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Det er ikke et sprint løb, men snarere et maratonløb…
@simontulloch
(+45) 20 20 43 92
I sikre hænder2013
I sikre hænder
2013
I sikre hænder
2013
I sikre hænder
2013
Forbedringsarbejdet var dejligt, hvad nu?
ELFT Quality Strategy
(2013 – 2020)
ELFT Driver diagram
AIM:
To provide the highest quality mental health
and community care in England
by 2020
Build the will
Build improvement
capability
Alignment
QI Projects
(clinical bundles)
1. Newsletters (paper and electronic)2. Stories from QI projects - at Trust Board, newsletters3. Annual conference4. Celebrate successes – support submissions for awards5. Share externally – social media, Open mornings, visits, microsite, engage key
influencers and stakeholders
1. Build and develop central QI team capability2. Online learning options3. Pocket QI for those interested in QI4. Improvement Science in Action waves5. Develop cohort and pipeline of QI coaches6. Bespoke learning, including Board sessions & commissioners
1. Embed local directorate structures & processes to support QI2. Align projects with directorate and Trust-wide priorities3. Support staff to find time and space for QI work4. Support deeper service user and carer involvement5. Support team managers and leaders to champion QI6. Align research, innovation, improvement and operations
Reducing Harm by 30% every year1. Reduce harm from inpatient violence2. Reduce harm from pressure ulcers3. Other harm reduction projects (not priority areas)
Right care, right place, right time1. Improving access to services2. Improving physical health 3. Other right care projects (not priority areas)
ELFT QI Projects
Pressure Ulcers
57,30%
73,10%
92,01%
UCL
LCL
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
28-A
pr-
14
12
-May
-14
26
-May
-14
09-J
un
-14
23-J
un
-14
07-J
ul-
14
21-J
ul-
14
04-A
ug-
14
18-A
ug-
14
01-S
ep-1
4
15-S
ep-1
4
29-S
ep-1
4
13-
Oct
-14
27-
Oct
-14
10-N
ov-
14
24-N
ov-
14
08-D
ec-1
4
22-D
ec-1
4
05-J
an-1
5
19-J
an-1
5
02-F
eb-1
5
16-F
eb-1
5
02-M
ar-1
5
23-M
ar-1
5
06-A
pr-
15
20-A
pr-
15
04
-May
-15
18
-May
-15
01-J
un
-15
15-J
un
-15
29-J
un
-15
13-J
ul-
15
27-J
ul-
15
10-A
ug-
15
24-A
ug-
15
07-S
ep-1
5
21-S
ep-1
5
05-
Oct
-15
19-
Oct
-15
02-N
ov-
15
16-N
ov-
15
Co
mp
leti
on
Rat
e /
%
Waterlow Completion Rate - P Chart
Aim:
Reduce grade 2 pressure ulcers in the EPCT
29%
61%
Grade 2 Pressure Ulcers – C Chart
We aim to provide high quality, continuously
improving care for our service users.
We do this through four types of activity…
ELFT Quality Strategy
(2013 – 2020)
The journey (so far…)
Inspiration & guidance
Inspiration & guidance
Sustaining improvement – a marathon
“Hard-won improvements often ‘backslide’ when the team turns its attention to other priorities.”
… especially when there are too many ‘projects’ to keep up with.
Sustaining improvement – a marathon
A framework which focuses on:
• The daily work of frontline staff
• Supported by a quality management system
• Clear definitions of ‘standard tasks’ and
‘responsibilities’ at all levels of the organizations
Sustaining improvement – a marathon
QualityPlanning
QualityImprovement
QualityControl
Quality Management
System
Manage the work
Improve the work
Design and manage systems
capable of delivering
quality
The Relationship of Quality Improvement and Quality Control
• QC and QI as interlocking loops of activity.
• Quality Control involves standard tasks, monitoring quality, and making routine adjustments and local improvements.
• When problems arise, the problem is escalated to a higher-level QI initiative to redesign the process, or to Quality Planning functions to fundamentally revise the production system.
The Relationship of Quality Improvement and Quality Control
• QC and QI as interlocking loops of activity.
• Quality Control involves standard tasks, monitoring quality, and making routine adjustments and local improvements.
• When problems arise, the problem is escalated to a higher-level QI initiative to redesign the process, or to Quality Planning functions to fundamentally revise the production system.
