Developing a Patient Safety Culture within NHS Scotland
Tuesday 20th September 2011
Unlocking the Potential
The Healthcare Improvement Programme for Foundation Doctors at Salisbury NHS Foundation
Trust (HImP)
Peter WilcockFormer Director of Service Improvement
Outline of presentation
• Context and overview of programme
• Brief introduction to some of the projects
• Some practical thoughts
• Work with junior doctors on improving safety – 2002/04
• New Modernising Medical Careers curriculum 2004- weak links to healthcare improvement per se but:
- opportunities
• Decision to use these as a springboard by Foundation Programme Director, Director of Medical Education, Director of Service Improvement
• First cohort began 2005
Background to the Programme
Broad learning aims
• Transferable knowledge and skills in healthcare improvement through undertaking an improvement project
• Legacy of real improvement
• Experience of interprofessional team working and broader organisational systems
Key programme elements
• Maintaining a patient focus
• Methods to learn about the current situation and identify priorities for improvement
• A practical framework to turn ideas into actions
• Using PDSA cycles to undertake small tests of change with simple feedback measures
The learning process (1)
Choosing topics- early experiences of poor quality or safety
- October brainstorming meeting
- involvement of senior Trust managers
- forming project groups
The learning process (2)
Implementing the programme
• Four core sessions spread over 9 months – bleep free
• Three bleep free hours in between
• Facilitated action learning groups – hospital consultant with another senior member of staff
• Peer facilitation
• HImP dedicated website on Trust intranet
• July presentation to hospital Clinical Governance Core session
Programme evaluationSelf reported learning
0% 20% 40% 60% 80% 100%
Managing risk and improving patient safety
Involving patients and carers in service development and projects
Inter-professional working
Inter-professional learning
Using the principles of ‘continuous quality improvement’ to improve care
Use of any specific methods such as: process mapping; fishbone
diagrams; root cause analysis, pareto principle, others? Please specify
Designing and contributing to clinical (other) audits?
Designing service improvements and testing them in practice (eg: using
Plan-Do-Study-Act cycles)Using recorded data in graphical form to display results and analyse
impacts of changes
Using reflective approaches such as diaries/logs to record own learning
a.b
.c.
d.e.
f.g
.h.
i.j.
Have not heard of the approach
Have heard of the approach but have no experience of its application
Have observed it at work but not been directly involved
Have been actively engaged in using this at work
Pre
Programme evaluationSelf reported learning
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Managing risk and improving patient safety
Involving patients and carers in service development and projects
Inter-professional working
Inter-professional learning
Using the principles of ‘continuous quality improvement’ to improve care
Use of any specific methods such as: process mapping; fishbone
diagrams; root cause analysis, pareto principle, others? Please specify
Designing and contributing to clinical (other) audits?
Designing service improvements and testing them in practice (eg: using
Plan-Do-Study-Act cycles)Using recorded data in graphical form to display results and analyse
impacts of changes
Using reflective approaches such as diaries/logs to record own learning
a.b.
c.d.
e.f.
g.
h.
i.j.
Have not heard of the approach
Have heard of the approach but have no experience in its application
Have observed it at w ork but have not been directly involved
Have been actively engaged in using this at w ork
Post
Programme evaluationQualitative feedback
• Brilliant idea – gets you involved in the healthcare system
• Sometimes frustrating
• Learned new ways of thinking and analysing
• Education isn’t the only thing we need to implement change
• We have worked well as a team
• Would encourage more MDT members to take part
Final comments
• F1 doctor“It made me feel worthwhile”
• Facilitator“It is the highlight of my week”
Some projects• Improving process for DVT risk assessment
• Finding urgently needed equipment in treatment rooms
• Locating patient notes and request forms on wards
• Improving weekend handovers
• Improving reliable access to notes and test results for newly admitted patients on MAU
• Speeding up internal consultant to consultant referrals
Results
• Drug chart
• Focus group
• Assessment tool trial
Before
After
Re-audit and Results• Implementation of
design to another treatment room
• Re-audit of times taken
• Reduction in times taken
• No difference between standardised rooms
• Faster times when unfamiliar room is standardised
Time taken to prepare for simple procedures in an unfamiliar treatment room.
