Derek Feeley Director-General Health and Social Care and Chief Executive NHSScotland

1. Derek FeeleyDirector-General Health and Social Care and Chief Executive NHSScotland Jason Leitch Clinical Director, The Quality Unit, Scottish Government

4. The Edge of Glory?

6. A legitimate Statement of Values “The Lothian Way” has been developed within NHS Lothian as a set of emergent values and associated behaviours identified as vital elements of the culture that NHS Lothian wants to build. Patients are first and foremost in this set of values however staff motivation and organisational reputation are central too. They are as follows: • Person Centred • Partnership • Integrity • Accountability • Innovation

7. Underlying cultural assumptions (the unwritten rules) Many organisations have unwritten rules which describe ‘the way we do things around here’. In NHS Lothian the following have been described consistently to us in one-to-one interviews: • Suppression of bad news – do not write it down • Gloss • You are on your own – ‘Just fix It’ “

8. Some less prominent headlines (in May alone…)

9. The real world? • Performance continues to improve • In many areas it is better than ever (and world class) • We can’t afford to stand still • Attitudes, ethics and values are as important as technical excellence • Reliability just as important in these areas – every person every time

10. We should choose to learn! “What if we choose to change? Could we craft joy from loss, pride from revision, and excellence from invention? Yes we can.” Don Berwick; British Journal of General Practice; Feb 2009

11. To change and to persist! “There were a number of definitions of courage, but now I was seeing it in its simplest form: you do what has to be done day after day, and you never quit.” ― Eric Greitens, The Heart and the Fist: The Education of a Humanitarian, the Making of a Navy SEAL

12. To make the right thing easier to do!

13. Tough Love?

14. So what if……? • We had the courage to persist in our pursuit of world-class care • We continued to make care safer, more effective and more person-centred • We choose to learn together • We share and renew our ethics and values • We make the right thing easier to do • We get ready for the next curve

15. Aims To deliver the highest quality healthcare services to the people of Scotland For NHSScotland to be recognised as world-leading in the quality of healthcare it provides

16. 2020 Vision Everyone is able to live longer healthier lives at home, or in a homely setting.

17. Getting to the third curve Co-production & assets Performance Improvement Performance Time

18. What will it take? • Redesign, creativity and innovation • New technologies and better use of existing technology • Prevention, assets and activation • Up our game on person centred care • Continued focus on performance and improvement • Shared and renewed ethics and values

19. JL

20. Getting to the third curve Performance Patients and families Time

21. Getting to the third curve Performance Performance Time

23. Median and 90th percentile waits for IP/DC 105 63 35 25

24. % of patient journeys within 18 weeks

25. “The overall financial performance of the NHS is good”Audit Scotland, 2011 good = euphoria

26. Getting to the third curve Performance Improvement Performance Time

28. “The Scottish Patient Safety Programme is without doubt one of the most ambitious patient safety initiatives in the world – national in scale, bold in aims, and disciplined in science.  It harnesses the energies and wisdom of Scotland’s health care leaders –NHS executives, QIS experts, clinical professionals, civil servants, and more – all aligned toward a common vision, making Scotland the safest nation on earth from the viewpoint of health care.” Don Berwick

29. % ICU mortality 24% improvement 18.2% 13.9%

30. Surgical Mortality 28%

31. Scotland HSMR – 9.5% reduction

32. 20%

34. 11.5%

35. Sepsis bundle compliance

36. Harm-free care

37. Katy:Zero Pressure Ulcers Stages 3 & 4 To: Memorial Hermann Katy Hospital Zero Pressure Ulcers for 36 Months January 1, 2008 to December 31, 2010 Zero Pressure Ulcers x 36 Months

38. Northwest:Zero Retained Foreign Bodies To: Memorial Hermann Northwest Hospital Zero Retained Foreign Bodies for 24 Months January 1, 2010 to December 31, 2010 Zero Retained Foreign Bodies x 24 Months

39. To: Memorial Hermann Sugar Land Hospital Zero Central Line Associated Blood Stream Infections for 36 Months February 1, 2008 to January 31, 2011 Sugar Land:Zero Central Line Blood Stream Infections Zero CLABSIs x 36 Months

40. High ReliabilityCertified Zero Hospitals Central Line Associated Bloodstream Infections (4) Ventilator Associated Pneumonias (7) Surgical Site Infections Retained Foreign Bodies (9) Iatrogenic Pneumothorax (4) Accidental Punctures and Lacerations Pressure Ulcers Stages III & IV (8) Hospital Associated Injuries (2) Deep Vein Thrombosis and/or Pulmonary Embolism (1) Deaths Among Surgical Inpatients with Serious Treatable Complications Birth Traumas (4) Serious Safety Events (1) 2012 40 Awards

41. 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.”

42. Getting to the third curve Co-production & assets Performance Improvement Performance Time

44. ~6500 people

45. ~550 beds Prepared by Peter Knight JIT June12

46. Doors