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The Scottish Early Years Collaborative

The Scottish Early Years Collaborative. 1941, William A. Foster. "Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.”. Juran’s trilogy. Quality planning.

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The Scottish Early Years Collaborative

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  1. The Scottish Early YearsCollaborative

  2. 1941, William A. Foster "Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.”

  3. Juran’s trilogy Quality planning Quality improvement Quality assurance

  4. Quality Improvement • “Quality Improvement is a broad range of activities of varying degrees of complexity and methodological and statistical rigor through which … providers develop, implement and assess small-scale interventions and identify those that work well and implement them more broadly in order to improve clinical practice.” Mary Ann Bailey, The Hastings Center

  5. Implementing at scale….can it be done? Will Ideas Execution

  6. Evidence based discovery  Evidence based delivery 17 years to get 14% of evidence into practice

  7. 25.1 harms per 100 admissions

  8. Our change theory • A clear and stretch goal • A method • Predictive, iterative testing

  9. “By what method?” • A Breakthrough Series Collaborative • underpinned by the Model for Improvement • A clear aim • Over 40 measures • Five change packages • Site visits, a listserve, learning sessions W.Edwards Deming

  10. IHI Breakthrough Series Collaborative Select Topic (develop mission) Participants (10-100 teams) Prework P Develop Framework & Changes P P A D A D A D Expert Meetings S S S LS 1 LS 2 LS 3 Holding the Gains Planning Group AP1 AP2 AP3 Supports Email (listserv) Phone Conferences Visits Assessments Monthly Team Reports LS – Learning Session AP – Action Period

  11. IHI Breakthrough Series Collaborative Select Topic (develop mission) Participants (10-100 teams) Prework P Develop Framework & Changes P P A D A D A D Expert Meetings S S S LS 1 LS 2 LS 3 Holding the Gains Planning Group AP1 AP2 AP3 Supports Email (listserv) Phone Conferences Visits Assessments Monthly Team Reports LS – Learning Session AP – Action Period

  12. What did the teams achieve?

  13. HSMR – Jan. – Mar. 2012 • Deaths and discharges = 221,674 • Observed deaths = 6401 • Expected deaths = 7167 • HSMR = 6401/7176 = 0.89 9902 fewer than expected deaths since January 2008 902 in this quarter alone

  14. HSMR: Scotland Jan. ’08  Mar. ‘12 1.03 10.6% reduction 0.89

  15. Surgical Mortality 35% 0.78% 0.51%

  16. General ward C.Difficile rate(per thousand patient days) 90% reduction 1.15 0.12

  17. ~6500 people

  18. Act your way into culture change

  19. Communities

  20. Aim Measures Changes Execution The Improvement Guide, API

  21. New measurement skills • Run charts • Transparency • All-or none measurement

  22. You can only learn as quickly as you test.

  23. Having the best professionals in the world is no longer enough

  24. @jasonleitch

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