Scotland’s Approach to Safety and Quality

Jason LeitchClinical Director

The Quality Unit, Scottish Government

@jasonleitch

• 5 million people• £12 billion• 14 Health Boards• 8 Support Boards• Integrated delivery• Moving towards

social care integration

Public Finances Fall in Government expenditure

Health Budget

191119311951197119912011

Source: Scotland 2011 Census

Scotland’s Demographics 1911 - 2011

Projected % Change in Scotland’s Population by age group 2006-2031

Source: GRO Scotland, 2007

Strategic Objectives

Aims:To deliver the highest quality healthcare services to the people of Scotland

For NHSScotland to be recognised as world-leading in the quality of healthcare it provides

The Healthcare Quality Strategy for 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.

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.

Triple Aim

Health of the

Population

Experience of Care

Best Value for Money

The IHI Triple Aim

Evidence based discovery

Evidence based delivery

17 years to get 14% of evidence into practice

Implementing at scale….can it be done?

WillIdeas

Execution

Improve Safety of Healthcare Services in Scotland

(15% reduction in HSMR by end of

2012)

Boards accept SPSP as a key strategic priority for

effective governance

Scottish Government sets SPSP as strategic

priority

Deliver the programme

Build a sustainable infrastructure for

improvement

Align SPSP with national improvement

programmes

Primary Drivers

Demonstrable results Clear, shared measurement setVisible on all senior leader agendasA cohesive and united programme

Secondary DriversAgreed set of outcomesReview & address outcome deliveryQuality & safety on every agendaInfrastructure supports Involve patients

Clinical faculty expert at improvement methods and coachingProgramme design and structure

BTS collaborativeAcceptance of pragmatic scienceRoyal Colleges support

Inventory of national programmes Engage with national programmesHarmonize metrics

By what method?

W. Edwards Deming

DESIGN DESIGN DESIGN DESIGN APPROVE

Conference Room

Real World

The Typical Approach…

IMPLEMENT

DESIGN

TEST & MODIFY

TEST & MODIFY

APPROVEIF

NECESSARY

Conference Room

Real WorldTEST & MODIFY

The Quality Improvement Approach

START TO IMPLEMENT

Our change theory

A clear and stretch goal A method Predictive, iterative testing

Breakthrough Series Collaborative

‘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. BerwickFormer 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

23% reduction from median

NHSScotland Surgical Mortality

Hospital Standardised Mortality Ratios (Seasonally Adjusted) Scotland: Dec 2002 to Mar 2012

0.6

0.7

0.8

0.9

1.0

1.1

1.2

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

Quarters

Sm

oo

thed

S

MR

average annual reduction 4.2%

(Apr 2010 to Mar 2012)

1.4% average annual reduction

(Oct 2002 to Jan 2010)

Smoo

thed

SM

R

How has the frontline done it?

Get goalsGet boldGet togetherGet a model (and stick

with it)Get patients and

families

Get the factsGet to the fieldGet a clockGet the numbersGet the stories

The Early Years Collaborative - Ambition

To make Scotland the best place in the world to grow up in by improving outcomes, and reducing inequalities, for all babies, children, mothers, fathers and families across Scotland to ensure that all children have the best start in life and are ready to succeed.

The Early Years Collaborative - Aims1. To ensure that women experience positive pregnancies which result in the birth of

more healthy babies as evidenced by a reduction of 15% in the rates of stillbirths (from 4.9 per 1,000 births in 2010 to 4.3 per 1,000 births in 2015) and infant mortality (from 3.7 per 1,000 live births in 2010 to 3.1 per 1,000 live births in 2015).

2. To ensure that 85% of all children within each Community Planning

Partnership have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review, by end-2016.

3. To ensure that 90% of all children within each Community Planning Partnership

have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017.

www.scotland.gov.uk/Topics/Health/Policy/2020-Vision/Strategic-NarrativeScotland’s 2020 Vision:

www.scotland.gov.uk/Topics/Health/Policy/2020-Vision/Quality-StrategyThe Quality Strategy:

The Quality Improvement Hub:www.qihub.scot.nhs.uk

Some Useful Links

Institute for Healthcare Improvement:www.ihi.org.uk

@jasonleitch