KQuIP DAYLiFe: Home Dialysis improvement programme Launch Event - - PowerPoint PPT Presentation

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KQuIP DAYLiFe: Home Dialysis improvement programme Launch Event - - PowerPoint PPT Presentation

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KQuIP DAYLiFe: Home Dialysis improvement programme Launch Event Master Slide Deck| Version 0.1 East and West Midlands - 30 January 2019 KQuIP Welcome and introductions Set up the day Richard Fluck, Project Lead Daljit Hothi, Project Lead

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KQuIP

DAYLiFe: Home Dialysis improvement programme – Launch Event

Master Slide Deck| Version 0.1

East and West Midlands - 30 January 2019

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Kidney Quality Improvement Partnership | Launch Event 2

KQuIP

Welcome and introductions Set up the day

Richard Fluck, Project Lead Daljit Hothi, Project Lead

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DAYLiFe: Home Dia ialysis im improvement programme

Richard Fluck

Consultant Renal Physician and Honorary Associate Professor

Department of Renal Medicine, Royal Derby Hospital & Centre for Kidney Research and Innovation Division of Health Sciences and Graduate Entry Medicine University of Nottingham

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Housekeeping and survival

Fire alarms and exits… Car Park … Toilet location… Mobiles and pagers… Photos… Breaks…

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Kidney Quality Improvement Partnership | Launch Event 5

KQuIP 09:35

Part 2 - KQuIP / The project - What will success look like

  • What is KQuIP / What is the project / KQuIP Partners Introductions
  • Variation in provision

Richard Fluck, Project Lead Daljit Hothi, Project Lead

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Objectives

  • Improve the care of people with end stage renal disease
  • Address variation
  • Reduce unmet need
  • Improve reliability
  • Minimise harm
  • Success is not a number (although measuring it helps)
  • Measurement for improvement – not judgement

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UK Renal Registry 19th Annual Report

Figure 13.16. Dialysis modality use by nation, 2014

International variation

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2017 Annual Data Report Volume 2, Chapter 1

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Variation by region (USA) vol 2 Figure 1.14 Map of the percentage of incident dialysis cases using home dialysis (peritoneal dialysis or home hemodialysis), by Health Service Area, 2011-2015

Data Source: Special analyses, USRDS ESRD Database. Values for cells with 10 or fewer patients are suppressed.

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UK Renal Registry 19th Annual Report

Figure 2.10. Detailed dialysis modality changes in prevalent RRT patients from 2000–2015

∗Scottish centres excluded as information on satellite HD was not available

Temporal changes: UK

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Defining success

  • You will be considering this as part of your process map, primary

drivers and measurement

  • At a national level, success will be a composite of
  • 1) increased numbers of people on home dialysis
  • 2) Improved patient experience and reported outcomes
  • 3) improved patient outcomes

Kidney Quality Improvement Partnership | Launch Event 10

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Kidney Quality Improvement Partnership | Launch Event 11

An introduction to our partners 09:42

Partnering Organisations - Kidney Care UK, Baxter and NxStage

Ann Cole, Baxter Matt Walker, NxStage Sandy Lines, Kidney Care UK

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Kidney Quality Improvement Partnership | Launch Event 12

KQuIP 9:45

Listening to people: a patient journey

Sam Mitchell, Patient

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Kidney Quality Improvement Partnership | Launch Event 13

KQuIP 10:05

Current position - Registry Data

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UK Renal Registry data 2012 and 2017

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9.8 14.8 21.4 28.7 26.2 15.5 18.8 17.3 21.8 23.2 18.2 13.9 13.1 25.1 19.9 9.1 15.4 16.7 18.3 13.8 3.3 4.0 3.9 8.1 7.2 5.9 7.8 7.2 6.0 5.0 4.3 4.1 3.8 14.3 6.5 6.7 7.5 10.0 5.8 9.2 86.9 81.2 74.7 63.2 66.7 78.6 73.5 75.5 72.2 71.8 77.5 81.9 83.1 60.6 73.6 84.3 77.2 73.3 76.0 77.0

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Percentage of patients

ICHD HHD PD

2012 2017

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Kidney Quality Improvement Partnership | Launch Event 15

10:15 working in individuals units for 20 minutes and prepare to feedback to room

Identify 3 things you have done well Identify 3 challenges for you

10:40 feedback to room (5 minutes per centre)

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Kidney Quality Improvement Partnership | Launch Event 16

KQuIP 11:30 you have a 15 minute break

Coffee

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Kidney Quality Improvement Partnership | Launch Event 17

KQuIP 11:45

Introduction to Launch of the project with a Q&A Open discussion across tables: spend 10 minutes in your mini networks: no need to feedback but compare your dreams and challenges – how will you help each other?

