Quality and safety in NHSScotland

1. Quality and safety in NHSScotland Jason Leitch National Clinical Lead for Quality

2. Mid Staffordshire report

3. 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

4. “Society’s huge investment in technological innovations that only modestly improve efficacy, by consuming resources needed for improved delivery of care, may cost more lives than it saves.” “Health, economic, and moral arguments make the case for spending less on technological advances and more on improving systems for delivering care.”

5. Fidelity vs Efficacy $100 Million $29 Billion $32 Billion 0.002%

6. The aspirin example • In patients who have had a stroke or TIA aspirin reduces risk by 23% • 100,000 patients – 23,000 fewer strokes • 58% of eligible patients receive aspirin = 13,340 fewer strokes

7. Two options • Fidelity – increase to 100% of eligible patients = 9,660 strokes • Efficacy – requires a proportional improvement over aspirin of 74% • Clopidogrel = 10% more efficacy than aspirin

8. What can be achieved?

9. 379 days without a CVC-related BSI

10. 2.2 day reduction in ALOS RAH - £1.5 millionGG&C - £9.5 million

11. 11.7% reduction in ICU Mortality

12. Boards Endorse Safety as Key Strategic Priority Deliver the programme Build a Sustainable Infrastructure for Improvement Align SPSP with national improvement programmes and measures Scottish Patient Safety Alliance (SPSA) Driver Diagram Primary Drivers Secondary Drivers National leaders openly endorse SPSP aims, failure is not an option for execs - Time and space given for improvement (not a target) -Royal Colleges serve in official capacity -Safety is an element of all programmes Scottish Government Sets PSA as Strategic Priority - -National Board development strategy -Ownership of agreed upon set of outcomes and measures -Quality and safety comprises 25% of agenda --Development of infrastructure that supports improvement and measurement -Clear improvement aims in strategic plan Improve Safety of Healthcare Services in Scotland -Segment hospitals , customize approach -In-country support for Boards -Spread strategy community hosp., primary care -One Team -”Everyone in the tent” -One Team -Develop experts in imp. methods and coaching -In-country measurement system, culture survey -Safety work migrates to appropriate agency -Training programmes developed in Scotland - Work with IST, QIS and HES to develop unified improvement approach -Align aims and measures with national programmes -Develop a portfolio and execution model -Build connection to safety in national work -Define within clinical governance framework

13. Driver 1

14. Trigger Tools

15. GTT definition of harm An adverse event where there is an injury or harm related to or from the delivery of care.

16. Categories of harm NCCMERP Index E Temporary harm, intervention required F Temporary harm, initial or prolonged hospitalisation G Permanent patient harm H Life sustaining intervention required I Contributing to Death

17. Burden of harm Adverse Event vs. Error “Error” definition bears upon concept of preventability, and is therefore process-focused “Adverse event” describes harm to the patient, and is thus outcome focused Adverse events Errors Mortality

20. Reasons to use a trigger tool Traditional reporting of errors, incidents, or events does not reliably occur in the best of cultures in healthcare Voluntary methods underestimate events and concentrate on what is interpreted as being preventable Easily identifies events without complex technology Can be integrated into a good sampling methodology

22. New Quality Aims • To make NHS Scotland a world leader in healthcare quality improvement. • To do so in a way that is meaningful to all.

23. 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.

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