Improvement Fellows Spring Networking event Wednesday 1 st March - - PowerPoint PPT Presentation

Improvement Fellows’ Spring Networking event

Wednesday 1st March 2017 Leeds

e: academy@yhahsn.nhs.uk / t: 01274 383966 www.improvementacademy.org

Our # for the event

#ImprovementFellows

@improvementacademy

Housekeeping

Welcome and introduction

Rebecca Lawton

Academic Advisor & Professor, Psychology of Healthcare Improvement Academy / University of Leeds

Programme

13.15 Introduction to Q Clare Ashby & Georgina Denis 14.00 Learning Bites: sharing improvement

• Skype’s the limit
• Implementing Safety Huddles in EOC
• Trust me I am your patient
• Reducing wait time from request for TTOs

Facilitated by Clare Ashby

• Dr Angela O’Donoghue
• Clare Ashby
• Graham Prestwich & Marilyn Foster
• Donald Richardson

14.45 Refreshments and Networking Georgina Denis available at the Health Foundation Q stand 15.15 Measuring safety culture in the Southwest Dr Matt Hill 15.45 Safety culture reflections and discussion Prof Mohammed A Mohammed 16.00 Finish

Improving patient care

The Yorkshire and Humber Patient Safety Translational Research Centre

University of Leeds AND Bradford Teaching Hospital Foundation Trust

Who are we?

2016 – £3.2 million research funding secured by theme leads 2016 - 19 publications by theme leads, 7 with international collaborators

Where are we?

900 Serious events 153,000 Patient Safety Incidents Regional NIHR CLAHRC Regional AHSN Improvement Academy Regional Patient Safety Collaborative

What will we do?

• Increase funding for research in patient safety and

implementation science

• Create centralized and coordinated oversight of patient

safety

• Address safety across the entire care continuum
• Support the health care workforce
• Partner with patients and families for the safest care
• Ensure that technology is safe and optimized to improve

patient safety

• Ensure that leaders establish and sustain a safety culture
• Create a common set of safety metrics that reflect

meaningful outcomes

Gandhi TK, Berwick DM, Shojania KG. Patient Safety at the Crossroads. JAMA. 2016;315(17):1829-1830. doi:10.1001/jama.2016.1759

Our ambition

Research that makes healthcare safer

Thank you for listening

Q: connecting people across the UK

Clare Ashby & Georgie Denis 1 March 2017

Contents

• 1. What Q is
• 2. What Q offers
• 3. How people can join
• 4. Q&A

What is Q?

• A connected community working

together to improve health and care quality across the UK

• Supports people in their existing

improvement work: making it easier to share ideas, enhance skills and make changes that benefit patients

15

Collaboratively designed

• Initial scoping: 300+ people fed in ideas
• Designed with 231 founding members – diverse

cross section of improvers from across the UK

What Q offers

What Q offers

What Q offers

What Q offers

Who can join Q?

Anticipating 1000s of members from all backgrounds Applicants need to demonstrate:

• Experience and understanding of improvement
• Thoughtful commitment to Q
• Decision Tree - is Q for you?

Growing Q

May 2015: 231 founding cohort Oct 2016: 216 pilot including:

• National
• rganisations
• Patient leaders

with national profile

Phased opportunities to apply:

November 2016

March 2017

May/August 2017

Recruitment in Yorkshire and Humber

Applications open on 9-3-17 and close on 10-4-17 Suggesting all Improvement Fellows consider a Q application Application portal link: https://aims.health.org.uk/register/ AIMS user manual: https://q.health.org.uk/wp- content/uploads/2016/11/AIMS-Applicant-User-Guide.pdf Not sure? Attend a Q drop in session with Clare Ashby on: 9th March, 13th March, 22nd March, 28th March, 6th April in the Improvement Academy

Looking forward

By 2020:

• Established large-scale, long-term home for improvers
• Connecting locally, regionally and nationally
• Vibrant community tackling local and cross-system priorities

Reactions? Questions?

Thank you

Visit us online: http://q.health.org.uk Email the Health Foundation: Q@health.org.uk Follow us on Twitter: @theQCommunity #theqinitiative

Learning Bites

Facilitated by Clare Ashby

Skype’s the Limit: a digital solution to patient demand

Dr Angela O’Donoghue GP, Harrogate CCG

Small rural surgery: 5700 Patients

What is the demand?

