Building the highest quality services in the country

1. Building the highest quality services in the country Nigel Barnes March 2008

2. Some Definitions • Quality • Quality of the intervention – right patient, right time, right intervention, right outcome • Quality of care – essence of care issues • Quality of environment – is the environment fit for purpose • Quality of pt experience – did the patient feel respected, cared for, informed etc

3. Some Definitions (2) • Safety • The avoidance of injury or harm to the patient from health care interventions intended to benefit • Ensuring necessary arrangements are in place in case patients suffer harm

4. Quality and Safety Initiatives • Clinical governance • Incident reporting & risk management • Clinical effectiveness – NICE & NSFs • Clinical Audit • Better use of information • Education and training • Essence of care • Standards for better health

5. Culture and leadership • NHS Targets • Financial pressures • NHS litigation • Confidence in NHS services • Board ownership of quality and safety • NHS staff putting quality and safety first

6. There’s much to be done! • Adverse events in hospital care • Health care associated infections • Poor communications • Drug related admissions • Patient accidents • Litigation claims/complaints/media reports • Unacceptable variations in performance

7. Key themes • Developing robust metrics for safety and quality • Patient feedback on quality services • Making the best of IT • Culture and leadership for quality and safety • Sharing of good practice • Commissioning for quality and safety

8. Where are we now? • Undertake a baseline assessment of quality and safety initiatives in organisations providing NHS services, building on regulatory assessments such as HCC ratings

9. First steps • Review evidence of best practice approaches to improving quality and safety in the NHS and other healthcare systems to inform and develop the participative programme

10. Metrics for quality and safety • Plenty of examples • QOF • Medicines Management • Surgical complications • Healthcare associated infections • Dr. Foster & CBSA • Driving improvement and reducing inappropriate variation

11. Improving Commissioning • Commissioning for quality • Commissioning for safety • Building the outcomes from other workstreams into high quality commissioning processes

12. Project objective • Develop frameworks for monitoring safety and quality of services including appropriate metrics for health services to help providers and support PCTs to commission for safety and quality

13. Patient feedback on services • What information do we require from patients to inform commissioning? • Environment • Staff attitudes • Patient experience • Treatment explanations and choices • Communications • How do we populate NHS Choices?

14. Making the best of IT • Using IT • to build in safety • Guide appropriate clinical choices • Streamline data collection • Sytematise audit • Capture patient feedback • Link into patient information on services

15. Next steps • Develop a series of packages of approaches to ensure that all elements within the CfH programme that support quality and safety are used to maximal effect.

16. Culture and leadership • Organisational leadership • Managerial and clinical leadership • Developing a workforce focused on quality and safety • Organisations and staff learn from significant events

17. Participative programme on quality and safety • Develop a participative programme for all organisations providing NHS services to improve quality and safety • Board ownership • WM objectives and local objectives • PDSA cycles • Share good practice and success

18. Improving safety • Utilise the work of the NPSA • Improve reporting • Learn from NPSA reports • Improve quantification of patient safety incidents • Demonstrate quantifiable reductions in incidents • Improve opportunities to share learning from incidents