Blog - Adopting Systems for Quality Improvement in Health & Care - David Fillingham

Following the recent launch our paper A Sense of Urgency, A Sense of Hope at a joint event with The King’s Fund, our Chief Executive David Fillingham takes a further look at the need for health and care organisations to adopt systems for quality improvement.

David Fillingham

It has been a long, difficult Winter for the NHS. Staff have worked incredibly hard to care for increasing numbers of patients at a time of tightening finances. Sadly, despite these great efforts, we have inevitably seen too many stories of long waiting times and a worsening experience in many places. Whilst the NHS has a marvellous ability to cope in adversity, the sense of it being in crisis is growing.

On one of the snowiest days of the year, the 1 March (allegedly the first day of Spring!) over a hundred hardy NHS folk battled their way through blizzards to a King’s Fund / AQuA event in Manchester where we launched AQuA's framework on building a system and culture of improvement, entitled A Sense of Urgency, A Sense of Hope.

By a show of hands delegates indicated that they were very familiar with the extreme pressures facing the NHS. They also recognised that the current political and economic context is such that, the sustained and large-scale investment needed in health and social care is unlikely to happen anytime soon.

The 'hope' rests in the fact that there is a strong evidence base, in other sectors and in healthcare, that the strategic application of improvement methods can improve both quality and productivity. This is not to say that more spending isn't needed, it is, but until the day it arrives there is a great deal that the NHS can do for itself to tackle the waste, delays and duplication in the system that are such a source of frustration for staff and patients alike.

The problem is that our improvement efforts are too often small-scale, piecemeal and not sustained. Organisations which have achieved transformational results, such as Jonkoping in Sweden, Virginia Mason in the US or Salford Royal and East London Foundation Trust here in the UK, have adopted a long-term approach to building their respective improvement systems.

AQuA's publication is based both on a review of the published evidence about how they have done that and on reflections on leading and supporting improvement efforts on the ground.

Our framework has five interdependent elements:

• Vision and Strategy - developing a plan that inspires and engages everyone. It should have bold aims, measurable goals and commit the organisation to building improvement capability at every level.
• Leadership and Culture - in an improvement culture patients and families are full partners in their care. Staff are empowered and supported to use their energy and creativity to solve problems, and leaders are positive role models who coach others in their chosen improvement approach
• Building Capability - there is a commitment to train all staff in improvement method and to give them the time and encouragement to use those skills. Leaders and coaches will have more advanced know how and there will be a small number of genuine experts. The Board will itself commit to receiving development to carry out its own improvement leadership role effectively
• Developing an Operating System - improvement methods will become 'hard wired' into the organisation with goals being cascaded via a process of 'catchball' and expertise focussed onto the biggest challenges. Over time an improvement approach will become "the way we do things around here" and an accepted part of daily work
• Aligning Support Services - staff working in HR, Finance, IT/Information and Estates have a great contribution to make. They will be fully engaged and these functions redesigned to support an improvement culture.

Last year NHS Improvement, alongside other national NHS bodies, published their strategy Developing People,Improving Care. This exhorts NHS organisations to make just these kind of investments in their own improvement capability.

The newly revised CQC inspection framework asks questions as to what progress is being made on the ground. Not only do organisations need to adopt such an approach if they want to emulate the best, now they are actively being encouraged to do so by inspectors and regulators.

This kind of work takes time and is a difficult path. It's all too easy to become overwhelmed by day to day pressures. Succeeding requires courage, curiosity, persistence and optimism.

But the prize is a great one...that of seeing staff glow with the pride using their own experience, energy and ideas to transform the care that patients receive.

Feel free to share your thoughts with us via Twitter @AQuA_NHS or get in touch via AQuA@srft.nhs.uk to request a hard copy of our paper.

Blog - Early Adopters & Spreading the Message - Norah Flood

In part four of our Person Centred Care blog series, Norah Flood, AQuA member and Assistant Director of Clinical Networks at North West Boroughs Healthcare NHS Foundation Trust, discusses the Trust’s implementation of Person Centred approaches and the importance of early adopters.

Noah Flood

‘We already do that’ and ‘I will not allow my patients to make a bad decision’ were the two stand out responses received when introducing the concept of Shared Decision Making (SDM) into a recently merged Community Physical Health and Mental Health organisation.

Fortunately, there were also plenty of open doors to be knocked on that welcomed the structure of tools to support the practitioner and patient to reach a decision together.

Initially, these doors belonged to the high volume services, possibly surprising, as a common concern among practitioners was the perceived extra time it would take in engaging in SDM conversations with patients. However, the case for enhanced compliance, reduced DNAs and increased patient satisfaction soon overcame those concerns.

Even better was the tangible evidence produced; demonstrating that patients did want to share in the decision, actually did know what their preferences were, and so did engage fully in their treatment plans.

