Scotland’s Approach to S afety and Q uality Jason Leitch Clinical Director

1. Scotland’s Approach to • Safety and Quality • Jason Leitch • Clinical Director • The Quality Unit, Scottish Government • @jasonleitch

2. 5 million people • £12 billion • 14 Health Boards • 8 Support Boards • Integrated delivery • Moving towards social care integration

3. Public Finances Fall in Government expenditure

4. Health Budget

5. Scotland’s Demographics 1911 - 2011 1991 2011 1911 1951 1971 1931 Source: Scotland 2011 Census

6. Projected % Change in Scotland’s Population • by age group 2006-2031 • Source: GRO Scotland, 2007

8. Strategic Objectives

9. Aims: To deliver the highest quality healthcare services to the people of Scotland For NHSScotland to be recognised as world-leading in the quality of healthcare it provides

10. 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. 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.

11. The IHI Triple Aim Triple Aim Health of the Population Best Value for Money Experience of Care

12. Evidence based discoveryEvidence based delivery 17 years to get 14%of evidence into practice

13. Implementing at scale….can it be done? Will Ideas Execution

15. Primary Drivers Secondary Drivers Boards accept SPSP as a key strategic priority for effective governance Scottish Government sets SPSP as strategic priority Deliver the programme Build a sustainable infrastructure for improvement Align SPSP with national improvement programmes Agreed set of outcomes Review & address outcome delivery Quality & safety on every agenda Infrastructure supports Involve patients Demonstrable results Clear, shared measurement set Visible on all senior leader agendas A cohesive and united programme Improve Safety of Healthcare Services in Scotland (15% reduction in HSMR by end of 2012) BTS collaborative Acceptance of pragmatic science Royal Colleges support Clinical faculty expert at improvement methods and coaching Programme design and structure Inventory of national programmes Engage with national programmes Harmonize metrics

16. By what method? W. Edwards Deming

17. The Typical Approach… Conference Room APPROVE DESIGN DESIGN DESIGN DESIGN Real World IMPLEMENT

18. The Quality Improvement Approach Conference Room APPROVE IF NECESSARY DESIGN Real World START TO IMPLEMENT TEST & MODIFY TEST & MODIFY TEST & MODIFY

19. Our change theory • A clear and stretch goal • A method • Predictive, iterative testing

20. Breakthrough Series Collaborative

21. The Model for Improvement • ‘This model is not magic, but it is probably the most useful single framework I have encountered in twenty years of my own work on quality improvement’ • Dr Donald M. Berwick • Former Administrator of the Centres for Medicare & Medicaid Services • Professor of Paediatrics and Health Care Policy • at the Harvard Medical School

22. NHSScotland Surgical Safety Briefings

23. NHSScotland Surgical Mortality 23% reduction from median

24. Hospital Standardised Mortality Ratios (Seasonally Adjusted) Scotland: Dec 2002 to Mar 2012 Smoothed SMR 1.4% average annual reduction average annual reduction 4.2% (Oct 2002 to Jan 2010) (Apr 2010 to Mar 2012)

26. How has the frontline done it? Get goals Get bold Get together Get a model (and stick with it) Get patients and families Get the facts Get to the field Get a clock Get the numbers Get the stories

29. The Early Years Collaborative - Ambition To make Scotland the best place in the world to grow up in by improving outcomes, and reducing inequalities, for all babies, children, mothers, fathers and families across Scotland to ensure that all children have the best start in life and are ready to succeed.

30. The Early Years Collaborative - Aims 1. To ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of stillbirths(from 4.9 per 1,000 births in 2010 to 4.3 per 1,000 births in 2015) and infant mortality (from 3.7 per 1,000 live births in 2010 to 3.1 per 1,000 live births in 2015). 2. To ensure that 85% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review, by end-2016. 3. To ensure that 90% of all children within each Community Planning Partnershiphave reached all of the expected developmental milestones at the time the child starts primary school, by end-2017.

32. Some Useful Links Scotland’s 2020 Vision: www.scotland.gov.uk/Topics/Health/Policy/2020-Vision/Strategic-Narrative The Quality Strategy: www.scotland.gov.uk/Topics/Health/Policy/2020-Vision/Quality-Strategy The Quality Improvement Hub: www.qihub.scot.nhs.uk Institute for Healthcare Improvement: www.ihi.org.uk

34. @jasonleitch