Leadership and Culture Follow us on twitter @spsp_mh #spspmh5
Agenda 11.15 - 11.20 Introduction – David Hall 11.20 - 11.35 Quality Improvement, Leadership and Culture – Amar Shah and Kevin Cleary 11.35 - 11.50 Service users leadership role and the Patient Safety Climate Tool – Joyce Mouriki, MBE and Wendy McAuslan 11.50 - 12.00 Questions and Answers – All presenters 12.00 - 12.15 Workstream essentials 12.15 - 12.30 Whole group discussion #spspmh5
Quality improvement Leadership and culture qi.eastlondon.nhs.uk @ELFT_QI
Mental health services Community health services Newham, Tower Hamlets, City & Hackney Newham Forensic services Urgent care centre All above & Waltham Forest, Redbridge, Barking & Dagenham, Newham Havering IAPT Child & Adolescent services, including tier 4 inpatient Newham, Richmond and Luton service Speech & Language Regional Mother & Baby unit Barnet
Cultural diversity Financial stability and Social strong Challenges deprivation assurance and systems opportunities in East London Commissioning Geographical arrangements diversity
Our quality improvement programme Why?
The strategic case for change Make quality our Enable our staff The economic National drivers absolute priority to lead change climate • Improving • The need to • The desire to • The need to do quality of care focus on a engage, free more with less is our core more and support purpose compassionate, our staff to – improving caring service innovate and quality whilst with patients drive change reducing cost • Of greatest first and importance to foremost all our • Engaged and stakeholders motivated staff • More leads to structured and improved • Build on the bottom-up patient excellent work approach to outcomes already improvement happening to improve quality
The culture we want to nurture A listening and learning Empowering staff to organisation drive improvement Patients, carers and families at the heart of all we do Re-balancing quality Increasing transparency control, assurance and and openness improvement
Our quality improvement programme How?
1. Launch event & roadshows 2. Microsite 3. Using the power of narrative Build the 4. Celebrate successes will 5. Network of champions / ambassadors 6. Learning events 1. Initial assessment of alignment & capability 2. Recruiting central QI team 3. Online training Build 4. Face-to-face training AIM: improvement 5. Follow-up coaching on projects To provide capability 6. Develop in-house training for 2016 onwards the highest 1. Align all projects with improvement aims quality 2. Align team / service goals with improvement aims mental 3. Align all corporate and support systems health and 4. Patient and carer involvement in all improvement Alignment community work care in 5. Embed improvement within management structures England by Reducing Harm by 30% every year 2020 1. Reduce harm from inpatient violence 2. Reduce harm from falls 3. Reduce harm from pressure ulcers 4. Reduce harm from medication errors 5. Reduce harm from restraints QI Projects Right care, right place, right time 1. Improving patient and carer experience 2. Reliable delivery of evidence-based care 3. Reducing delays and inefficiencies in the system 4. Improving access to care at the right location
QI microsite the online hub for the programme Build the qi.eastlondon.nhs.uk will Staff and service user newsletter reaches 4000 AIM: people every To provide month the highest quality Bespoke QI learning mental events for staff, service health and users, commissioners, QI launch event and roadshows governors community attended by over 1000 staff, service users and carers care in England by 2020
AIM: To provide the highest quality Face to face improvement training mental - hundreds of staff, services users, Support for health and Governors to be trained over the improvement work from next few years community the Trust’s QI team care in England by 2020 Build improvement capability Strategic partnership IHI Open School with IHI available to all
