Sheffield Children’s Hospital Diabetes Team

1. Sheffield Children’s Hospital Diabetes Team QI Initiative – Our Experience

2. Sheffield Children’s Hospital Diabetes Team Carrie MacKenzie - Champion Neil Wright Emma Randle - Co Champion AsthaSoni Sarah Hawnt Charlotte Elder Mark Denial Elspeth Ferguson Will Marshall Allison Low Claire TallisSundharKanagasabathy Gerry Bennet AbdunasrAlaber Alison Darby Paul Manning Ann Walker

3. National QI Initiative • Participated in National Pilot scheme of the “QI” initiative – Quality Improvement • Developed by Diabetes Network & RCPCH • Involved 10 Units form around UK • Aim is to use QI methodologies to improve outcomes in Diabetes • Maintain in improvement in HbA1c nationally • Based on experience of QI implementation in Sweden

4. What Does QI Involve? • Day 1 & 2 – Weekend (Sat/Sun) E Midlands Hotel • Improvement methods • Process mapping • Team planning • Using data • Day 3 – Birmingham • Teams sharing – World Café • Human factors • Project measurements • Day 4 – Birmingham • Lena Hanberger, Linkoping University • Shared Swedish experience • Day 5 & 6 – Weekend (Sat/Sun) E Midlands Hotel Needed to persuade Trust to pay £1500 for Hotel for each weekend! Webinars interspersed with face to face meetings

5. QI Training • Whistle stop tour of various different management techniques • Ishikawa – fish diagrams • PDSA – Plan Do Study Act • Test, Spread, Sustain • Learning from others • “World Café” • Spreading good practice • Human factors (personality types) • “Nay sayers” • Thinking hats

6. Our QI Journey……. Mission To empower, encourage and educate young people with Diabetes to confidently manage their Diabetes to live happy, healthy and successful lives Aim To achieve HBA1c of 48 mmol/mol at 3 and 12 months after diagnosis Problem identified Poor control in 1st year after diagnosis Our patients ~ 220 T1DM aged 0-17 yrs Dec 15-Dec 16 = 24 new patients Median HBA1c 53 mmol/mol at 3months; 56 mmol/mol at 12 months 1st QI project To introduce CHO counting, from diagnosis, as an in-patient

7. SCDT QI Meetings • Team have pre-clinic QI meetings fortnightly 08.15-08.45 • All encouraged to attend • Agenda sent out in advance • Meeting chaired by QI Champion • Time-keeping by co-Champion • Tasks allocated, notes taken and circulated asap after meetings • Bright Spots identified along with progress on Tasks at each meeting

8. Our Improvement journey so far and how have we improved our team working? • Excellent attendance rates • Infectious “can do” attitude • Whole Team “buy in” • Bright Spots identified • “Be brave” • “It doesn’t have to be perfect” • Sustenance is provided Put the fish on the table… Be brave.. Fail fast…

9. Our QI Journey! Nov 2017

10. Bright spot! Ward suggested all Diabetes patients come to them!

11. Data – Measure what you do! Median HbA1c @ 3month = 44.5 mmol/mol Mean BG @ 30 days = 6.7 mmol/l

12. Run Charts

13. Our other areas of work Series Microteaching topics developed HbA1c tracking – personalised sheet

14. What have we learnt ? How are we building into our daily work? • Be brave • Fail fast • Put the fish on the table • Team tenacity • Enthusiasm is infectious • Raise our profile • Closer working relations with ward staff • We work better with cake! • You need a “Director of Fun” • You need a “Communications Director”

15. Questions?