Thursday 5th September 2013
Stories for Improvement
Insert name of presentation on Master Slide
• 14.00
Welcome & intro to WebEx
• 14.05
National Service User Group Update
Mike Spencer, 1000 Lives Plus, Patient and Person Driven Care Lead
• 14.20
Improving Quality Together:
Making Improvement a Habit
Dominique Bird, IQT National Lead
• 14.40
• 14.50
• 15.00
Stories for Improvement
National Service User Group Update
• Meeting held 2nd September 2013
• Three outputs now issued:
– Patient Experience Domains
– Patient Experience Framework
– Core Question set
• Each UHB and Trust required to submit plans
for roll out by 27th September
• Organisations will need to be able to
demonstrate improvements
National Service User Group Update
• Agreed to recommend that the group continues
• Key issues to take forward are:
How information is presented to Boards and the public
Equality issues
Analysis and quality assurance
Use of different methods
• Measuring Patient Experience
Improving Quality Together:
Making Improvement a Habit
Most people would like to ‘do something
about quality’ but don't have the time.
They are too busy dealing with
complaints, correcting mistakes, doing
the wrong things right and doing what
they do twice.
paraphrased from Øvretveit (1992)
Improving Quality Together aims to support a
change in mindset in NHS Wales, where each
individual demonstrates a belief that:
 They have one job and two roles: to do and
 Small step changes can make a big impact.
To do this, we need one common language of
improvement and a consistent approach to its
3 levels of development.
Supported by local Improvement Coaches.
Complemented by Board level development.
Learning outcomes developed for each level.
Suggested delivery model for each level.
Quality Delivery Plan 2012
• ACTION 2: 1000 Lives Plus will continue to be the
core NHS improvement programme, ensuring a
common and consistent language and approach to
• ACTION 4: Health boards and trusts will agree a plan
to train 25 per cent of their directly employed and
contractor workforce in quality improvement
methodology (at basic, expert or leadership level) by
the end of March 2014, supported by 1000 Lives Plus.
Improving Quality Together
• Common language of improvement
• Focus on person-centred care
• Consolidation of quality improvement in
NHS to date
• Framework of quality improvement skills
• Support delivery of local improvement
Improving Quality Together Levels
Awareness of quality
improvement approach
Able to lead
system -wide
improvement and
assurance, and
create a culture
where everyone
feels engaged
and accountable
Able to apply quality
Able to apply quality improvement
improvement approach
approach independently and
with support
support others
Bronze Level
Awareness of quality
improvement approach
What is quality in healthcare?
Together for Health (published in 2011) sets out the 5 year programme for improving
health and healthcare within NHS Wales using 6 quality domains.
Provide care that is
respectful and responsive
to individuals' needs and
Person-centred care example: Beryl's Story
With the people we are caring for at the
heart of all that we do, the starting point
should always be what is best for the
person as a whole.
An approach in Sweden puts patients at
the centre of all care.
The Esther Network ensures the system
fits the individual, instead of the
individual fitting in with the system.
Often we find that the services we
provide to patients don’t give them what
they actually need.
Here is Beryl’s story, where she initially
did not receive the service she needed.
Person-centred care example: Beryl's Story
Beryl is 84 and has arthritis. She recently
had a fall and was admitted to hospital
with a fractured leg.
On her return home she found it difficult to
get to the shops, which she used to visit
once a week, not only for her food, but
also for the company, as she met up with
a few friends from around the village.
Person-centred care example: Beryl's Story
As she was struggling, meals on wheels
were arranged for her, ensuring that she
no longer needed to go shopping for food
and making sure she was well fed.
Beryl left the house less and less, she
became more and more dependent on the
service, and more depressed as she very
rarely saw her friends.
Person-centred care example: Beryl's Story
Fortunately, this became clear to the
district nurse who visited Beryl regularly,
who provided a link with a local voluntary
organisation who now take Beryl shopping.
She is now much happier and feels more
Benefits of a person-centred approach
As shown in Beryl’s story there many benefits of a person-centred
•It can ensure we have an NHS that meets the needs of our users
•It can ensure access to services is easy and equitable
•Patients are the only ones who see the whole pathway
•They have a unique perspective of NHS systems – what seems obvious
to us, as we’ve worked in the systems and picked up the jargon, may not
make sense to patients
•By focusing on person-centred care, complaints will reduce and
expectations can be managed
•It can provide valuable connections with the communities in which we all
Person-centred care
There are 6 elements to person-centred care to consider:
Information considerations
Give clear, timely and relevant information, for example, develop
information material for patients, their families and carers in
collaboration with patients, families and carers.
Involve the patient
Involve the patient in
choosing the best
treatment/care option
Support self management
Agree and work towards achieving
daily goals with patients and their
families. Goals could be getting out
of bed, walk to the next ward,
agreeing a discharge date, etc
Person-centred care
The right environment
Providing access to care in the right
environment where staff have the
rights skills required.
Listen and learn
Regularly listen and learn
from the experiences of
staff, patients, carers etc
to drive improvement.
Involve citizens
Ensure citizens are able and
encouraged to get involved in local
service redesign.
Silver Level
Able to apply quality
improvement approach
with support
2.1, 3.1
Quality in healthcare
Crossing the Quality Chasm: A New Health System for the 21st Century, The Institute of Medicine, 2001
1.1, 5.1, 5.2
Person-centred approach
“A patient is the most important
person in our hospital.
They are not an interruption to our
work, they are the purpose of it.
They are not an outsider in our
hospital; they are a part of it.
We are not doing a favour by
serving them, they are doing us a
favour by giving us an opportunity
to do so.”
Mahatma Gandhi
1.1, 5.1, 5.2
Person-centred approach
What does the service look like from the
person’s perspective?
What does the person need/want?
What is important for the person following
their last contact with the service?
Use Stories for Improvement to support this
Patient experience
On your table spend 10 mins reviewing
this letter of thanks and consider:
– Was this a person-centred approach to
– Were there any issues you can draw out?
– Areas for improvement?
– How would you feed this back to the team?
• Person-centred care underpins IQT
• However, we do not teach how to gather
patient stories, etc.
• We direct teams to their Stories for
Improvement leads
• Develop this theme further in the
training? Ideas?
Future WebEx
• Co-production and involving patients in
improvements in quality to be held November
(date TBC)
1000 Lives Plus
Patient & Person Driven Care Newsletter
• Send stories or
items for inclusion
Thank you!

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