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Leadership and Culture

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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

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Quality improvement Leadership and culture

@ELFT_QI qi.eastlondon.nhs.uk

Mental health services

Newham, Tower Hamlets, City & Hackney

Forensic services

All above & Waltham Forest, Redbridge, Barking & Dagenham, Havering

Child & Adolescent services, including tier 4 inpatient service Regional Mother & Baby unit Community health services

Newham

Urgent care centre

Newham

IAPT

Newham, Richmond and Luton

Speech & Language

Barnet

Challenges and

• pportunities

in East London

Cultural diversity Social deprivation Geographical diversity Commissioning arrangements Financial stability and strong assurance systems

Our quality improvement programme

Why?

The strategic case for change

Make quality our absolute priority

• Improving

quality of care is our core purpose

• Of greatest

importance to all our stakeholders

• Build on the

excellent work already happening to improve quality National drivers

• The need to

focus on a more compassionate, caring service with patients first and foremost

• More

structured and bottom-up approach to improvement Enable our staff to lead change

• The desire to

engage, free and support

• ur staff to

innovate and drive change

• Engaged and

motivated staff leads to improved patient

• utcomes

The economic climate

• The need to do

more with less – improving quality whilst reducing cost

The culture we want to nurture

A listening and learning

• rganisation

Empowering staff to drive improvement Increasing transparency and openness Re-balancing quality control, assurance and improvement Patients, carers and families at the heart of all we do

Our quality improvement programme

How?

AIM: To provide the highest quality mental health and community care in England by 2020

Build the will

Build improvement capability

Alignment QI Projects

• 1. Launch event & roadshows
• 2. Microsite
• 3. Using the power of narrative
• 4. Celebrate successes
• 5. Network of champions / ambassadors
• 6. Learning events
• 1. Initial assessment of alignment & capability
• 2. Recruiting central QI team
• 3. Online training
• 4. Face-to-face training
• 5. Follow-up coaching on projects
• 6. Develop in-house training for 2016 onwards
• 1. Align all projects with improvement aims
• 2. Align team / service goals with improvement aims
• 3. Align all corporate and support systems
• 4. Patient and carer involvement in all improvement

work

• 5. Embed improvement within management structures

Reducing Harm by 30% every year

• 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

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

AIM: To provide the highest quality mental health and community care in England by 2020

Build the will

QI microsite the online hub for the programme qi.eastlondon.nhs.uk Staff and service user newsletter reaches 4000 people every month QI launch event and roadshows attended by over 1000 staff, service users and carers Bespoke QI learning events for staff, service users, commissioners, governors

AIM: To provide the highest quality mental health and community care in England by 2020 Build improvement capability

Face to face improvement training

• hundreds of staff, services users,

Governors to be trained over the next few years Support for improvement work from the Trust’s QI team IHI Open School available to all Strategic partnership with IHI

Experts Front line staff Clinical leaders Directorate improvement leads Board

Estimated number = 3300 Requirement = introduction to quality improvement, identifying problems, change ideas, testing and measuring change Time-frame = train 10-20% in 2 years Estimated number = 250 Requirement = deeper understanding

• f improvement methodology,

measurement and using data, leading teams in QI Time-frame = train 30-50% in 2 years Estimated number = 30 Requirement = deeper understanding

• f improvement methodology,

understanding variation, coaching teams and individuals Time-frame = train 100% in 2 years Estimated number = 10 Requirement = setting direction and big goals, executive leadership,

• versight of improvement, being a

champion, understanding variation to lead Time-frame = train 100% in 2 years Estimated number = 5 Requirement = deep statistical process control, deep improvement methods, effective plans for implementation & spread Time-frame = train 100% in 2 years

Where are we?

On track to train over 500 people through 5 six-month waves of learning between 2014-16. First 3 waves delivered with the IHI On track. All senior staff being encouraged to join QI training over next 2 years New need recognised. Developing improvement coaches programme will train 30 QI coaches in 2015 On track. Most Executives will have undertaken the ISIA, and Board training has been delivered in 2015. Currently have 3 improvement advisors, with 1.5wte deployed to QI. Will need to build more capacity at this level.

AIM: To provide the highest quality mental health and community care in England by 2020

A process is in place for teams to submit project ideas to the QI team, who will help with planning, structure and measurement, and ensure projects are aligned with our high- level aims.

Alignment

Quality improvement programme-project support structures

AIM: To provide the highest quality mental health and community care in England by 2020

QI Projects

QI Projects – 100+ active projects across Trust Directorates, teams are working on improvement projects that support our ambition to Reducing Harm by 30% every year and deliver Right care, right place, right time Improving Physical Health Monitoring Following Rapid Tranquillisation Reducing violence on inpatient wards Improving the handover process for on-call doctors

Reducing harm by 30% every year

0.1 1 10 100 1000

04/01/12 18/02/12 25/02/12 07/03/12 23/03/12 30/03/12 31/03/12 17/04/12 19/04/12 09/05/12 04/06/12 17/06/12 22/06/12 17/07/12 30/07/12 28/08/12 11/09/12 17/09/12 21/09/12 10/10/12 07/11/12 09/01/13 20/04/13 17/05/13 02/07/13 08/10/13 11/10/13

Days between incidents of physical violence

Days between incidents of physical violence

• Globe adult acute ward – (T Chart)

