Chris Caldwell Dean of Healthcare Professions,

1. Building capability in quality improvement to improve population health outcomes:UCL Partners working in partnership with Health Education England locally Chris Caldwell Dean of Healthcare Professions, Health Education North Central & East London, England

2. No conflicts of interest to declare

3. Session Aims • To explore a framework for building quality improvement capability within the workforce at scale • To consider the potential of this approach for patients and population health outcomes

4. Background • Great Ormond Street Hospital in London • Health Education North Central & East London • UCL Partners

5. Great Ormond Street Hospital for Children • Transformational Goal: • Zero Harm • No Waste • No waits

6. Model of Improvement Project Identification and Planning Measurement Engagement; Human Factors; Appreciative Inquiry Process Mapping, Lean and Value Evaluation and After Action Review Spread & Sustain Project support by expert “Buddy” Assessment with accreditation The Curriculum ‘model’

7. Leap Ahead Learning Programme Mini-Leap Ahead – Transforming Care on your Ward Introduction to Improvement Methodology Transformation Improvement Methodology Programme (TIMP) Enabling Doctors in Quality Improvement & Patient Safety (EQuIP) Advanced & Bespoke Programmes Leadership & coaching Programme Evolution: Continuous Quality Improvement

8. Designated one of 15 Academic Health Science Networks in England in May 2013 - largest in UK • Serving a diverse population of over six million people in London Hertfordshire Bedfordshire & Essex. 

9. UCLP Mission To translate research and innovation in care delivery into measurable health gain for patients and populations through partnership across settings and sectors, and through excellence in education

10. Health Education North Central & East London

11. Shared Values Integrated Compassionate Knowledgeable Rigorous Collaborative Improvement focussed Innovation • Patient centred Transparent • Inclusive • Multidisciplinary • Pan-organisation • Integrated • Partnership

12. Transforming Health through Education … Creating a learning culture where all want to learn and keep on learning....

13. …enablepeopleto gain the skills and knowledgerequired … to delivermeasurablehealth gains to peopleandpopulations Vision

14. Building Quality Improvement Capability within a wide Context What the external world prioritises Leadership and alignment Leadership and alignment Strategy Operating system Individual action Institutional action • Measurement and reporting • Capability development • Learning Outcomes

15. Three Areas of work • Deteriorating Patient Project • UCLP Partners Academy (Frail Elderly) • Educational Development & Fellowships

17. And addresses some big issues … and an important problem A local need - A clear and urgent clinical need identified across partner Trusts • Of national relevance • - Cardiac arrests in hospitals • mostly predictable • often avoidable • usually fatal (13% survival) • NCEPOD (2012) ‘Cardiac Arrest Procedures: Time to Intervene?’

18. We homed in on a few key measurements & interventions

19. Key elements of deteriorating patient

20. SHMI :National Ranking Expected vs. Observed deaths UCLP Trusts: Apr 12– March 12 Welcome Abbott Sepsis at Royal Free Data Trust Updates

21. Aiming to halve arrests: 2010 - 2012 And, 61 % reduction in variance of cardiac arrests across original 6 hospitals from 2010 to 2012

22. Approach to delivery • Academy programme development commenced in October 2013 • The Academy offers all staff the opportunity to develop improvement, innovation and implementation skills for patient and population benefit. • The Academy is being designed and applied alongside real time work programmes • The first phase is working with Barking Havering and Redbridge to reshape service provision for the frailty elderly • Engaging staff from health social care, voluntary sector and patient groups

23. Educational Development & Fellowships • Working in partnership as commissioner and provider

24. NCEL Medical commissions 2014/15 Foundation 800 Surgery 379 Medicine 577 Public Health Medicine Medicine 1827 30 Sport & Exercise Medicine Pathology 145 9 4,154 Medical & Dental Posts and supporting infrastructure tbc NIHR 74 Ophthalmology Clinical Oncology Psychiatry 917 Anaesthetics / ICM 314 Psychiatry 311 30 Obstetrics & Gynaecology 163 Clinical Radiology 49 424 ACCS 90 Emergency Medicine GP 566 ACCS Paediatrics 320 Dentistry Dentistry 472 198 23

25. NCEL Non-Medical commissions 2014/15 Clinical Psychology Occupational Therapy 85 46 Improving Access to Psychological Therapies (IAPT) 52 Therapeutic Radiography 31 Physiotherapy 86 Mental health 126 Diagnostic Radiography 70 Mental Health Practitioner 23 Speech and Language Therapy 65 AHPs 397 29 Dietetics 5 Child Psychotherapy 17 2,306 university places and supporting infrastructure 14 Operating Dept. Practitioner Podiatry 15 Healthcare Scientist 25 Learning Disability Health Visiting 60 Nurses and midwives 1,613 38 District Nursing Other 170 72 Pharmacist 27 Emergency Nurse Practitioners 19 School Nursing 65 57 Practice Nursing Dental Care Professions Adult Nursing 690 Mental Health 209 21 9 Midwifery 235 Child Nursing 245 11 Pharmacy Technician Physician’s Assistant Midwifery Support Workers 24

26. Educational Development & Fellowships • ‘Darzi’ Leadership Fellowships • Other Fellowships • Inter-professional learning opportunities in leadership & quality improvement

27. What works in changing a culture? “A powerful person at the top, or a large enough group from anywhere in the organization, decides the old ways are not working, figures out a change vision, starts acting differently, and enlists others to act differently. If the new actions produce better results, if the results are communicated and celebrated, and if they are not killed off by the old culture fighting its rear-guard action, new norms will form and new shared values will grow” And what doesn’t work? “Some group decides what the new culture should be. It turns a list of values over to the communications or HR departments with the order that they tell people what the new culture is. They cascade the message down the hierarchy, and little to nothing changes” John Kotter, Quoted in BMJ editorial March 2013

28. But what else works? Connecting with Communities of Practice … Articulate shared vision Lead Manage Identify success criteria Design curricula Harness existing skills/knowledge/research Evaluate/review Celebrate success Identifypriorities Engage others Co-create measure Share Mobilise resources act Co-design plan

29. Building Strategic Networks Bring people together… Community of engagement Community of interest System Community of practice … to bring about change

30. Learningto share • Cultural change takes time • Gently push but pull hard • Keep it simple • Just in time training backed up by expert coaching • Measurement & analytical skills • Don't ignore the ‘middle’ • Sometimes special things are needed for special people • Don't over estimate the confidence of coaches • Where you start might not be important • Keep ‘rocking the boat’ but make sure you hold your friends in there with you