The NHS Tayside ExperienceThe NHS Tayside Experience

Linking Knowledge Management Linking Knowledge Management with Quality Improvementwith Quality Improvement

Carrie MarrAssociate Director of Change and Innovation

Tayside Centre for Organisational Effectiveness

FindingsFindings

Factors used by leading QI organisations to come to improved patients results

Build Infrastructure

& Capacity

Quality program organisation Education

Leadership development

Priorities maintained during crises Stability of general management and

program management Choosing tools compatible with

strategy and culture

Program logisticsMeasurement systemsInformation systems

Culture:• goodwill• Measurement• Evidence based learning• Learning organisation

Ref: Staines 2009

The Balance of Quality and CostThe Balance of Quality and Cost

The Healthcare Quality Strategy The Healthcare Quality Strategy for Scotlandfor Scotland

The Healthcare Quality Strategy The Healthcare Quality Strategy for Scotlandfor 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.

Clinically 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.

NHS Scotland NHS Scotland Efficiency and ProductivityEfficiency and Productivity

Endoscopy

A&E

in-patient

out-patient

rehab

day case

acute services

acutereceiving

ward(Med/Surg)

MIU

SAS

OOH

OOH, urgent & emergency services (community)

NHS 24

GDP

GP

Community Pharmacists

family health services

Optom

refer to GP

sub-contractout-reach

Specialist acute care

tertiary services

routinedischarge

complexdischarge

LocalAuthorities

Partner & Vol organisations

refer on-going community care

1.09 million

75,979

26,077

656,466

21,089

44,242

67,032

?

104,669

242,268

3.45 LOS U/Sched

4.0 LOS Elective

Walk-In43,967

Radiology

20,670

GP referral

GP direct

access

GP referral

day patient34,659

OutpatientClinic

Community Services – partnership model with LA

Home Visit

district nursinghealth visitingspecialist nursingAHP (e.g. physio, OT)

elderly care

Care in the community

Community (day) Hospitals

mental health

Day Patient

Inpatient

other

8,725

36,929

430,000

120,000

52,300

128,685

247,703

99,006

37,273

6,697

Laboratory10,685,631

?

86,204

77,041 3,586

Endoscopy

95,592

17,430

M 5,360

15,881

Direct access inpatients

27,352

48,627

+ 12%

+ 3%

+ 1.8%+ 8%

Endoscopy

A&E

in-patient

out-patient

rehab

day case

acute services

acutereceiving

ward(Med/Surg)

MIU

SAS

OOH

OOH, urgent & emergency services (community)

NHS 24

GDP

GP

Community Pharmacists

family health services

Optom

refer to GP

sub-contractout-reach

Specialist acute care

tertiary services

routinedischarge

complexdischarge

LocalAuthorities

Partner & Vol organisations

refer on-going community care

1.09 million

75,979

26,077

656,466

21,089

44,242

67,032

?

104,669

242,268

3.45 LOS U/Sched

4.0 LOS Elective

Walk-In43,967

Radiology

20,670

GP referral

GP direct

access

GP referral

day patient34,659

OutpatientClinic

Community Services – partnership model with LA

Home Visit

district nursinghealth visitingspecialist nursingAHP (e.g. physio, OT)

elderly care

Care in the community

Community (day) Hospitals

mental health

Day Patient

Inpatient

other

OutpatientClinic

Community Services – partnership model with LA

Home Visit

district nursinghealth visitingspecialist nursingAHP (e.g. physio, OT)

elderly care

Care in the community

Community (day) Hospitals

mental health

Day Patient

Inpatient

other

8,725

36,929

430,000

120,000

52,300

128,685

247,703

99,006

37,273

6,697

Laboratory10,685,631

?

86,204

77,041 3,586

Endoscopy

95,592

17,430

M 5,360

15,881

Direct access inpatients

27,352

48,627

+ 12%

+ 3%

+ 1.8%+ 8%

Assessing the management

information requirements to support

better patient flow management

Assessing the management

information requirements to support

better patient flow management

To consult with stakeholders across

the whole system & recommend

areas of priority

To consult with stakeholders across

the whole system & recommend

areas of priority

Identify areas of existing & potential

constraints within the whole system

Identify areas of existing & potential

constraints within the whole system

Assess the performance of the

whole health system with respect to

local and national targets

Assess the performance of the

whole health system with respect to

local and national targets

Whole Systems Analysis – Business Challenge An Integrated Care Challenge HealthSocial Care ++

2010 - 20132010 - 2013

TACTICAL STRATEGIC

DEALING WITH THE 5%

SPENDING THE 95% BETTER

PRODUCTIVITY & EFFICIENCY

CRES

SERVICE OPTIMISATION

TRANSFORMATION

2010 - 20122010 - 2012

TACTICAL STRATEGIC

DEALING WITH THE 5% SPENDING THE 95% BETTER

Prevention of admissionImproved Day care

Improved service liaison and dischargeReduced hospital stays and bed days

Case management – improved pathwaysIntermediate care

Care home interfaceMedications reviews

Housing/home care supportTechnologies

Maximise health and social care services

Cost minimisationWorkforce efficienciesTeleheath / telecare

Virtual wardsWorkforce redesign

Self care and enablementNew models of care in dementia, falls,

end of life careWorking with communities - coproduction

The Knowledge PortalThe Knowledge PortalThe Shift to All Learn : All Teach as a MovementThe Shift to All Learn : All Teach as a Movement

Developing local

improvement stories

Widening our improvement conversations and networks

ProfoundKnowledge

&Evidence of Standards

Adopt & Adapt Improvement Tools and Technology

Harvest andshare and

enable new ideas

Sharing experiences and embedding the improvement

cultureMeasuring the effectiveness

of improvement activities

Individual Microsystemfrontline

MesosystemMiddle mgrs

Macrosystem Policy

Real time tests of change

Improvement Evidence

• Workplace VLE• Communities of Practice

Developing a culture of

improvement

Our Organisational Our Organisational Effectiveness PlanEffectiveness Plan

Building Capacity

& Capability in Knowledge Management

Improvement AcademyeLearning PortalScience and Art of QITools and Techniques

Knowledge Management Portal•Locally

•NationallyImprovement evidence (eg Dashboards, case studies, clinical pathways)

Improvement experiences (Patients, staff, partners)Improvement Network

• Real time information and measurement systems

• Sharing evidence of improvement

• Clinical engagement

• Data for discussion not judgement

Improvement Culture• How much by when• Rapid cycle testing• Evidence based approach

Team Vitality• Staff engagement • Employee Voice

Facing the FutureBoard Effectiveness ProgrammeTCOE as an Innovation HubJoint Clinical Boards

Leadership and Management DevelopmentVirtual learning environmentUndergraduate support

Our inquiry so farOur inquiry so far

Governance of credible real time knowledge

Reliability – the 2 step challenge

User friendly for all staff

Opportunity to integrate with PDP’s and individual learning priorities

Sharing success and achievement is an essential component

Linkage of improvement – research – policy – practice

Evolving role of Improvement and Development Advisers, Librarians and learning and development staff in support of this approach