Frailty at the Front Door phase 2 Launch Event Wednesday 18 th - - PowerPoint PPT Presentation

Improvement Hub Enabling health and social care improvement

Frailty at the Front Door phase 2 Launch Event

Wednesday 18th September 2019 200 SVS, Glasgow #ihubfrailty

Wi-Fi User name: 200SVS Password: September200

Housekeeping

• Please put mobile phones on silent
• If you hear a fire alarm, please proceed to the nearest fire exit
• WiFi name: SVS200, Password: September200
• Yellow lanyards – here to help
• Sign in at registration if you require CPD/attendance certificate
• Tweet #ihubfrailty
• Evaluation forms are on tables, please fill them out throughout the

day

Aims of the day

• Discuss the programme aims and interventions
• Meet the other teams involved in the collaborative
• Agree ways of future collaborations and communication
• Support networking and improvement skills

Improvement Hub Enabling health and social care improvement

A National Collaborative

Graham Ellis National Clinical Lead, Older People and Frailty, Healthcare Improvement Scotland #ihubfrailty

Wi-Fi User name: SVS200 Password: September200

Lego

Who wants to go to the moon?

Who wants to go to the moon?

Who wants to go to the moon?

Who wants to go to the moon?

Who wants to go to the moon?

Who wants to go to the moon?

Who wants to go to the moon?

Who wants to go to the moon?

Screening Frailty unit Pathways Resource Build team Data for improvement Engagement Knowledge and skills Testing Effective MDT working

Culture

• Collective beliefs, values and

behaviours

• Change the behaviours to

change the culture

• Change the language to

change the behaviours and beliefs

Lego

Lego and Honda…

• “There is no break-through

without break up”

Lego and Honda…

• “There is no break-through

without break up”

• “When we come up with one

good idea, we keep going till we have a second…” Honda

Lego and Honda…

• “If you do what you have

always done you will get what you have always gotten” Mark Twain

Lego and Honda…

• “If you do what you have

always done you will get what you have always gotten” Mark Twain

• “The definition of insanity is

doing the same thing over and

• ver and hoping for a different
• utcome” Albert Einstein

Improvement Hub Enabling health and social care improvement

Collaborative Orientation

Jen Pennycook Associate Improvement Advisor, Healthcare Improvement Scotland

#ihubfrailty @jennypenny2006

Welcome to phase 2

Objectives

• Improve the processes for identifying frailty
• Strengthen links between secondary, primary and social

care to ensure all care options are considered

• Improve the processes for delivering early effective

comprehensive geriatric assessment

• Improve the coordinated response to frailty
• Develop improvement capacity and capability in NHS

boards using recognised quality improvement (QI) methodology.

Who are we?

Graham Ellis, Clinical Lead Geraldine Jordan, Portfolio Lead Jen Pennycook Associate Improvement Advisor Sara Turner, Project Officer Keir Robertson Information Analyst Leanne Baxter, Administrative Officer Alison Grant, Senior Project Officer Alison Redpath Data and Measurement Advisor

Who are you?

Aim

Primary Driver

Secondary Driver/Change Concept To improve outcomes and experience for older people living with frailty presenting to acute services *For the purpose of the collaborative the population

• f interest is people over 75

years of age* Rapidly and reliably identifying frailty at the front door

Early recognition of frailty

 Early recognition of frailty using a reliable screening process  Establish multi-disciplinary team to initiate CGA team with the appropriate level of autonomy to make decisions that determine the pathway of care  Ensure the team initiating CGA is available to coordinate screening and next steps as early as possible in the person’s journey to facilitate good decision making  Educate and raise awareness so that staff understand their role and expected response regarding frailty screening and assessment

Delivering early Comprehensive Geriatric Assessment (CGA)

Initiation of CGA

 Engage with patient, family, carers as early as possible to establish history, the person’s wishes and support needs  Ensure the team initiating CGA is involved at the earliest possible opportunity to commence CGA within 24 hours and diagnose, plan and direct the person to the correct pathway of care

Improving the coordination

• f care for people living with

frailty

Early, coordinated, multi-disciplinary planning



Embed a multi-disciplinary daily frailty huddle involving the team initiating CGA and representatives from hospital, community, primary and health and social care settings.



Use these huddles to support early diagnosis and holistic planning for treatment, rehabilitation, support and long term follow up



Consider the available range of care options offered locally across hospital, community, intermediate care and health and social care to ensure coordinated support is attuned to the specific needs of the person, with the focus on support at home or a homely setting wherever possible.