Pressure Ulcers
57,30%
73,10%
92,01%
UCL
LCL
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
28-
Ap
r-14
05-
May
-14
12-
May
-14
19-
May
-14
26-
May
-14
02-
Jun-
14
09-
Jun-
14
16-
Jun-
14
23-
Jun-
14
30-
Jun-
14
07-
Jul-
14
14-
Jul-
14
21-
Jul-
14
28-
Jul-
14
04-
Au
g-1
4
11-
Au
g-1
4
18-
Au
g-1
4
25-
Au
g-1
4
01-
Sep
-14
08-
Sep
-14
15-
Sep
-14
22-
Sep
-14
29-
Sep
-14
06-
Oct
-14
13-
Oct
-14
20-
Oct
-14
27-
Oct
-14
03-N
ov-
14
10-N
ov-
14
17-N
ov-
14
24-N
ov-
14
01-D
ec-1
4
08-D
ec-1
4
15-D
ec-1
4
22-D
ec-1
4
29-D
ec-1
4
05-
Jan-
15
12-
Jan-
15
19-
Jan-
15
26-
Jan-
15
02-F
eb-1
5
09-F
eb-1
5
16-F
eb-1
5
23-F
eb-1
5
02-M
ar-1
5
16-M
ar-0
0
23-M
ar-1
5
30-M
ar-1
5
06-
Ap
r-15
13-
Ap
r-15
20-
Ap
r-15
27-
Ap
r-15
04-
May
-15
11-
May
-15
18-
May
-15
25-
May
-15
01-
Jun-
15
08-
Jun-
15
15-
Jun-
15
22-
Jun-
15
29-
Jun-
15
06-
Jul-
15
13-
Jul-
15
20-
Jul-
15
27-
Jul-
15
03-
Au
g-1
5
10-
Au
g-1
5
17-
Au
g-1
5
24-
Au
g-1
5
31-
Au
g-1
5
07-
Sep
-15
14-
Sep
-15
21-
Sep
-15
28-
Sep
-15
05-
Oct
-15
12-
Oct
-15
19-
Oct
-15
26-
Oct
-15
02-N
ov-
15
09-N
ov-
15
16-N
ov-
15
11-
Jan-
16
Co
mp
leti
on
Rat
e /
%
Waterlow Completion Rate - P Chart
The Relationship of Quality Improvement and Quality Control
• QC and QI as interlocking loops of activity.
• Quality Control involves standard tasks, monitoring quality, and making routine adjustments and local improvements.
• When problems arise, the problem is escalated to a higher-level QI initiative to redesign the process, or to Quality Planning functions to fundamentally revise the production system.
Pressure Ulcers
57,30%
73,10%
92,01%
UCL
LCL
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
28-
Ap
r-14
05-
May
-14
12-
May
-14
19-
May
-14
26-
May
-14
02-
Jun-
14
09-
Jun-
14
16-
Jun-
14
23-
Jun-
14
30-
Jun-
14
07-
Jul-
14
14-
Jul-
14
21-
Jul-
14
28-
Jul-
14
04-
Au
g-1
4
11-
Au
g-1
4
18-
Au
g-1
4
25-
Au
g-1
4
01-
Sep
-14
08-
Sep
-14
15-
Sep
-14
22-
Sep
-14
29-
Sep
-14
06-
Oct
-14
13-
Oct
-14
20-
Oct
-14
27-
Oct
-14
03-N
ov-
14
10-N
ov-
14
17-N
ov-
14
24-N
ov-
14
01-D
ec-1
4
08-D
ec-1
4
15-D
ec-1
4
22-D
ec-1
4
29-D
ec-1
4
05-
Jan-
15
12-
Jan-
15
19-
Jan-
15
26-
Jan-
15
02-F
eb-1
5
09-F
eb-1
5
16-F
eb-1
5
23-F
eb-1
5
02-M
ar-1
5
16-M
ar-0
0
23-M
ar-1
5
30-M
ar-1
5
06-
Ap
r-15
13-
Ap
r-15
20-
Ap
r-15
27-
Ap
r-15
04-
May
-15
11-
May
-15
18-
May
-15
25-
May
-15
01-
Jun-
15
08-
Jun-
15
15-
Jun-
15
22-
Jun-
15
29-
Jun-
15
06-
Jul-
15
13-
Jul-
15
20-
Jul-
15
27-
Jul-
15
03-
Au
g-1
5
10-
Au
g-1
5
17-
Au
g-1
5
24-
Au
g-1
5
31-
Au
g-1
5
07-
Sep
-15
14-
Sep
-15
21-
Sep
-15
28-
Sep
-15
05-
Oct
-15
12-
Oct
-15
19-
Oct
-15
26-
Oct
-15
02-N
ov-
15
09-N
ov-
15
16-N
ov-
15
11-
Jan-
16
Co
mp
leti
on
Rat
e /
%
Waterlow Completion Rate - P Chart
The Relationship of Quality Improvement and Quality Control
• QC and QI as interlocking loops of activity.
• Quality Control involves standard tasks, monitoring quality, and making routine adjustments and local improvements.
