Quality Improvement, Testing and Real Life Improvement

Professor Jason Leitch National Clinical Director

Healthcare Quality

Scottish Government

@jasonleitch

Thank

“Strong evidence for an innovation is necessary but not

sufficient to result in its adoption”

Mark Freeman, 2012, The International Journal of

Management Education

“Prosperity, fairness and

participation"

Wealthier & Fairer

Smarter

Healthier Safer & Stronger

Greener

Public Finances Fall in Government expenditure

Projected % change in age structure of Scotland’s population: 2010-2035

27% of people in Glasgow have a

degree or professional qualification

27% of people in Glasgow have no

qualifications at all

Source: ScotPho

Implementing at scale…. can it be done?

Execution

Ideas

Will

“By what method?... only the method

counts”

W Edwards Deming

DESIGN DESIGN DESIGN DESIGN APPROVE

Conference Room

Real World

The Typical Approach…

IMPLEMENT

DESIGN

TEST & MODIFY

TEST & MODIFY

APPROVE IF NECESSARY

Conference Room

Real World TEST &

MODIFY

The Quality Improvement Approach

START TO IMPLEMENT

Our change theory

A clear and stretch goal

A method

Predictive, iterative testing

‘This model is not magic, but it is probably the most useful single

framework I have encountered in twenty years of my own work on

quality improvement’

Dr Donald M. Berwick Former Administrator of the Centres for Medicare &

Medicaid Services Professor of Paediatrics and Health Care Policy

at the Harvard Medical School

The Model for Improvement

NHSScotland Surgical Safety Briefings

NHSScotland Surgical Mortality

NHSScotland Hospital Standardised Mortality Ratio

October 2006 to March 2015

General Medical Services

Pharmacy

Community Nursing

Dentistry

% Sepsis Six: < 1 hour

Sepsis: % Antibiotics < 1 hour

% 30 day Mortality of ICD 10 A40/A41

26 Months

Percentage of children seen by panel within 12 weeks of recommendation

Barshare Primary East Ayrshire

Outcome Measure - Percentage time spent in class per week

(aggregated for all 4 pupils)

Scores Support

Daily Average Instructional Time

2012

18 classrooms 2013

63 classrooms 2014

80 classrooms

Increase in average score between initial evaluation and

final evaluation

The first choice we make each and

every day is, "Will we act upon life, or will we merely be

acted upon?"

Stephen Covey

Circle of Influence

Circle of Concern

Stephen Covey: The 7 Habits of Highly Effective People (1989)

@jasonleitch