QIPP Leadership and Workforce Roadshow Better Care at Lower Cost AQuA’s Support for QIPP

1. QIPP Leadership and Workforce RoadshowBetter Care at Lower CostAQuA’s Support for QIPP David Fillingham 1st May 2012

4. The challenge is to improve quality whilst also reducing costs Source: Jim Easton, QIPP Increasing “Drift” “Investment” Cost “Cuts” “Redesign” Reduced Reduced Quality Increasing

5. What is AQuA? • Better care at lower cost • Reducing Harm • Enhanced Recovery Pathways • Long Term Conditions • Shared Decision Making • What about the workers?

6. About AQuA • A membership organisation (56 PCTs, FTs, NHS Trusts), founded in April 2010 • Our mission is to support our members to improve health and the quality of healthcare by providing: • Early successes include AQ, Reducing Mortality Collaborative, Safety Express Plus, AQuA Academy • We work with commissioners and providers and in all sectors of healthcare

7. NHS Outcomes Framework

9. How we work… “AWR” Evidence and Intelligence Robust Improvement Methods Clinical and Management Champions Incentives Peer to Peer Spread

10. Better Care at Lower Cost • Reducing Harm • Enhanced Recovery Pathways • Long Term Conditions • Shared Decision Makings

11. AQuA’s Harm Free Programme Boards on Board Safety Ambassador Reducing Mortality Collaborative Safer Care As A Driver Within All That We Do! Enhanced Recovery Provider Productivity Lean Shared Decision Making Long Term Conditions Integration Mental Health Program Patient Experience AQ Safety Express ‘Plus’ Mortality Collaborative AIM CIA Safer Care Workbooks Safety Express ‘Plus’ Mortality Collaborative AIM CIA Rapid Spread Pilot Safer Care Workbooks WebEx Series

12. Safety Thermometer data for the Northwest IN CONFIDENCE

15. Long Term Conditions – the QIPP Opportunity • Long term conditions (LTCs) represent 50% of GP appointments, 64% of outpatient attendances and 70% of inpatient bed days (Source: 2009 General Lifestyle Survey). • LTC QIPP Programme content • Risk profiling of the population • Implementation of integrated neighbourhood care teams • Systematic implementation of self care/ shared decision making and supported self management • Do all three • Programme Targets: • 20% reduction in emergency admissions for LTCs • 25% reduction in length of stay for LTCs • improved patient experience of care delivery.

16. AQuA Support for Long Term Conditions (LTC’s) • LTC QIPP Collaborative (in participation with National Team) • AQuA/ADASS Locality Scorecard and learning exchanges • Advancing Quality • Improving Outcomes Packs • Dementia Improvement Community … and … in the pipeline: • Children and Young People • Self Management Programme • Physical and Mental Health

17. Enhanced Recovery This is a pathway for patients incorporating compelling clinical evidence, significant changes in clinical practice & the principle of patients as partners in their care. To date this has been rigorously tested and proved within surgical care pathways but now it is being applied to maternity, medical and emergency pathways The impact of Enhanced Recovery (ER): • Reduction in unnecessary activity along the pathway • Good patient experience • Improved clinical outcomes • Up to 50% reduction in post operative complications & stable or reduced readmission rates • A reduction in use of HDU/ITU beds • LOS reductions, which can lead to both reduced excess bed days / payments & further clinical risks

18. Optimising pre operative haemoglobin levels • Managing pre existing co morbidities e.g. diabetes • Shared decision making The Generic ERP pathway • Admission on day • Optimised Fluid Hydration • CHO Loading • Reduced starvation • No / reduced oral bowel preparation ( bowel surgery) • Planned mobilisation • Rapid hydration & nourishment • Appropriate IV therapy • No wound drains • No NG (bowel surgery) • Catheters removed early • Regular oral analgesia • Paracetamol and NSAIDS • Avoidance of systemic opiate-based analgesia where possible or administered topically Referral from Primary Care Pre- Operative • Optimised health / medical condition • Pre operative health & risk assessment • PT information and expectation managed • DX planning (EDD) • Pre-operative therapy instruction as appropriate Admission Intra- Operative • Minimally invasive surgery • Use of transverse incisions (abdominal) • No NG tube (bowel surgery) • Use of regional / LA with sedation • Epidural management (inc thoracic) • Optimised fluid management Individualised goal directed fluid therapy Post- Operative • DX when criteria met • Therapy support (stoma, physio) • 24hr telephone follow up Follow Up

19. Enhanced Recovery 2012/13 • Enhanced Recovery Summit - 30th April 2012 • North West Enhanced Recovery Leads Network -promoting local learning through local champions and peer to peer learning • Steering Board - chaired by Tony Bell, Chief Executive Royal Liverpool and Broadgreen • Aligning with SHA’s QIPP Programme/ Provider Productivity as an exemplar clinical pathway

20. Shared Decision Making

21. Involve me in decisions Medical decision making has evolved from a paternalistic model...

22. To a patient centred

23. Why Use Shared Decision Making? • Improve knowledge • Increase the agreement between personal values and the patient’s decision • Patients are empowered, feel more confident, enhances recovery • Improve quality of care and reduce costs • Potential reduction in litigation and complaints

24. Decision Aids reduce rates of discretionary surgery RR=0.76 (0.6, 0.9)

25. How do we take the money out? • Reduce harm, reduce length of stay, reduce admissions, prevent escalation • Reduce expensive “acute” capacity – beds, staff, overheads • Invest in prevention and chronic disease management • A joined up approach with sharing of risks and benefits

26. What about the workers?

27. New ways of working • New job roles • Engaging everyone in the improvement effort • Leading change – “the why, the what and the how”

28. Leadership Why? What? How? Management Coaching Myles Downey: Effective Coaching

29. Leadership • Creating an inspiring vision • What does it mean for me • Real life stories • Grounded and honest Why? What? How? Coaching Management • New job roles • New processes • Measuring progress • Service redesign • Role modelling new behaviours • Building a culture of improvement

30. How to find out more about AQuA http://www.advancingqualityalliance.nhs.uk

31. So… • Better care can cost less • We need to engage everyone in the improvement effort • Leaders need to address the what, the how, and the why