Quality is Never an Accident !
Jill Young
Mike Higgins
© Golden Jubilee National Hospital, March 2014
Which GP Practice would you choose?
Which GP Practice would you choose?
Which GP Practice would you choose?
Which GP Practice would you choose?
Use performance targets with caution !
NHS Scotland
14 – Health Boards
8 – National Boards
Challenges
• Access
• Treatment time targets
• Healthcare guarantees
• Quality & Innovation
National Waiting Times Centre Board (NWTC)
Our Health Board – 3 Dimensions
National - NHS & Public Sector
4* Hotel, Conference & Health Club
Patients stay free charge (6000+)
On call staff and training
Accredited ‘Centre of Excellence’
8 x ‘Quality Awards’ Hotel Oscars
Beardmore Conference
Hotel
Our Health Board – 3 Dimensions
Clinical Skills Centre
* Simulation training
* Live AV links
* Surgical Skills rooms
* Flexible Wet Lab
Dedicated Research Centre
* Specialised Consulting rooms
* Laboratory, Pharmacy, Echo
Excellence in Health, Research & Learning
Golden Jubilee National Hospital
• Major Orthopaedic Centre of Excellence
• Largest Heart & Lung Centre UK
• Range of Elective Procedures for NHS Boards
• Interventional Diagnostic Unit
Orthopaedic
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5 State of the art theatres
European training centre
‘Computer assisted’ surgery (CAOS)
CALEDonia Technique
Enhanced Recovery Programme
Highest complexity & volume
25% Scotland’s Hip and Knee replacements
12% of Scotland’s Cataracts
Heart and Lung
• One of largest UK Cardiothoracic Centres
• All adult Heart and Lung surgery (WoS)
• National Services
AHF, Heart Transplants & VAD’s
Adult Congenital Cardiac Unit
Pulmonary Vascular Unit
• Her Majesty the Queen on 3 July 2008
Local Delivery Plan
Board/Government
Board Performance
Wait Times
Safety
Staff
Activity
£
Organisation targets & indicators
SMT
Division &
Organisation
Performance
Surgical
Medicine
Hotel
Science
centre
Divisions Plan
LDP Targets
Divisions Plan
Actions LDP Targets
Hotel Plan
Performance Mg
Actions LDP Targets BCHS Plan
local Indicators
Performance MgActions LDP Targets
local Indicators
Performance MgActions
Performance
local Indicators
Local Indicators
Division
Performance
monitoring
Overall Performance
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Robust Targets & Indicators
Balanced Scorecard
Organisational eVisibility
Top/upper quartile in performance
But……does that ensure quality?
Hit the target and miss the point!
Quality is Never an Accident!
NHS Scotland – Quality Strategy
Deliver the highest quality healthcare
NHS Scotland amongst best in the world
Quality Ambitions
• Safe
• Effective
• Person Centred
2020 Vision and Values
Leading Quality, Research & Innovation
Valuing Dignity & Respect
A ‘Can Do’ attitude
Leading Commitment to Quality
Understanding our responsibilities
Effectively working together
Safe, Effective, Person Centred
© Golden Jubilee National Hospital, April 2013
Better outcomes in hospitals where...
The Board spends more than 25% of time on Quality issues
The Board receives a formal Quality performance report
Is a high level of interaction with Medical Staff on Quality
Executive compensation is based on Quality & Innovation
CEO is identified as person with greatest impact on Q&I
Vaughn T, Koepke M, Kroch et. al. 2006
Quality & Innovation Group
“Lead and align quality & innovation activities to achieve our 2020 vision”
• Innovation framework
• Co-ordinate a Register of ‘Talent’
• Develop a matrix of Quality Indicators
• Interactive Dashboards
• Innovation Centre
• Improvement Club
• Quality fund
“Safe, Effective, Person Centred” in all we do
Triangulation
Stage 1- alignment
Clinical Experience
Stage 2 - Evolve
Patients
• Board Agenda
• Governance Committees
• Local Delivery Plan
• P&P / Scorecard
Quality
• Objectives
Targets
Range Indicators
Wait Times – Safe
Effective
Person centred
Staff
Values
Quality Assurance
‘iDashboard’
Values
Dashboard
Clinical
Dashboard
Targets
• Quality assurance on an organisational basis
• Starting point for innovation & improvement
• Continuous scrutiny and evolution
•‘First of its kind’, ownership & collective responsibility
© Golden Jubilee National Hospital, April 2013
iDashboards
© Golden Jubilee National Hospital, April 2013
2 “Person Centred, Safe, Effective” in all we do
• 99% recommend us
• 98% treated with care
Patients
• 98% respect & dignity
Quality
Targets
Staff
• All targets exceeded
• Turnover <0.8%
• 900% increase activity
• Grievances <0.6%
• Hand Hygiene 99%
• Sickness
• Low Length of Stay
• 93% Happy extra mile
• Reduced Mortality
• Complaints 0.08%
<4%
Human Factors
Error is normal
Performance is variable
Systems interact with People & Culture
NASA & British Airways
Human Factors cause:
•73% Aviation Incidents
•86% Industry Incidents
• % of NHS?
