Scottish Patient Safety Programme: lessons learnt in Scotland
Professor 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 FinancesFall in Government expenditure
Scotland’s approach
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
2020 Vision/Quality Ambitions
“Safe, effective and person‐centred care
which supports people to live as long as possible at home or in a homely
setting.”
Implementing at scale….can it be done?
Execution
Ideas
Will
Our change theory
A clear and stretch goalA methodPredictive, iterative testing
How Do We View Our Measures?
Improvem
ent
Judgement
Research
Judgement Research
Improvement
Performance
AimsTo Further Improve the Safety of People in Acute Adult
Healthcare1. Reduce Harm95% of people in acute adult health care free from harms in the Scottish Patient Safety Index by 2015:
Cardiac ArrestCatheter Acquired Urinary Tract InfectionsPressure UlcersFalls
2. Reduce Hospital Associated MortalityReduce HSMR by 20% by 2015.
Don Berwick
• Get goals• Get bold• Get together• Get a model (and stick with it)
• Get patients and families
• Get the facts• Get to the field• Get a clock• Get the numbers• Get the stories
How has the frontline done it?
NHSScotland Surgical Safety Briefings
NHSScotland Surgical Mortality
Scottish ICUs Averaged Bundle Reliabilityand VAP Rate/1000 ventilator days
60%
70%
80%
90%
100%
Oct-07
Apr-08
Oct-08
Apr-09
Oct-09
Apr-10
Oct-10
Apr-11
Oct-11
Apr-12
Oct-12
Apr-13
Oct-13
Apr-14
Oct-14
0
5
10
15
20
25
Average VAP Bundle Reliability
Average VAP rate/1000ventilator daysMedian for 2008
Better
Better
60%
70%
80%
90%
100%
Oct-07
Apr-08
Oct-08
Apr-09
Oct-09
Apr-10
Oct-10
Apr-11
Oct-11
Apr-12
Oct-12
Apr-13
Oct-13
Apr-14
Oct-14
0
5
10
15
20
25
Average VAP Bundle Reliability
Average VAP rate/1000ventilator daysMedian for 2008
Better
Better
60%
70%
80%
90%
100%
Jul-0
7
Jul-0
8
Jul-0
9
Jul-1
0
Jul-1
1
Jul-1
2
Jul-1
3
Jul-1
4
0
1
2
3
4
5
Average Central Line InsertionBundle Reliability
Average Central line BloodStream Infection/1000 linedaysMedian in 2008
Better
Better
60%
70%
80%
90%
100%
Jul-0
7
Jul-0
8
Jul-0
9
Jul-1
0
Jul-1
1
Jul-1
2
Jul-1
3
Jul-1
4
0
1
2
3
4
5
Average Central Line InsertionBundle Reliability
Average Central line BloodStream Infection/1000 linedaysMedian in 2008
Better
Better
Scottish ICUs Average Central Line Insertion Bundle& Central Line Related Blood Stream Infection rate
/1000 days
Hospital Standardised Mortality Ratio Scotland: 2006 to Sep 2013
Kendra
7 year old Severe autism
Kendra
@jasonleitch