October 2012 Ros Gray Head of Safety in Healthcare

1. October 2012 Ros Gray Head of Safety in Healthcare

2. We will cover • National context to safety in healthcare • National aims – and specifics related to smoking in pregnancy as an example • Use of Improvement Methodology • Launch of the SPSP Maternal Quality Improvement Collaborative

4. 381 The number of women experiencing severe morbidity reported in the 7th SCASMM report (published 2011).

5. 71% The proportion of women reported to have received optimal management of severe obstetric haemmorhage

6. “...everyone in healthcare really has two jobs when they come to work every day: to do their work and to improve it.” What is ‘‘quality improvement’’ and how can it transform healthcare? Batalden,P; Davidoff.F Qual Saf Health Care. 2007 February; 16(1): 2–3

7. Institute of Medicine’s 6 Dimensions of Quality

8. The Healthcare Quality Strategy for Scotland Person-Centred- Mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision making. Clinically Effective- The most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. Safe - There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.

9. Be bold “Bringing excellence to scale” Don Berwick

10. B Next… • Primary care safety • Mental health safety • Sepsis / Venous thrombo-embolism • Medicines reconciliation • Maternal safety

11. Subject Matter Knowledge: Specialist knowledge and skills required to be a good clinician Subject Matter Knowledge Profound Knowledge Improvement Profound Knowledge: The interaction of the theories of systems, variation, epistemology and psychology.

12. All improvement is local Clinicians working in partnership with patients

13. But... Societal context Political and policy context Organisational context Team context Clinicians working in partnership with patients

14. QI is... a complex social intervention Quality Improvement can be described as a complex intervention that involves a number of inter-related components: training in specific improvement methods and approaches, the creation of improvement teams, data feedback, tailored facilitation and support. Lilford 2003

15. New tools ...

16. Relentless Measurement “In God we trust… All others bring data.”W. Edwards Deming

17. http://www.scottishpatientsafetyprogramme.scot.nhs.uk/programmehttp://www.scottishpatientsafetyprogramme.scot.nhs.uk/programme

18. R Workstreams &InterventionsCONSIDERING ….How will we organise ourselves for the next collaborative? • Critical Care • Ventilator acquired pneumonia bundle, catheter related infection • General Ward • Early rescue • Communication • Medicines Management • Medicines reconciliation • High risk medicines • Perioperative • Surgical pause; briefings • Infection prevention/control • Leadership • Executive safety walk rounds • Executive leadership; board patient safety profile

19. our examples are there C. Diff in Lothian

20. NHSSCOTLAND HSMR TO MARCH 2012 – ↓10.6%

21. VAP bundle compliance 7% improvement 92% 85%

22. VAP rate (per thousand ventilator days) 61% reduction 9.11 3.54

23. Central line bundle compliance 5% improvement 89% 94%

24. Central line infection rate (per thousand line days) 2.8 70% reduction 0.84

25. It isn’t magic !

26. The Model for Improvement 1 Gerald J. Langley, Kevin M. Nolan, Thomas W. Nolan, Clifford L. Norman, and Lloyd P. Provost, 1996 The Improvement Guide, San Francisco: JosseyBass

27. PDSA cycles • Encourages change • Drives a focus on data • Repeated, small, rapid tests of change

28. Maternity Care Quality Improvement Collaborative To improve outcomes and reduce inequalities in outcomes by providing a safe, high quality care experience for all women, babies and families across maternity care settings in Scotland.

29. Outcomes To reduce the number of avoidable adverse events in women and babies by 30% by 2015 Increase the percentage of women satisfied with their experience of maternity care to > 95%.

30. Sub aims by 2015- how much, by when? Reduce the avoidable proportion of stillbirths and neonatal mortality by 15% Reduce severe PPH by 30% Reduce the incidence of non medically indicated elective deliveries prior to 39 weeks gestation by 30% To offer all women CO monitoring at the booking for antenatal care appointment To refer 90% of women who have raised CO levels or who are smokers to smoking cessation services. To provide a tailored package of care to all women who continue to smoke duringpregnancy

31. Social and lifestyle factors 2009 ISD data 25% of babies are born into the areas of highest deprivation in Scotland- 15000 per year 32% of pregnant women from these most deprived areas reported smoking at booking Drug abuse very poorly recorded – 592 women discharged from maternity hospitals recorded as drug users 11% of women who die during pregnancy are substance misusers CMACE 2007

32. Maternal smoking 18.1% of pregnant women reported smoking at booking 32% in the most deprived 6% in least deprived Affects all aspects of pregnancy and beyond: conception, miscarriage, congenital anomalies, growth restriction, stillbirth, cot death ISD 2009

34. Substance misuse

35. Substance misuse Miscarriages, ectopic pregnancies, fetal abnormalities, pre term rupture of membranes, medical problems, venous thrombosis, medication, IUGR, abnormal fetal heart rate, emergency caesarean section, prematurity, stillbirth, neonatal death, admission to NICU, postnatal depression, death

36. Hard to reach women 20% of women who died in most recent confidential enquiry either first booked for antenatal care after 20 weeks gestation, missed over four routine antenatal appointments, or did not seek care at all CMACE Saving Mothers Lives 2007

38. Our opportunity… “ I look through a half-opened door into a future full of interest, intriguing beyond my power to describe ” William Mayo 1931

39. Why is culture important ? Organisations with a positive safety culture are more likely to learn openly and effectively from failure and adapt their working practices appropriately.

40. What is ‘safety climate’? The measurable, surface components that provide a “snapshot” of the underlying safety culture. Colla JB, Bracken AC, Kinney LM, et al. Measuring patient safety climate: a review of surveys. Qual Saf Health Care 2005;14:364e66.

41. Our Practice Safety Climate

42. Much of the value of these types of surveys lies in raising the profile of patient safety and promoting conversations, .... that’s when the improvements come through The Health Foundation, 2011

43. Be bold “Bringing excellence to scale” Don Berwick

45. 11th Annual Report - 2016

46. ? The number of women experiencing severe morbidity reported in the 11th SCASMM report (published 2016).

47. ? % The proportion of women reported to have received optimal management of severe obstetric haemmorhage

48. “Each of you ... All of us” “ The key is collective impact !” “ working together means that you should never worry alone.”

49. Thank You