Optimise transitions to place of care through multi-disciplinary/multi-agency working.

Build an effective team

Conditions for successful improvement

 Provide clinical and executive leadership that aligns and supports strategic and improvement goals  Bring together teams that have the right skills and a shared purpose for improvement  Enable teams to access team coaching  Ensure that data is available that supports improvement  Understand and utilise your context to identify opportunities for improvement

What is a collaborative?

A Breakthrough Series Collaborative is a short-term (6 to 15 month) learning system that brings together a large number of teams from hospitals or clinics to seek improvement in a focused topic area.

http://www.ihi.org/resources/Pages/IHIWhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx

Frailty at the Front Door – phase 2

Sept Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr 2019 2020 2021

Frailty at the front door phase 2 Launch Event Project Surgery 1 Project Surgery 2 Project Surgery 3 End of phase event

Reporting template submitted quarterly Steering group Webex – Phase 1 & 2

Key

Frailty at the Front Door – phase1

What was most valued by participants of phase 1?

Site Visits for support & challenge Networking to share experiences Time out to think & plan HIS national role as a driver for change Support from the data team Credible clinical leadership Underpinned by open & honest communication

What could have made it better?

Be prescriptive about team make-up Be more pro-active about reporting Facilitate more peer support Provide an

• nline platform

for sharing

What have we done differently?

What do we need from you?

What do you need from us?

Data and measurement

Process measures Outcome measures Balancing measures

 Percentage of people over 75 years old who are screened for frailty on arrival to front door  Percentage of people who meet the criteria for CGA who have CGA initiated within 24 hours  Average time to specialist geriatric bed  Percentage of people discharged from geriatric medicine within 24 hours of admission to hospital  Percentage of people admitted to geriatric medicine whose length of stay is longer than 7 days  Average length of hospital stay for people admitted to geriatric medicine  Number of people discharged from geriatric medicine, who have been readmitted within 7 days  Number of people discharged from geriatric medicine, who have been re-admitted within 30 days

Workbook

Time period total time in hours and minutes to reach specialist geriatric bed following positive screen for frailty number of people referred to specialist bed by CGA team Average time to specialist geriatric bed Jan 16 #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A Time period total number of people aged 75 or more who are screened for frailty using a reliable screening tool total number of people aged 75 or

• ver in sample

% of people over 75 years old who are screened for frailty on arrival to front door Apr 17 #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A

What next?

• Data and reporting templates will

be sent to the project lead

• Project charter will be sent

electronically

• Dates will be confirmed for value

stream mapping

Dates for your diary

• 1st data submission 15th October (monthly)
• 1st Steering group WebEx 24th October
• 1st Project surgery 13th November
• 1st progress report 15th November

Contact details

Jen.pennycook@nhs.net Telephone 0131 623 4389 hcis.acutecare@nhs.net Telephone 0131 314 1253 (Sara)

Refreshment Break

Improvement Hub Enabling health and social care improvement

Highly Effective Teams

Ali Keast Specialist Lead, NHS Education for Scotland

#ihubfrailty

What is this session about?

• The characteristics commonly seen in high performing

teams, and the dysfunctions which undermine them.

• Understand your network and use that to develop your

teams influence.

• Identify sources of resilience for you and your

collaborative team.

Examples of High Performing Teams

The apple pie analogy

Michael A. West et al, Lancaster University, 2013

• 1. Do you have clear objectives?
• 2. Are there interdependencies between the roles that

require you to work together?

• 3. Do you meet regularly to review team performance?

Katzenbach & Smith Definition “A team is a small number of people with complementary skills who are committed to a common purpose, a set of performance goals, and an approach for which they hold themselves mutually accountable.”

J.R. Katzenbach and D.K. Smith, ‘The Wisdom of Teams’, Harvard Business School Press, 1993

5 Characteristics of High Performing Teams

Meaningful Common Purpose

Complimentary Skills Mutual Accountability Specific Performance Goal Strong Team Commitment

J.R. Katzenbach and D.K. Smith

Activity

Individual Think about your collaborative team. Rate the team against each of the five characteristics using the following scale.

• 3 – this is a key strength for this team
• 2 - this characteristic is present but could develop further
• 1 – this is an area of weakness and needs focussed attention

Discuss at your tables What actions can you take to support the team?

• To further develop a key strength
• To improve an area of weakness

Look at this another way

What stops teams from performing to their highest potential?