Leaders in the field are essential but more crucial are the fast followers. What we found was that spread and adoption in Community Physical Health Services was both rapid and successful. Possibly because services were proactive in seeking out support to engage in SDM and adopted, or created, patient information to assist patients in determining what was best for them.

Equipment Services, Dietetics and Weight Management, Podiatry, and MSK became self-sufficient in utilising SDM and developing tools to support patients. Furthermore our Intermediate Care services introduced SDM and achieved a cultural shift in how risk was assessed and managed. This is best demonstrated by Jim's story.

An early advocate of SDM came from our Secure Care Services, who utilised this approach to support the introduction of the Trust’s smoke free policy. Tools to support service users to stop smoking were co-produced with service users, ward staff and pharmacy.

The response was both positive and immediate and the concept of Shared Decision Making was soon transferred to the unit’s multi-disciplinary team meetings; now the service user has the opportunity to fully participate if not lead their MDT.                                                                  

News travelled fast and on the back of one success came enquiries and suggestions for where else Shared Decision Making could be applied.

Another early adopter was our CAMHS services, where it was always felt that continuity of practitioner was of the upmost importance and while no-one denied that, it was realised that not all practitioners are skilled to offer the full range of interventions.

Therefore, tools were developed to assist families in deciding which therapeutic intervention they preferred to receive, and how that decision was affected if it meant moving to a different therapist.

This approach was spread to other services by the ‘share and adopt’ method, and Shared Decision Making has become something we already do across the organisation.

You can share your thoughts with Norah on Twitter via @NorahFlood1  or @AQuA_NHS, or feel free to leave a comment below.

In our next blog we hear from another of our members, Caroline Poole, Clinical Improvement Lead at Pennine Care NHS Foundation Trust; who explores a systems approach to measuring person centred care.

Stay tuned to our news page for more updates!

A Sense of Urgency, A Sense of Hope – Our Latest Paper on Continuous Improvement for Health & Care

We’re delighted to announce the publication of A Sense of Urgency, A Sense of Hope; our latest paper by our Chief Executive David Fillingham CBE and Director Lesley Massey exploring how organisations can develop and support a culture and system for continuous improvement.

In the paper, David and Lesley take a look at recent best practise, changes to the health and care landscape, and distil over eight years’ experience of working with members as the North West’s quality improvement body, into five key domains where organisations can support and invest in a quality improvement system:

• Vision
• Leadership & Culture
• Capability
• Developing an Operating System
• Aligning Support Services

Download your copy here

Speaking on its publication, David said:

“We’re really excited to share our new paper, and hope it offers our colleagues across health and care an in-depth framework to help support their aims for continuous improvement.”

“Whilst we recognise the extreme pressure the NHS and wider care sector continues to face, we feel it’s important to still look for a light at the end of the tunnel. Therefore it is vital organisations invest in improvement, if we are to meet the demands of better, more efficient care and improved outcomes for patients.”

“We really believe this is possible and as we highlight throughout the text, there are a number of organisations we can look to for inspiration to achieve this together.”

Throughout the paper, the pair also look at case studies from our work with members, including from: Aintree Hospital NHS Foundation Trust, Manchester University NHS Foundation Trust, Mid Cheshire Hospitals NHS Foundation Trust, North West Boroughs Healthcare NHS Foundation Trust.

Other examples also point to leading improvement organisations from other industries and sectors outside of health and care.

The paper was recently launched to over 100 delegates at a joint event with The King’s Fund; exploring successful approaches to quality improvement. Following the event, co-author Lesley Massey said:

“At the event delegates gave us some fantastic feedback on the framework and each of its five domains.

“We’re now developing a self-assessment diagnostic to support the framework, and would welcome interest from colleagues across the country who would be interested in testing this.”

If you would like to request a hard copy of the paper, or are interested in testing the self-assessment diagnostic, please get in touch via AQuA@srft.nhs.uk. Alternatively, feel free to share your thoughts with us via Twitter @AQuA_NHS.

Blog – From Patient to Practitioner – My Lived Experience of Working with AQuA – Carl O’Loughlin

Carl O’Loughlin has been a member of AQuA’s Lived Experience Panel since 2015. As he starts his training to become a qualified mental health nurse, he shares his experience of working with us for the past three years.

Carl O'Loughlin

I first came into contact with AQuA in June 2015, when I was working as an involvement representative on a peer support project in the Cheshire and Wirral Partnership NHS Foundation Trust (CWP). Through this project I met Paul Greenwood, AQuA’s Mental Health Improvement Advisor; who was running a Restraint Reduction initiative on one of the CWP inpatient wards.

During our meeting, I shared with him my work with CWP, together with my own lived experience of using mental health services and my professional background; where I had experience of quality improvement.

Paul also told me that AQuA was forming a Lived Experience panel and after applying to join this and an interview, I was pleased to be offered the role as one of five Lived Experience Affiliates on this panel.

At my first Panel meeting, it was evident each of us on the panel had a significant and varied range of lived experience of healthcare services. Since then, we’ve all been welcomed by AQuA staff as a fundamental and key part of the organisation.

