NHS Highland Quality and Patient Safety Framework

1. NHS Highland Quality and Patient Safety Framework Quality Care to Every Patient, Every DaySupporting Better Value

2. Context Better Health, Better Care Action Plan 2007 – commitment to improving the health of the Scottish population In 2009, agreement to develop a Quality Strategy for NHS Scotland, with aim to deliver the very best healthcare possible Strategy issued on 10th May 2010

3. What is the Quality Strategy? • Firstly, it is about putting people at the centre of our NHS. It will mean that the NHS will listen to patients’ views, gather information about their perceptions and personal experience of care and respond to what people tell us • Secondly, it is about building on the values of our staff and their commitment to providing their best possible care reliably – for every person, every time • Thirdly, it is about making measurable improvement in the aspects of quality of care that patients and their families see as really important

4. “What will make Scotland a world leader will be the combined effect of millions of individual care encounters that are consistently person-centered, clinically effective and safe for every person, all the time”

5. How do we define Quality Healthcare? • Show care and compassion • Be clear in our communications and explanations • Effectively collaborate as we work closely with others • Provide clean and safe care environments • Ensure there is continuity of care to support people • Reliably maintain the clinical excellence patients have come to expect

6. What Matters Most to Patients(Better Together Priorities Survey) A clean ward Staff cleaning their hands before touching patients Being treated quickly in an emergency Getting the best treatment for my condition Doctors knowing enough about my condition and treatment Clear explanations about what will happen during an operation or procedure Being told the risks and benefits of any treatment in a way I can understand Clear explanations of my condition or treatment Being treated with dignity and respect Being told how my operation has gone in a way I can understand

7. Institute of Medicine:Framework for Quality

8. Institute of Medicine’s Six Dimensions of Quality

9. NHS Highland Quality and Patient Safety Framework Patient Experience

10. What does this mean for Patients and Staff? Patient experience Quality of care includes quality of caring. This means how personal care is – in essence it is about treating patients as individuals, with compassion, dignity and respect Clinical Effectiveness This means delivering care based on the best evidence and understanding success rates from different treatments for different conditions. An important aspect of this is knowing how effective the care is from the patient’s own perspective. Examples include knowing complication rates, improvement in pain free movements after joint replacement or ability to return to work after treatment for depression. It is also important to know what processes have been followed, an example may be uptake of a recommended drug therapy. Patient Safety We must do no harm to patients. This means having a safe and clean environment, reducing avoidable harm such as excessive drug errors or rates of healthcare associated infection

11. What does this mean for NHS Highland?

12. Discussion • What do you want to do differently, which would enable you to deliver a higher quality of care to patients – what is the first thing you would start with? • What else needs to change to support you in delivering the highest quality healthcare?

13. How will we know we have been successful? Developing Quality Measures As a first step we have agreed a number of hospital based quality metrics • Adverse event rate • Clostridium Difficile Infections • Staphylococcus Aureus Bacteraemias • Total Mortality Rate • Hospital Standardised Mortality Rate (HSMR) • Readmission within 7 days • Readmission within 28 days • Length of stay • Complaints • Sickness absence

14. Proposed Suite of 12 National Quality Outcome Measures • Healthcare experience • Staff experience • Staff attendance • Healthcare associated infection • Emergency admissions • Adverse events • Hospital standardised mortality rate (HSMR) • Proportion of people who live beyond 75 years • Patient reported outcomes • Patient experience of access • Self assessed general health • Percentage of last 12 months of life spent in preferred place of care To be agreed by October 2010 for implementation with HEAT targets for 2011/12

15. Prototype of NHS Highland Hospital Clinical Dashboard

16. The Dashboard • The organisation (Board) is ‘driving the car’ and looks at the dashboard to see how the journey is progressing • The mechanics gather the data and decide how to display it • The staff provide the right gauges and look at how to calibrate the process If the goal is high quality care, the dashboard is a tool to help get there. It is a ‘springboard for discussion’ rather than an end in itself (From Laurie Larson, How to Drive a Quality Dashboard)

17. Next Steps: • Quality Survey issued to all NHS Highland – please respond and encourage others • Development of an Implementation and Communication Plan for NHS Highland’s Quality and Patient Safety Framework • Work required for the National Quality Strategy • Identify and develop Clinical Quality Measures for Community Hospitals, Mental Health and Primary Care

18. Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek. Barack Obama