Richard Fluck, Project Lead Units

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NHS change model

Kidney Quality Improvement Partnership | Launch Event 18

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Transforming Participation 2 www.thinkkidneys.nhs.uk/ckd

TP2 change model

  • PDSA cycles
  • Process mapping
  • Driver diagram
  • SPC
  • TP2 programme

management

  • Run charts
  • Patient measures (YHS)
  • Medical outcomes (UKRR)
  • System measures (use of resource)
  • NHSE Long Term Plan
  • Personalised care strategy
  • Working group at

unit level

  • Engage wider

team with context/aims and purpose of programme

  • Invite influencers

to peer assist day

  • Logistics of survey returns
  • Use of Patient View for sustainable

collection

  • Success requires

leadership and support at all levels

  • Potential for registry to

support Shortsmoor training for TP2 leaders

18/12/2018

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Kidney Quality Improvement Partnership | Launch Event 20

Unit QI Project Lead Variation Organisation Variation Style Variation QE 23 19-28 27 23-34 18 15-21 Heartlands Coventry 21 20-22 29 28-30 21 16-25 Wolverhampton 26 25-27 30 28-33 15 14-17 Dudley 22 / 28 21

  • N. Midlands

22 22-23 23 23-24 14 14 Shrewsbury 26 24-26 22 18 Leicester 20 18-23 24 24-26 15 13-17 Nottingham 22 20-26 24 20-30 17 12-19 Derby 27 25-27 29 29-33 20 18-24

Are you ready for change - Results

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Patient perspective: drivers for change

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Processes, choice and shared decision making

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Think about patient flow: process measures

  • Selection
  • Initiation
  • Maintenance
  • Drop out

Start PD pathway Plan dialysis access - insert PD catheter Patient and MDT sign off for PD pathway Assess for suitability– clinical, patient factors and home suitability Screen low clearance, Prevalent HD, Incident HD, Failed Tx Identify potential PD patients through shared decision making Figure 4 PD pathway adapted from Perit Dial Int. 2013 May-Jun;33(3):233-41. doi: 10.3747/pdi.2012.00119.Peritoneal dialysis and the process of modality selection. Blake PG, Quinn RR, Oliver MJ. 24 Kidney Quality Improvement Partnership | Launch Event

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QI techniques – a brief overview

What you will work on today

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QI is not a religion

  • Things to get comfortable with
  • A driver diagram – designed to focus you on the objective whilst breaking it down

into doable chunks

  • A process map – how do patients flow through your system
  • Measures – a mix of simple measures captured at least monthly to allow you to

check whether change has happened

  • Statistical process control charts – not as bad as it sounds
  • PDSA cycles – simple tests of a change

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Web system to support you

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Project management

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Statistical process control charts

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This is for another day!

  • Bedtime reading
  • https://improvement.nhs.uk/documents/2748/NHS_MAKING_DATA_

COUNT_FINAL.pdf

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Kidney Quality Improvement Partnership | Launch Event 31

KQuIP 11:45

Introduction to Launch of the project with a Q&A Open discussion across tables: spend 10 minutes in your mini networks: no need to feedback but compare your dreams and challenges – how will you help each other?

