developing an effective local quality improvement programme
TRANSCRIPT
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Developing an effective local quality
improvement programme and
supporting staff to deliver quality care
Carl Walker
National Quality Improvement &
Clinical Audit Network (NQICAN) chair
@cwwalker10 @nqican #clinicalaudit #healthqi
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Who am I?
• Worked in Clinical Audit / Quality improvement roles at
University Hospitals of Leicester NHS Trust since graduating
from university 15+ years ago with BSc in Stats/Business
• Been clinical audit manager for last 6 years
• Recently completed IHI course on Quality Improvement
• Elected as National Quality Improvement & Clinical Audit
Network (NQICAN) chair (October 15)
• Been to Ethiopia to teach clinical audit
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Why is the next 30 minutes going
to be useful to you?
• Share evidence / experiences as to what works and why
• Explain how best to measure the effectiveness of your quality improvement projects
• Clarify Clinical audits role as a quality improvement process
• Examples of case studies / resources that are available to help
To find out more about your regional
network and how to join visit:
www.nqican.org.uk
NQICAN brings together 15
regional clinical
audit/effectiveness networks
from across England, providing
‘a voice’ for staff working in
these areas in health and
social care organisations.
NQICAN supports the
development of regional
networks, national clinical
audit as well as engaging,
influence and being a point of
contact for key organisations
such as HQIP.
@nqican @cwwalker10
Email: [email protected]
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
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Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
3 things in life are certain
• Taxes
• Death
• Change or quality improvement
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
We’re all quality improvers! Challenge
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Quality Improvement
“ QI is better patient experience and outcomes
achieved through changing provider behaviour and
organisation through using a systematic change
method and strategy”
Ovreveit
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016 menofmaxima.com
Current position
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
3 types of measurement in
healthcare
• Assurance / Accountability / Judgement – are we
meeting our standards?
• Improvement – we’ve got a problem / we know we
need to improve
• Research – we don’t know the best way to treat this
group of patients
• Clinical audit ‘rightly or wrongly’ is used for all 3 of these
and sometimes all in the same project
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Source:
QI Tools
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Quality Improvement – should be built into all services provided
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Assurance v Improvement
Dashboard
Run chart
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
UHL Model
Project Plan –
Improvement or Assurance?
Do we know how we are doing?
YesDo we need to
improve?
Yes – QI methods
No – reject plan
No
Should we know
how we are
doing?
Yes – classic clinical audit (assurance)
No – reject plan
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Improving systems
• Every system is perfectly designed
to deliver the results it gets
……..Paul Batalden
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Ideal
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Ref: Healthcare Quality Quest - Quality Improvement for Healthcare Manual
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
What’s needed for success?
– Strategy
– Structure and systems
– Culture
– Technical support
Ref: Healthcare Quality Quest - Quality Improvement for Healthcare Manual
Original studies of the sustained implementation of quality improvement in healthcare
organizations in the USA identified that continuously successful improvement
programmes are associated with the presence of these four dimensions in the
organization
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
What’s needed for success?
• Strategy — integrating quality improvement-related
goals into the organization’s strategic priorities and
defining the organization’s direction, policies and roles
relating to quality improvement
• Structure and systems — defining how the
organization’s improvement programme is directed,
supervised, facilitated and monitored, how learning
about quality improvement is disseminated in the
organization, and systems such as access to data to
support improvement
Ref: Healthcare Quality Quest - Quality Improvement for Healthcare Manual
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
What’s needed for success?
• Culture — committing to a shared purpose related to
quality improvement and the use of scientific
principles and practices to achieve improvement, and
developing clinical teams to work collaboratively with
frontline staff participation and continuous learning
• Technical support — providing appropriate and
effective training on quality improvement tools for
staff and providing skilled ‘enablers’ to advise on and
support improvement programmes and activities.
Ref: Healthcare Quality Quest - Quality Improvement for Healthcare Manual
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Case study – QI Structure / Approach
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
QI Strategy Case study
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Building the picture/ Growing the culture
Quality
Improvement
Audit
Patient Experience / Complaints
Performance
Peer Review
Soft Intelligence
Serious Incidents
Mortality Review
Inspection
Finance
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Search ‘Gondar Audit’
Gondar ‘Can do’ attitude
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
UHL Clinical Audit Programme – Overview : Process &
outcome measures
Process measures
• No of projects registered
• % running to schedule
• % action plans implemented to deadlines
Outcome measures
• % of re-audits showing improvements
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
IHI PH556x: Practical Improvement
Science in Healthcare: A Roadmap for
Getting Results
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Model for improvement
Image: The Model for Improvement, developed by the Associates for Process Improvement, - IHI course
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
3 types of measures
� Outcome Measures: Voice of the customer or patient. How is the system performing? What is the result?
� Process Measures: Voice of the workings of the system. Are the parts/steps in the system performing as planned?
� Balancing Measures: Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures? (e.g. unanticipated consequences, other factors influencing outcome, outcomes in other conditions that share processes)
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Results from 2 spot check audits:
40
70
60
30
0
10
20
30
40
50
60
70
80
1st Audit (April 2015) Re-audit (Jan 2016)
Co
mp
lain
ce w
ith
sta
nd
ard
% Yes
No
What conclusion would you make from this result?
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Did we improve by 30%?
• Answer – No / Impossible to tell based on this
info
• Spot check audits are for assurance / judgement
– not measuring improvement
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Did we improve by 30%?
�Was the same methodology repeated? Was there any potential bias introduced by the methods used? Context?
�What is the sample size?
� If yes is it representative of the patient population?
�Audit results based on samples are estimates of the whole population.
�What had changed since last years audit? If nothing then this is just variation or sample error
�Danger of providing false assurance
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Rapid cycle audit / knowing how you are doing
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
“If I had to reduce my message for
management to just a few words,
I’d say it all had to do with reducing
variation.”
Dr. W. Edwards Deming
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
"Collaborative learning through safety and quality improvement networks can be extremely effective and should be encouraged across the NHS. The best networks are those that are owned by their members, who determine priorities for their own learning."
(Berwick Report, 2013)
Determining own priorities…
The NHS Change Model
Effective Quality Improvement Programme – Carl Walker, NQICAN Chair @nqican
Clinical Audit for Improvement 5th October 2016
Thanks for listening
www.nqican.org.uk
@cwwalker10
@nqican
#clinicalaudit