The changing face of stroke care – fast forward

1. The changing face of stroke care – fast forward Stroke developments… Ian GoltonDirector NHS Stroke Improvement Programme

4. What is the Stroke Improvement Programme? • “To support local networks the Department of Health is establishing a central team within the NHS … The main task of this team will be to ensure that specific support is available to develop stroke networks “(National Stroke Strategy, p58) • Part ofNHS Improvement, alsosupporting networks in cardiac and lung care, and working with cancer networks • Based on 8 years experience improving heart disease services • Work closely with the Department of Health and key national organisations • Our job: support the development of Stroke Care Networks and implementation of the Stroke Strategy

5. Clinical Microsystems

6. Layers of the onion: the ‘systems within systems’ that work together to provide care for patients Self-care National, policy, legislation, evidence Macro-organisation Individual care-giver & patient Clinical Microsystem

7. National, policy, legislation, evidence

10. “ …there is uncertainty everywhere, and every meeting includes conversations of ‘no money’ and how can savings be made” “I’ve never experienced so much turmoil - it feels on the coal face that we are waiting for some disaster to happen” Stroke Specialist Nurse with over 20 years NHS experience

13. http://www.nice.org.uk/aboutnice/cof/ConsultationOnCOFIndicators.jsphttp://www.nice.org.uk/aboutnice/cof/ConsultationOnCOFIndicators.jsp

16. “In stroke, the best care is also the most cost-effective care…” Professor Sir Roger Boyle,Former National Director for Heart Disease & Stroke

17. Performance Data • 1090 bed days saved • Reduction of inpatient stroke beds from 56 to 34 • Maintenance of inpatient performance within reduced bed base • Stroke service LOS reduced – 21 days to 12 days

21. Macro-organisation

25. Ossie Newell MBE Founder of @astroke www.atastroke.org.uk

28. Layers of the onion: the ‘systems within systems’ that work together to provide care for patients Clinical Microsystem

29. Generative relationships PDSA cycles Workforce Development ACT PLAN Flow charts & deployment charts S R T STUDY DO A Run charts & control charts Data & measures Global Aim Template Variable 40 35 30 25 Ounces F 20 15 10 5 0 C S Date Clinical value compass £ Task Force Crew   Fishbone diagrams Team Ladder of inference Small groups Left-hand column Meeting skills & disciplines

33. More top tips… • Get the wind behind you - alignment with policy, guidelines, strategic goals, organisation priorities etc. • Get (as much as possible) management support, up to and including chief executives • Be clear what you’re trying to do an why - there are only 3 reasons to change • Involve (as much as possible) the whole team • Test, test and test again before anything irrevocable or expensive is done • Gather data - meaningful, good quality, minimal - to show the effects and track progress • Use your patients as your guide and support

34. http://www.patientopinion.org.uk/

37. Individual care-giver & patient

38. Harry Clarke, Counsellor and Stroke Survivor

39. “Give time to listen. And a much undervalued word is kindness. Be kind…be kind to that person. Kindness doesn’t cost any money. Just be kind”

41. www.improvement.nhs.uk/stroke