The Scottish Early Years
Collaborative
"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.”
1941, William A. Foster
Juran’s trilogy
Quality planning
Quality assurance
Quality improvement
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
Implementing at scale….
can it be done?
Will
Ideas
Execution
Evidence based discovery 
Evidence based delivery
17 years to get 14% of evidence
into practice
25.1 harms per 100 admissions
Our change theory
• A clear and stretch goal
• A method
• Predictive, iterative testing
“By what method?”
W.Edwards Deming
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
IHI Breakthrough Series Collaborative
Select
Topic
Participants (10-100 teams)
(develop
mission)
Expert
Meetings
Prework
Develop
Framework
& Changes
Planning
Group
P
P
A
D
A
S
P
D
A
S
LS 1
LS 2
AP1
AP2
D
S
LS 3
Supports
LS – Learning Session
AP – Action Period
Email (listserv)
Visits
Phone Conferences
Assessments
Monthly Team Reports
AP3
Holding
the Gains
IHI Breakthrough Series Collaborative
Select
Topic
Participants (10-100 teams)
(develop
mission)
Expert
Meetings
Prework
Develop
Framework
& Changes
Planning
Group
P
P
A
D
A
S
P
D
A
S
LS 1
LS 2
AP1
AP2
D
S
LS 3
Supports
LS – Learning Session
AP – Action Period
Email (listserv)
Visits
Phone Conferences
Assessments
Monthly Team Reports
AP3
Holding
the Gains
What did the teams achieve?
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
20
pr
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HSMR
HSMR: Scotland
Jan. ’08  Mar. ‘12
1.05
1.03
1.00
0.95
0.90
0.89
0.85
0.80
Compiled from reported data by Jason Leitch – September 2012
0.00
Year of discharge
2011/12*,p
2010/11*
2009/10*
1.40
2008/09*
2007/08
2006/07
2005/06
2004/05
2003/04
2002/03
2001/02
2000/01
1999/00
1998/99
1997/98
1996/97
1995/96
1994/95
1993/94
1992/93
1991/92
1990/91
1989/90
1988/89
1987/88
1986/87
1985/86
1984/85
1983/84
1982/83
1981/82
% Mortality on Discharge
Surgical Mortality
35%
1.20
1.00
0.80
0.78%
0.60
0.40
0.51%
0.20
General ward C.Difficile rate
(per thousand patient days)
2.5
1.15
90% reduction
2
1.5
1
0.12
0.5
Ja
n08
Ap
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8
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Ja
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Ap
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9
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n10
Ap
r- 1
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Ju
l-1
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-1
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Ja
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Ap
r- 1
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Prepared 1st March 2012
~6500
people
Act your way into
culture change
Communities
Aim
Measures
Changes
Execution
The Improvement Guide, API
New measurement skills
• Run charts
• Transparency
• All-or none measurement
You can only learn as quickly
as you test.
Having the best
professionals in the world
is no longer enough
@jasonleitch