract
of QI Report
Infection (CAUTI)
Mortality Reviews
Theatres
GTT Reviews
Community Falls
1000 Lives Data - Aims
Q&PSIMDept
Support for
data reports
QI Report of 1000
Lives measures to
Q&PS Committee
Reports to Divisional
Quality & Patient
Safety Groups
Data to Directorate
Quality Imp./Audit
Meetings
Locally held 1000 Lives
spreadsheets/audits
Board
Data
Divisional
data
Directorate
data
Frontline
data
Support &
Leadership for
work
Divisional QI Projects
Working with divisions to set up Quality Improvement
Programmes
 Eg. O&G QuIP Programme, priorities for division,
QuIP teams leading each project
Aim to incorporate divisional priorities, national audits
and 1000 Lives work
But…not all plain sailing!
Project Support Team
Bringing together expertise
from across the health board
 Clinicians
 Improvement managers
 Clinical audit
To support divisions with their
QI programmes
5 arms – ABCi Project Support
Team
Linking with Cardiff University
– Mathematical Modelling
Meeting new people and
learning from each other
Developing a confident Project
Support Team
 Learning from others –
shadowing Improvement
Leads to see techniques in
practice
 Involvement in larger service
level change
 Silver IQT Training
 Supporting smaller QI
projects – ie. Turning a
Clinical Audit into a QI Project
 Linking QI methods with
National Audits
Aim of ABCi
Bringing a framework and methodologies for
clinical teams to improve the services they
deliver
Helping make improvement part of everyone’s
job
The process will help teams understand clinical
outcomes, patient experience, efficiency and
how they spend their money
Thinking about a whole system
Best evidence and practice
Functions
Developing and supporting leaders
Quality Improvement Training (IQT)
ABCi Project Support Team – supporting
divisional QI projects/programmes
Innovation and knowledge management
Modelling Unit
Structure
Working with divisions to develop and support
a programme for improvement
Identifying improvement champions within
each Division
Having an accountable link back to ABCi
Allocating measurement and mathematics
resource to each division
Some final thoughts…
Prof. Nick Black
Call for ‘Quality’ not ‘Audit’ Departments
[HQIP Clinical Audit for Improvement Conference. London Feb 2013]
National Advisory Group for Clinical Audit & Enquiries (DOH)
Consultation on Future of Audit staff in Trusts
- Proposals include:
Distinguishing between quality assessment and quality
improvement
Quality Departments integrating clinicians, managers and clinical
audit staff
Training in technical skills such as Improvement Science and
Behavioural Skills
Clinical Audit
QI – Model for
Improvement SPC
Re-Audit
Snapshot in time of overall
performance compared to
evidence based standards.
Highlights where there are
deficiencies in practice
Real-time monitoring of
performance over time.
Interventions for change are
implemented and their effects
assessed almost immediately
Snapshot in time of overall
performance. Checks that
standards are maintained
and improved where
necessary
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Standard A
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Integrating Clinical
Audit with QI
The Clinical Audit Gap
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Clinical audit doesn’t give
us methods to make
change
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Standard B
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Standard C
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Clinical Audit doesn’t
measure during the
process of change
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Thankyou
[email protected]
Twitter @rachelnfletcher
Follow
on
Twitter @ABCiAb
On your tables please discuss:
How can you integrate the national clinical audit/local
audit with Quality Improvement Methodology?
How does your organisation set priorities for the use of
Clinical Audit/Quality Improvement resources?
What do I need to do to change my practice in the
light of what I have heard today?