31st May 2017

Dr Brian Robson MBChB, FRCGP, MPH, DRCOG

Medical Director Health Foundation / IHI Quality Improvement Fellow

CULTURE, CULTURE EVERYWHERE ...

• Great opportunity for collaboration• Building relationships

2556 miles

“ Working together means that you should never worry alone.”

‘COLLECTIVE IMPACT’

Maureen Bisognano

THANK YOU NEW BRUNSWICK ...BRIAN, LULU AND ROSE ....

.... AND EDDIE’S WIVES!

800-565-7421

CULTURE ....

800-565-7421 If you'd like to feel just right, laugh and have some fun,Meet some friendly people, and get some fishin’ done,You can dial Prince Edward Isle, and it won't cost you none,For information, on vacation, phone the land of fun...

Eight Double Zero, Five Six Five, Seven Four Two One

That's the magic number, free for everyone,Phone today, and sail away, to the Island in the sun...

Eight Double Zero, Five Six Five, Seven Four Two One

Golf the courses, play the horses, nothin's out of reach,Fishing for the tuna, or bathing at the beach,

Make this call the best of all for Prince Edward Island fun,Eight Double Zero, Five Six Five, Seven Four Two OneEight Double Zero, Five Six Five, Seven Four Two One

by Stompin’ Tom Connors

CULTURE ? LEADERSHIP? PSYCHOLOGICAL SAFETY?

“ Good morning,I am your captain and I

would like to explain why we are so delayed and what is going to happen next ...”

Captain, KLM flight 691

Glasgow, 29th May 2017

MANY THINGS IN COMMON

http://www.curling.ca

40% in PEI !

WELL DONE CANADA !

SO WE HAVE SOME DIFFERENCES ...

Scotland Canada

Population 5,373,000 35, 959, 927

Size 80,077 km2 9.985 million km2

Population Density 67 / km2 4 / km2

With a land mass of 80,077 km2

Scotland could fit within Lake Superior (82,100 km2)

‘HEALTH’ SPEND

http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/health-care-spending-compared

14

• 5.37 million population• £13 billion H&SC budget• 14 territorial boards• Special boards

‐ NHS Education for Scotland‐ NHS National Services Scotland‐ Scottish Ambulance Service‐ Golden Jubilee Foundation‐ NHS Health Scotland‐ State Hospital‐ NHS 24 

• Moving to integrated health & social care• Public Body – Healthcare Improvement            

Scotland

WHAT WE DO

Death Certification Review Service

SCOTLAND’S QUALITY JOURNEY

‘This is not the end. It is not even the beginning of the end,

but it is, perhaps, the end of the beginning.’

Sir Winston Churchill

AGNES’ STORY

QUALITY IMPROVEMENT IS MESSY

Swensen S, Pugh M, McMullan C, Kabcenell A. High‐Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs.  Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013. (Available at ihi.org)

http://www.ihi.org/resources/pages/ihiwhitepapers/highimpactleadership

1. Create Vision& Build Will

We have had 5 decades of clinical audit and 10 years

of clinical governance. The future will focus on

patient safety and reducing harm.

Prof Sir Graham Teasdale

NATIONAL COMMITMENT TO QUALITY

http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf Scottish Government, May 2010

3 Quality Ambitions• Safe care• Effective care• Person-centred

care

Convening the co‐producers  

Celebrating success

Young Academy of Scotland: Influencing Policy

Dr Catherine Calderwood  Chief Medical Officer for Scotland,obstetrician and gynaecologist

http://www.gov.scot/Publications/2016/01/3745/downloads

People felt most energised by the

potential to positively influence culture

through more shared decision

making...http://www.gov.scot/Publications/2017/02/3336”

“

2. Develop Capability

“...everyone in healthcare really has

two jobs when they come to work every

day: to do their work and to improve it.”

What is ‘‘quality improvement’’ and how can it transform healthcare?Batalden,P; Davidoff.F Qual Saf Health Care. 2007 February; 16(1): 2–3

Subject Matter Knowledge

Subject Matter Knowledge: Specialist knowledge and skills required to be a good clinician

Profound Knowledge: The interaction of the theories of systems, variation, epistemology and psychology.

Profound Knowledge

Improvement

EARLY SUPPORT

NEW TOOLS ...

Improvement Science Leadership for Improvement

IHI Improvement Advisor Waves

Quality Improvement Fellowship

IntroductoryKnowledge

AdvancedKnowledge

AdvancedKnowledge

Improvement Capacity Building:Scotland’s Approach 

Scottish Improvement Leader (ScIL)

Impr Science in Action

Boards on Board

Improvement Collaboratives

laura.allison@nes.scot.nhs.uk

QUALITY & SAFETY FELLOWS (COHORTS 1-9)

189Quality &

Safety Fellows

118Medics

61NMAHPs

9Pharmacists

1Dentist

125 28 13 11 10 1 1Scotland N Ireland Ireland Denmark Norway England Wales

“I have realised that there is a greater world out there. I want to be a credible clinician improving care:

this is my professional future”SPSP Fellow, 2014

“Pursuing change without the leadership of clinicians is extremely hazardous.”

