Improving Quality Across the Health System in Leeds

1. The Evidence Becky Malby • Improving Quality Across the Health System in Leeds

2. Literature review • Collaborative Quality Improvement • Networks for Improvement • Comparison to other initiatives to work at scale/ system level e.g. Clarc? LEEDS INSTITUTE FOR QUALITY HEALTHCARE

3. Key lessons from the literature that informs LIQH Design The Environment • Local city-wide collaboratives may be able to present a more functional, viable and sustainable option particularly if it has a well-supported and functional health delivery system already in place. • There should be an equal and enabling atmosphere within collaborative underpinned by consistent leadership that motivates and encourages all members to work as functioning unit. • An ‘enabling environment buffering short-term factors that undermine success’, in [conjunction with]effective learning strategies and methods to test [improvements] and scale up are [required] (Baker, 2011: p.13) The Leadership • The ability to create a vision for innovation and translate that vision into strategy is essential, and co-ordination between both policy and operational spheres is critical for supporting the implementation of intricate innovations at large scale. • It takes an extraordinary leader(s) to move this type of entity forward and to generate buy-in (consensus) from all participants. • Leadership of improvement collaboratives is the most important variable in operating or sustaining any collaborative venture. LEEDS INSTITUTE FOR QUALITY HEALTHCARE

4. Key lessons cont • The Partnerships • Different organisations and individuals need time to learn and adapt to one another • Managers must be willing to relinquish aspects of their territory and focus on sharing and caring and concern for society (Axelsson and Axelsson, 2009) – creating a greater common purpose. • ’If improvement is to be maintained and/or continued, plans are needed at an early stage for sustaining and building on the structures and capacities which the programme will create’ (Øvretveit and Klazinga, 2013). • The Teams • ‘Promoting professional cultures that support teamwork, continuous improvement and patient engagement’ is essential for high performing collaborative systems (Baker, 2011: p.13) • The most successful types of inter-organizational collaborations are those where grounded and stable multidisciplinary teams have been long established and maintained over time (Axelsson and Axelsson, 2006) LEEDS INSTITUTE FOR QUALITY HEALTHCARE

5. The Change Approach • ‘Grounding the improvement network in what really inspires them, [and this] reframes improvement work in a powerful way’(The Health Foundation., 2014: p.4). • The notion of a magic bullet could be flawed in improvement collaboratives. Observers advise not to bite off more that one can chew and to be realistic about what can be achieved (Øvretveit and Klazinga, 2013). • Tensions associated with sustainability include their vulnerability to an ‘evaporation effect’ in the post project phase (Dixon-Woods, 2012: vi). • It is important to be aware that two thirds of change processes were unsuccessfully implemented (Jacobs et al., 2014). Effective change management and health care improvement are dependent upon a holistic focus as opposed to a focus on singular systemic elements over others. • Targeting of specific individuals and personalised training and development and also internal marketing were effective (De Silva, 2014b • The Evaluation • Acquiring sufficient data from QICs for the intention of evaluation purposes is a particularly tricky endeavour (Watson and Scales, 2013, Ovretveit, 2011). An effect evaluation must be combined with a process evaluation in the context of large scale health programmes (Raijmakers et al., 2014). LEEDS INSTITUTE FOR QUALITY HEALTHCARE

6. The Proposition - Hypothesis Quality improvement across a health system requires : • Systems leaders to relinquish territory in service to a wider shared and visible common purpose • A professional culture of teamwork, accountability, and improvement • Shared decisions with patients and carers • Evidence of impact LEEDS INSTITUTE FOR QUALITY HEALTHCARE

7. What helps? • An equal and enabling atmosphere within collaboratives underpinned by consistent leadership that motivates and encourages all members to work as functioning unit. • ‘Enabling environment buffering short-term factors that undermine success’, in [conjunction with] • Effective learning strategies and • Methods to test [improvements] and scale up are [required] • Data from which to scrutinise variation and review improvement • Time for different organisations and individuals to learn from and adapt to each other • Stable multidisciplinary teams maintained over time • Patient engagement • Not predicating one intervention over another – working with the whole • Having a plan for sustainability over the longer term, once the excitement of the new has dissipated LEEDS INSTITUTE FOR QUALITY HEALTHCARE

8. This Underpins the Leeds Model (LIQH as technology) LEEDS INSTITUTE FOR QUALITY HEALTHCARE

9. Why is this different from other places? • Whole City • Systems Leadership tied into the learning • Learning programmes across whole patient experience • Clinical Priorities chosen by street level practitioners based on what inspires them matched to strategy level priorities • Dedicated data and improvement resource • Clinician owned and lead LEEDS INSTITUTE FOR QUALITY HEALTHCARE