• When problems arise, the problem is escalated to a higher-level QI initiative to redesign the process, or to Quality Planning functions to fundamentally revise the production system.
Pressure Ulcers
57,30%
73,10%
92,01%
UCL
LCL
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
28-
Ap
r-14
05-
May
-14
12-
May
-14
19-
May
-14
26-
May
-14
02-
Jun-
14
09-
Jun-
14
16-
Jun-
14
23-
Jun-
14
30-
Jun-
14
07-
Jul-
14
14-
Jul-
14
21-
Jul-
14
28-
Jul-
14
04-
Au
g-1
4
11-
Au
g-1
4
18-
Au
g-1
4
25-
Au
g-1
4
01-
Sep
-14
08-
Sep
-14
15-
Sep
-14
22-
Sep
-14
29-
Sep
-14
06-
Oct
-14
13-
Oct
-14
20-
Oct
-14
27-
Oct
-14
03-N
ov-
14
10-N
ov-
14
17-N
ov-
14
24-N
ov-
14
01-D
ec-1
4
08-D
ec-1
4
15-D
ec-1
4
22-D
ec-1
4
29-D
ec-1
4
05-
Jan-
15
12-
Jan-
15
19-
Jan-
15
26-
Jan-
15
02-F
eb-1
5
09-F
eb-1
5
16-F
eb-1
5
23-F
eb-1
5
02-M
ar-1
5
16-M
ar-0
0
23-M
ar-1
5
30-M
ar-1
5
06-
Ap
r-15
13-
Ap
r-15
20-
Ap
r-15
27-
Ap
r-15
04-
May
-15
11-
May
-15
18-
May
-15
25-
May
-15
01-
Jun-
15
08-
Jun-
15
15-
Jun-
15
22-
Jun-
15
29-
Jun-
15
06-
Jul-
15
13-
Jul-
15
20-
Jul-
15
27-
Jul-
15
03-
Au
g-1
5
10-
Au
g-1
5
17-
Au
g-1
5
24-
Au
g-1
5
31-
Au
g-1
5
07-
Sep
-15
14-
Sep
-15
21-
Sep
-15
28-
Sep
-15
05-
Oct
-15
12-
Oct
-15
19-
Oct
-15
26-
Oct
-15
02-N
ov-
15
09-N
ov-
15
16-N
ov-
15
11-
Jan-
16
Co
mp
leti
on
Rat
e /
%
Waterlow Completion Rate - P Chart
The Relationship of Quality Improvement and Quality Control
• QC and QI as interlocking loops of activity.
• Quality Control involves standard tasks, monitoring quality, and making routine adjustments and local improvements.
• When problems arise, the problem is escalated to a higher-level QI initiative to redesign the process, or to Quality Planning functions to fundamentally revise the production system.
The Relationship of Quality Improvement and Quality Control
• QC and QI as interlocking loops of activity.
• Quality Control involves standard tasks, monitoring quality, and making routine adjustments and local improvements.
• When problems arise, the problem is escalated to a higher-level QI initiative to redesign the process, or to Quality Planning functions to fundamentally revise the production system.
The Relationship of Quality Improvement and Quality Control
• QC and QI as interlocking loops of activity.
• Quality Control involves standard tasks, monitoring quality, and making routine adjustments and local improvements.
• When problems arise, the problem is escalated to a higher-level QI initiative to redesign the process, or to Quality Planning functions to fundamentally revise the production system.
Daily catheter care (KAD packet elements are met)
Bente Øllgaard – Thisted Kommune
Median; 100,00
Mål; 95
92
93
94
95
96
97
98
99
100ja
nu
ar 2
01
7
feb
ruar
20
17
mar
ts 2
01
7
apri
l 20
17
maj
20
17
jun
i 20
17
juli
20
17
augu
st 2
01
7
sep
tem
ber
20
17
okt
ob
er 2
01
7
no
vem
be
r 2
01
7
dec
emb
er
20
17
jan
uar
20
18
feb
ruar
20
18
mar
ts 2
01
8
apri
l 20
18
%
Alt-eller-intetAndel situationer i forbindelse med daglig kateterpleje, hvor KAD-pakkens elementer
er opfyldt
Median Mål Alt eller intet
Quality Improvement or
Quality Control?
Medicinpakken
Tove Hagen – Lolland Kommune
Quality Improvement or
Quality Control?
Sustaining improvement is…
…essential (but bloody difficult!)
Sustaining improvement requires…
…the development of more robust systems to ensure sustained improvements in outcomes.
Incorporating the different elements of improvement, control & planning.
Forbedringsarbejdet er dejligt, og det er
den måde, vi arbejder på.
I SIKRE HÆNDER MARATON 2013 - ?
Tusind tak!