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Prior to change
After change
Before… & …After
The Handover!
HANT computer system
CLINICAL GOVERNANCE - HALF DAY Tuesday 19 th July 2011
1:30pm – 5pm
All staff / disciplines are requested to attend whe re possible
Lecture Theatre, Level 5 Post Grad Centre
CORE SESSION 1:30 – 3:15pm
Service Improvement - Health Improvement Projects
1:45 Introduction – Dr Claire Page, Director, Foundation Prog.
2:00 “This season’s guide to side room standardisation: fashion for the future” - Hand Hygiene (Georgina Wood, Emma Grimshaw & Clare Rivers) Standardising and simplifying side room policy to avoid confusion and lower transmission of infection.
2:15 “Oxygen – a breath of fresh air” - Oxygen prescribing (Dan O’Shea, Sam Leach, Panos Prevezanos, Cath Roels) Junior doctors to champion the improvement of oxygen prescribing at SDH.
2:30 “Keeping Track of our patients” - Escalation practice (Theo Delisle, Claire Sethu, Steven Lester, Michele Giorg i & Christopher John) When patients move wards, they can be “lost” due to inappropriate or incomplete update of Consultant lists. We’ve looked at ways to standardise this process to prevent this from happening.
3:00 “Improving weekend ward work” - Bleeps at weekend (Nicola Amos, Kirsty Jenner & Moira Graham) Reducing the number of non-urgent bleeps to the ward cover F1 to prioritise acutely unwell patients, aid teamwork between healthcare professionals and improve patient care
3:15 Medicine, Madness & Money - Service improvements in Clinical Psychology (Kate Jenkins) Cognitive stimulation activities with elderly patients - helping to reduce length of stay
5:00pm Directorate / Department sessions � These are arranged separately by individual Directorates and departments. � Most departments have a lead clinician that arranges the agendas for the
half-day sessions. � If you are unsure of structure/venue please contact your Senior Nurse or
Clinical Director
Learning outcomes
• Small change = BIG DIFFERENCE
• Our project- negotiation- resistance to change- champions- meetings are key
• Success of healthcare improvement in a DGH
Learning points
� Principles of service improvement
� Collaborative working and good communication is essential
� Learning about and interacting with different professionals in the trust
� Improvements to the Trust which will benefit patients as well as staff
What we’ve learnt
• Teamwork• Time management• Developing an understanding of audits
and how the hospital system works.
What have we learnt about the Improvement Process?
• Liaising with numerous different committees, each with a slightly different role, and co-ordinating their input
• Difficult to navigate the system– Need somebody with insight into various boards
and their roles• Involves effective teamwork and
communication to co-ordinate project work around our rotas
• Need an aim that gains the support of colleagues and maintains our own interest and motivation
Dissemination
Foundation Doctors’ Presentations
• National Association of Clinical Tutors (2008, 2009, 2010)
• UK Office for the Foundation Programme Conference (2009)
• International Forum for Quality and Safety in Healthcare (Berlin 2009, Nice 2010, Amsterdam 2011)
• International Patient Safety Congress 2009
Some practical tips (1)
Provide clear benefits for:
(i) Patients – projects close to patient care
(ii) Learners – relevance to own practice, innovative way to address curriculum; strengthen CV
(iii) Facilitators – influence the future, satisfaction
(iv) Trust – real, important, improvements to care
Some practical tips (2)
Learning
i.Involve FY Docs in project choice
ii.Be clear what the core learning outcomes are
iii.Match educational/coaching approaches to context
iv.Encourage reflection on experience, organisational and personal. NB Team dynamics.
v.Be clear about purpose of assessment - beware burden
Some practical tips (3)
Time
i. Prepare a broad timeline with key milestones
ii. Have a clear end of project event – eg presentation/dragons den
iii. Consider protected time for learners and facilitators
iv. Identify someone to act as central contact point and provide administrative support
Some practical tips (4)
Support
i. Encourage senior doctors to allow F1s to attend sessions
ii. Create links with interprofessional clinical teams - avoid ‘orphan’ projects
iii. Keep in touch with progress – link-in with facilitators
iv.Consider post-project sustainability
v. Provide high profile leadership and support