Improving Care for Older People in Acute Care Tuesday 21 May 2013 14.00 – 15.30 Webex Improvement Clinic
Webex Outcome 1. To link-up with test sites/local teams to hear about challenges and highlights 2. To provide an update on the Improving Care for Older People in Acute Care work stream, following improvement planning event on 28 March 2013 3. To share examples of good practice 4. To provide support for teams as they continue improvement journey
Agenda 14.00 Welcome & Introductions Webex Orientation 14.15 Improving care for older people in acute care update • 28 March event feedback • Qualitative work (focus groups and interviews) 14.20 Supporting your improvement journey – building on progress Annette Bartley (IHI Fellow) 14.40 Test site feedback – challenges, highlights, opportunities • Pam Milliken, NHS Lanarkshire – Testing Think Frailty Triage Tool • Laura Riach, NHS Greater Glasgow and Clyde – Approach to testing the delirium bundle 15.00 Our experience of developing and testing a bundle - Adrian Hopper (Guys & St Thomas) 15.15 Discussion; Q & A session with Adrian 15.30 Close
Welcome & Introductions • OPAC Team • Experts on the webex – Annette Bartley (IHI Fellow), Adrian Hopper (Guys & St Thomas) • Team introductions (one person each team) Penny Bond Michelle Miller Karen Goudie Joanne McDonald Kirstan Shields Annemarie Hazel McIntosh Jane Millar Long
Webex good practice If you are in a group: • Don’t have side conversations while presentations or group discussions are taking place • Mute your phone when you are not speaking (*6) • Remember to speak into the telephone speaker • Acknowledge questions asked remotely If you are dialling as an individual • Use the chat box to ask questions and get involved in discussions • If you’re having technical difficulties message the host via the Webex chat function, or call the contact number All users • Remember to introduce yourself before speaking
Some user tips • Key #1 to check all participants are on the call • Key *6 to mute • Key *0 for Operator assistance.
NHS Board Delegate NHS Ayrshire & Arran Amanda Johnson NHS Fife Helen Skinner and Annette McArthur NHS Forth Valley Linda Wolff NHS Greater Glasgow & Clyde Christine Roberts, Laura Keel, David Craig, Christine McAlpine, Sandra Shields and Elaine Burt NHS Highland Caroline Parr and Ruth Mantle NHS Lanarkshire Maggie Hogg, Linda Guild and Joe Hands NHS Lothian James McWilliams and Louise Robertson NHS Shetland Jane Astles and Linda Leslie NHS Western Isles Frances Robertson Healthcare Improvement Scotland Irene Robertson, Jane Miller, Kirstan Shields, Annemarie Long, Hazel McIntosh, Michelle Miller and Penny Bond
Improving Care for Older People in Acute Care Update
Flash report highlights • Feedback from 28 th March – improvement planning & engagement event • Change packages shared with teams • Testing of delirium bundle and frailty triage screening tool • Improvement support visits • OPAC session at PCHC event 31 st May
Guest Speakers • Annette Bartley, IHI Fellow • Adrian Hopper, Associate Medical Director for Patient Safety, Guy’s and St Thomas’ Hospital
Commitments from March 2013 – March 2014 Your Commitment (Teams) Our Commitment (HIS) Attend and contribute to Learning Session 2 of Person Support teams at learning sessions, improvement Centred Health and Care Event (Special OPAC session planning and engagement events and improvement on Frailty and Delirium 31 May 2013) clinics, improvement support visits, share and spread good practice and enhance improvement skills. Attend OPAC Improvement Planning and Engagement Sessions in September 2013 and February 2014 to share results from testing, challenges and opportunities Provide monthly progress reports – last Friday of every Provide feedback on progress reports and support for month improvement where required. Share practice at learning sessions through Provide a national platform for sharing of good presentations and story boards. practice, learning and celebrating success Make connections locally with other improvement Identify opportunities to link improvement work with activity other national improvement activity Write case study of your experience and findings Produce a final report and publication from this work. Identify opportunities to showcase nationally and internationally.