We’ve also had quarterly meetings with either the Chief Executive or Directors, to update them on the work we do with programmes and AQuA members; which demonstrates how important AQuA value the work the panel does.

Since joining, I’ve received significant training on everything from Human Factors, Introduction to Improvement, Shared Decision Making, Dementia Awareness, Safety and Mortality and Motivational Interviewing. AQuA has also facilitated my Experience Based Design Coaches training.

My presentation and report writing skills have also improved significantly, together with my knowledge of health and social care services and how they are organised and operate.  All of this training, skills development and knowledge will prove invaluable to my nursing studies and any future nursing roles.

During this time I’ve had the privilege to work on a range of programmes, including Whole System Flow, Mental Health, Restraint Reduction, Safety, Academy and Shared Decision Making.

There’s a range of work that I’m proud of from my time with AQuA.  The most prominent of these is our work with three systems as part of the 2017/18 Whole System Flow programme. Together as a Panel, we’ve spent the last six months visiting and interviewing service users and carers from each of the three systems.

This work has given us a deep insight into what it is really like to be a service user or carer using each system, and allowed us to produce a detailed lived experience report for each system.

Each of their project teams have fed back that these ‘real’ experiences gathered by the Panel has been the most important part of each project. It’s been clear that diagnosing issues and problems in each of these systems wouldn’t have been possible without these insights.

This piece of work has been incredibly rewarding and enjoyable personally; with the patients really valuing the opportunity to share their experiences with us.

All in all, it’s been an absolute pleasure to work with AQuA as a Lived Experience Affiliate for the last three years.  I’ve found AQuA to be a highly forward-thinking organisation at all times, especially with regard to quality improvement and co-production.

Staff have really welcomed all members of the Panel, and have actively worked to co-produce and embed lived experience into their programme design and delivery. They practice ‘real’ co-production, are happy to receive challenges and feedback from panel members, and use this to actively improve their work.

I’m certainly going to miss working for AQuA and everyone that I work with there, but I’m also excited to be starting a new chapter in my life with my nursing studies about to commence.

Feel free to share your thoughts and comments with Carl, or wish him good luck with his nursing training, via Twitter @Carloloughlin1 or @AQuA_NHS. 

Joanna Bircher Joins the AQuA Board

We’re delighted to welcome Dr Joanna Bircher, GP and Clinical Director for the Greater Manchester GP Excellence Programme as a new member of our Board.

Dr Joanna Bircher

Our Board plays a vital role in helping to set our overall vision for our work with members and customers, and Joanna joins as the sixth of our Directors taken from our member organisations across the North West; alongside four external independent Directors.

Speaking on the announcement, Chief Executive David Fillingham said:
“We’re delighted to welcome Joanna to the Board. She has wealth of experience not just as a GP in Tameside, but also as a clinical leader across the region and on a number of national projects.

“Our Board have a real range of experience across health and care, which we benefit from massively in terms of our work with our members and customers. We’re really looking forward to working with her in the coming weeks and months, and adding her knowledge and skills to the team.”

Adding to this, Joanna said:

“I am so pleased to be joining the AQuA board at a time when it is being increasingly recognised that supporting UK General Practice to develop Quality Improvement capability may help the NHS to respond to the current challenges.

"I hope to bring with me the ‘eyes and ears’ of a working GP, with experience in applying QI methods at the front line to support AQuA in its mission to improve health and care quality.”

In addition to her role with Greater Manchester Health and Social Care Partnership, Joanna is a fellow for The Health Foundation’s prestigious Generation Q, and Quality Improvement Clinical lead for NHS Tameside and Glossop Clinical Commissioning Group.

She has also been a GP partner at Lockside Medical Centre, Stalybridge, since qualifying as a GP in 1998, and combines her clinical duties with GP training for the North West Deanery.

In addition, she has also been a Clinical Support Fellow for Quality Improvement at the Royal College of GPs since 2014, as well as their joint clinical lead for the college’s work on the National Diabetes Audit.

Joanna is highly passionate about quality improvement in general practice, and used her Generation Q fellowship to explore ways to support frontline staff across GP practices to deliver improvements.

Joanna regularly shares her thoughts and updates on Twitter via @JoannaBircherQI. For more information on our Board, please visit our website.

Blog - The Importance of Person Centred Care

Person Centred Care is about ensuring patients are at the centre of all aspects of their health and care, and that their individual needs, wishes and circumstances are listened to, considered and respected.

In the first of our new series of blogs exploring this approach, our Programme Manager Brook Howells looks at the case of why it's important for the NHS to achieve genuine Person Centred Care.

Over the next instalments, both AQuA staff and our members will be sharing their own thoughts and experiences of different aspects of Person Centred Care, so stay tuned to our News Page for more updates!