Better continuity, better capacity

Reduced waiting times in Mins

Patients driving QI: Continual Feedback

INSTAGRAM BUSINESS CARD

Instagram

Social Media Strategy

Joe Blunden- NHS elect

Shine studies

North Yorkshire GPs to offer digital appointments

Human Factors Analysis and Safety Huddles

March 2017

Clare Ashby, Head of Safety Yorkshire Ambulance Service

What are human factors?

Human factors is the science of understanding human performance within a given system. Translated into a healthcare context, human factors has been defined as: “Enhancing clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture,

• rganization on human behaviour and abilities, and application
• f that knowledge in clinical settings.” Catchpole, 2011

Human factors are found in design, in teamwork, in incident investigations and in working in the real world.

Human factors benefits

Reduction of harm through better design of healthcare systems and equipment Understanding why healthcare staff make errors and how ‘systems factors’ threaten patient safety Improving the safety culture of teams and

• rganisations

Enhancing teamwork and improving communication between healthcare staff Improving how we learn when things go wrong Predicting ‘what could go wrong’

Working together to make things better

Human factors EOC analysis

Working together to make things better Human factor category Number of incidents Number of complaints Situational awareness 83 1 Communications 57 5 Decision making 136 28 Team Working 125 1 Leadership 13 Managing stress 7 3 Coping with fatigue 1 Total for year 459 38

Human factor examples

DESCISION MAKING EMD - Fast, time pressured, reliant on what they tell you, what you hear – spell street wrong, spell medication wrong, = wrong address or wrong drug noted - possible patient harm TEAM WORKING Dispatcher – under pressure, many jobs at once, not up to date with SOP, bariatric case, can’t identify ISU, can’t identify staff to assist – possible patient harm COMMUNICATION EMD or Dispatcher – fail to pass on information about scene safety – unwarranted stand off – possible patient harm

Human factors & safety huddles

Safety huddles - ignite a spirit of learning

“We are achieving results now, that none of us thought were possible 12 months ago”

Consultant Medicine for Older People, LTHT

Addressing Teamwork+Safety Culture Celebrating success Making measurement visible

Safety Culture improved

Safety Huddle key characteristics

Focused meeting about one or more agreed harm/s Informed by QI tools and visual feedback Senior clinical leadership Agreed actions - set of team/individual actions (aimed at reducing risk of patient harm) Daily (Monday - Friday as minimum) - same time and place Brief (5-15 minutes) Multidisciplinary ALL the frontline team Celebration, celebration, celebration!!

Human factors benefits

Reduction of harm through better design of healthcare systems and equipment Understanding why healthcare staff make errors and how ‘systems factors’ threaten patient safety Improving the safety culture of teams and

• rganisations

Enhancing teamwork and improving communication between healthcare staff Improving how we learn when things go wrong Predicting ‘what could go wrong’

Can safety huddles help us address this?

Safety Huddle EOC feedback

Many issues were discussed and ideas/solutions taken away from this

It’s a step forward

Great for brainstorming ideas, concerns and expectations I was initially sceptical, however now feel they are invaluable

I felt included in the discussions

Good to get point of view of

• ther disciplines in relaxed
• atmosphere. Feel more

valued and part of bigger team

I think it is a good to discuss things in this way and get everyone's in put

Yes, as patient safety should always be a concern

Safety Huddle EOC characteristics

Were there any safety events or significant near misses in the last 12/24 hours? Have there been any threats to patient safety recently and are there any safety issues that may impact on our ability to provide safe care today? Are we dealing with any situations that detract from

• ur ability to focus on safe care delivery to patients?

Do we have any high-risk procedures or deficiencies in equipment supplies, staffing or skill mix that may act as a barrier to safe delivery of care?

Safety Huddle EOC communication

Potential items of discussion may include;

• Incidents
• staffing levels (CMS/Dispatch/Operational)
• performance (EOC & Operational)
• skill mix, sickness absence & RTWs
• traffic reports & weather
• vehicle availability & shortfalls
• staff welfare issues
• hospital & on scene delays
• equipment availability/reliability (including IT)

newly implemented/recently updated procedures

Safety Huddle key characteristics

Focused meeting about one or more agreed harm/s Informed by QI tools and visual feedback Senior clinical leadership Agreed actions - set of team/individual actions (aimed at reducing risk of patient harm) Daily (Monday - Friday as minimum) - same time and place Brief (5-15 minutes) Multidisciplinary ALL the frontline team Celebration, celebration, celebration????

