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The Quality Delivery Plan for the NHS in Wales (2012-2016)

1000 Lives Plus: Implementing the Actions

Aim

This paper outlines the approach by 1000 Lives Plus to deliver actions two and four within the Quality Delivery Plan, and to support additional actions as appropriate.

Formal approval is sought from the 1000 Lives Plus National Programme Board to take forward the actions as outlined below.

Overview of 1000 Lives Plus

1000 Lives Plus isthe national improvement programme, supporting organisations and individuals, to deliver the highest quality and safest healthcare for the people of Wales. The programme is focussedon building capacity in improvement skills and sustaining and spreading improvements. It supports frontline staff across Wales throughevidence-based ‘programme areas’ and provides clinical leadership through its Faculty. It is committedto engaging patients and students in improvement work and promotes an internationally-recognised quality improvement methodology

Strategic Context

The Quality Delivery Plan (Welsh Government, 2012) sets out the Welsh Government’s ambitions for achieving excellence in Welsh healthcare by 2016. The vision is for a quality driven NHS, focused on providing high quality care and excellent patient experience.

The plan sets a double goal - for both quality improvement and quality assurance. These two goals require a strong desire to do the right thing, to do it well and to be able to continuously demonstrate positive progress.Actions to drive quality improvement include inspiring all staff and managers to take responsibility for improving the quality of care they provide, and will be supported by 1000 Lives Plus.

Implementing the Actions

The Plan specifically outlines two key actions for 1000 Lives Plus and a series of actions that the National Programme will support.

ACTION 2: 1000 Lives Plus will continue to be the core NHS improvement programme, ensuring a common and consistent language and approach to improvement.

The experience of the Safer Patients Initiative, 1000 Lives and many other programmes in Wales and beyond, has shown that some simple principles and techniques can increase success in providing reliable and consistent care. Even so, improvement will only be maintained and spread if those techniques are widely understood and shape the way that whole organisations work (Shortell, 1998).

1000 Lives Plus will continue to work with NHS organisations and stakeholders to ensure a consistent approach to improvement through the use of the Model for Improvement (originally developed by Associated for Process Improvement The aim is to create a shared understanding and language for the way the NHS and public services set about improvement.

This will be implemented through a variety of mechanisms:

  1. Mini-collaboratives

1000 Lives Plus will continue to deliver a series of evidence-based improvement programmes which focus on specific clinical areas to enablefrontline staff and leaders to introduce and test new ways of working and spread proven best practice.

It has adopted and developed the Institute for Healthcare Improvement’s collaborative programme as the primary methodology for enabling healthcare teams to improve the quality of patient outcomes whilst reducing harm, waste and variation. The methodology draws together participants with a shared improvement goal and supports them in using the Model for Improvement and measuring improvement, whilst allowing the sharing of ideas, experience and tools to promote a culture in which improvement can thrive.

The programmes will be delivered through the collaborative framework until a spread plan is in place within all participating organisations and spread is underway beyond the pilot area/population.

Appendix 1 outlines the current timeline for the existing collaborative programmes and the associate spread scoring system.

The work programme for 1000 Lives Plus is based on the evidence of need and the potential to deliver change. Its priorities need to align with the national needs of the QDP and the local needs of service delivery plans.

National collaborative programmes will reflect NHS Wales’ priorities and connect to Board agendas. Chief Executives of Trusts and Health Boards working with Welsh Government will need to develop an agreed mechanism to review the programme list and identify priorities for the future.

This will ensure that improvement is seen as a central tool to deliver the Together for Health agenda.

  1. Local capacity and capability

Together for Health and the Quality Delivery Plan envisage a shift towards quality driven care and the widespread use of improvement methodology across NHS Wales. Improvement faculties have been established in healthcare organisations across the world and have demonstrated value in linking organisation objectives to clinical work and energising the pace of change. Most Trusts and Health Boards in Wales have started to consider how they will establish a locally appropriate resource to achieve these aims.

There is a general agreement that these developments need to follow the principles of subsidiarity, reflecting local needs and opportunities. There is a role for the 1000 Lives Plus team to provide resources which need only be produced once nationally and to drive pace.