Brook Howells, AQuA Programme Manager

NHS policy has been driving the person-centred care (PCC) agenda for over 20 years, but the system has been slow to respond. With current austerity, there is an increased imperative to achieve the paradigm shift, away from traditional paternalistic models of care towards a more enabling, facilitative culture of healthcare delivery that supports PCC. This has been described as clinicians shifting from “parent to coach”.

Supporting self-management was the number one priority identified for commissioners of NHS healthcare services (The King’s Fund, 2015). Coulter et al (2008) state that: “too often, the way in which clinicians and patients interact tends to promote passivity and dependence, instead of self-reliance, thus sapping patients’ self-confidence and undermining their ability to cope” (p.5).

Despite these policy drivers, the system has been slow to respond at scale. Whilst evidence of improvements can be seen in pockets, for example in chronic kidney disease, the whole-scale change is difficult to evidence, and it appears that the shift is dependent on groups of individuals having sufficient motivation to drive the change within their locus of control.

The Advancing Quality Alliance (AQuA) has been working with clinicians and healthcare organisations since 2011, supporting a change in culture through quality improvement methodology and coaching techniques. The transformation is relatively easy for individuals and small teams or services to complete successfully, but achieving systemic change remains a major challenge, despite the obvious benefits.

We know that there are a lot of competing priorities vying for attention across healthcare right now and often PCC is, erroneously, seen as a “nice to have”; the cherry that will top the cake once the rest is successfully baked, rather than as a fundamental and necessary part of the solution.

There are clear indicators that many see the opportunities though since influential documents and policies like the Five Year Forward View point towards PCC as an essential element of modern healthcare. So why are we still so far away from achieving the goal of truly person-centred care embedded across all we do?

Trying to answer this question, a small group of people passionate about person-centred care has formed a community of interest, to share ideas, challenge each other and provide mutual support.

In recognition that a lot of this thinking would be of interest to a much wider audience, AQuA is launching a series of blogs by the group members about some of the key successes and challenges noted to date.

We hope this will inspire others, whether they be clinicians, patients or system leaders, to consider what more they can do to support PCC, and we welcome comments, queries and requests to join the party!

Next time...Brook takes a look at why the NHS has historically struggled with Person Centred Care, and how this is changing.

In the meantime, feel free to share your thoughts with Brook on Twitter via @BrookH_AQuA or @AQuA_NHS, or leave a comment below.

AQuA Lived Experience Affiliate Starts Nursing Training

The Advancing Quality Alliance (AQuA) is delighted to share news that Carl O’Loughlin, one of our Lived Experience Affiliates, will be taking his first step into nursing as he begins his training to become a Mental Health nurse at the University of Chester in February 2018.

Carl O'Loughlin, Lived Experience Affiliate

Carl, who started his career training to be a Chartered Accountant, has worked alongside our staff and members for a number of years, to help design our programmes and offers, and ensure patient experience is at the heart of our work. To support him during his studies, Carl has also been awarded one of the prestigious Margaret Parkinson Scholarship’s from the Royal College of Nursing Foundation.

Speaking on the news, Carl said:

“I am absolutely delighted to have been offered a place to begin my Mental Health Nursing degree. I am passionate about mental health care and I want to use my own personal lived experience of severe mental illness to try and make a difference to others suffering similar problems.

“My 'lived experience' roles at the Advancing Quality Alliance, Cheshire and Wirral Partnership NHS Foundation Trust and CLARCH North West Coast have provided me with invaluable experience and have certainly been the driving force behind me wanting to become a mental health nurse.

“I am also extremely proud and honoured to have been awarded a Margaret Parkinson Scholarship from the Royal College of Nursing Foundation which will support me throughout the 3 years of the course.”

Paul Greenwood, Mental Health Improvement Advisor, said:

“We’re really pleased for Carl and wish him all the best as he takes his first step into nursing. It is a pleasure to work alongside him as part of our Lived Experience Panel as he brings such a wealth of experience to our work, both from his previous career as an accountant and through his own personal experience of mental health.

“We’re delighted that the work with us inspired him to take this decision, and I know he’ll have a lot to offer when he qualifies in the years to come.”

Carl will continue to work with us through the Lived Experience Panel throughout his training. To find out more about the panel, please visit our website, or contact Paul.Greenwood@srft.nhs.uk.

RECAP - AQuA Welcomes The King’s Fund’s Chris Ham for Place Based Care

The Advancing Quality Alliance (AQuA) were delighted to welcome Professor Chris Ham, Chief Executive of The King’s Fund, for an exciting masterclass exploring pace based health and care.

Chris addressed over 100 senior leaders from across health and social about the ten key design principles for successful place based care, and some of the challenges behind this at the event in Manchester; hosted alongside our partners NHS Mersey Internal Audit Agency (MIAA), NHS North West Leadership Academy (NHS NWLA), and the Association of Directors of Adult Social Services (ADASS) North West.

Speaking after the event, Cathy Sloan, Head of System Transformation, said:

“It was fantastic to welcome Chris to Manchester for this masterclass. The King’s Fund have really led the way in the thinking behind place based care in the UK, and it was really good to hear about some of the key principles of how we can deliver these in practice.