5 Dysfunctions of a Team

Inattention to

RESULTS

Lack of

COMMITMENT

Fear of

CONFLICT

Absence of

TRUST

Avoidance of

ACCOUNTABILITY

Patrick Lencioni, The Five Dysfunctions of a Team: A Leadership Fable2002

5 Dysfunctions of a Team

Lack of

COMMITMENT

Fear of

CONFLICT

Absence of

TRUST

Avoidance of

ACCOUNTABILITY

Focus on collective

OUTCOMES

Encourage

CLARITY

Mine for candid

DEBATE

Get commitment and

BUY-IN

Courage to be

VULNERABLE

Inattention to

RESULTS

Circle

• f

Influence

Circle of Concern

Our Collaborative Team A Team C Team C

Resilience is our armour to stress

5 Capabilities of Resilience

Perspective Emotional Intelligence Purpose, Values and Strengths Managing physical energy Connection

Roffey Park Institute (2014)

5 Capabilities of Resilience

Individually

• Which capability do you feel MOST resilient in?
• Which capability do you feel LEAST resilient in?
• What action will you take to support yourself now?

Systems Thinking for Everyday Work

Small group discussion

• Discuss your systems context and culture
• What are you particularly good at as a collaborative?
• What could you spend more time developing as a collaborative?
• Decide on at least 1 clear action.

Systems Thinking for Everyday Work

Lunch

Improvement Hub Enabling health and social care improvement

Learning from phase 1: Overview and Q&A

#ihubfrailty

Improvement Hub Enabling health and social care improvement

Learning from Phase 1

Alison Redpath Data & Measurement Advisor, Healthcare Improvement Scotland

What we learnt

• Data systems are complex and varied
• Analytical resource can be hard to access at sites
• Each team will have different ways of collecting data

What we are most proud of

• Being involved in site visits
• Teams recognising what help we can give

Our advice for your team

• Collect data manually until data from systems is reliable
• Review your data regularly and share it
• Ask for help from our team

Learning from phase 1: NHS Greater Glasgow & Clyde

Lara Mitchell Consultant Medicine for the elderly, clinical lead for acute site, NHS Greater Glasgow & Clyde Carolanne O’Neill Elderley Care Assistant Nurse, NHS Greater Glasgow & Clyde #ihubfrailty

What we learnt

• Have clear aims/goals
• Understand your system
• Involve stakeholders
• Share practice
• Keep the profile high at a hospital level

What we learnt

• Invest in your team- they will flourish
• Own your data and work on consistent

metrics at hospital level

• Feedback and debrief regularly
• Be brave
• Be accountable to ‘someone’

What are we most proud of? THE DATA

5 10 15 20 25 30

Short Stay ward

• pened

Short Stay ward moved

29%

reduction in LOS

20%

increased access >1000

>40

extra patients alive at home

£>3M

cost avoided

What are we most proud of? THE DATA

CARE COORDINATION Creation of a pathway. From our own data, we know double the amount of patients are getting to our wards earlier and we are taking less from the medical wards

100 200 300 400 500 600 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 Jan-18 Apr-18 Jul-18 Oct-18 Jan-19 Apr-19

Number accepted to DME from all sources

Short stay ward opens. Frailty team established

20 40 60 80 100 120 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 Jan-18 Apr-18 Jul-18 Oct-18 Jan-19 Apr-19

Number transferred directly to DME bed from Medical wards

Short stay ward opens. Frailty team established

What are you most proud of ? THE TEAM

• They look after each other
• They have great ideas
• They educate others
• They have improved the flow and

care for the older adult at QEUH

• They have changed the culture on

the ground floor and improved person centred care

The consultants trust us [ECAN nurses] to make the right decisions – we had a good relationship with them anyway, this work has made it better Change in culture on the ground floor

Our advice for your team

• Clear goals
• Data – if you can’t get it at hospital

level- DIY

• Regular reflection and team

meetings

• Everyone is an expert in something!

‘Do or do not there is no try’

Improvement Hub Enabling health and social care improvement

Learning from phase 1: NHS Forth Valley

Sarah Henderson Consultant, NHS Forth Valley Deborah Lynch Senior Quality Improvement Advisor, NHS Forth Valley

#ihubfrailty

What we learnt

• Timing
• Right people
• Approach - Structure/reporting/doers meeting
• Clear about aims – you can’t change everything in a week
• Get a Deborah – Data is the key to everything, IT systems

are not always great and manual might have to do

What we are most proud of

• Our team – everyone from FIT nurses, AHP’s, QI support,

managers, IJB’s, consultants

• Progress – changing a whole system and now starting to

think even bigger – “whole system approach to frailty”