NASA & B.A. Team Skills
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Briefings (all crew)
Communication & Decision
Enquiry & assertion
Leadership and Followership
Team Climate
Workload & Distractions
Honesty
Safety problems exist in the NHS
Incorrect priorities do damage
Staff are not to blame
With too many in charge, no one is
Fear is toxic to safety
Human Factors
166
Jose Sanchez, 31 yrs
40
Kitty Genovese, 28 yrs
What number are you ?
‘Bystander Effect’
Human Factors
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B.A. Pilots to train teams
Competency based Leadership
Coaching / mentor programmes
Safety briefings, Surgical Pause
Equipment, skills, ‘time out’
Register of talent, showcase & reward
Independence of scrutiny – volunteers eg
‘Guardians of
Quality’
Quality of recruitment?
Doctors (expensive assets!)
• Before
Legislation, inflexible, 1hr interview, (?pre-determined)
• 2009 ‘CEL25’ Boards could design own approach
• We wanted
Evidence based, full team input
Based on Safety, Quality & our leadership needs
Transparent and measurable
Leadership Recruitment Framework C
7 Essential Competencies
• Clinical Skills
• Safety & Quality
• Innovation & Research
• Communication
• Decision Making
•Leadership/Team working
•Corporate awareness
Leadership Recruitment Framework C
7 Essential Competencies
5 Dimensions
1) Psychometric Testing
Oxford – Personality Test,
Hogan – Motivation, values & Preference
Leadership Recruitment Framework C
7 Essential Competencies
5 Dimensions
2) Clinical Assessment
• Panel- MD, Clinicians, Uni, Royal Colleges
• Evidence based
• References, Log books, Portfolios
• Appraisal, Medical Education
Leadership Recruitment Framework C
7 Essential Competencies
5 Dimensions
3) Formal presentation
Leadership Recruitment Framework C
7 Essential Competencies
5 Dimensions
Human Factors – essential
4) MDT meeting – 2 cases
Leadership Recruitment Framework C
7 Essential Competencies
5 Dimensions
5) Competency Based Interview
CEO, MD, Managers, Nursing
Human Factors – essential
Competency Based Questions & Scores
Safety & Innovation
Personalised to each candidate
Decision!
Outcomes
• Candidates – “thorough, fair and full opportunity”
• Unique approach to recruitment of ‘leaders’
• Use for all senior appointments & owned by staff
• Confidence and transparency in final decision
The Four Leadership Questions
Do you know • how good you are?
• where you stand relative to the best?
• where the variation exists?
• the rate of improvement over time?
M Bisognano, CEO
1601 - Jms Lancaster successful experiment of lemon juice to
prevent scurvy. When did the British Fleet adopt this treatment?
1.
2.
3.
4.
1602
1689
1796
1865
264 years....
Innovation
By prioritising and protecting ‘Safety & Quality’ with space & time
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idashboards
Enhanced Recovery Programme
3D Training software
Sutureless valves
Single Lung Ventilation,
Clinical portal,
Cathi audit
Major Research grants
‘Touchpoints’ programme
Quality walk rounds
CBAS
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Volunteer walk rounds
Innovation Café
Improvement Club
Innovation Hub
New devices & techniques
Artificial Hearts (VADs)
PAVR (heart valve insertion)
Orthopaedic research & trials
New patient menus
Staff social events
Accreditation and Awards
Personal Thoughts
“Always focus on Safety & Quality”
“Don’t hit the target & miss the point”
‘Freedom with Art of care not freedom with the science’
Thank You
Jill Young
Mike Higgins
© Golden Jubilee National Hospital, March 2014