“It was also inspiring to hear from our members in St Helens and at the Greater Manchester Health & Social Care Partnership, on how these systems have started to be implemented in their localities.  Sarah Bullock from St Helens Cares and Tim Griffith from Greater Manchester described the very different ways their systems are developing place based care.”

Watch back Chris’s presentation below.

The Journey to Place Based Systems of Care: Learning from what works with @profchrisham #PlaceBasedCare https://t.co/Yd1wgxeyUT

— AQuA (@AQuA_NHS) September 21, 2017

Place based care is where local health and care providers, commissioners, local authorities and other organisations work together to establish coordinated systems and plan their services to address the healthcare needs of their local population.

If you missed the session, you can catch up on some of the key points from the day via our multimedia recap below.

AQuA Staff Among Latest to Join Q Community

The Advancing Quality Alliance (AQuA) is pleased to announce that its Safety & Mortality Improvement Lead Kayleigh Price is among the latest selected to join the prestigious Q Community.

Led by The Health Foundation, Q aims to bring together improvement practitioners from across the UK to share ideas, learning and best practice to support improvement projects and innovation.

Kayleigh Price, Improvement Lead

Kayleigh, who joins eight other AQuA staff who were previously selected for Q, said of the announcement:

“I’m really excited to be accepted as a member of Q and look forward to being a part of an exciting, diverse and dynamic community.

“I can’t wait to get going and start learning from others and sharing my own experiences too.”

Over the past year, The Health Foundation have been working alongside Academic Health Science Networks (AHSNs) across the UK, to coordinate recruitment to Q.

Kayleigh was part of the latest intake for the Greater Manchester AHSN area, with a previous intake held for the Innovation Agency (formerly North West Coast AHSN) footprint earlier this year.

Q now has almost 1800 members frmo across the UK, including a number from across the North West.

Our Chief Executive David Fillingham will also be speaking at the Q Community national event in Liverpool on 23 November, which will explore how members can learn from each other and do things differently to improve outcomes.

We’ll also be sharing further details about this event in the coming weeks.

For more information about Q, including a full directory of members, visit the Q Community website. You can also follow updates on Twitter via @theQCommunity.

AQuA Annual General Meeting (AGM) - Thursday 3 August

The Advancing Quality Alliance (AQuA) would like to invite senior leaders from the across membership to attend our Annual General Meeting (AGM) on Thursday 3 August.

At the AGM, we will be talking about our key achievements and programmes from 2016/17, as well as outlining our strategic direction with members and customers for the coming years.

Speaking ahead the meeting, Lesley Massey, Director, said:

“As a membership organisation, we really appreciate the insight and input we gain from our members.

“The AGM is a great chance for senior leaders to find out more about our work from the past year, as well as our vision for the future; not just with their own organisation but across the whole membership footprint.”

Members will also have the opportunity to meet our Board, several of whom are also members, as well as meet our staff from across our teams and programmes.

The meeting will take place on Thursday 3 August, 11:30am – 12:30pm, at our offices in Sale, Greater Manchester.

If you would like to attend, please confirm your attendance by contacting Carole Maloney, on Carole.Maloney@srft.nhs.uk or calling 0161 206 5187 by the end of Monday 31 July.

Blog – International Inspiration for Person Centred Care – Cathryn Sloan

Cathryn Sloan is AQuA’s Head of System Transformation. Here she shares some exciting examples of how person centred care looks like in practice from around the globe, following her recent visit to the International Conference for Integrated Care in Dublin.

Cathryn Sloan

I was really pleased to be selected by the International Foundation for Integrated Care (IFIC) to deliver an oral poster presentation as part of the International Conference on Integrated Care (ICIC) held in Dublin earlier in May.

The title of the poster was ‘Putting Person Centred Pathways into Practice’ and it described the really powerful work AQuA’s Lived Experience Panel does with our members.

It became really apparent over the three days of the conference that IFIC (and its partners, Health Service Executive, Ireland and the National Clinical and Integrated Care Programmes) had taken the principle of person centred care very seriously and it formed a really strong thread through all of the plenary and workshop sessions.

The conference itself was awarded ‘Patients Included’ Charter status, as it had been co-designed and planned with patients and caregivers. Patients, caregivers and advocates were very much a key part of the programme, and we heard from many about their experiences of care and how integration of health and care services had benefitted them.

There are just too many examples of how people receiving care actively participated in the conference but here a couple that really stood out for me:

Thriving in New York City

During his plenary session, Gary Belkin from New York described the ‘Thrive’ programme which is the mental health plan for New York.

The programme aims to train 250,000 New Yorkers to provide mental health first aid to their communities, empowering all citizens to take action on Mental Health and addiction and shift the focus from punishment to public health awareness.

It was an incredibly powerful example of how people with a lived experience of Mental Health can help build systems of care.

