Setting the scene 9 September 2010

Setting the sceneAlan Willson 9 September 2010

Setting the scene 9 September 2010

“..we have to accelerate the adoption and full implementation of best and evidence-based practice in all settings all of the time – there can no longer be any justification for not doing this.

Paul Williams letter to Chief Executives, launching 1000 Lives Plus. March 2010.

1000 Lives Plus – Reducing harm, waste and variation.

Setting the scene 9 September 2010

Why is this difficult?

“Evidence-based therapies that prevent morbidity and death are often not translated into clinical practice. One reason for this is that research often neglects to look at how to deliver therapies to patients. Consequently,errors of omission are prevalent and cause substantial preventable harm”

BMJ, Oct 2008, Vol 337

Setting the scene 9 September 2010

1000 Lives Plus and the Strategy for NHS Wales - “ National Purpose, Local Action”.

How clinically led service improvement will be driven..• For national improvement priorities, HB’s will assemble a clinically-

led team.• Teams from across Wales come together for peer learning.• Teams agree objectives internally and with HB management.• Teams agree measures to track process.• Teams collect information to track internal trends and to compare

progress between teams.• Team leaders share experience and help each other via site visits

and learning events.

Setting the scene 9 September 2010

The 1000 Lives Plus - Drawing on the evidence of what works

Pronovost et al (2008) Translating evidence into Practice – A model for large scale knowledge translation. BMJ

Setting the scene 9 September 2010

Achieving better outcomes

Patient’s experience

and outcomes

Safe, reliable care

Value and efficiency

Team performance and staff wellbeing

Setting the scene 9 September 2010

• Be clear who is holding you to account for progress and how this is aligned with your other objectives.

• Being accountable for team progress is about providing support and challenge.

• Monitoring progress needs informal visibility and formal review.• Understanding what is being measured and why.• Always insist on basing conversations around the data.• Understand the importance of testing, implementing reliable

processes, spreading and sustaining changes.• Be alert to words like ‘audit’; ‘pilot’ and ‘roll-out’.

Some key pointers for leaders

Setting the scene 9 September 2010

Understand what you are measuring and why..

Measurement for Improvement

Measurement for Assurance

Board level Frontline team level

Core assurance measures•Mortality rates•Harm rates

Improvement measure•% compliance with daily team briefings•% patients risk assessed for DVT•% patients with titrated doses

Setting the scene 9 September 2010

When progress is difficult, the reason is likely to relate to one or more of the following:– Failure of Will e.g. a few strong “blockers,” lack of investment in

training and education, lack of back-up from more senior levels.– Failure of Ideas e.g.Not drawing on the evidence base, or not

participating in Learning Sets.– Failure of Execution e.g. The leader does not have the authority

(as well as the responsibility) to deploy the resources s/he needs. Cross- service links have not been clarified. Competing priorities have not been reconciled. The Model for Improvement is not being used.

Obstacles and barriers

Setting the scene 9 September 2010

Building accountable leadership and communication by using SBAR

Divisional Teams

Clinical teams

DirectorateTeams

Exec Team

SituationThe processes you are seeking to improve and how far you have progressed towards your aims.

BackgroundThe context of Transforming Theatres and 1000L+.

AssessmentMake sure this is supported by data:

•Progress over time (run charts).•Tests of change

Obstacles to progress (Will, Ideas, Execution).

RecommendationThe actions that are needed to unblock obstacles to progress.

Setting the scene 9 September 2010