Thursday 5th September 2013 Stories for Improvement Insert name of presentation on Master Slide Agenda • 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 Q&A • 14.50 A.O.B • 15.00 Close 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 – http://www.health.org.uk/publications/measuring-patientexperience/ 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) Purpose 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 improve. Small step changes can make a big impact. To do this, we need one common language of improvement and a consistent approach to its delivery. Structure • • • • • 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. Context 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 improvement. • 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 priorities Improving Quality Together Levels Bronze: Awareness of quality improvement approach Board: Able to lead system -wide quality improvement and assurance, and create a culture where everyone feels engaged and accountable Silver: Gold: Able to apply quality Able to apply quality improvement improvement approach approach independently and with support support others Bronze Level Bronze: Awareness of quality improvement approach What is quality in healthcare? Introduction Together for Health (published in 2011) sets out the 5 year programme for improving health and healthcare within NHS Wales using 6 quality domains. Person-centred Provide care that is respectful and responsive to individuals' needs and values. 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 Background 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 Assessment 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 Recommendation 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 independent. Benefits of a person-centred approach As shown in Beryl’s story there many benefits of a person-centred approach: •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 live 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 Silver: 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 care? – Were there any issues you can draw out? – Areas for improvement? – How would you feed this back to the team? Conclusion • 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? Questions? A.O.B 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 Alison.Hinton@wales.nhs.uk stories or items for inclusion Thank you!