Making Safety Visible Whole system safetyembedding QI integrated

Making Safety Visible Whole system safety…embedding QI, integrated systems, prediction and prevention Or Our journey, SQE and Shaping the future Hugh Mc. Caughey Chief Executive, SEHSC Trust 9 th November 2017

Northern Ireland…

And of course…. Integrated Health and Social care system • • • Acute Hospital services Older people Mental health Disability services Childrens services (incl Homes; LAC; Children in need) • Primary Care • Prison Healthcare (but not GPs)

LEADERSHIP WORKSHOP & MASTERCLASS Putting SQIE (Safety/Quality Improvement/Experience) at the core of what we do Hugh Mc. Caughey 21 June 2011

My Personal Journey How we judge success A service Failure

1. Our SQE Approach Some Questions. . if you dont like PM/LSD : • How would you want your service assessed? • How would you prove its safe? • What are your teams/services objectives? • How would you improve your service? • How would you make it better? • How was it for you? • What was your experience

Performance Management Some Questions to ask • your service is safe - SAFETY • your teams objective QUALITY • success to your team + • What do the people think EXPERIENCE • What are the implications if you cant?

SQE in SET Our Goal. . . for every service: • Assure the SAFETY • Improve the QUALITY • Test the EXPERIENCE

Francis Report + Patient Safety “These failures were in part due to a focus on achieving targets, achieving financial balance and seeking Foundation Trust status at the cost of delivering acceptable standards of care” “There was an institutional culture in which the business of the system was put ahead of the priority that should have been given to the protection of patients” Sir Robert Francis

SQE and Quality Improvement You can read the book… • now see the movie • http: //www. health. org. uk/b ottoms-up

Overall Chairman's award 2017 Quality Improvement project for 2017 SQE Programme

IHI Leadership framework

Quality Improvement (QI) & Innovation Academy Level 1 Everyone Working or in Training in Health and Social Care E-learning Option 1 & 2 Click here for information SQE Lite Click here for information Level 2 Staff leading smallstep-change(s) with support Level 3 Staff who lead team(s) or service(s) Leading in Safety, Quality & Experience (SQE) Programme Click here for information Foundation SQE Junior Doctors (Starting October 2016) QI Fellowship (Under development) MSc in Business Improvement Click here for information

SET people trained in QI Level 1 Level 2 Level 3 TOTAL QI Programme Participants SQE Lite 245 Level 1 Q 2020 1117 ILM Level 2+3 107 SQE Programme 525 Other level 2 85 QI Fellowship 9 IHI IA prog 5 MSc in Bus Improvement 6 Other 7 2106

SQE “Is it working? ” • Save Lives …Acute Kidney Failure Tracheostomy project; Sepsis 6 • Reduced Risk Theatre Specimens; Wristband project; Single Unit transfusion • Improve Outcomes…Engagement of LAC; Unallocated cases; Reduced Post Partum Haemorrhage • Improved Experience…Prison Choir ; Learning Disability Day Care; Reduced Falls

IS IT CHANGING OUR CULTURE? Quality of care is my organisations top priority 85% 80% 75% 70% 65% 60% 55% 50% 45% 40% 2009 FY 12/13 SET FY 15/16 NATIONAL AVERAGE

Shaping the Future Or Saving the NHS, Social care and Public services

Our Improvement Philosophy Source R. Lloyd IHI, 2012

Testing the safety model

Ageing Population

POPULATION HEALTH WELLBEING INDEPENDENCE ILL HEALTH CHRONIC ILL DISEASE HEALTH INEQUALITIES & DEPRIVATION CHRONIC DISEASE DEPENDENCE CHILDREN IN NEED INEQUALITIES & DEPRIVATION DEPENDENCE CHILDREN IN NEED E A R L I E R I N T E R V E N T I O N EXCELLENCE IN TRANSFORMING YOUR CARE LTC/CHRONICITY HEALTH IMPROVEMENT HEALTH INEQUALITIES SERVICES PEOPLE PROCESSES F R A N C I S C U L T U R E G O V E R N A N C E S Q A F E T Y U A LI T Y E X P E R I E N C E CYPSP INADEQUATE INNOVATION & TECHNOLOGY

“The purpose of effective (political/public) leadership, put simply, is to improve population health and patient care” Kings Fund Report: Leadership & Engagement for Improvement in the NHS

Pf. G and Outcomes focus “Pf. G is about delivering what really matters to people”. OBA is the vehicle to deliver it. Arlene Foster; OBA Belfast Oct 16

4 key Health+Wellbeing outcomes: • People will enjoy long healthy active lives. • Children and young people will experience the best start in life. • People will experience high quality health and social care services. • People will feel cared for and supported.