Where are we? Estimated number = 3300 On track to train over 500 Requirement = introduction to quality people through 5 six-month improvement, identifying problems, waves of learning between change ideas, testing and measuring 2014-16. First 3 waves change delivered with the IHI Time-frame = train 10-20% in 2 years Experts Estimated number = 250 Requirement = deeper understanding On track. All senior staff Front line staff of improvement methodology, being encouraged to join QI measurement and using data, leading training over next 2 years teams in QI Time-frame = train 30-50% in 2 years Clinical leaders Estimated number = 30 Requirement = deeper understanding New need recognised. Directorate of improvement methodology, Developing improvement improvement understanding variation, coaching coaches programme will train leads teams and individuals 30 QI coaches in 2015 Time-frame = train 100% in 2 years Board Estimated number = 10 Requirement = setting direction and On track. Most Executives big goals, executive leadership, will have undertaken the oversight of improvement, being a ISIA, and Board training has champion, understanding variation to been delivered in 2015. lead Time-frame = train 100% in 2 years Estimated number = 5 Currently have 3 Requirement = deep statistical process improvement advisors, with control, deep improvement methods, 1.5wte deployed to QI. effective plans for implementation & Will need to build more spread capacity at this level. Time-frame = train 100% in 2 years
Quality improvement programme-project support structures A process is in place for teams to submit project ideas to the QI team, who will help Alignment with planning, structure and AIM: measurement, and To provide ensure projects are aligned with our high- the highest level aims. quality mental health and community care in England by 2020
AIM: To provide the highest quality mental health and community care in QI Projects – 100+ active projects across Trust Directorates, teams are working on England by improvement projects that support our ambition to Reducing Harm by 30% every year 2020 and deliver Right care, right place, right time QI Projects Improving Physical Health Reducing violence on Improving the handover Monitoring Following Rapid inpatient wards process for on-call doctors Tranquillisation
Days between incidents of physical Reducing harm violence 1000 by 30% every 100 0.1 10 1 04/01/12 18/02/12 25/02/12 year 07/03/12 23/03/12 Days between incidents of physical violence 30/03/12 31/03/12 - Globe adult acute ward – (T Chart) 17/04/12 19/04/12 09/05/12 Organisation level data 04/06/12 17/06/12 22/06/12 17/07/12 30/07/12 introduced 28/08/12 BVC 11/09/12 17/09/12 21/09/12 10/10/12 07/11/12 09/01/13 Inpatient violence 20/04/13 17/05/13 02/07/13 08/10/13 11/10/13 100 0.1 10 1 17/08/13 18/08/13 27/08/13 09/09/13 Days between incidents of physical violence 24/09/13 24/09/13 15/10/13 18/10/13 - 3 older adult wards (T Chart) 22/10/13 24/10/13 01/11/13 04/11/13 06/11/13 11/11/13 15/11/13 29/11/13 26/12/13 13/01/14 20/01/14 11/02/14 25/02/14 25/03/14 27/03/14 04/04/14 11/05/14 22/05/14 30/05/14
Staff feeling satisfied with the quality of Staff agreeing that their role makes a Effective Team Working work and patients care they are able to difference to patients 4.2 deliver 98 90 4.1 95 85 4 Score (%) 80 Score (%) 92 75 Score 3.9 89 70 3.8 86 65 83 3.7 STAFF EXPERIENCE AND SATISFACTION 60 55 80 3.6 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014 Staff experiencing physical violence from Staff able to contribute towards Staff reporting errors, near misses or incidents witnessed in last month patients / relatives / or the public in last improvements at work 85 12 months 50 80 95 40 75 Score (%) 85 Score (%) Score (%) 30 70 75 20 65 65 10 60 55 55 0 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014 Staff job satisfaction Staff recommendation of the trust as a Staff Motivation at Work 4 place to work or receive treatment 4.1 4.2 3.9 4 4 3.8 3.9 3.8 Score Score Score 3.7 3.8 3.6 3.6 3.7 3.4 3.5 3.6 3.2 3.4 3 3.5 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014
Leading cultural transformation through QI
Build a broad Take time to Shift decision- coalition for bring people making to the change with you edge Building will Develop a Find some Use the power compelling clear signals of stories narrative of change Take every opportunity to celebrate
Building capability & Train all levels Be prepared and across to invest capacity disciplines Realign Stop lower existing value work resources
Alignment & integration Create a Start at the top support structure Ensure patients Build a learning and carers are system integral Line of sight Ensure the from team to context is ripe system goals
Project Sponsor QI Team QI Resources QI Forums
Think big. Start small. Move fast.
Organisational culture is created by what leaders pay attention to…
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