Denise Evans
Lead Nurse Y&H Neonatal ODN
March 16 th 2015

QUALITY
 an essential or distinctive characteristic, property, or attribute : peculiar and essential character : An inherent or distinguishing characteristic; a property: the non-inferiority or superiority of something .
IMPROVEMENT
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Improvement is the process of a thing moving from one state to a state considered to be better, usually through some action intended to bring about that better state.
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ASQ is a global leader in quality and consists of a community of passionate people who use their tools, ideas and expertise to make our world better.
[quality is] the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
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There is evidence of poor patient experiences and outcomes
Economic downturn response - not indiscriminate cuts
Improving efficiency
Driving up quality
Reducing levels of harm initiatives such as quality accounts and the
Commissioning for Quality and Innovation
(CQUIN) payment framework.
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Safe – avoiding harm
Effective - evidence of benefit
Patient-centred - partnership
Timely – avoid harmful delays
Efficient – avoid waste
Equitable – does not vary in quality
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Paralysis –Fixed head position.
Visiting – Visitors corridor
Access – NO ENTRY
Pain relief
Separation – bonding - developmental care
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Sometimes used to describe trivia but the smallest details are what we share today.
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‘How do we know what constitutes good care?’
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1. Convincing people that there is a problem
2. Convincing people that the solution chosen is the right one
3. Getting data collection and monitoring systems right
4. Excess ambitions and ‘projectness’
5. The organisational context, culture and capacities
6. Tribalism and lack of staff engagement
7. Leadership
8. Balancing carrots and sticks – harnessing commitment through incentives and potential sanctions
9. Securing sustainability
10. Considering the side effects of change.
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Harm Free Care “Its not just counting its caring”
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Neonatal Unit & Postnatal Care
1. Is there a measurable outcome of harm? (can we define what the harm is?)
2. Does it happen enough on one day each month to be picked up in point prevalence testing?
3. Is the information accessible and quick and easy to collect?
4. Does this affect the patient in all settings?
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Deterioration
Extravasation
Pain
Skin Integrity
Measurement and gathering data are vital elements of any attempt to improve performance or quality, and are also needed to assess its impact.
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Design principles for the instrument were agreed as follows:
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Clinically valid with clear operational definitions for harm outcomes (in this case,
pressure ulcers, falls, catheter associated urinary tract infection and venous
thromboembolism).
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Efficient : it should not take longer than 10 minutes per patient and must fit within the
daily work flow of frontline clinicians.
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Equitable and capable of being used wherever the patient is located (e.g. in a home,
community or hospital setting).
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Timely : giving an immediate summary of results that can be used by teams in their
improvement work.
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Patient focused : measuring the absence of all four outcomes in individual patients
‘harm free’ care as well as the individual harms.
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Focused on all harm irrespective of perceived availability or attribution.
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Easy to aggregate to show results at the ward, region or national levels.
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Involving the clinical team early on when setting aspirations and goals
Ensuring senior clinical involvement and peer influence
Obtaining credible endorsement – for example, from the royal colleges
Involving clinical networks across organisational boundaries
Providing evidence that the change has been successful elsewhere
Embedding an understanding of quality improvement into training and education of healthcare professionals.
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Each cycle starts with hunches, theories and ideas and helps them evolve into knowledge that can inform action and, ultimately, produce positive outcomes.
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‘What are we trying to accomplish?’
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––‘How will we know that a change is an improvement?’
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––‘What changes can we make that will result in improvement?’
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Focus on quality, not targets – if effective care is delivered and the focus is on quality, safety and outcomes, the targets are delivered as a consequence of that process, not the other way around.
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 need to find ways of freeing up staff time to take part in training programmes
‘We want everybody to feel that they have the opportunity to solve problems and improve the things that they see every day,’
 The team across the pathway all need to work together with one goal.
Improved outcomes not looking to blame “Not me”
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What clinical care do neonates need?
Safe delivery & stabilisation +/resuscitation at birth & minimal handling!!!!
Effective assessment of medical & nursing needs
Competent staff to undertake procedures safely & deliver optimal care in hospital & on transport
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All showed evidence of the same problems of poor clinical competence, insufficient recognition of risk, inappropriate pursuit of normal childbirth and failures of team-working, as seen previously. Initial investigation was again deficient and failed to identify manifest problems.
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We found clear evidence of distortion of the truth in responses to investigation, including particularly the supposed universal lack of knowledge of the significance of hypothermia in a newborn baby staffed and equipped to provide a restricted range of neonatal care, but not to deal with more pre-term babies who needed more intensive forms of care.
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Jeremy Hunt, Secretary of State for
Health, has set a clear expectation of a
Paperless NHS by 2018, stating that technology will be the saviour of the
NHS. Only with world class information systems will the NHS deliver world class care.
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Quality improvement made simple Second edition, August 2013.
© 2013 Health Foundation ISBN 978-1-
906461-47-8© 2015 The Health Foundation
Building the foundations for improvement is published by the Health Foundation, 90 Long
Acre, London WC2E 9RA
The Report of the Morecambe Bay
Investigation March 2015
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