Improvement & Innovation in the NHS

1. Improvement & Innovation in the NHS Bernard Crump

2. The Case for Improvement • The NHS is improving; • Improved mortality from CHD and Cancer • Faster access to A&E, GP, Outpatients and Surgery • Improved patient satisfaction • It bears comparison with most other health care systems; • But it needs to improve a lot more because • There is wide variation in clinical practice • Evidence that care is not as safe as it could be • Costs of care are rising in a manner which is unsustainable • Patient experience is still not satisfactory

3. Length of Stay for Fractured Hip

4. Safe Care 1

5. And is not new…..

6. National Patient Safety Agency

7. The burden of error NPSA Observatory Report 2005

8. Rising Costs Wanless

9. …and patient experience?

10. And turning to innovation……

11. We aren’t very quick to learn

12. ….and • In the UK we have a very innovative clinical work force • Invented CT scanning, MRI scanning, Hip replacement, genetic fingerprinting etc……. • But these were not identified by the NHS and by UK industry as having potential • And they have been largely exploited and developed in other countries

13. But we have had some success….. • The last decade has seen a significant healthcare improvement movement with growing impact • There are examples in the UK and abroad which show what can be achieved

14. Example 1Increase the reliabilityof therapeutic interventions through a “care bundle” approach • Example for reducing ventilator associated pneumonia: • Elevating the head of the bed >30o (Drakulovic 1999) • DVT prophylaxis (Cook et al 2001) • Peptic ulcer prophylaxis (Yang & Lewis 2003) • Managing sedation effectively with sedation Holds (Kress 2000) • Tight Control of Blood glucose 4.4-6.1 mils (Van den Berghe 2001) • Can be applied to • Surgical site infection • Central line management • Myocardial Infarction • etc etc

15. West Middlesex Hospital

16. West Middlesex Hospital

17. Reducing LOS at West MiddlesexGuess when the new hospital opened? New Hospital Opened May 2003

18. 3 NHS Trusts, original Community of Practice 295 ‘lives saved’ since April 2004

19. Performance Improvement - Across 155 Trusts 100% 95% 90% Performance 85% 80% The movement of trusts in terms of actual performance & in percentage improvement between Oct/Dec 2003 & Apr/Jun 2004 75% 70% -10% -5% 0% 5% 10% 15% 20% 25% 30% October-December 2003 April/June 2004

20. Veteran’s Administration • Dramatic improvement over a 4 year period • In the face of contracting revenue • Key elements • Spectacular leadership • Engaged clinicians • Well liked electronic record with data as a by product • Metrics the clinicians believed • Real time comparative feedback

21. IHI 100,000 lives campaign • Many deaths in US hospitals attributable to deficient care systems • The Campaign • Voluntary • Inspirational goal and figurehead • Credible interventions • Good logistics • “Political” campaign techniques • “Some is not a number….Soon is not a time” • Between 10th December 2004 and 9am 14th June 2006 • Nearly 3000 US hospitals signed up and • Between 115k and 144k lives were saved.

22. Range of techniques • Clinical microsystems • Lean thinking • Six Sigma • Theory of Constraints

23. Promoting Improvement & Innovation • Major focus of attention in th UK and internationally over the last decade • Some notable progress here and abroad • Current UK approach is driven by principles of public sector reform • Standards (Health Care Commission and NICE) • Devolved responsibility (PCTs and Foundation Trusts) • Consumerism (Patient Choice) • Competition (Plurality of supplier base, Payment by Results)

24. The NHS Institute: Scope Learning Leadership Development Priority programmes that help drive the NHS reform agenda Product and technological Innovation (NIC) Service Improvement

25. Current Priorities • Preventing and managing Healthcare Associated Infections • No Delays; supporting improved access to services • Long Term Conditions; supporting the NHS to improve care • Delivering Value & Quality; improving productivity • Building capacity and capability in improvement and innovation • Speeding the adoption of beneficial healthcare technologies

26. A range of stratagems… • Improvement that relates to standards • Improvement supported by NICE guidance • Improvement mandated by commissioners • Improvement driven by the tariff • Improvement in response to benchmarks • Improvement in response to leadership • Improvement through performance management • Improvement led by patient experience • Improvement following enhanced improvement capability • Improvement professionally led

27. Voluntary Compelled Standards NICE Commissioners Performance Management Tariff Benchmarks Patient Experience External Leadership Improvement capability Professionally led Line Management Internal

28. Prerequisites • Reliable data and agreed metrics • Understanding of current performance • Knowledge of best performance • What drives performance? • What constrains performance? • Range of change and improvement tools • Capable users of these tools • An improvement system

29. Institute contribution • Focused on the prerequisites • Building capacity • Development of tools • Understanding of global best practice including good practice in the NHS • A balance of what and how • “Docking” with the improvement system in each part of the country

30. CHSCI • Shares the aim of building capacity and capability in health and social care delivery • An approach based on using and extending the evidence base • Building on the relationships between the University and local NHS and social care partners • May the Centre go from strength to strength.