amarshah@nhs.net @DrAmarShah Dr. Amar Shah ME Forum 2019 Orientation Consultant forensic psychiatrist & Chief quality officer East London NHS Foundation Trust National improvement lead for mental health safety (England)
As part of our extensive program and with CPD hours awarded based on actual time spent learning, credit hours are offered based on attendance per session, requiring delegates to attend a minimum of 80% of a session to qualify for the allocated CPD hours. • Less than 80% attendance per session = 0 CPD hours ME Forum 2019 Orientation • 80% or higher attendance per session = full allotted CPD hours Total CPD hours for the forum are awarded based on the sum of CPD hours earned from all individual sessions.
Conflict of Interest The speaker(s) or presenter(s) in this session has/have no conflict of interest or disclosure in relation to this presentation. ME Forum 2019 Orientation
Learning Objectives At the end of this session, participants will be able to: 1. Appreciate the different aspects of a quality management system 2. Identify existing mechanisms within your service for managing quality 3. Develop new ideas for how to create a balanced management system for quality of care ME Forum 2019 Orientation
Once upon a time…
Now: A complex system
Now: A complex system
Performing well?
Audit Financial Assurance incentives Performance Inspections management Key Quality & Quality performance improvement performance indicators
improving quality = quality improvement
We aim to provide high quality, continuously improving care Quality for our patients management and service system users. We do this through four types of activity…
Identify clear measures of quality for the Identify the needs of the customer/ service, and monitor these over time. population Take corrective action when Develop service models to meet appropriate the needs Internal vigilance to Put in place structures hold gains made and processes to through improvement manage the service Quality management Quality management system system Identify what matters Periodic checks to most ensure the service is meeting the needs of Design project and bring the customer/population together a diverse team Actions to address gaps identified Discover solutions through involving those closest to the work, test ideas, implement and then scale up
IMPROVEMEN CONTRO DESIGN CONTROL T L Original Zone of Quality Quality Control Improvement A P UCL Ac Pla t n S D QUALITY Study Do PLANNING LCL New Zone of Quality Control PERFORMANCE SHIFT MONTH WEEK MONTH LESSONS LEARNT
Identify the needs of the customer/ population Develop service models to meet the needs Put in place structures and processes to manage the service Quality management system
Identify the needs of the customer/ population Develop service models to meet the needs Put in place structures and processes to manage the service Quality management Periodic checks to system ensure the service is meeting the needs of the customer/population Actions to address gaps identified
Identify the needs of the customer/ population Develop service models to meet the needs Put in place structures and processes to manage the service Quality management system Identify what matters Periodic checks to most ensure the service is meeting the needs of Design project and bring the customer/population together a diverse team Actions to address gaps identified Discover solutions through involving those closest to the work, test ideas, implement and then scale up
What is quality improvement?
Unpredictable Dynamic Self-organising Complex systems Adaptive Emergent Unpredictable Non-linear
The return on investment from QI Revenue Cost reduction Cost avoidance Productivity & efficiency Staff experience Patient, carer and family experience and outcomes
So, what’s our method?
AIM To reduce the use of restrictive practice (restraints, seclusion and rapid tranquilisation) by one-third by April 2020
MEASURES
CHANGES
TEST
Identify clear measures of quality for the Identify the needs of the customer/ service, and monitor these over time. population Take corrective action when Develop service models to meet appropriate the needs Internal vigilance to Put in place structures hold gains made and processes to through improvement manage the service Quality management system Identify what matters Periodic checks to most ensure the service is meeting the needs of Design project and bring the customer/population together a diverse team Actions to address gaps identified Discover solutions through involving those closest to the work, test ideas, implement and then scale up
Components of a quality control system Standard Measures work Visual Escalation management protocols
68 % Sustaining the reduction of 1 violent incidents each week
Data for learning VS Data for judgement
Everyone's Responsibilities Task Daily Weekly MonthlyAs required Tools required Red/Orange/Green/Purple dots or pens x Put dots on the safety cross as an incident happen on the ward Definition of incident types (colour dots) Printed copies for daily or monthly safety crosses Safety cross Change the safety cross (frequency depends on type of safety x x cross used by the ward) Safety Huddle book x Call/Participate/record safety huddle at least twice a day x Follow up on safety huddle plans/actions Active/Lead/Guide/participate in safety discussion in x community meetings Bring safety cross to meeting x Participate in patient led safety huddles Have access to LifeQI for violence reduction data x LifeQi log ins x Induct new starters Welcome packs Specific Responsibilities Modern Matrons/Ward Managers x Allocate who will input LifeQi data x Present and interpret data to MDT/community meetings LifeQi log ins Allocate time in away days to discuss performance (review), x compare to standards (reflect), and any actions required (react) Data to prevent detorioration Service Users x Participate in Service User led safety huddle x Induct new service users to the ward Welcome pack
Visual Management • Makes important information visible to all • Presents information in an easy to understand way by using visual signals instead of text, so that anyone can follow them easily • Designed to allow quick recognition of the information being presented to increase the response time
So, what do we all do to support each of these types of activity? Quality management system
As the team leader or manager …
I am transparent about I contribute to service planning and how the team is the commissioning process performing, and take corrective action when I put in place the structures and needed processes for service delivery I empower the team to share and solve small I support regular time problems on a daily basis for team reflection As the team I stay atuned to hard I facilitate the team and soft intelligence to and our service users leader or to identify our biggest ensure we sustain the manager … gains achieved area for improvement I bring together a diverse project team I share assurance data with the team and help I help the team find make sense of all the time to improve the various types of data service and remove barriers to this I take action to address gaps against agreed I support the team to standards share their learning
I monitor how our team is performing I listen to the feedback from our service users/customers/carers I take the initiative to raise and solve problems on a daily I share my view with basis the team about our biggest opportunity As a team I ensure my daily for improvement member … practice meets agreed standards, or justify I contribute my when I depart from change ideas to the these area that the team is currently working on I use the tools of QI I participate in to develop a strategy, assurance activities such test ideas and as audit, inspection, implement these into learning lessons daily practice
I help identify the best service model I monitor how our to meet the needs of the population, team is performing utilising my clinical expertise and knowledge of the evidence I listen to the feedback from our service users/customers/carers I take the initiative to I contribute my views raise and solve about our team’s problems on a daily biggest area of basis opportunity As the senior I ensure my daily I utilise my clinical clinician … practice meets agreed expertise and research standards, or justify knowledge to bring when I depart from ideas to the team these I support the team to involve a diverse range of people in I help identify and set the improvement work standards against which the team is measured I help the team find time to improve the I participate in assurance service and remove activities barriers to this
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