The changing face of stroke care – fast forward
Stroke developments…
Ian Golton
Director
NHS Stroke Improvement Programme
What is the Stroke Improvement Programme?
• “To support local networks the Department of Health is
establishing a central team within the NHS … The main task of
this team will be to ensure that specific support is available to
develop stroke networks “
(National Stroke Strategy, p58)
• Part of NHS Improvement, also supporting networks in
cardiac and lung care, and working with cancer networks
• Based on 8 years experience improving heart disease services
• Work closely with the Department of Health and key national
organisations
• Our job: support the development of Stroke Care Networks
and implementation of the Stroke Strategy
Clinical Microsystems
Layers of the onion: the ‘systems within systems’ that work
together to provide care for patients
Selfcare
National,
policy,
legislation,
evidence
Macroorganisation
Individual
care-giver
& patient
Clinical
Microsystem
National,
policy,
legislation,
evidence
“ …there is uncertainty everywhere, and every
meeting includes conversations of ‘no money’
and how can savings be made”
“I’ve never experienced so much turmoil - it
feels on the coal face that we are waiting for
some disaster to happen”
Stroke Specialist Nurse with over 20 years NHS experience
http://www.nice.org.uk/aboutnice/cof/ConsultationOnCOFIndicators.jsp
“In stroke, the best care is
also the most costeffective care…”
Professor Sir Roger Boyle,
Former National Director for Heart
Disease & Stroke
Performance Data
• 1090 bed days saved
• Reduction of inpatient stroke beds from 56 to 34
• Maintenance of inpatient performance within reduced
bed base
• Stroke service LOS reduced – 21 days to 12 days
Macroorganisation
Ossie Newell MBE
Founder of @astroke
www.atastroke.org.uk
Layers of the onion: the ‘systems within systems’ that work
together to provide care for patients
Clinical
Microsystem
Run charts &
control charts
Ladder of
inference
PDSA cycles
Generative
relationships
Variable
40
35
Ounces
30
Flow charts &
deployment
charts
25
20
15
10
5
0
S
R
T
A
Date
Workforce
Development
Data & measures
F
C
S
£
Clinical value
compass
Global Aim
Template
Small groups
Task
Force
Meeting
skills & disciplines

Team
Left-hand
column
Crew
Fishbone
diagrams
More top tips…
• Get the wind behind you - alignment with policy, guidelines,
strategic goals, organisation priorities etc.
• Get (as much as possible) management support, up to and
including chief executives
• Be clear what you’re trying to do an why - there are only 3
reasons to change
• Involve (as much as possible) the whole team
• Test, test and test again before anything irrevocable or
expensive is done
• Gather data - meaningful, good quality, minimal - to show the
effects and track progress
• Use your patients as your guide and support
http://www.patientopinion.org.uk/
Individual
care-giver
& patient
Harry Clarke, Counsellor and Stroke Survivor
“Give time to listen. And a much
undervalued word is kindness.
Be kind…be kind to that person.
Kindness doesn’t cost any
money. Just be kind”
www.improvement.nhs.uk/stroke