Quality Improvement in Healthcare

1. Quality Improvement in Healthcare The National Opportunities 24-10-07

3. Three Part Problem... Improve Individual Experience Improve Population Health Control Inflation of Per Capita Costs The root of the problem in health care is that the business models of almost all health care organizations depend on keeping these three aims separate. Society on the other hand needs these three aims optimized (given appropriate weightings on the components) simultaneously. --- (Tom Nolan, PhD)

4. 17 years to apply 14% of research knowledge to patient care! Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yrbk of Med Informatics 2000; 65-70 10. Balas EA, Boren SA. Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000: Patient-centered Systems. Stuttgart, Germany: Schattauer, 2000:65–70. <abalas@health.missouri.edu>10. Balas EA, Boren SA. Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000: Patient-centered Systems. Stuttgart, Germany: Schattauer, 2000:65–70. <abalas@health.missouri.edu>

5. Misuse McGlynn, et al: The quality of health care delivered to adults in the United States. NEJM 2003; 348: 2635-2645 (June 26, 2003) 439 indicators of clinical quality of care 30 acute and chronic conditions, plus prevention Medical records for 6712 patients Participants had received 54.9% of scientifically indicated care (Acute: 53.5%; Chronic: 56.1%; Preventive: 54.9%) Conclusion: The “Defect Rate” in the technical quality of American health care is approximately 45%

6. Quality Improvement “Health Care Quality Improvement is a broad range of activities of varying degrees of complexity and methodological and statistical rigor through which health care providers develop, implement and assess small-scale interventions and identify those that work well and implement them more broadly in order to improve clinical practice.” Mary Ann Bailey, The Hastings Center

8. “A New Health System for the 21st Century

11. Aim Aligned Timed Numeric Unachievable

12. Measures

13. R Lloyd, Institute for Healthcare Improvement

15. R Lloyd, Institute for Healthcare Improvement

16. Scottish Patient Safety Alliance

17. Step 1 The Scottish Patient Safety Programme

18. Aims Make care safer by a measurable amount Mortality: 15% reduction Adverse Events: 30% reduction Build improvement capacity in NHS Scotland

19. Interventions Critical Care E.g: ventilator acquired pneumonia rate Ward E.g.: Crash call rate Medicines management E.g.: Adverse drug events Theatres E.g.: Surgical site infection rate Leadership E.g.:Safety walkarounds

20. New lessons 1 ? 2 ? 5 ? all Spread and sustainability Capacity building

21. Board/Hospital Structure

22. NHS - opportunity for Improvement in Healthcare? For Single system Universal access Population approach Team working No other incentives Loyal and motivated workforce Against Negativity Sparse clinical leadership Professional silos Organisational silos Low level of improvement skills

23. “Do not be content with mediocrity. Do your job so well that nobody could do it better. “ Martin Luther King