BVC introduced 0.1 1 10 100

Days between incidents of physical violence

• 3 older adult wards (T Chart)

Inpatient violence

Organisation level data

STAFF EXPERIENCE AND SATISFACTION

55 60 65 70 75 80 85 90

2010 2011 2012 2013 2014 Score (%) Staff feeling satisfied with the quality of work and patients care they are able to deliver

80 83 86 89 92 95 98

2010 2011 2012 2013 2014 Score (%) Staff agreeing that their role makes a difference to patients

3.6 3.7 3.8 3.9 4 4.1 4.2

2010 2011 2012 2013 2014 Score Effective Team Working

55 65 75 85 95

2010 2011 2012 2013 2014 Score (%) Staff reporting errors, near misses or incidents witnessed in last month

10 20 30 40 50

2010 2011 2012 2013 2014 Score (%) Staff experiencing physical violence from patients / relatives / or the public in last 12 months

55 60 65 70 75 80 85

2010 2011 2012 2013 2014 Score (%) Staff able to contribute towards improvements at work

3.4 3.5 3.6 3.7 3.8 3.9 4

2010 2011 2012 2013 2014 Score Staff job satisfaction

3 3.2 3.4 3.6 3.8 4 4.2

2010 2011 2012 2013 2014 Score Staff recommendation of the trust as a place to work or receive treatment

3.5 3.6 3.7 3.8 3.9 4 4.1

2010 2011 2012 2013 2014 Score Staff Motivation at Work

Leading cultural transformation through QI

Building will

Build a broad coalition for change Take time to bring people with you Shift decision- making to the edge Develop a compelling narrative Find some clear signals

• f change

Use the power

• f stories

Take every

• pportunity to

celebrate

Building capability & capacity

Be prepared to invest Train all levels and across disciplines Realign existing resources Stop lower value work

Alignment & integration

Start at the top Create a support structure Build a learning system Ensure patients and carers are integral Ensure the context is ripe Line of sight from team to system goals

QI Team QI Resources Project Sponsor QI Forums

Think big. Start small. Move fast.

Organisational culture is created by what leaders pay attention to…

web qi.eastlondon.nhs.uk email qi@eastlondon.nhs.uk @ELFT_QI

Service User Leadership and Culture

Joyce Mouriki, VOX’s chairperson Wendy McAuslan, VOX’s Development Coordinator

Leaders don’t create followers.. they create more leaders Tom Peters

Agreed Understanding of Leadership?

Mary O’Hagen, Leadership for empowerment and equality, International Journal of Leadership, December 2009 Conventional Leadership Service User Leadership

Focuses on the ‘how’ of leadership, not its purpose. The purpose of leadership is equality and empowerment for peers. Denies the darker forces at play, such as power User/survivor experience ‘power over’ has left them suspicious of it and in need of a model of power with leadership Focuses on the individual leader as hero who takes away responsibility from followers. A broad definition of leadership and a belief in sharing it. Lacks inquiry about personal and social factors that shape leadership. Knowledge base is one of lived experience.

Important Elements in Service User Leadership

Personal development through the experience of mental distress. Empathy for other service users/patients. Ability to encourage others to use their strengths and resources. Ability to relate to diverse groups of service users/patients. Ability to be non-judgemental

VOX Leadership Program

An asset based community development approach

• recruits and trains a number of “community leaders”
• focuses on key populations who experience structural

and mental health inequalities

• creates peer leaders who are best placed to challenge

stigma and discrimination

• peer leaders can provide specific training sessions to

diverse groups and organisations using a community conversations approach

General population approach-Developing leadership in order to;

• Support patients to have a greater awareness of their situation

so that they can make informed decisions and choices; e.g. encourage using advocacy

• Support patients to have more control over the direction of

their lives; e.g. support the development of advance statements

• Understand the patients perspective e.g. develop tools which

tap into their views (patient safety climate tool)

• and challenge stigma, injustice and social exclusion (in

conjunction with practitioners and members of the wider community)

Ultimate Aim Shared Leadership?

• Shared purpose and collective goals
• Social support - recognition of everyones’

contributions and accomplishments.

• Voice – the degree of input.

Carson et al. (2007)]

Patient Safety Climate Tool

Has been used in 11 boards with 300 service users

Service user leadership myth or reality?

• Methods to demonstrate better outcomes – example

community conversations

• Shared learning – events co facilitated by service user

leads- better shared understanding

• Tools designed by service users for service users –

implemented jointly for maximum benefit

• And continuous improvement

Who can help? - to find out more about VOX contact Wendy

www.voxscotland.org.uk Wendy McAuslan wmcauslan@mentalhealth.org.uk 0141 572 1663

Questions and Answers David Hall Amar Shah Kevin Cleary Joyce Mouriki, MBE Wendy McAuslan

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Leadership and Culture Essentials

• Patient Safety Climate Tool
• Staff Climate Tool
• Leadership walkrounds/ safety conversations
• Learning from adverse events

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Workstream essentials – questions/issues

• Are they correct?
• If not, what should they be?
• What are we already doing?
• What change packages, bundles, interventions

should be developed and tested to deliver them?

Lunch – available outside Strathallan Foyer and opposite Stuart Lounge Storyboard viewing – Strathallan Drop in data surgery - Glenallan