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Leading Better Care After the grail?

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Whether there are validated measures that could be used as a proxy for ... Were there none who were discontented with what they ... then what is possible, and ... – PowerPoint PPT presentation

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Title: Leading Better Care After the grail?


1
Leading Better Care After the grail?
  • Professor Angela Wallace
  • Director of Nursing, NHS Forth Valley
  • Chair of LBC Programme Board

2
Overview
  • Its an old Story.
  • What's different about today?
  • Why is it all too difficult?
  • Houston we have a problem..
  • What can we do to make it different this time?
  • How can we demonstrate impact and outcome. The
    LBC scrolls
  • So can we deliver..the grail found?

3
Across the world, there is one issue challenging
the healthcare improvement movement more than any
other
  • how do we reduce costs whilst simultaneously
    improving the quality of care?
  • It seems that , in the NHS and other healthcare
    systems, cost and quality are seen as trade-offs
    or alternative priorities.

4
  • Push me
  • Within our organisations, clinicians often view
    themselves as the 'defenders' of quality,
    protecting patients and professional standards
    against the demands of managers or the Finance
    Team.
  • Pull me
  • Financial leaders may see themselves as
    defending the bottom line against the excesses
    and lack of cost control of clinical teams. This
    leads nonclinical leaders to use methods of
    cost-cutting and financial scrutiny which may
    appear ill-considered and heavy-handed to
    clinicians

5
  • Definition
  • any ultimate, but elusive, goal pursued as in a
    quest

6
Is our grail high quality care?
  • What is high quality patient care? And do you
    have ityes/no/dont know
  • Do you know your service the quality of care the
    experience
  • The cost of your service control of the budget
  • The reliability of care evidence based care
  • Relationship based care dignity respect
  • Competency and capability of your workforce

7
One of the essential qualities of the clinician
is interest in humanity, for the secret of the
care of the patient is in caring for the
patient Harvey Chochinov 2002
8
Creating the vision
  • Leadership resilience is about maintaining focus
    on the things that matter when the going gets
    tough

9
Greatness is not a function of circumstance
greatness is largely a matter of conscious choice
and discipline Jim Collins I believed that
we wanted greatness for our patients
10
Houston why do I still have a problem
11
So what will be different this time
12
In God we trust .everyone else must bring data
William Deming
13
Leading Better Care
14
By the end of 2010
  • Senior Charge Nurses in hospital settings will be
    working in the context of the revised role
  • The majority of in-patient areas to have Clinical
    Quality Indicators in place
  • The SCN will be the visible embodiment of
    clinical leadership in NHS settings, coordinating
    patient care, and inspiring the nursing/midwifery
    team

15
Leading Better Care (LBC) Dec 2010
  • 2138 SCNs to be included in refocusing their role
    by the end of 2010 this is up from 1823 in Sept
    2009
  • 2108 SCNs are currently engaged in refocusing
    their role
  • 99 of SCNs identified by each board are engaged
    in the LBC process
  • Areas planning to use the CQIs across NHS
    Scotland
  • Falls 869 areas / 747 areas currently
  • Food, Fluid Nutrition 972 areas
  • / 847 areas currently
  • Pressure Area Care 921 areas
  • / 790 areas currently

16
(No Transcript)
17
Clinical Quality Indicators - CQIs
18
What are Clinical Quality Indicators (CQIs)?
  • Evidenced based indicators that support the
    measurement of the quality, safety and
    reliability of care. The CQIs focus on quality
    improvement rather than a measure of performance.
    They are currently process indicators which
    measure aspects of nursing care such as
    assessment and interventions.

19
(No Transcript)
20
Clinical Quality Indicators
NHS Board examples
21
An individual ward example
Falls CQI - Not using safety cross yet no falls
since 26th July 2010 - 138 days. FFN CQI -
Evidenced that Protected meal times were working.
Initiated discussion and laminated information
sheets were produced for staff with measured
amounts of fluids for consistency and for
patients with type of diet required. PAC CQI -
Not using safety cross yet - last pressure ulcer
17th august 2009.
22
An individual ward example
23
Releasing Time to Care
24
Releasing Time to Care
  • Provides
  • A structured framework for continuous improvement
  • Support to Senior Charge Nurses their teams and
    the Multi disciplinary teams to use improvement
    tools
  • Teams with the tools and techniques to release
    capacity within the current resource envelope

25
Releasing Time to Care
  • It is essential not to consider the principles
    and application of Releasing Time to Care
    independently of other quality improvement
    strategies/methods and work streams.
  • RTC should be perceived as integral to how we
    function and can contribute directly and
    indirectly to improved patient experience.

