The Leeds Institute for Quality Healthcare Improving Quality Across the Health System in Leeds

1. The Leeds Institute for Quality Healthcare • Improving Quality Across the Health System in Leeds “People like to change they just don’t like being changed” Winston Churchill

2. BackgroundLiberating the NHS 2010 • NHS more accountable to patients • Relentless focus on clinical outcomes • Doctors and Nurses able to use professional judgement about what is right for patients Which meant: GPs in charge of CCGs – Dr to Dr dialogue on quality and spend BUT tensions in policy increased regulation, and performance management

3. The Leeds Medical Senate2011-14 • Development programme initially whilst in shadow form • Secured commitment to leading together across Leeds • Creating a focus on clinical quality • Ambition for the future catalysed by visit to Intermountain Healthcare and Rocky Mountain Health Plans

4. Purpose Goals Pathway 1: Selection Pathway 2: Change Results (Performance) Measurement for improvement Measurement for Selection & Accountability Knowledge about Process and Results Knowledge about Performance Care Delivery Organizations Consumers Purchasers Regulators Patients Contractors Referring Clinicians Motivation Care Delivery Teams and Practitioners Ref: Berwick, D.M., James, B.C., and Coye, M. The connections between quality measurement and improvement. Medical Care 2003; 41(1):I30-39 (Jan).

5. Why do we need a Quality Institute in Leeds? “Compliance detracts from innovation”

6. Intermountain chose 6 high cost high output processes. • TURP, CABG, Pacemaker, Cholecystectomy, Hip/knee arthroplasty, • Community acquired pneumonia They compared clinicians where statistically meaningful. - smallest range variation 60% - largest range variation 460% And found (of course) that variation in clinical practice is endemic. The issue is what can you learn from this that will improve quality and value? “95% of your job is to do the job and 5% of your time is about improving it.”

7. “Professional autonomy means accountable to our peers” "It's not that we encourage, we demand that clinicians vary based on patient need“ "If you’re different from your colleagues either we have something to teach you or you have something to teach us" Data doesn’t show who is good or bad Seek best care don’t fix blame Engagement with groups takes time

8. Agreement between Nurse, Medical Directors/ Leads and CEOs in Leeds (NHS, Social Care)

9. The Leeds Institute for Quality Healthcare integrates the ideas from International high-performing systems alongside our own expertise and capability, particularly in working with patients/ service users, carers and communities

10. Leeds Institute for Quality Healthcare Purpose The Institute will secure improvement in quality care, by enabling clinicians to develop shared expertise in innovation and improvement; and by having a rigorous approach to professional accountability through reviewing variation and decision-making, supported by systematic use of data. This focus will create a culture of continuously providing best quality clinical care at the best value with patients/ service users across Leeds. We know that working and learning together about improving care is the fastest and most economical way to get the best we can for service users. Creating this focus through the Institute will make room for what we need to do to make the biggest impact. We also know that involving service users in that work will add even more value, so that is a key part of our plan.

11. We believe that: Quality will be improved by working with patients/ service users and carers to make decisions together We will improve patients/ service users experience across NHS organisations/ pathways by undertaking improvement and innovation together 95% of professional’s job is to do the job and 5% is about improving it, demonstrated through data We need a compelling narrative for transformation 'better quality care at best value for all’ New possibilities will emerge from discussion about our differences and it is possible that we can develop more effective relationships. Shared core education and learning to create shared language will generate ways of improving quality in Leeds across the system Everyone's got something to teach everyone’s got something to learn A systematic quality improvement approach will bring us the best value

12. The Leeds Institute for Quality Healthcare

13. 3 Clinical priorities a year based on generating: • A real benefit for patients/service users • Value across the system • Culture change across primary & secondary care These 3 per annum will be: Key priorities for the health system in Leeds; championed by clinicians; producing short and medium term results.

14. What will the Leeds Institute do?

15. Logistics

16. Partnerships

18. Sepsis Bundle Compliance and Mortality Rate (2004-2010) Red – Mortality Green – Total bundle rate Lower blue – 95% LCL Upper blue – 95% UCL

19. Focus on the whole not the tail

20. Critical Themes in High Performing SystemsAdapted from Baker & Denis 2011