The changing face of stroke care – fast forward

NHS Stroke Improvement Programme

Ian GoltonDirector

Stroke developments…

What is the Stroke Improvement Programme?

• “To support local networks the Department of Health is establishing a central team within the NHS … The main task of this team will be to ensure that specific support is available to develop stroke networks “(National Stroke Strategy, p58)

• Part of NHS Improvement, also supporting networks in cardiac and lung care, and working with cancer networks

• Based on 8 years experience improving heart disease services

• Work closely with the Department of Health and key national organisations

• Our job: support the development of Stroke Care Networks and implementation of the Stroke Strategy

Clinical MicrosystemsClinical Microsystems

Layers of the onion: the ‘systems within systems’ that work Layers of the onion: the ‘systems within systems’ that work together to provide care for patientstogether to provide care for patients

National, policy,

legislation, evidence

Macro-organisation

Clinical Microsystem

Individual care-giver & patient

Self-care

National, policy,

legislation, evidence

“ …there is uncertainty everywhere, and every meeting includes conversations of ‘no money’ and how can savings be made”

Stroke Specialist Nurse with over 20 years NHS experience

“I’ve never experienced so much turmoil - it feels on the coal face that we are waiting for some disaster to happen”

http://www.nice.org.uk/aboutnice/cof/ConsultationOnCOFIndicators.jsp

“In stroke, the best care is also the most cost-effective care…”Professor Sir Roger Boyle,Former National Director for Heart Disease & Stroke

Performance Data• 1090 bed days saved

• Reduction of inpatient stroke beds from 56 to 34

• Maintenance of inpatient performance within reduced bed base

• Stroke service LOS reduced – 21 days to 12 days

Macro-organisation

www.atastroke.org.ukwww.atastroke.org.uk

Ossie Newell MBEOssie Newell MBE

Founder of @astrokeFounder of @astroke

Layers of the onion: the ‘systems within systems’ that work Layers of the onion: the ‘systems within systems’ that work together to provide care for patientstogether to provide care for patients

Clinical Microsystem

WorkforceDevelopment

Small groups

Task Force

Team

CrewPLAN

PLAN

DODO

STUDY

STUDY

ACTACT

PDSA cycles

Flow charts &deployment

charts

Fishbonediagrams

Meetingskills & disciplines

Variable

0

5

10

15

20

25

30

35

40

Date

Ou

nce

s

Run charts &control charts

Global AimTemplate

Data & measures

F

£

C S

Clinical value compass

Ladder of inference

Left-hand column

Generativerelationships

S

T

A

R

http://upload.wikimedia.org/wikipedia/commons/6/69/Motherhood_and_apple_pie.jpg

More top tips…

• Get the wind behind you - alignment with policy, guidelines, strategic goals, organisation priorities etc.

• Get (as much as possible) management support, up to and including chief executives

• Be clear what you’re trying to do an why - there are only 3 reasons to change

• Involve (as much as possible) the whole team

• Test, test and test again before anything irrevocable or expensive is done

• Gather data - meaningful, good quality, minimal - to show the effects and track progress

• Use your patients as your guide and support

http://www.patientopinion.org.uk/http://www.patientopinion.org.uk/

Individual care-giver & patient

Harry Clarke, Counsellor and Stroke Survivor

“Give time to listen. And a much undervalued word is kindness. Be kind…be kind to that person. Kindness doesn’t cost any money. Just be kind”

www.improvement.nhs.uk/stroke