New world based on Outcomes Target Based Outcome Based • LSD Focus…how quickly • Do more…how fast • For less…how efficient Features • Performance driven • Short term • Drive harder • But…does it improve society • What's the aim/objective • Difference to society • Value added Features • Value driven…to add value • Longer term • To improve health and wellbeing • Sustainable/Affordable

Aspiration A great place to live A great place to work A great place for care and support

Corporate Plan

Programme for Government Outcomes We give our children the best start in life We enjoy long, healthy, active lives • Early Intervention Social Investment Fund (Incredible Years / Mentoring) • Early Intervention Communities (with Atlantic Philanthropies) • NFP and NPP intensive antenatal support • Roots of Empathy with QUB • Early Intervention Transformation Programme (EITP) in Maternity (Solihull) • Family Support Hubs • EITP Child Minder scheme • • We care for others and we help those in need Daily Mile school initiative Emotional Wellbeing Hub Lets Prevent Diabetes Youth Health Advice Clinics in Colleges SPEAR Cardiac Prevention Programme Staff Wellbeing Initiative Improving access to Green Spaces with Councils Alcohol and You • Caring Communities & Volunteer Befriending • WHO Age Friendly Status • Active Aging programme with Councils • LAC Employment and Education Initiatives with Further and Higher education

Programme for Government Outcomes We give our children the best start in life Improved parenting and early support for families Improved child attachment & emotional wellbeing All children reaching their potential Tackling obesity and inactivity at an early age We enjoy long, healthy, active lives Supporting behaviour change with those at risk of developing a Long Term Health Condition Improved emotional wellbeing at an early stage • Early Intervention Social Investment Fund (Incredible Years / Mentoring) • Early Intervention Communities (with Atlantic Philanthropies) • NFP and NPP intensive antenatal support • Roots of Empathy with QUB • Early Intervention Transformation Programme (EITP) in Maternity (Solihull) • Family Support Hubs • EITP Child Minder scheme • • We care for others and we help those in need Tackling social isolation with older people Improved outcomes for looked after children Daily Mile school initiative Emotional Wellbeing Hub Lets Prevent Diabetes Youth Health Advice Clinics in Colleges SPEAR Cardiac Prevention Programme Staff Wellbeing Initiative Improving access to Green Spaces with Councils Alcohol and You • Caring Communities & Volunteer Befriending • WHO Age Friendly Status • Active Aging programme with Councils • LAC Employment and Education Initiatives with Further and Higher education

KP diabetes burden to surge over time Pre-diabetes 20121 960, 000 52% develop 29% develop diabetes over 10 diabetes 2 years over 3 years 2 New cases of diabetes by 2015 482, 630 KP members with type 2 DM in 20123 477, 383 = $3. 48 B/year 4 New cases of diabetes by 2022 = 14 499, 200 $3. 64 B/year 4 1 – Preliminary data; CMI Analysis October 2012. Pre-diabetes defined according to ADA definition using lab values. 2 – Diabetes Prevention Research Group; Diabetes Prevention Program 3 – Preliminary data; CMI Analysis, as of March 31 2012. CORE KP HEDIS Diabetes cohort, minus expected % of Type 1 diabetes per CDC national prevalence 4 – Based on average annual medical expenditure estimates, Vojta et al, Hlth 33 Aff, Jan 2012. Effective Interventions for Stemming Diabetes and Pre-Diabetes Copyright © 2015 Kaiser Permanente

Type 2 Diabetes Growth d Northern Ireland – d Historical growth f 04/17 (90% are Type 2) from d f d d Scotland: Anticipated rates to 2028 In 10 years there will be an extra 45, 000+ Type 2 patients across NI at a cost of £ 220 m - £ 300 m per annum (£ 30£ 50 m per Trust

The Evidence – targeting those most at risk Current practice in NI for Pre-diabetics Diabetes Prevention Study in US UK Research translation - Many patients are diagnosed as pre-diabetic each month through routine GP HBA 1 C tests Seminal 10 year longitudinal study that demonstrated: - - Currently no / little support provided to these patients in primary care at point of diagnosis - More than half of all pre-diabetics will develop Type 2 in 10 years - Disease progression from prediabetes to Type 2 can be stopped (for at least 10 years) in 67% of pre-diabetics by a tailored intensive lifestyle modification / coaching programme (c. 25 sessions) NICE Guidance for high risk / pre-diabetic patients recommends at least a 16 hour intensive lifestyle modification programme delivered to all prediabetics - Diagnosis plays an important role in building motivation - NHS England has developed a number of Diabetes Prevention pilots based on the NICE guidance. These pilots make use of the annual GP health check in England. - Evaluations of these pilots are not yet complete. - Some patients angry with GPs at not being told that they were pre-diabetic - There is no proactive risk stratification to ask high risk patients to attend for an HBA 1 C - In SE Trust, GPs have welcomed (and are using) new CCG referral process for these patients onto the lower dose NHS Desmond Lets Prevent programme - In the Southern area, a pilot identified 2109 high risk patients who were then invited for an HBA 1 C test. From this number, 802 were diagnosed as pre-diabetic and 252 as Type 2 - The effect was delivered via a 7% decrease in weight and an increase to moderate physical activity levels - KP has developed a 26 session intensive lifestyle coaching programme delivered over 6 months for all its pre-diabetics

“The purpose of effective (political/public) leadership, put simply, is to improve population health and patient care” Kings Fund Report: Leadership & Engagement for Improvement in the NHS

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