The Not-So-Secret Ingredients for Scotland’s Health Care Transformation
Professor Jason Leitch Clinical Director
The Quality Unit, Scottish Government
@jasonleitch
Lucy and Lewis
• 5 million people • £12 billion • 14 Health Boards • 8 Support Boards • Integrated delivery • Moving towards
social care integration
Public Finances Fall in Government expenditure
1911 1931 1951 1971 1991 2011
Source: Scotland 2011 Census
Scotland’s Demographics 1911 - 2011
Alcohol Related Mortality UK Countries 1990-2005
Source: Office for National Statistics 2007
People living in more deprived areas in Scotland develop multimorbidity 10 years
before those living in the most affluent areas
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.”
Quality of Care
Primary Care
Integrated Care
Safe Care
Unscheduled and Emergency Care
Person Centred Care
Care for Multiple and Chronic Illnesses
Health of the Population
Early Years
Health Inequalities
Prevention
Value & Financial
Sustainability
Innovation
Efficiency & Productivity
Workforce
12 Priority Areas for Action
ROUTE MAP TO THE 20:20 VISION
NEW PUBLIC MANAGEMENT Targets, sanctions, inspections
QUALITY IMPROVEMENT
MOBILISING SOCIAL ACTION
Outcom
es
Time
Getting to the Third Curve
Sharing power
Keeping power
Ceding power
Implementing at scale…. can it be done?
Execution
Ideas
Will
“By what method?... only the method
counts”
W Edwards Deming
DESIGN DESIGN DESIGN DESIGN APPROVE
Conference Room
Real World
The Typical Approach…
IMPLEMENT
DESIGN
TEST & MODIFY
TEST & MODIFY
APPROVE IF NECESSARY
Conference Room
Real World TEST &
MODIFY
The Quality Improvement Approach
START TO IMPLEMENT
Large scale change….. developing our thinking over time
From the industrial era - doing
To the social era - connecting
Large scale change….. developing our thinking over time
Our change theory
A clear and stretch goal
A method
Predictive, iterative testing
Aims To Further Improve the Safety of People in Acute Adult
Healthcare
1. Reduce Harm 95% of people in acute adult health care free from harms in the Scottish Patient Safety Index by 2015: Cardiac Arrest Catheter Acquired Urinary Tract Infections Pressure Ulcers Falls
2. Reduce Hospital Associated Mortality Reduce HSMR by 20% by 2015.
NHSScotland Surgical Safety Briefings
NHSScotland Surgical Mortality
Rate of staphylococcus aureus bacteraemia (including MRSA) cases across NHSScotland was 0.30 per 1,000
acute occupied bed days (2006–2013)
Rate of identifications of CDI across NHSScotland was 0.37 per 1,000 occupied bed days among patients aged 65 & over
(2008 – 2013)
Hospital Standardised Mortality Ratio Scotland: 2006 to Sep 2013
The Early Years Collaborative - Ambition
“To make Scotland the best place in the world to grow up.”
Provide the Leadership System to
support quality improvement across
the Early Years Collaborative
90% of children at Grassmarket nursery school will receive a bedtime story
“Now he wants to sit with me.
He didn’t do that before, he just ran
around...”
“He wants me to do stuff with him like his garage. Now he
takes my hand.”
“He sits and cuddles in.
He’s bonding with me. He is listening
to me.”
“He is starting to turn the pages by himself and he is noticing if I miss a
page.”
Mental Models for Leadership
Volume Value
High Impact Leadership Behaviours
High Impact Leadership Framework
Engage Across Boundaries
Engage Across Boundaries
Shape Culture
Create Vision and Build
Will
Deliver Results
Develop Capability
Driven by People and Community
@jasonleitch