The Dutch Touch to Training

The second example that really resonated with me was the WeLearn programme from the Netherlands; this a pilot programme where patients and clinical students learn together, undertaking training in Shared Decision Making, communication skills amongst other things.

The pilot has demonstrated that medical students gain a far greater understanding of how they can work in partnership with their patients to deliver care more effectively. The programme is about to be rolled out across all medical training.

Often, patients, carers, families and people with a lived experience of care are seen as bystanders in the health process, so it was really heartening to see how the international health and care community is embracing working in partnership!

I am looking forward to next year’s conference in the Netherlands to see how some of the programmes have progressed.

You can share your thoughts with Cathryn on Twitter via @Catieranger or @AQuA_NHS. You can also find out more about AQuA work around Person Centred Care on our website.

Blog – How Improvement Can Resuscitate the NHS – Amanda Huddleston

Amanda Huddleston is AQuA’s Quality Improvement Lead for Safety & Mortality. Following her recent visit to the recent International Forum for Quality & Safety in Healthcare conference in London, she shares her thoughts on challenging leadership culture, and using root cause analysis for improvement.

Amanda Huddleston

The NHS and public sector as a whole are experiencing unprecedented demand; the daily battle to deliver safe, timely and effective care is a huge challenge. At the sharp end, this is more and more leading to increased harm, poor patient experience, delays and a clapped out workforce on a daily basis.

As an NHS ‘lifer’ with over 20 years nursing experience, this makes me feel helpless, sad and angry. So, when I was given the opportunity to attend the BMJ/IHI International Forum on Quality and Safety in London, (to co-present the AQuA poster about ‘using safety culture assessments to drive safety improvement’) I grabbed the chance to see what the rest of the UK and indeed the world are doing to fix our NHS.

After surviving the inevitable commute (does anyone in London look happy?), I set off in search of a panacea. Whilst mingling with the other 2999 international delegates from over 70 countries, I noted five key things:

1. Silver bullets sadly don’t exist
2. No matter where you are from in the world, we are essentially all seeking to improve quality and safety
3. Quality improvement science and the IHI model are a proven methodology 
4. Most people use bits this model but tend to skip the measurement (meaning it’s a pet project not an improvement and sadly change isn’t sustained)
5. The ‘soft’ elements of quality improvement are the most important bit

The conference focused on the ‘softer elements’. I have felt for a long time these aspects have been underestimated and have in the past been neglected. It was great to hear throughout the sessions the evidence to support a more holistic view of quality improvement.

Encouraging ‘curious leadership’ to change culture

An interesting seminar from NHS Wales kickstarted my conference by advocating ‘curious leadership’, in which Emma Thomas (1000 Lives Programme Manager) shared findings of a huge programme to build a quality improvement focused workforce by training all student AHPs, medics and nurses.

Their findings demonstrated the benefits of this approach, as there was a positive shift in the culture of the whole workforce, including a reduction in negative behaviour deriving from hierarchy. Supporting students to be more curious and challenge and question the status quo benefited everyone, as it generated fresh ideas and new approaches to old problems.

For those of us NHS oldies with a few miles on the clock, the culture shift and leadership element requires us to build confidence in others and take a step back to allow experiential learning.

The benefits and evidence to support a less direct leadership approach were also echoed in the keynote from Derek Feely (President and CEO of the IHI) and his ‘sidekick’ Jason Leitch (National Clinical Director, Healthcare Quality).

The quote of the conference for me was: “heroic leadership is out! New leaders need to be comfortable with complexity and generous with power.” So, tempting as it is to don a cape (or a uniform) and wade in to do a quick fix, it is best to hold back.

I’ve been guilty of jumping in myself; my inner nurse is very eager to make things better at all costs! The evidence and learning shows the only way we can fix our broken system is to create a bottom-up, patient and front line staff quality improvement revolution.

Using Root Cause Analysis to drive improvement
Throughout the conference I also picked up a few new ways to tune in and before acting, understand the context and scope of what’s happening and what needs to be achieved. Using root cause analysis (RCA) to establish special or common cause bizarrely floated my boat.

The session lead by Carol Haraden (IHI Vice-President) and Amelia Brooks (IHI European Director of Patient Safety) to take RCA to the next level explained using understanding of measures and problems to drive improvement.

Listening to RCAs and seeing them as stories from those who are part of the system is a fantastic way of moving RCA from a negative, punitive task to a true source learning. Real food for thought and some ideas that will be implemented into an AQuA programme coming your way soon!

In summary, my takeaway thought (confirmed with so many examples) is that, if you give others permission to act and to be the agents of change, it will increase the likelihood of success and sustainability. This requires us to be brave, give up power, and to become facilitative, rather than managerial.

At a time of targets and pressure to perform, this may prove difficult but the evidence at the IHI event clearly demonstrated this shift as being productive, safer, better for patients and importantly, will help to shift the negative feeling of helplessness and will give us the much needed shot of joy and positivity needed to resuscitate the NHS.