May 13 21 May Webex Improvement Clinic 30-31 May People at the centre of health and Care : Learning Session 2 Last Friday Submit test data to michelle.miller3@nhs.net Jun 13 Test Site Visits – to arrange a visit from the OPAC team to discuss progress, 1-30 highlights and challenges please contact michelle.miller3@nhs.net Last Friday Submit test data to michelle.miller3@nhs.net Jul 13 Test Site Visits – to arrange a visit from the OPAC team to discuss progress, 1-31 highlights and challenges please contact michelle.miller3@nhs.net OPAC KEY DATES TBC Webex Improvement Clinic Last Friday Submit test data to michelle.miller3@nhs.net Aug 13 2013-14 Last Friday Submit test data to michelle.miller3@nhs.net Sep 13 Date tbc Improving Planning and Engagement Event TBC Webex Improvement Clinic Last Friday Submit test data to michelle.miller3@nhs.net Oct 13 Last Friday Submit test data to michelle.miller3@nhs.net Nov 13 20-21 Nov People at the centre of health and Care : Learning Session 3 (provisional date) TBC Webex Improvement Clinic Last Friday Submit test data to michelle.miller3@nhs.net Dec 13 Last Friday Submit test data to michelle.miller3@nhs.net Jan 14 TBC Webex Improvement Clinic Last Friday Submit test data to michelle.miller3@nhs.net Feb 14 Date tbc Improving Planning and Engagement Event Last Friday Submit test data to michelle.miller3@nhs.net
Improving Care for Older People in Acute Care Maintaining Momentum Annette Bartley RN BA (hon) MSc MPH Quality Improvement Consultant
Respect the Reality in Practice 5/22/2013
How great leaders inspire action http://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action.html Simon Sinek
Getting it right -First do no harm! • Fundamental Safety Principles – Prevention – Detection – Mitigation
Focus on patients Warm but chaotic Everything works Relational Efficient but impersonal Unpleasant and inefficient Coordinated, integrated “Cold comfort farm” Warm, fed, watered “Battery chicks?” Transactional
Holding up the mirror Of all changes I’ve observed, only about 5% were improvements, the rest, at best, were illusions of progress. W. Edwards Deming – We must become masters of improvement – We must learn how to improve rapidly – We must learn to discern the difference between improvement and illusions of progress
Insanity: doing the same thing over and over again and expecting different results. Albert Einstein, (attributed) US (German-born) physicist (1879 - 1955)
Expectations Setting a pace and momentum for this work • Leadership • Commitment • Active participation • Feedback • Engagement – http://www.ted.com/talks/drew_dudley_everyday_leadership.html
Expectations • Empower frontline teams • Enable local ownership • Support teams and provide guidance • Avoid the ABCD of external support – Arrive – Belittle – Criticise – Depart • Education and training • Reporting progress
Maintaining momentum • Focus on involving all the multi-disciplinary TEAM • Be clear about your collective overall aim/s for this work • Ensure you get baseline measures in place before you start testing any changes • Remember he/she that tests … wins • Plan to test your changes using the PDSA methodology • Systematically work through changes, building upon the learning • Never give up!!
Where are we now? • Time to take stock • What has been achieved to date? • What plans do you have for maintaining momentum? • What are your key challenges and barriers? • Next steps?
Key Ingredients for Improvement A Clear Aim – Measurement- Action 5/22/2013
The Model for Improvement Changes That Model for Improvement Result in What are we trying to accomplish? Improvement How will we know that a change is an improvement? A P What change can we make that S D will result in improvement? Implementation of Change Wide-Scale Tests Hunches A P of Change Theories S D Follow-up Ideas Tests Very Small Scale Test
Data over time
Making the connections PDSA Risk Identification PDSA Risk Assessment Communication of PDSA Risk status Appropriate preventative PDSA strategy implemented Evaluation of outcome
How will we know change is an improvement? Three Types of Measures Outcome Measures: Voice of the customer or patient. How is the system performing? What is the result? Process Measures: Voice of the workings of the system. Are the parts/steps in the system performing as planned? Balancing Measures: Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures? (e.g. unanticipated consequences, other factors influencing outcome)
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