1000 Lives Plus will continue to drive shared learning between partners and from outside Wales, and create the expectation and environment in which faculties play a vital role. It will do more work to frame the “value” discussion and will work to influence senior leadership and the NHS in general on the need for quality improvement in general and faculties in particular.

The programme will ensure join up with the “organisational development work stream” so that there is a clear focus on quality improvement. It will emulate the Scottish “Boards on Board” model to ensure that non-executive directors are champions for improvement methodology. To support organisations with progress, 1000 Lives Plus will also reflect back to health boards and trusts how they are doing in developing the skills base.

  1. Developing Person centred care models and methods

1000 Lives Plus will help support NHS organisations and staff to realign services in accordance with patient need and include citizens at the centre of healthcare planning and provision.

It will support Welsh Government to scope a new programme for 2012-13 to reflect government policy on measuring and improving patient experience.

The programme will broaden its current focus to incorporate a range of approaches and offer new tools to achieve co-design and enablement for patients and populations. This will include the ongoing development of person centred-care case studies to promote good practice and share learning locally, nationally and internationally.

A literature review of the international evidence base for person centred care will prioritise interventions and measures (process and outcomes) to be considered for implementation in Wales. The service and key stakeholders will be engaged in the development of a driver diagram to encompass international good practice.

All collaborative programmes will be audited to ensure person centred care features as a theme incorporated into drivers and interventions. The review will ensure a consistent and strengthened approach, which reflects local, national and international learning.

  1. Engaging the future Workforce in Quality Improvement

1000 Lives Plus will continue to work with universities to embed a standardised approach to quality and service improvement into their existing education programmes.

Improvement training sessions will continue to be delivered to all health profession students across Wales, with an emphasis placed on supporting academics to deliver future training sessions within their institutions.

The programme will work to support join-up between student improvement projects and organisational priorities.

The 1000 Lives Plus Student Chapter will continue to evolve as a national online resource for students to access improvement materials, publications and training opportunities.

It will work to co-host student improvement events with the Royal Colleges and work to identify student opportunities within existing collaborative programmes.

The Chapter will use social media and additional mechanisms create a self-sustaining network of improvement enthusiasts and will deliver communication campaigns to support key 1000 Lives Plus themes or programmes of work e.g. the S.T.O.P and person-centred care campaigns.

  1. Quality as the Business Strategy

1000 Lives Plus will support organisations to build a culture that allows innovation to flourish and puts quality at the core of all our strategic and business planning.

The Programme will prioritise gathering evidence from other healthcare systems which shows that improving quality reduces costs of treatment and improves value-for-money across the whole healthcare system.

Evidence-gathering will also bebuilt into future improvement projects to further explore the link between increased quality and reduced costs. 1000 Lives Plus will work with partners to establish work which will accelerate this agenda in Wales.

  1. Public health evidence and research

The current work to link the 1000 Lives Plus programme development with the mapping of health and healthcare outcomes will be accelerated.

The 1000 Lives Plus programme will always include at least one project which targets population health. This will link with services that actively promote healthy lifestyle messages through a wide range of media to ensure they complement the message.

Champions for Health is the first programme to meet this aim and is an all-Wales project to equip healthcare staff to become more effective role models and advocates of public health messages.The project is being led by the Directors of Public Health in Wales, Public Health Wales and is supported 1000 Lives Plus.

1000 Lives Plus will strengthen links with academic departments across Wales to stimulate and align research and evaluation in support of improvement work. It will build on recent successful experience in jointly designed bids for research funding.

  1. Communications

1000 Lives Plus will continue to provide support to organisations through effective communications which engage key stakeholders, introduce interventions and bring about change.

It will support individual programme areas, through the development of clinical how to guides, raising the profile of work taking place through local and national media opportunities, as well as internally within NHS Wales health boards and trusts and professional bodies. This will be achieved through the development of micro-campaigns, like S.T.O.P. which is focusing on reducing infections through the use of medical devices.