Safety Huddle important elements

Informed by QI tools and visual feedback Celebration, celebration, celebration???? Ideas for what is possible in EOC? What measurements can we use? How can we display them easily? How do we celebrate our success?

EOC the next steps

Spread of safety huddles and human factor work to continue Think about how you can get involved! Displays of measurement, learning and celebration How do you work as a team? How do you learn as a team? Is patient safety central to all you do?

Questions

‘Trust me I am your patient’ Establishing a movement of Lay fellows

Graham Prestwich & Marilyn Foster Lay Improvement Fellows/’Patient experts’

Graham Prestwich

Lay Member Leeds Area Prescribing Committee

• Achieving desired outcomes of care is far

more important and far more valuable than just delivering processes of care.

• Patients and carers make a critical

contribution to achieving the desired and expected outcomes from medicines

• Patient led initiative ‘sponsored’ by The Leeds

Area Prescribing Committee

• Patients identified the problem ‘unresolved issues’
• Patient focus groups identified what is important
• Patients in partnership are part of the solution

(innovation) x (n) x (effective communications) = Likelihood of making a real difference

@MrGPrestwich

Marilyn

• Importance of Self Care & Prevention
• Self Care –Patient involvement
• Move from Crisis Care to Prevention -

breaking the cycle

• Difficult but essential to achieve
• How I personally contribute.

Questions? Thoughts / feedback to:

Claire.marsh@bthft.nhs.uk

Reducing the wait time from request for TTOs

Dr Donald Richardson York Hospitals NHSFT

Problem

Improvement in a complex system

is complicated!

0 hours 1 2 3 4 5 6hours

?

Pharmacy Audit -2015

Actions

• Planning more discharges in advance so that more

patients can be discharged before 11am

• Communicating discharges to pharmacy more

effectively

• Reducing the gap between patients being informed

about their discharge, pharmacy being informed and the discharge prescription being written

– Actions in parallel are much better

• Developing a discharge pledge about the completion

time for discharge prescriptions received by pharmacy and responsibilities of all staff.

Highlighting the planned discharge date for all patients

Validated by pharmacist

• to ensure accuracy of information
• allows the pharmacist to review the patient’s

drug chart and medical notes

• and speak to the patient

Reconcile medications

Access to pharmacist

• Ensuring wards are informed each day who

their ward pharmacist is

• How to contact them when discharge

prescriptions are required.

• All staff urged to contact pharmacists asap
• For urgent discharge prescriptions, the

pharmacy discharge team can also be contacted within pharmacy opening hours

Remove reliance on in hours pharmacy

• Making pre-packs of commonly prescribed

medicines available.

– These can be supplied directly from the ward on discharge

• Outsourced dispensing partner in York

– To validate and dispense discharge prescriptions after the hospital pharmacy has closed

Reviewing and monitoring workflow in the pharmacy dept (inc dispensary)

• Patient boards for TTOs

– Symbol for TTOs – Colour coding for pharmacy action

• Pharmacy discharge teams

– Second team geographically based

Highlighting the planned discharge date for all patients

Discharge TTOs process

• Planning discharges
• Doctors ordering TTOs
• Communicating required order to pharmacist
• Validating Order
• Processing order
• Dispensing prescription

All for a purple tick!

7 minutes reduction

NATALIE ALIE BR BRYE YERS RS, , ALA LAYA YA KH KHATUN UN GA GARY Y HA HARDCAST DCASTLE LE

Thanks to

Discharge prescriptions

• Highlighting the planned discharge date for all patients on the Core Patient Database (CPD) so this

can be worked towards by all healthcare professionals.

• Producing an accurate list of all the medicines a patient is taking on discharge, including medicines

that have been stopped and the reasons for this. This is produced electronically to ensure that the information is clear and is supplied to the GP in a timely way.

• Ensuring that discharge prescriptions are validated by a pharmacist at ward level prior to them

being dispensed. This is to ensure accuracy of information and allows the pharmacist to review the patient’s drug chart and medical notes and speak to the patient. It also ensures that patient’s own medicines and medicines supplied for them during their admission are checked and used wherever possible.

• Ensuring wards are informed each day who their ward pharmacist in and how to contact them

when discharge prescriptions are required. For urgent discharge prescriptions, the pharmacy discharge team can also be contacted within pharmacy opening hours.

• Making pre-packs of commonly prescribed medicines available. These can be supplied directly from

the ward on discharge.

• Enabling Healthcare at Home, the outsourcing dispensing partner in York to validate and dispense

discharge prescriptions after the hospital pharmacy has closed. This service is available until 8pm for wards in York that have been identified as having high numbers of admissions and discharges.

