PERSON CENTRED, SAFE AND EFFECTIVE
HEALTHCARE
A QUALITY STRATEGY FOR NHSSCOTLAND
Purpose
• To inform you of the development of the
quality strategy
• To work with you, sharing thinking and
ideas
• To consider the ways in which the quality
strategy will affect NHS Scotland and
services
• To hear your thoughts on how to make it
happen
PROPOSED AIMS FOR QUALITY
STRATEGY?
1. To make NHS Scotland a world leader in
healthcare quality.
2. To do so in a way that is meaningful to all.
KEY MESSAGES
•
•
•
•
Not ‘just another strategy’
Not top down imposition
Integrated rather than additional
A development of Better Health Better
Care – not a replacement
• Built on shared values
• For the whole of the NHS, our partners
and for the public
WHAT PEOPLE SEE AS HIGH
QUALITY HEALTHCARE?
• caring and compassionate health services;
• collaborating effectively with clinicians,
patients and others;
• confidence and trust in health services;
• providing a clean and safe care environment;
• improving the access to care and continuity of
care;
• delivering clinical excellence
The aim is to get out in front;
Some foundations
Work to do…
THE CONTEXT
Ageing Population
Economic position
Health inequalities
Changing expectations
The Right Time?
• Everyone working in or with NHSScotland is
already committed to providing high quality
healthcare
• Demographic, resource and cultural context
combine to create clear drivers and a unique
challenge/opportunity
• We know that marginal changes will not create
the scale of change required
• NHSScotland particularly well placed, through its
structures, values and through the foundations
already in place to take action and achieve these
aims, positioning it amongst the best in the world.
The perfect storm?
Where values and expectations align
THE QUALITY STRATEGY
What people have said…
A unique and important opportunity for all of us to work
together to make our NHS even better, for everyone.
We all need to understand what our respective
expectations, roles and responsibilities are, and make
a shared commitment to take the action required of
each of us to make the changes needed to ensure that
our NHS delivers the very best quality healthcare for
us all, now and into the future.
How will we do it?
PROPOSED APPROACH
• Person-centred : beyond shared decision making
– i.e. relationship-based care in the very fabric of
every interaction (Every Person Every Time).
• Clinically effective : with a focus on reducing
unnecessary variation in delivering care and
treatment, and in support for managing long term
conditions
• Safety : throughout primary, mental and acute
services achieving significant reductions in
adverse events
• Efficient, timely and equitable integrated
Aim
Key Drivers
Person Centred
Scotland is a
World leader in
Healthcare
Quality
Effective
Safe
Quality
infrastructure
Priority Areas For Action
1. Improve and embed patient reported outcomes and
experience across all NHS services
2. Support staff, patients and carers to create partnerships which
result in shared decision making
3, Inform and support people to manage and maintain their health,
and to manage ill health
1. Ensure continuity in all care pathways through implementation
of long term conditions action plan and other key opportunities
2. Apply information from quality data to drive consistently better
care across NHS
3. Promote culture of improvement in NHS at all levels
1. Secure the improvements which have been delivered
through the success of the Patient Safety Programme, and
2. Roll out across other areas of NHS activity
support integrated programme of action to reduce
occurrence of HAI
1. Establish appropriate governance arrangements
2. Develop information to provide rapid feedback
to identify and tackle risk
3. Develop outcome measures to drive and monitor progress
4. Develop data for improvement
IMPLEMENTATION - APPROACH
• Overarching and integrating approach –
NOT additional
• Bottom up – will be achieved through the
accumulation of ‘excellent’ interactions, every
person every time
IMPLEMENTATION - ROLES
Patients, their families and carers and the public
• Mobilising and supporting public by
Communicating expectations, responsibilities –
building on mutuality
Everyone delivering healthcare services for NHS
• Mobilising and supporting Staff through
development, KSF, revalidation, assessment
reshaping etc
NHS management and Scottish Government
• Making whole system changes – alignment in
governance, measurement/performance targets,
and policy development etc
Key Drivers
Person Centred
Effective
Safe
Quality
infrastructure
Priority Areas For Action
1. Improve and embed patient reported
outcomes and experience across all NHS services
2. Support staff, patients and carers to create