The importance and challenge of clinical leadership. The Kings Fund. 2013

http://www.kingsfund.org.uk/sites/files/kf/field/field_document/don‐berwick‐the‐importance‐and‐challenge‐of‐clinical‐leadership.pdf

Don Berwick

ENGAGING CLINICIANS – OUR APPROACH

http://www.healthcareimprovementscotland.org/previous_resources/policy_and_strategy/clinical_engagement_strategy.aspx

http://www.healthcareimprovementscotland.org/our_work/clinical_engagement/qi_connect.aspx

May

201

7

QI Connect: our reach

organisations

572

@HISQIConnect

OUR GLOBAL REACH

LEARNING TOGETHER..... AGAIN ... AND AGAIN...

http://www.healthcareimprovementscotland.org/our_work/clinical_engagement/qi_connect.aspx

@HISQIConnect

Don NormanThe Design Lab

University of California25 May

Stephen SwensenMayo Clinic

2 May

QI CONNECT 2017: INNOVATION & INTEGRATION

Emmanuel GobillotGlobal Author & Speaker

4 April

Anna RothContra Costa Regional 

Medical Center27 July

Bill LucasUniversity of Winchester

28 September

Chris HamThe Kings Fund

26 January

Jaideep PrabhuCambridge Judge Business School

21 February

Sally MagnusonPlaylist for LifeNovember (TBC)

Brené BrownResearcher &

Storyteller31 August

Tom MarshburnNASA

26 October

http://www.healthcareimprovementscotland.org/our_work/clinical_engagement/qi_connect.asp

3.Deliver Results

Our change theory

A clear and stretch goalA methodPredictive, iterative testing

RELENTLESS MEASUREMENT

“In God we trust… All others bring data.”

W. Edwards Deming

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NHSScotland Hospital Standardised Mortality Ratio 

October 2006 to December 2015

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NHS FV ICU VAP incidence/% VAP Preventon bundle compliance Sept 05 - Dec 12

NHS Greater Glasgow & Clyde PICUVAP Rate per 1000 Ventilation Days

Jan 2013 – Sep 2015 

NHS Forth Valley Pressure Ulcer CountNovember 2010 – May 2015

Total Falls Rate for 7 Scottish BoardsJanuary 2014 – June 2015

NHS Scotland

Shaping the Future

The what&

the how

http://www.scottishpatientsafetyprogramme.scot.nhs.uk/Media/Docs/20160613%20SPSP90DayProcessFinalReport%20v%203%200.pdf

http://www.scottishpatientsafetyprogramme.scot.nhs.uk/Media/Docs/20160613%20SPSP90DayProcessFinalReport%20v%203%200.pdf

•Deterioration•Medicines•‘system enablers’ 

•measures• transitions•context, culture, relationships

•Acute kidney injury•Emergency laparotomy...

SEPSIS 6 60

http://www.scottishpatientsafetyprogramme.scot.nhs.uk/Media/Docs/Acute%20Adult%20Care/sepsis%20VTE%20evaluation%20short%20report%20‐%20FINAL‐%202015‐06‐29%20(2).pdf

DATA ON EVERY WARD .... IN PUBLIC !

Courtesy of Malcolm Daniel

BEHIND THE DATA

LET’S STAND UP

Via @docandrewmurray

4.Engage Across Boundaries

Strategic Direction of Change

Improving Population Health

Health and social care 

http://ihub.scot

5.Shape Culture

SMART ISN’T ENOUGH

https://www.amazon.co.uk/d/Books/Checklist-Manifesto-How-Things-Right-Atul-Gawande/1846683149

“... using a checklist requires [doctors] to embrace different values from ones we’ve had, like

humility, discipline, team.”

BEHIND THE TOOLS...

Safety Climate Survey Results

Much of the value of these types of surveys lies in raising the profile of patient safety and

promoting conversations, .... that’s when the improvements come through

The Health Foundation, 2011

ELAINE’S STORY

TEAM BRIEFINGS ...

“I now consider the safety brief to be every bit as important to the safety of our patients as what I do as a surgeon during the operation...”

“ ....I don’t know why theatre teams are allowed not to do a morning brief .... I wouldn’t operate without it !”

Surgeon

CHANGING THE CULTURE...

NHSScotland Surgical Safety Briefings

Royal Hospital for Sick Children, YorkhillPICU Total Delayed Discharges (+ 4 hrs)

Hospital Huddle started 7th Jan 2013

….over 1,700 leadership walkrounds have been conducted in Scotland.

Since 2008…….

Patients are and feel safe,Staff feel and are safe

#mhimprove

‘We don’t really call it SPSP, that’s just what we do......’

#mhimprove

ARE YOU....

6. Driven by Persons & Community

78

“The patient experience will define the future of the NHS in Scotland”

Paul Gray Director General and CEO NHS Scotland

ARE YOU SIGNED UP ?

http://www.whatmatterstoyou.scot

Swensen S, Pugh M, McMullan C, Kabcenell A. High‐Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs.  Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013. (Available at ihi.org)

http://www.ihi.org/resources/pages/ihiwhitepapers/highimpactleadership

brian.robson@nhs.net@brobson3

Thank You