Building Improvement Capability Across Boundaries

1. Building Improvement Capability Across Boundaries QExchange 2019 July 2019

2. Welcome Everyone

3. National Context & Approach Suzie Bailey – Director of Leadership and OD The King’s Fund July 2019

4. National context and approach Recent history What is the current national approach? Early learning from Integrated Care Systems (ICSs) Sheffield example

5. Imperatives for improvement 2014-15

6. Working together to support improvement

7. National framework – December 2016 https://improvement.nhs.uk/uploads/documents/Developing_People-Improving_Care-010216.pdf

8. 5 conditions Leaders equipped to develop high quality local health and care systems in partnership Knowledge of improvement methods and how to use them at all levels Compassionate, inclusive & effective leaders at all levels Enabling, supportive and aligned regulation and oversight Support systems for learning at local, regional and national levels

9. Three national pledges Pledge 1: We will support local decision-makers through collectively reshaping the regulatory and oversight environment. In particular, we owe local organisations and systems time and space to establish continuous improvement cultures Pledge 2: We will model in all our dealings with the sector and in our own organisations the inclusive, compassionate leadership and attention to people development that establish continues improvement cultures Pledge 3:We will use the framework as a guide when we do anything at a national level concerning leadership, improvement and talent management so we engage across the sector with one voice.

10. Progress against national framework 2019? ‘…has made some impact, it has not led to the widespread culture change it set out to deliver. In part, this is because the national bodies have not visibly demonstrated the importance of the framework and in part because a framework alone is not enough to bring about this change’ https://www.longtermplan.nhs.uk/publication/interim-nhs-people-plan/

11. Relational, relational, relational…

12. Early lessons from ICSs? Invest in building collaborative relationships at all levels of the system– this can only be done locally and takes time and commitment.  Promote and value system leadership–continuing emphasis on collective and distributed leadership, ensuring leaders have dedicated time to fulfil their roles. Draw on the skills and leadership of frontline staff– staff should be front and centre of plans to redesign services, with clinical leadership at the fore.  https://www.kingsfund.org.uk/publications/year-integrated-care-systems

13. Sheffield– improvement across boundaries

14. ‘Let’s try changing something tomorrow’

15. A cheap day return ticket to Reading

16. The Big Room approach

17. The Big Room in practice

18. Collective Leadership Leadership is the responsibility of all - anyone with expertise taking responsibility when appropriate Shared, inclusive leadership in teams and across teams Interdependent, collaborative leadership – across the system/organisation Consistent approach to leadership – authentic, open, curious, appreciative, compassionate http://www.kingsfund.org.uk/publications/developing-collective-leadership-health-care West, M. A., Lyubovnikova, J., Eckert, R., & Denis, J.L. , (2014),Collective leadership for cultures of high quality health care. http://dx.doi.org/10.1108/JOEPP-07-2014-0039

19. What’s your burning ambition? Motivation is a fire from within. If someone else tries to light that fire under you, chances are it will burn very briefly”  ― Peter Fuda http://www.peterfuda.com/

20. Building Improvement Capability Across Boundaries Andrew Seaton – Quality Improvement & Safety Director, GSQIA – Gloucestershire Hospitals July 2019

21. Building Improvement Capability Across Boundaries Building for Improvement Delivery of widespread Improvement Programmes of Improvement Social Movement, Adult learning, Recognition & Reward, What’s in it for you?

22. “Theory is splendid but until put into practice it is valueless” James Cash Penny

23. Quality Improvement Pathway

24. Improving effectiveness of delivery – Quality Framework Quality Management “What’s important for your patients and service” What do we need to improve? Are we meeting standards? Are we ready to provide quality care today? What are we learning? Specialty based Gold Quality Improvement Coaches

25. Building Improvement Capability Across Boundaries Designed for cross boundary working

26. Building a brand - joining a club

27. Building Improvement Capability Across Boundaries Working across boundaries #QIHour ICS Delivering Improvement Network Academy of Fab NHS Stuff GSQIA West of England AHSN Website & Intranet

28. The second #QIHour tweet chat focused on Measurement for Improvement with special contribution from @samriley #PlotTheDots There were 1,766,000 impressions (the number of times a #QIHour tweet was shown in a twitter users feed). 180 participants sent out 997 tweets Thank you to everyone contributed using #QIhour