• Reviewing and monitoring workflow in the pharmacy dispensary to ensure efficiency and continual

service improvement.

Refreshments and Networking

Georgina Denis available at Q stand

#ImprovementFellows

Safety Culture Where are we now?

1st March 2017

Matt Hill, Consultant Anaesthetist & Regional Patient Safety Lead

2/19/2019

Where I started……

Why measure safety culture?

Performance = capability x behaviour

2/19/2019

Surveying

• Paper & manual entry
• Paper and scanning
• Web-based
• Automatic analysis
• Safe and Reliable

Healthcare

The Bidet effect – Phil Hammond

SAQ v SCORE SAQ

• Job Satisfaction
• Working Conditions
• Stress recognition
• Perception of Management
• Teamwork
• Safety Climate

SCORE

• Work/life Balance
• Learning Environment
• Resilience
• Local

leadership/Management

• Teamwork
• Safety Climate

Teamwork Climate

Safety Climate

Survey Domains

Domain Definition Learning Environment Learning measures the ability of a work setting to self- reflect, identify problems and solve them Local Leadership Measures the level of confidence that respondents have in the support they receive from their local leaders including positive feedback Burnout and Resilience Measures the degree of cynicism that respondents feel and is linked to absenteeism, poor staff retention, low staff morale, poor performance, disturbed sleep and all cause mortality for the respondent, but also the clinical

• utcomes of their patients

Teamwork Measures how effectively different disciplines coordinate their efforts and whether they work in a psychologically safe environment Safety Measures the degree to which mindfulness and psychological safety exist in the work setting

2/19/2019

Value

“SCORE has given us a valuable way of delving down into a deeper layer of understanding and insight...and to continue to develop, grow and thrive but in a more healthy and sustainable way!” “Sometimes, we are so service focussed that we forget that we are people – staff health and wellbeing is as important as the care we provide… it is crucial to build resilience and sustainability.” Associate Director, Mental Health Trust

Teamwork

Teamwork

Local Leadership Domain

Safe and Reliable Healthcare

...communicates their expectations

to me about my performance.

...provides meaningful feedback to

people about their performance.

...provides useful feedback about

my performance.

...provides frequent feedback

about my performance.

...regularly makes time to pause

and reflect with me about my work.

...regularly makes time to provide

positive feedback to me about how I am doing.

69 % 48 % % 37 % 39 % 34 % 34 % 38

In this work setting, local leadership... is available at predictable times.

Teamwork Domain

Safe and Reliable Healthcare

Disagreements in this work setting are appropriately resolved ie not who is right but what is best for the patient Communication breakdowns are NOT common when this work setting interacts with other work settings Communication breakdowns are NOT common in this work setting. Dealing with difficult colleagues is NOT consistently a challenging part of my job The people here from different disciplines/backgrounds work together as a well co-ordinated team It is easy for personnel here to ask questions when there is something that they do not understand. In this work setting, it is NOT difficult to speak up if I perceive a problem with patient

care.

% 63 % 17 33 % % 37 % 84 91 % % 73

Safety Climate Domain

Safe and Reliable Healthcare

My suggestions about quality would be acted upon if I expressed them to management

The values of the organisations leadership are the same values that people in this work setting think are important. In this work setting, it is NOT difficult to discuss errors I would feel safe being treated here as a patient. The culture in this work setting makes it easy to learn from the errors of

• thers

I receive appropriate feedback about my performance Errors are handled appropriately in this work setting

50 % 46 % % 60 85 % 58 % % 36 % 68

matt.hill1@nhs.net

Safety culture reflections and discussion

• Prof. Mohammed Amin Mohammed

Professor of Healthcare, Quality & Effectiveness, University of Bradford

Questions?

#ImprovementFellows

Forthcoming Improvement Academy Events

15th Mar 2017 Problem Structuring Masterclass, The Studio, Leeds 21st Apr 2017 Achieving Behaviour Change (Leadership Fellows), The Studio, Leeds 26th Apr 2017 Silver Quality Improvement Training, Principal York Hotel, York 13th Jul 2017 Silver Quality Improvement Training, Cedar Court Hotel, Wakefield 26th May 2017 Achieving Behaviour Change (open to all), The Studio, Leeds www.improvementacademy.org

Thank you for attending

#ImprovementFellows

e: academy@yhahsn.nhs.uk / t: 01274 383966 www.improvementacademy.org