1000 Lives Plus will continue to lead the NHS Wales Communications Study Days, which are designed to enhance the skills of healthcare communication professionals, as well as highlighting the potential for effective communications across wider management settings.

Ensuring that Wales has a common and consistent language for improvement will be achieved in part through the production of key resources, including white papers, Tools for Improvement and specific profession-based versions of ‘The Quality Improvement Guide’. New resource opportunities will be explored, like the development of Apps, as demonstrated with the NEWS Wales App for identifying deteriorating patients.

The programme will continue to promote and celebrate the improvement work and achievements of organisations, teams and individuals across Wales, through its website, developing social media presence and schedule for exhibiting at national and international exhibitions and conferences.

ACTION 4: Health Boards and Trusts will agree a plan to train 25 per cent of their directly employed and contractor workforce in quality improvement methodology (at basic, expert or leadership level) by the end of March 2014, supported by 1000 Lives Plus.

1000 Lives Plus will work with the service, NLIAH and PSMW to agree a plan to train the directly employed and contractor workforce in the continuous quality improvement methodology.

The curriculum will be appropriate for both service staff and the future workforce across all professions and universities in Wales, and build upon existing central and local material. It will comprise online and face-to-face teaching modules and resources for:

  • Leadership – Individuals on Boards / CEOs who need to know the outcomes and impact of improvement programmes and how this is measured.
  • Expert – Individuals leading improvement teams and significant clinical areas.
  • Basic – All NHS staff and contractors within the organisation

The Curriculum Planning Group will develop the content by March 2013. The Implementation Group will ensure organisational readiness from January 2013, with training commencing from April 2013 to March 2014.

In this phase, delivery will be in partnership and include the training of accredited local tutors (approximately 20 per organisation). The training plan will be developed with Workforce and OD colleagues and local faculties in each organisation to bring together the business methods of NHS Wales and the improvement agenda.

The plan will include proposals to maintain that rate thereafter through delivery at local health board and trust level.

1000 Lives Plus will also support the delivery of several additional actions within the Quality Delivery Plan:

1 / The National Quality and Safety Forum will provide oversight and strategic direction in determining areas needing a national focus and attention. / 1000 Lives Plus will feed in to the Forum and take guidance from the areas determined as a national focus.
3 / Welsh Government will establish a Good Practice and Innovation Panel in summer 2012. / 1000 Lives Plus may co-house staff and both groups will mutually inform each other’s work.
5 / During 2012 Welsh Government will develop a national approach to measuring health service user experience. / 1000 Lives Plus will support the work taken forward by the Chief Nursing Officer through the actions outlined under Action Two point 3 “Developing Person centred care models and methods” in this paper.
6 / In 2012/13 Welsh Government will publish an annual rolling programme of clinical audit and outcome reviews. / 1000 Lives Plus will work to develop an outline process for the role of clinical audit and quality improvement as part of the overall cycle in driving change in NHS Wales. National change programmes will bring together information from national audits and look to reduce the gap analysis through the improvement methodology.
8 / During 2012 Health Boards and Trusts will work together to put effective processes in place to ensure the prompt uptake of evidence-based new technologies that maximise benefit and value. / 1000 Lives Plus will explore the broader use of evidence-based new technologies and ensure the regular and rapid review of its evidence-based tools and resources to ensure maximum benefit to the service and patients. The role of new media and social media will also be considered e.g. Apps.
10 / The Welsh Government will work with the NHS to develop Quality Triggers and a standard template for the Annual Quality Statement by October 2012 in readiness for organisations to report for the first time at the end of 2012/13. / 1000 Lives Plus will build upon the Quality and Safety reporting developed as part of the Annual Quality Framework. It will support organisations to focus on quality and outcomes to drive improvement, with an integrated approach to reporting that includes patient safety, effectiveness and user experience.
11 / Welsh Government will work with the NHS to develop an initial Outcome Indicator Framework, supported by service specific performance measures by summer 2012. / 1000 Lives Plus will work with colleagues in Public Health Wales, NWIS, NLIAH, DSU and Welsh Government to develop a “Measurement for Managers” training programme. This will support the wider organisation transformation agenda.