partnerships which result in shared decision making
3, Inform and support people to manage and maintain
their health, and to manage ill health
1. Ensure continuity in all care pathways through
implementation of long term conditions action plan
and other key opportunities
2. Apply information from quality data to drive
consistently better care across NHS
3. Promote culture of improvement in NHS at all levels
Specific Improvement Interventions
1. Develop and introduce patient reported experience and
outcome measures
2. Establish CARE measures in all clinical appraisal and
In revalidation
3. Develop and introduce collaborative decision-making
through relationship-based care reflecting
individual circumstance
1. Ensure Anticipatory Care Plan in place
of the 5% population most at risk (SPARRA)
2. Shift the balance of care and reduce
variation
3. Reduce re-admission
4. Implement long term condition action plan
5. Ensure alignment of GP enhanced services
1. Secure the improvements which have been delivered
through the success of the Patient Safety Programme, and
2. Roll out across other areas of NHS activity
support integrated programme of action to reduce
occurrence of HAI
1.Accelerate spread of Scottish Patient Safety
Programme (SPSP) throughout acute care
2. Develop approaches to improve patient safety in
Primary Care and Mental Health
3. Make the Electronic Care Summary widely available
4. Integrate the work of the HAI taskforce with the SPSP
1. Establish appropriate governance arrangements
2. Develop information to provide rapid feedback
to identify and tackle risk
3. Develop outcome measures to drive and monitor
progress
4. Develop data for improvement
1. Establish Quality Alliance
2. Develop ‘Quality Dashboard’
3. Develop Quality Measures and align with HEAT
4. NHS: QIS and NHS;NSS;ISD to establish appropriate
data to support continuous improvement
3-TIERS OF MEASURES?
• High level outcomes
• Intermediate Outputs
• Local/short term actions/outputs
and at each level –
appropriate measures/targets/indicators…
POTENTIAL AREAS FOR MEASUREMENT ?
Patient
Staff
System
Personcentred
experience
satisfaction
Anticipatory
care
Effective
outcome
capability and
capacity
Re-admission
Safe
cleanliness
cleanliness
adverse events
HAI
HSMR
It can be done…
“NHS
Scotland has undertaken a bold, comprehensive,
and scientifically grounded programme to improve
patient safety. The dedication of NHS leadership at all
levels to this endeavor is apparent to me, and bodes
well for success. In its scale and ambition, the Scottish
Patient Safety Programme marks Scotland as leader –
second to no nation on earth – in its commitment
to reducing harm to patients dramatically and
continually.”
Don Berwick June 2008
Will people say the same about our Quality Strategy?
NEXT STEPS
• Launch draft Strategy Document – Oct ‘09
• Engage in discussion/consultation - Oct/Nov ‘09 (NHS
events 19/21)
• Launch Quality Strategy Jan’10
• Detailed collaboration and consultation about ‘bottom-up’
implementation, building on successful local and national
approaches – Jan’10 onwards
• Launch Communications Strategy – Jan ’10
• Establish approach to ensuring alignment in workforce
development, policy, governance, measurement etc
QUESTIONS
• Do you agree that this is the right thing to do - why?
• How would you describe high quality healthcare ?
• Do you think these are the right drivers to use and initial areas to
focus on?
• What are the hurdles/risks, how do we mitigate against them and
what do we need to stop doing?
• What do we need to do first?
• What do you think success would look like, and what measures
should we pursue to report progress?
• Do we need to be explicit about the need to embed efficiency,
equity and access, and how do we achieve this?
Questions for Quality measures
• What do you think about this general 3-tier approach to
measures of quality (person-centred, safe, effective from
patient, staff and system perspective)?
• What type of measures should we use to report progress
at the high/outcome level? How should they relate to the
National Outcomes/Government Purpose
• What type of measures are appropriate at the
Intermediate/output level? For improvement? How
should they relate to HEAT targets?
• Do we need to agree a core set of local/short term
activity/output measures, or should these be for local
determination?
• Do we have the information required to inform these
measures/targets and indicators? If not – how do we
establish it? Do we need to stop collecting other data?
• Do we need to be explicit about the need to embed
efficiency, equity and access in the Quality Strategy by
developing appropriate measures at each level? How do
we achieve this?