26
Releasing Time to Care (RTC)Dec 2010
  • 15 boards currently undertaking RTC
  • 349 general wards includes HDU/ ITU, midwifery,
    neonatal areas
  • 78 mental health wards
  • 35 community hospital ward
  • 31 out patient departments
  • Total 493 wards / departments

27
This chart portrays the increase in the number of
areas undertaking RTC all Boards show an
increase in wards implementing RTC for Quarter 3
2010/11 compared with Quarter 2 In total RTC
has been rolled out to another 200 wards over
quarter 3 compared with quarter 2 this equates
to a 74 increase
28
Case studies / digital stories sharing the
success and challenges of LBC and RTC
implementation can be accessed at
www.leadingbettercare.scot.nhs.uk
29
Next Steps..
30
  • LBC implementation is continued and sustained in
    the acute setting which includes mental health,
    maternity and neonatal settings.
  • LBC is adapted for implementation in the
    community and implemented in the community
    setting across all NHS Boards in Scotland.
  • A programme to support SCN line managers
    understand their role in supporting staff in the
    implementation RTC and LBC is developed and
    implemented across NHS Scotland.
  • The extension of LBC to charge nurses and
    aspiring charge nurses as part of workforce
    development and succession planning is scoped out
    and implemented if the scoping exercise
    identifies this as worthwhile
  • Nursing staff are able to collect and interpret
    data which enables them to continually improve
    patient experience, care and the clinical
    environment.
  • NHS Boards learn from good practice in
    implementing LBC through sharing case studies and
    networking with colleagues both locally and
    nationally.

31
What will success look like..
  • Were there none who were discontented with what
    they have, the world would never reach anything
    better
  • Florence Nightingale
  • So my message is this..
  • What are we going to do differently..

32
Can we deliver..
  • I think one's feelings waste themselves in
    words they ought all to be distilled into
    actions which bring results.Florence
    Nightingale

33
"Start by doing what is necessary, then what is
possible, and suddenly you are doing the
impossible." St. Francis of Assisi
34
Care Governance Delivering Better Care
35
Care Governance assurance of care quality
through professional leadership
  • Care Governance is a vehicle to support NHS
    Boards strengthen the NMAHP contribution to the
    Quality Strategy.
  • It will use real time information to inform
    improvement and strengthen involvement and
    ownership of all staff in their contribution to
    the delivery of safe, effective and person
    centred care.
  • It seeks to strengthen the connectivity between
    the quality of everyday care and the reporting of
    quality at NHS Board level.

36
PROFESSIONAL
ACCOUNTABILITY PRACTICE
CORPORATE
GOVERNANCE

CLINICAL GOVERNANCE
CARE GOVERNANCE
STAFF GOVERNANCE
37
Strategic Professional Direction and Priorities
Leadership
Assurance that the Career Framework, Quality
Standards, Professional Regulation, Resources,
CIT, etc are in place
Structure
Assurance that we have the things in place which
will support quality
Facilitation
Professional Accountability Practice
Assurance that we are doing the right things
Process
Assurance that the results are what we wanted
Outcomes
38
How will we know if we are delivering good
quality?
  • This approach should bring greater coherence to
    what we are measuring. (simple dashboard)
  • We should be addressing perceived gaps and areas
    where patients tell us we consistently get it
    wrong ie communication, note keeping, attitudes
    and behaviours of staff.
  • We will be using the evidence to develop
    indicators and predictors of quality (safe,
    effective and person centred) which will give us
    real time information for improvement and connect
    staff with the impact of changes in their
    everyday practice.

39
Supporting Work-stream on Professionalism
  • Audrey Cowie
  • 5 May 2011

40
David Sterns principles and related concepts
PRINCIPLE RELATED CONCEPTS
Excellence Competence, standards, ethics, legal boundaries, communication
Accountability Professional Client contract, self-regulation, etc
Humanism Dignity, Respect, Compassion, Empathy, Honour, Integrity
Altruism Opposite of self-interest acting in the best interests of clients
41
Objectives of Work-stream
  • Develop a pragmatic expression of key features of
    professionalism
  • Inform and oversee the development of
    methodologies that will assist with the
    assessment (self or otherwise) of professionalism
  • Consider the relevance of its findings to the
    wider healthcare workforce in NHSScotland.
  • Make recommendations to and compile a report for
    the NMAHP Coordinating Council.

42
Focus of the groups work will be on
  • 1. The individual health care 'worker', not the
    profession as a group
  • 2. The context of relationships practitioner
    patient practitioner team members
    practitioner wider organisation / context, etc,
    etc
  • 3. The impact of culture on the system and on the
    individuals outward manifestation of
    professionalism.
  • 4. The concept of 'caring for' and 'caring about'
    and the duty of care to oneself as a professional
    as well as to others.

43
  • 5. The place of role models, mentoring and 'self
    learning' in developing professionalism.
  • 6. The patients perspective and the importance
    of person-centredness as an aspect of
    professionalism.
  • 7. The role of insightful refection and
    structured constructive feedback and its impact
    on practice.
  • 8. Whether there are validated measures that
    could be used as a proxy for 'professionalism'.

44
  • 9. Articulating all work with existing (or
    developing) governance frameworks
  • 10.Considering evidence-based work that focuses
    on the concept and measurement of professionalism
    relevant to the UK / Scottish context.
  • 11.Reinforcing Revitalisation and Actualisation
    as keywords in any communications.

45
  • QUESTIONS?
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