Richard Fluck, Project Lead Units

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Kidney Quality Improvement Partnership | Launch Event 32

KQuIP 12:30

Driver diagram and measurement for improvement (Think about this over lunch)

Richard Fluck, Project Lead Daljit Hothi, Project Lead

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KQuIP UK National Home Dialysis QI Project DAYLiFe: Dialysis at yours: Life fulfilled

To increase the proportion of patients on home dialysis therapies in England

Clear Vision & Purpose

Leadership

i) Organisational ii) Medical iii) Nursing iv) Patient Leadership

Organisational Culture

Values, behaviours & mindset

Expertise [Knowledge& skills]

Patients

Determining ‘suitable’ home dialysis patients

Develop patient exclusion criteria, dependent on local expertise

Home dialysis training

Effectiveness & experience of training pathway

Patient awareness, recruitment & retention

Patient Education & Informed Choice; Patient & carer experience; Peer support; Carer support

Organisational Infrastructure

Financial support Training facilities Commissioning dialysis consumables and machines Home modifications Access to respite care Multidisciplinary team supported by community team

DRIVER DIAGRAM: Home Dialysis

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Measures: the Donabedian model

  • Remember to include
  • Patient centred measures
  • Balancing measures
  • What can you collect routinely?
  • What can the registry supply?
  • How would you present it?

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Kidney Quality Improvement Partnership | Launch Event 36

KQuIP

Lunch 12:45 – network, relax, recharge, think

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Kidney Quality Improvement Partnership | Launch Event 37

KQuIP 13:45 until 14:25

Group Activity

  • Review and finalise driver diagram – Unit and mini

networks level discussions

  • Discuss and agree measures for each unit – Include base

measures.

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Measures: the Donabedian model

  • Remember to include
  • Patient centred measures
  • Balancing measures
  • What can you collect routinely?
  • What can the registry supply?
  • How would you present it?

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Measurement model: use your driver diagram

Balancing measures Balancing measures

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Kidney Quality Improvement Partnership | Launch Event 41

KQuIP 14:25

Feedback session 5 minutes per mini network What is your primary driver statement? What measures have you identified across your driver diagram?

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Kidney Quality Improvement Partnership | Launch Event 42

KQuIP 14:55

Coffee

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Kidney Quality Improvement Partnership | Launch Event 43

KQuIP 15:10

Introduction to Process Map / Plan PDSA Cycles

Richard Fluck, Project Lead Daljit Hothi, Project Lead

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Think about patient flow: process flow

  • Selection
  • Initiation
  • Maintenance
  • Drop out

Start PD pathway Plan dialysis access - insert PD catheter Patient and MDT sign off for PD pathway Assess for suitability– clinical, patient factors and home suitability Screen low clearance, Prevalent HD, Incident HD, Failed Tx Identify potential PD patients through shared decision making Figure 4 PD pathway adapted from Perit Dial Int. 2013 May-Jun;33(3):233-41. doi: 10.3747/pdi.2012.00119.Peritoneal dialysis and the process of modality selection. Blake PG, Quinn RR, Oliver MJ. 44 Kidney Quality Improvement Partnership | Launch Event

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The project cycle: use your process chart to think of problems

  • Research and discovery
  • Consider barriers and evidence
  • Consider solutions and ideas
  • Long list
  • Short list
  • Test ideas
  • Test, evaluate, share
  • PDSA cycles
  • Review and report then repeat process

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PDSA cycles

  • Plan – the change to be tested or implemented
  • Do – carry out the test or change
  • Study – based on the measurable outcomes agreed before starting
  • ut, collect data before and after the change and reflect on the

impact of the change and what was learned

  • Act – plan the next change cycle or full implementation.

https://improvement.nhs.uk/documents/2142/plan-do-study-act.pdf

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Iterate

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Suggested central mechanism to change

  • Monthly MDT: patient flow management
  • Review all incident patients
  • Assess drop offs
  • Training status
  • Review critical data – hospitalisation, infections, technique issues
  • Consider review of low clearance lists

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Kidney Quality Improvement Partnership | Launch Event 49

KQuIP 15:20-16:00

Group Activity Refine and then use your process map to design and plan your first PDSA Cycle(s)

Units

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Kidney Quality Improvement Partnership | Launch Event 50

KQuIP 16:00

Feedback session 5 minutes per unit

Units

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Kidney Quality Improvement Partnership | Launch Event 51

KQuIP

Closing session

  • QI Support from KQuIP – Role of programme manager
  • Industry partners support