If you’d like to share your own thoughts with Amanda, you can get in touch on Twitter via @MCR_Nurse, or email Amanda.Huddleston@srft.nhs.uk. You can also follow the conversation from the IHI conference via #Quality2017.

Blog - The Promise of Manager-Clinician Partnerships in the NHS

Andrew Wilson is a Senior Business Intelligence Analyst at AQuA. Following his visit to April’s International Forum on Quality and Safety in Healthcare in London, he shares his thoughts on how the NHS needs to bridge the gap between clinicians and managers…

Andy Wilson

There were many fault lines that scarred society in 2016. Deep divisions between young and old, town and country, were evident across the social fabric of these shores throughout the last year. When we think back to the world of 2015, it feels more distant rather than a mere eighteen months ago.

Whilst there is no doubt that, like any other area of government, the process of leaving the European Union will have a significant impact on healthcare, the opening paragraph was not written with Brexit in mind.

Whilst Brexit will undoubtedly have an impact on the NHS, the focus of this blog is on junior doctors. In early 2016, the junior doctors’ strikes were leading news stories for several weeks. Strong opinions were held on both sides of the argument about the morality of the strikes, their impact on patients, the main protestations of junior doctors and who is responsible for this disagreement reaching this point.

Whichever side or viewpoint you took on the junior doctors’ strikes, I’m sure that you would agree that these are the clinicians who in five, ten or twenty years from now will be clinical leaders across the NHS.

Throw into the mix the pressure the NHS will be suffering over the next decade, a larger population with greater healthcare needs, you could be forgiven for thinking that the chasm between junior doctor and management of the NHS is not traversable.

Learning from Guy’s and St Thomas’ example

At the Quality Forum conference I was fortunate enough to attend a presentation by Joanne Ward (a deputy general manager) and Chris Meadows (a Critical Care Consultant) at Guy’s and St Thomas’ NHS Foundation Trust.

Joanne spoke of how she felt it was critical that she spent more time in the clinical setting she was managing, to better understand the work the clinical team undertook, and their perspective of how the NHS functioned.

Chris told delegates of his experience as a new consultant, attempting to encourage his juniors to develop a better understanding of the work NHS managers do, and how the NHS functions. He also spoke about how their roles cross paths, and how the Trust had developed a programme to pair similar junior doctors and NHS managers, with the idea of letting them lead on a quality improvement project.

The programme consisted of a series of workshops and shadowing of roles to match managers and clinicians. The result of this was to have a formidable partnership that could engage with fellow clinicians to establish the underlying problem affecting patient care and work with managers to explore all options to achieve an improvement. Joanne and Chris also went on to talk about the various achievements of these partnerships had had at the Trust.

Hope for positive partnerships

So despite the picture of doom I painted earlier in this, I want to stress that here is just one (and I’m sure there are many more) tangible example of quality improvement working alongside the clinical leaders of tomorrow.

The gains in fostering more of these Manager-Clinician relationships are potentially massive in patient and experience terms, and there is a simplicity to their work financially too.

Link junior doctors with people who have the capability to change patient pathways, and you can achieve improved patient outcomes and a more engaged staff.

Blog - Thinking Safety at the Quality Forum

Andrea McGuinness is AQuA’s Programme Lead for Safety & Mortality. Here she shares her some of her early points from April’s International Forum on Quality & Safety in Healthcare Conference.

Andrea McGuinness

Even as I write this just half a day through the conference, I am already overwhelmed with the sheer volume and brilliance of health and care staff from across the globe.

The passion and ingenuity of people and most importantly, the pride with which they continue driving safety and quality, humbles me.

Here I just wanted to share with you a few key themes picked up from the conference so far…

Doing care with, not to

We need to make it the norm to have patients and families leading safety improvement. After all, who has most to lose when care goes wrong?  We have endless possibilities available to us once we get over doing to, and move to doing with patients and families.

Quality improvement and safety culture

The second theme making a massive impact on me is the power of quality improvement to provide safer cultures within all teams and across all aspects of health and social care. 

Speakers here are sharing how QI with leadership support releases staff to make services safer. It creates purpose and meaning for staff who are often frustrated and caught in a spiral of dissatisfaction about the services in which they work.

We have to choose to make a positive experience

My final theme is around the value and passion, commitment and concern that our staff have for the services they work in. What role do we have in creating positive environments for all those who experience health and care? Those who use and those who work within them?

Leadership, influence, permission and values are something every single one of us can affect. We all have the choice to do this. We can choose to make a positive difference   No one chooses to make a negative impact but do we sometimes choose not to bother?

What we see and hear from AQuA members, and from the international safety community, is that when we learn and share together we make it easier to make a positive difference, and we’ll be sharing more of our learning from the conference in the coming weeks.

You can find more about our work to improve safety on our website. Please do drop us a line if you’d like to discuss this, or anything in this blog further, at either @1McGuinness on Twitter, or via andrea.mcguinness@srft.nhs.uk.