29. One Gloucestershire

30. Glouce-ster Acute SWAST Glouce-ster Care Services Gloucestershire Health Care Task Group Deteriorating Patient CCG 2Gether Trust Out of Hours GP General Practice Using NEWS Nursing Home

31. Andrew Seaton Quality Improvement & Safety Director Twitter @GSQIA @Seaty63

32. RUBIS.Qi Northumbria Healthcare Scaling Up: supporting early adopters July 2019

33. What is HIP QIP Scaling Up? Programme aim: To improve safety and care for patients with hip fracture via a multidisciplinary, pathway approach across 6 NHS organisations in England and Scotland and save 100 lives by December 2018. https://dms.licdn.com/playback/C5605AQGh69UALXx7-A/c48c8dde359e4092aa564832299c3714/feedshare-mp4_3300/1488578169071-zmy00q?e=1562832000&v=beta&t=xD1SE1F8M73N_f8CDq9nN7U_wXZn8fwHypnWQXb8Sj4

34. Working Groups Care coordination / flow through pathways to base site A&E and pre op assessment Personalised end of life care Pain management Real time measurement and reporting Nutrition and hydration Mortality Patient information and mobility

35. Collaboration and Shared Purpose

36. Building Capability 6 organisations 5 learning events Monthly improvement coaching 6 peer reviews by BOA Collective leadership All teach, all learn Sharing innovations Embedded real time patient experience data reporting and co-production 5 nutritional assistants recruited and trained

37. The Results So Far • 119 lives saved so far • 100 extra patients returning to their own homes • Length of stay reduced by 2 days • 29,000 extra meals • 10% increase in patients mobilised on the day of or after surgery Watch the film: https://youtu.be/SqBOCB5wWy8

39. Visit us online: https://nhsrubisqi.co.uk/ • Phone us:01670 529650 • Follow us on Twitter:@RUBISQi @annaburhouse • Connect with us on LinkedIn

40. RCP Quality Improvement Collaboratives: building the teams and skills for improvement July 2019

41. Royal College of Physicians Quality Improvement Programme (RCPQI) Leadership for improvement Develop medical leaders who can influence and embed a culture of quality and continuous improvement Research and development Develop, adapt, design new improvement methods and knowledge Bespoke support Provide expert assessment and support in tackling particular organisational and service challenges Breakthrough collaboratives 6-9 month, topic specific, quality improvement course for clinicians and their teams Building capacity Equip the healthcare workforce with skills and expertise to continuously improve services Virtual hub Connecting people, best practice, tools and evidence Aims to make quality improvement easily accessible to all doctors and support physicians in developing and providing safe, timely, evidence-based, efficient and patient-centred care to achieve the RCP’s strategic aim of improving quality Delivered through 6 work streams, supported by a faculty of quality improvement experts RCP QI Faculty

42. Model for Improvement Act Plan Study Do RCPQI: Breakthrough Series Collaborative RCPQI Collaboratives What are we trying to accomplish? (aim) Based on the Institute for Healthcare Improvement breakthrough series methodology 8-10 healthcare teams Dedicated time to work towards improvement goals Supported by an expert teaching faculty Model for Improvement allows teams to have a structure to follow throughout the process to make their projects as successful as possible, and ensures attendees are learning more about QI theory rather than just running a project. RCPQI hosted collaboratives: IBD (x2), inpatient diabetes (x 2), smoking cessation, preventing secondary fractures How will we know that a change is an improvement? (measurement) What change can we make that will result in an improvement? (ideas)

43. Learning session 2 Involving patients in QI, measurement, team presentations Learning session 3 Team poster presentations, scale up and spread, publication Learning session 1 Introduction to QI, setting your aim, driver diagrams Evaluation webinar Final feedback from teams on scale up Month 0 1 2 3 4 5 6 7 8 9 10 11 12 Action period 3 Measurement, scale up of improvements, publication Action period 1 Coaching calls, collecting baseline data, P D S A Action period 2 Coaching calls, measurement, P D S A Team call with RCPQI project manager Agree proposed aim Expectations & objectives

44. Participant feedback

45. Preventing secondary fractures cohort Learning session 2, 17 May, Liverpool “Last year, prior to this [breakthrough series collaborative], we lost the will for this work, so thank you for getting us to prioritise improvement”

46. Visit us online: www.rcplondon.ac.uk/quality-improvement • Email us:rcpqi@rcplondon.ac.uk • Follow us on Twitter: @RCP_QIPS

47. Questions, Thoughts and Reflections