Richard Fluck, Project Lead Catherine Stannard, KQuIP Programme Manager Industry Partners

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Kidney Quality Improvement Partnership (KQuIP) Quality Improvement Support

Catherine Stannard

QI Programme Manager

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30/01/2019

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Kidney Quality Improvement Partnership | Midlands

Preparation phase

Regional Day

  • To bring together the region
  • To review national and region level data
  • To decide on a regional quality improvement priority

QI meeting

  • Engagement
  • Develop a shared purpose
  • Begin collaboration within the region
  • Begin planning the year

Leadership

  • To provide an understanding of effective leadership
  • To build greater understanding of each other and different ways of working / thinking / strengths

Leadership into Action

  • To consolidate learning from leadership course and how it can be applied to DAYLife
  • To continue planning the DAYLife programme (data/ drivers/ outcomes)
  • To plan the launch event together

Engage Mobilise Learn Co-design Plan

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30/01/2019

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Kidney Quality Improvement Partnership | Midlands

Project phase

Launch event

  • Agree a project plan
  • Co-design outcomes and measures
  • Launch project
  • Co-design methods

Introduction to QI 1 day

  • Quality improvement and tools
  • Measurement / Life QI
  • Project Model and NHS Change Model
  • PDSA

Sharing and learning 1 day

  • Reflection on progress and overcoming challenges
  • Peer assist (informal learning)
  • Sign posting to tools and information
  • Sustainability

Maintaining momentum 1 day

  • Review of progress
  • Sustainability

January 2019 March 2019 May 2019 September 2019

P-D-S-A Measure

Share learning

Collaborate Peer assist

Monthly support visits to units offered from KQuIP

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30/01/2019

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Kidney Quality Improvement Partnership | Midlands

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30/01/2019

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Kidney Quality Improvement Partnership | Midlands

My role…

Support to connect teams – collaboration Assimilate and communicate learning between KQUIP collaboratives – action learning sets, webinars Website resources and communications Support for organising and providing training /meeting venues / sponsorship

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KQuIP…

  • IS…

Facilitative Enabling Local ownership - teams are responsible for the decisions, results and actions Keeping the energy, momentum, drive Tailored support

2/28/2019

Kidney Quality Improvement Partnership | Midlands

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IS NOT… The subject matter expert or owner of the project Directive Inflexible or rigid

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30/01/2019

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Kidney Quality Improvement Partnership | Midlands

Project phase

Launch event

  • Agree a project plan
  • Co-design outcomes and measures
  • Launch project
  • Co-design methods

Introduction to QI 1 day

  • Quality improvement and tools
  • Measurement / Life QI
  • Project Model and NHS Change Model
  • PDSA

Sharing and learning 1 day

  • Reflection on progress and overcoming challenges
  • Peer assist (informal learning)
  • Sign posting to tools and information
  • Sustainability

Maintaining momentum 1 day

  • Review of progress
  • Sustainability

January 2019 March 2019 May 2019 September 2019

P-D-S-A Measure

Share learning

Collaborate Peer assist

Monthly support visits to units offered from KQuIP

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Kidney Quality Improvement Partnership | Launch Event 59

KQuIP

Close and network

Thank you

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How to find out more

Catherine Stannard KQuIP Programme Manager UK Renal Registry Catherine.Stannard@renalregistry.nhs.uk Teresa Wallace Think Kidneys Programme Coordinator UK Renal Registry Teresajane.Wallace@renalregistry.nhs.uk Kidney Quality Improvement Partnership | Launch Event 60

Contact Think Kidneys

Richard Fluck KQuIP Home Therapies Project Lead Richard.Fluck@nhs.net Paul Cockwell Chair of KQuIP Paul.Cockwell@uhb.nhs.uk Sharlene Greenwood Chair of KQuIP Sharlene.greenwood@nhs.net Ron Cullen Chief Executive Renal Association Ron.cullen@renalregistry.nhs.uk www.linkedin.com/company/think-kidneys www.twitter.com/ThinkKidneys www.facebook.com/thinkkidneys www.youtube.com/user/thinkkidneys www.slideshare.net/ThinkKidneys