Applications Open to Teams – Applied Human Factors in Healthcare for Teams Programme

We’re looking for teams of five members to join us for an in-depth programme into how to improve patient safety through reducing risk in everyday behaviour and tasks.

Human factors describes understanding how everyday human error and behaviours can impact on the safety and quality of patient care.

Starting in March, our five-day Applied Human Factors in Healthcare programme is designed to give teams a thorough understanding of human factors, and support them to apply their knowledge to a specific safety challenge within own service and environment.

This is an exciting chance for teams of multi-disciplinary / multi-organisation members looking to better understand the effectiveness of human factors, to work alongside some of the leading human factors and patient safety experts throughout the North West.

The programme will take place on the following dates:

• Monday 6 March
• Wednesday 22 March
• Tuesday 4 April
• Friday 21 April
• Tuesday 9 May

Applications are open to teams of five members and at least two of these must have a basic understanding of human factors. Please note, that all team members must be available to attend all five dates.

To apply, please download and complete the application form and return to the above email address by the end of Monday 20 February.

For more information, please download the programme flyer, or contact Rose.O’Reilly@srft.nhs.uk or call 0161 206 8680.

AQuA and The Health Foundation Publish Joint Report on Whole System Flow

Click the image to download the report

The Advancing Quality Alliance (AQuA), in partnership with The Health Foundation, are pleased to announce the publication of a joint report on our work exploring Whole System Flow across health and social care systems.

The report, The Challenge and Potential of Whole System Flow: Improving flow across whole health and social care systems, was co-written by AQuA Chief Executive David Fillingham CBE and The Health Foundation’s Bryan Jones and Penny Pereira, and details key findings and research gained from the past 12 months of working on this new programme.

Speaking on its publication, David Fillingham said:

AQuA Chief Executive
David Fillingham

“Understanding and improving Whole System Flow should be a major priority, not just for colleagues working in the NHS, but also those across the wider health and social care landscape.

“Working on this new programme in partnership with The Health Foundation has been a fantastic opportunity. We’ve had a great response to our work so far, and this report is the product of the drive and commitment of our staff and of the many AQuA members and partners who have made such valuable contributions.

“Whilst its findings may not offer the ‘magic bullet’ to solving flow that some may seek, it does offers insights into how we can work together to tackle this complex challenge, and so secure better outcomes for patients.”

Penny Pereira, Deputy Director of Improvement at The Health Foundation, said

“At its heart, improving flow is about tackling the delays and duplication that are frustrating for all those in the health and care system. Getting flow right is critical to the delivery of new service models, improving quality of care and productivity. But it’s the impact it will have on the daily experiences of service users and staff that matters most.

“We need to look well beyond seeking just quick fixes for A&E. Extending work on flow to span whole health and social care economies takes time and investment. If every organisation in each health and social care economy were able and willing to work collaboratively to design services that optimise flow, it could lead to major improvements in patient and service user experience and outcomes, as well as improved productivity. It is for these reasons that flow should be a top priority."

The report also acknowledges the contributions of AQuA staff Wendy Lewis, Andrew Wilson and David Dixon for their work throughout the programme.

Since May, AQuA have held a series of events exploring different aspects of Flow with both our members across the North West, and wider partners working across health and social care.

Download the report in full here.

Wendy Lewis, AQuA’s Whole System Flow Programme Lead, also shared her thoughts on working on this programme in her recent blog, which you can read here.

For latest updates on the programme, follow us on Twitter @AQuA_NHS or via the hashtag #SystemFlow.

Applications Open - Developing Patient Safety Leaders Programme

We are currently seeking applications from AQuA members for an exciting programme designed

to develop the essential skills and knowledge to lead improvements to patient safety.

Starting in February, our four-day Developing Patient Safety Leaders programme will give members the opportunity to develop a deeper understanding of patient safety, and learn how they can drive improvements in the quality and safety of care delivered to patients.

Our team of Improvements Advisors will support participants throughout the programme to develop key safety leadership skills, and help them apply this to their individual roles and environments.

Topics covered over the four days will include quality improvement tools, effective patient safety culture, Human Factors, how to measure for sustainable improvements, and safety from a patient perspective.

This opportunity is suitable for a wide range of roles, particularly those looking to have a greater impact on influencing or planning patient safety improvements. However, participants do need to have a basic knowledge and experience of quality improvement.

Participants must also be available to attend all four dates:

• Thursday 2 February 2017 - Bolton
• Wednesday 22 February - Bolton
• Thursday 9 March OR Friday 7 April - AQuA Offices, Sale
• Thursday 5 May - Salford

Further information can be found in the programme plan. To apply, please download the application form and return to Rose.O'Reilly@srft.nhs.uk.

The deadline for applications is Friday 20 January 2017. Successful applications will be contacted a week after the deadline.

If you would like a further discussion about the course, please contact Rose via the email address above.