The UCLH Quality Improvement
Framework
Guy Young
Head of Quality Improvement
What is quality?
• Excellence in meeting customers’
expectations
• In healthcare 3 components:
– Is it safe?
– Is it effective?
– Is the experience good for the patient?
Why do we need a quality
improvement programme?
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ay
ril
25
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pt
em t
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e
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ec er
em
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Ja er
nu
Fe ary
br
ua
r
M y
ar
ch
Ap
ril
M
ay
Ju
ne
Ju
Au ly
gu
st
Se
pt
O
ct
N
ov
D
ec
Ja
n
Fe
b
M
ar
ch
Ju
M
Ap
Number
Falls with harm 2010-2011
30
Moderate +
All harm
Target
20
15
10
5
0
Composite patient experience scores 2010/11
90
89
88
87
%
86
85
84
83
82
81
80
Apr-10 May-10 Jun-10
Jul-10
Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11
13
19
11
8 17
53 51
49
48
45
41
Patient board 10
23
6.
32
21
40
46
31
27
38
58
4
29
9 1.
20
47
5. 24
18 26
62
14
16
Discharge
Midwives
44 lounge
station
12
25
22
28
7
35
Clean Treatment
utility room
15
Patient board
30
39
54
42
33
2.
56
Midwives 50 37
Dirty 43 Patient
utility
bathroom station
55
34
52
Ward
reception
desk
57
60
3.
59
61
Paeds
room
36
SPAGHETTI DIAGRAM OF ONE MIDWIVES’S TRAVEL ON
POSTNATAL WARD
Key Findings:
• In one hour, one midwife in charge of discharging women from the ward had 62 different stop
offs
• Clusters of stop offs at patient boards, midwives stations, bays of women being discharged
and in the clean utility room
• Midwife was interrupted twelve times with questions and queries from colleagues, women and
their partners
• Difficult to identify which woman to discharge next because of information on the patient white
boards.
• Ward environment increases hunting and gathering time.
The UCLH Quality Improvement
Framework
• A way of delivering continuous quality
improvement at ward/unit level driven by
frontline staff
– Draws on:
• Transforming Care at the Bedside
• Productive Ward
• Lean
• Aligns well with HIAs and Energising for
Excellence
Key themes
• Transformational Leadership
• Safe and Reliable Care
• Vitality and Teamwork
• Patient-Centered Care
• Value-added Care Processes
Cross cutting interventions
•
•
•
•
•
Intentional rounding
Patient status boards
SBAR
The Well Organised Ward (5S)
Care bundles
How it is done?
• Change driven by frontline staff
• Staff agree areas for improvement and
identify potential solutions (snorkel)
• Small tests of change
• Adoption and spread
Results of a snorkel
Small tests of change
• Small means small!
– One nurse
– One patient
– One time/one shift
The PDSA Model Components
• Plan an activity or improvement test
• Do the activity (implement the improvement
plan)
• Study the Impact of the improvement plan
(what was learned)
• Act determine what changes are to be made
in light of what you have learned.
Measures Display Boards
Patient status board
Environments after 5s
Situation to date
• 8 pathfinder wards
– 4 TCAB
– 4 Productive ward
• 6 new wards this year
• From May onwards 4 wards to join every 2
months
• 1 full day start up training required (5 staff)