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WELCOME

Assessing and transforming the culture of an NHS Service Changing culture and values in practice 9 July 2013 Andrew Foster Chief Executive. WELCOME. “OUR BIGGEST ASSET IS OUR STAFF” NOT A CLICHE. Our journey to a new culture. My journey. DH 2001 to 2006 Worked with Don Berwick

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WELCOME

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  1. Assessing and transforming the culture of an NHS ServiceChanging culture and values in practice9 July 2013Andrew FosterChief Executive

  2. WELCOME

  3. “OUR BIGGEST ASSET IS OUR STAFF” NOT A CLICHE

  4. Our journey to a new culture

  5. My journey • DH 2001 to 2006 • Worked with Don Berwick • Went to two IHI Conferences in USA • And two in Europe • London 2003 – 100,000 lives • 2007 Wrightington, Wigan & Leigh • Quality as a unifying motivator

  6. Quality and Safety in Wigan 2007

  7. Introducing quality 2007 to 2009 • Our business strategy for FT status • 2 directors to the IHI • 2 burning decks – infections and HSMR • Initial success: • Rapid improvement • Quality Account pioneers • Private Eye

  8. Embedding quality 2009 to 2011 • Annual delegations to IHI • Weekly deaths analysis • NHS Institute LIPS courses • Fractured neck of femur • Matching Michigan • Falls and pressure ulcers • Never Events • WHO checklist • CQINs • The Board’s role in quality • Umesh Prabhu

  9. Where next? 2011 onwards • Organisational clarity • Mission, vision, strategy and objectives • The WWL Wheel • And: • Continuing delegations to IHI • Zero harm • QUEST • The Quality Executive and Quality Faculty

  10. Trust objectives • Our mission: to provide the best quality health care for all our patients • Our vision: to be in the top 10% for everything we do • Our strategy: to be safe, effective and caring

  11. The NHS is very complex

  12. The WWL wheel

  13. Safe

  14. Quality and safety • Quality equal to performance and finance • Nothing is more important than safety • Higher quality and safety = lower cost • Science of healthcare improvement • We measure what we do

  15. MRSA bacteraemia

  16. Clostridium Difficile

  17. “Clean your hands”

  18. And last year…. • 27 Serious Falls • 7 Pressure ulcers • Zero Never Events • 92% Hand Hygiene • 12 Zero harm wards • 96% VTE prophylaxis • 1 Central line infection • 95% Patient observations • 90% WHO surgical checklist • 3 Ventilator Acquired Pneumonia • IHI ‘bundles’ of evidence-based interventions……..and many more

  19. Effective

  20. We didn’t even know

  21. HSMR – Jan 2006 to Dec 2007

  22. Presentation to consultants 09.05.08 OVERVIEW • Our SMR is unacceptable • By following evidence-based methods we can achieve a dramatic improvement • Please support this with your mind and your heart

  23. We know what we are doing

  24. Quick win – Dec 2007 to Nov 2009

  25. Mortality – May 2011 to April 2013

  26. Mortality last twelve years

  27. HSMR – 2007 to 2013 (Unadjusted)

  28. Unadjusted deaths in Hospital 25% reduction over 5 years

  29. Caring

  30. Our patients

  31. Our patients

  32. Should be a joined up strategy

  33. NHS North Quality Dashboard

  34. But we are not as good as we would like to be • SAFE – CQC inspection revealed poor medicines management • EFFECTIVE - HSMR is 96 we want <83 • CARING – we have a number of harrowing incidents and complaints • And… • The Francis Reports • Global trigger tool • Non-compliance with checklists

  35. We are still harming patients • Weekend admissions • Sepsis • Catheterisation • Infection • Thrombo-embolisms • Malnutrition and dehydration • Medication errors • Falls • Non-compliance with check lists • Deteriorating patient • Right patient right ward

  36. Where next? • From Flowers in a Desert to an Orchard • The Quality Executive • The Quality Faculty • Quality Champions

  37. The Quality Champions BRONZE • Andrea Arkwright Marion Ashworth • Anita Baker Diraviyam Balasubramanian • Ian Bett Chris Birchall • Dan Buck Kath Collins • Cheryl Dagnall Shaun Dainty • Gill Davenport Janet Duffy • Helen Flowers Andrew Foster • Karen Foster Ruth Gregory • Stephen Gulliford Phil Harris • Joanne Heggarty Elaine Hibbs • Jawad Hussain Jackie Hylton • Sean Jackson Alison Jones • Pauline Jones Shams Khan • Diane Lee Lucy Lyon • Victoria Lofthouse Nisar Mahmood • Micky Malhotra Sonia McDiarmid • Tricia McDonnell Carrie McManus • Marius Paraoan Mike Parks • Hitesh Patel Louise Piscina • Radhika Rangaraju Andrea Rostron • Carol Rozman Connie Sharrock • Peta Stross Ram Sundar • Gail Swift Diane Swindlehurst • Axel Sylvan Clare Thomas • Andy Thompson Debbie Travis • Andrew Twist Debbie Waywell • Kim Whiteside Jodie Whittle • Angela Winterton SILVER • Ayaz Abbasi Sanjay Arya • Linda B’-Jones Marie Corfield • Martin Farrier Linda Smyth GOLD • GILL HARRIS

  38. Quality Governance System

  39. SUMMARY • We have come a long way and are proud of some key achievements • Patients at the heart of everything • Strategy - Safe, Effective and Caring • But we still have a long way to go

  40. Light at the end of the tunnel?

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