• DATA

Screening for Frailty

Screening commenced 6th Feb call handler A/L 10 20 30 40 50 60 70 80 90 100 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18 Jul 18 Aug 18 Sep 18 Oct 18 Nov 18 Dec 18 Jan 19 Feb 19 Mar 19 Apr 19 Percentage

Percentage of people over 75 years old who are screened for frailty on arrival to front door in FVRH

Graph 1: Number of patients screened for frailty

Week 4-Feb 11-Feb 18-Feb 25-Feb 04-Mar 11-Mar 18-Mar 25-Mar 01-Apr 08-Apr 15-Apr 22-Apr 29-Apr 06-May 13-May 20-May 27-May 03-Jun 10-Jun 17-Jun 24-Jun 01-Jul Over 75 123 104 123 116 109 120 138 76 151 126 159 122 113 143 137 123 118 127 115 121 128 128 Under 75 229 139 179 198 178 175 225 89 225 205 153 191 172 168 204 162 156 145 150 165 176 174 Total 352 243 302 314 287 295 363 165 376 331 312 313 285 311 341 285 274 272 265 286 304 302

77

Week 8-Jul 15-Jul 22-Jul 29-Jul Over 75 119 112 128 120 Under 75 184 171 154 145 Total 303 283 282 265

Graph 2: % of patients 75 years and over discharged directly from CAU/AAU

*source Information Services Inpatient report

Our advice for your team

• Be clear about what you want to do so you can tell everyone

who’ll listen

• Use all those people who have agreed to help
• Persevere – you will get there
• Listen to what other people are doing, learn and then just

steal.

Improvement Hub Enabling health and social care improvement

Practical Improvement

Scott Purdie Associate Improvement Advisor, Living Well in Communities Team, Healthcare Improvement Scotland

#ihubfrailty

Outcomes for session

• 1. Making changes within a system
• 2. How to increase your chances of success
• 3. Making room for improvement

A system

Another system

What is a system

An interdependent group of items, people, or processes working together toward a common aim In practise this means…. What that practically means, people working together to achieve a shared aim

Move away from this… Move away from this…

… to this Stepping out to see the bigger picture

Move away from this

To this, a shared effort understood by all

Over to you, take 15 minutes

What steps have you taken to address the human side of change? How well do you understand the system you are working in? Are you confident you understand what may be affecting performance for your system? What information do you already have?

How to make sense of it all

Some things that will help

More sense, more questions?

Over to you, take 10 minutes

What would you hope to achieve by using them? What tools could be useful and why? Who needs to be involved? How long will you need? Any resources required?

Develop Change Ideas

• How big or small is the change
• Buy in
• Likely hood of success
• Resources required
• Can it be scaled up

Rapid testing to full scale

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

1 change, 1 test 1 change, Multiple tests Multiple changes, Multiple tests AIM AIM Measures Changes

Decision making on PDSA’s, the 4 As

• Abandon
• Amplify
• Adapt
• Adopt

Visual Management

A P D S

A P D S

A P D S

A P D S

A P D S

A P D S

D S

A P D S

AIM PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS TESTS OF CHANGE

A P D S

A P D S

A P D S

M M M M M M

Act on small rocks through testing to impact the big rocks when you scale up

Right People, Right Roles & Responsibilities

• Identify the willing and needed
• Build relationships and trust
• It takes a group
• A network of people with shared aims
• Buy in at all levels
• Roles & Responsibilities
• Decision making

Over to you, take 20 minutes

Plan and design you next steps What tasks need to be done Decide what will be test, where, how etc Who needs to be involved? How long will you need? Any resources required?

Thoughts and Questions

By now you will… 1.Understand making changes within a system 2.How to increase your chances of success 3.Make room for improvement

Refreshment Break

Improvement Hub Enabling health and social care improvement

Knowledge Hub

Sara Turner Project Officer, Healthcare Improvement Scotland

#ihubfrailty

Knowledge Hub

www.khub.net

Register to join

Register your details Once registered click on “Groups” then search for “Frailty at the Front Door”

Request to join group

Improvement Hub Enabling health and social care improvement

Team planning and next steps

Jen Pennycook Associate Improvement Advisor, Healthcare Improvement Scotland

#ihubfrailty

Important dates

• First data submission is Tuesday 15th

October

• First Project Surgery is Wednesday 13

November at Delta House, Glasgow

• First Steering Group Webex is Thursday

24th October at 2pm

Evaluation

Over to you

• Planning
• Project Charter
• Roles and

Responsibilities

• Get to know the team