Publication of Advancing Quality (AQ) 2015/16 Clinical Intervention Measure Results

Nadine Boczkowski,
AQ Programme Director

The Advancing Quality Alliance’s (AQuA) flagship reliability of care programme, Advancing Quality (AQ), has recently published 2015/16 clinical intervention measure results for its NHS member organisations across the North West.

The AQ programme, which was founded in 2008, supports partners to improve the consistency and quality of clinical care across a number of Clinical Focus Areas (CFAs) such as; Acute Kidney Injury, Hip and Knee Replacement, Sepsis and Early Intervention Psychosis.

For each of these areas, a set of core quality measures are identified and agreed by local clinical experts across the region, aligned to national standard guidelines. Working to ensure every eligible patient receives the standard care every time, according to each measure has proven to positively impact outcomes; not only helping to save lives but reduce re-admissions, complications and length of hospital stay.

Nadine Boczkowski, Director for the AQ Programme said:

“We know that people’s health in the North West is generally worse than the England average. In part this is due to the high levels of deprivation seen across the region compared to other areas of England. The AQ programme provides an approach to measure and evidence base the delivery of consistent quality practices in prevalent conditions across the North West.

“Although there has been decline in results in some areas, impacted by changes to measure definitions and thresholds, it is encouraging to see such positive and increasing results in critical areas such as sepsis, AMI and Diabetes . The ongoing commitment of member organisations and their staff to continuously improve and sustain the quality of clinical care is unfounded. 2015/16 continued to identify and spread the scope and scale of best practice by coming together as a collaborative community, sharing knowledge and learning to drive innovation and improvement.’’

The results, which are featured in full on www.advancingqualitynw.nhs.uk can be viewed by hospital or locality. Hospitals included in the published results are commissioned to participate in the programme as part of their local contracts. Some participating organisation’s data may not be published if they do not meet the data quality / completeness threshold for public reporting.

The Clinical Focus Areas included in the 2015/16 results are:

• Acute Kidney Injury
• Alcohol Related Liver Disease
• Chronic Obstructive Pulmonary Disease
• Dementia
• Diabetes 
• Heart Attack
• Heart Bypass
• Heart Failure
• Hip Fracture
• Hip or Knee Replacement Surgery
• Pneumonia
• Psychosis
• Sepsis

The Trusts with 2015/16 results being published today are:

Acute Trusts

• Aintree University Hospital NHS Foundation Trust
• Countess of Chester Hospital NHS Foundation Trust
• East Cheshire NHS Trust
• East Lancashire Hospitals NHS Trust
• Lancashire Teaching Hospitals NHS Foundation Trust
• Liverpool Heart and Chest Hospital NHS Foundation Trust
• Mid Cheshire Hospitals NHS Foundation Trust
• Pennine Acute Hospitals NHS Trust
• Royal Liverpool and Broadgreen University Hospitals NHS Trust
• Salford Royal NHS Foundation Trust
• Southport and Ormskirk Hospital NHS Trust
• St Helen’s and Knowsley Teaching Hospital NHS Trust
• Stockport NHS Foundation Trust
• Tameside Hospital NHS Foundation Trust
• University Hospitals of Morecambe Bay NHS Foundation Trust
• Warrington and Halton Hospitals NHS Foundation Trust
• Wirral University Teaching Hospital NHS Foundation Trust

Mental Health and Care Trusts

• 5 Boroughs Partnership NHS Foundation Trust
• Cheshire and Wirral Partnership NHS Foundation Trust
• Greater Manchester West Mental Health NHS Foundation Trust
• Lancashire Care NHS Foundation Trust
• Mersey Care NHS Foundation Trust
• Pennine Care NHS Foundation Trust

Independent sector providers

• BMI Healthcare - The Alexandra Hospital
• Ramsay Healthcare UK - Euxton Hall Hospital
• Ramsay Healthcare UK - Fulwood Hall Hospital
• Ramsay Healthcare UK - Renacres Hospital

Patients should be at centre of decisions about their care, says NICE

NICE - the National Institute for Health and Care Excellence - has joined forces with a wide range of leading health care organisations to help get patients more involved in decisions about their care.

SDM can improve relationships
between patients and clinicians

NICE, alongside NHS England, the General Medical Council, universities and other organisations have come together to form the ‘Shared Decision Making Collaborative’.

The collaborative hopes to promote a move away from ‘top-down’ medicine, towards a culture where clinicians and health care professionals work together with their patients to choose the most appropriate tests, treatments and support packages.

A set of intentions and commitments, which will help make shared decisions about care a reality in everyday clinical practice, has been set out by the collaborative in their consensus statement and action plan.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said:
“When health care professionals work together with patients, research shows that more appropriate decisions are made about their care. This can lead to improved patient safety, better patient satisfaction and more efficient use of resources.

“It’s important that a culture of shared decision making is embedded into clinical practice. NICE, through our collaboration with other leading health care organisations, will make sure that patient centred care becomes an everyday reality in our health service.”

Emma Walker, AQuA

Emma Walker, Portfolio Lead for Shared Decision Making at the Advancing Quality Alliance (AQuA), said:
“We are delighted to be involved with the National Shared Decision Making Consensus Statement. We are looking forward to working with a range of national partners to support the embedding of SDM into practice; drawing on AQuA’s experience of working with teams and organisations in practice and sharing a range of resources, tools and case studies that we have developed over the past 4 years.”

As part of the collaborative, NICE has pledged to:

• raise awareness and promote shared decision making at a local and national level through a series of case studies
• work with NHS England to ensure that shared decision making tools are embedded within guidance and pathways
• look at existing ways to measure shared decision making in clinical practice through its indicators programme
• advocate for research funding to look into the effectiveness and cost-effectiveness of shared decision making

Other leading health care bodies have also pledged their intentions and ambitions in the action plan. These include:

• NHS England to make sure that involving patients in decisions about their care is rooted in ongoing work programmes
• Healthwatch England to help support shared decision making on a local level
• The General Medical Council to incorporate shared decision making within its Generic professional capabilities framework, which sets out the knowledge, skills and behaviours which doctors need.

To find out more about NICE, please visit their website or follow them on Twitter @NICEComms.

AQuA Showcase Work on Shared Decision Making at NHS Expo 2016

Last week the Advancing Quality Alliance (AQuA), the North West’s leading organisation in quality improvement, joined thousands of colleagues from across the NHS, to showcase our work at the Health and Care Innovation Expo (NHS Expo) in Manchester.

Emma Walker, who leads our work on Shared Decision Making (SDM), joined partners at the NHS Right Care’s dedicated zone to lead presentations on AQuA’s work on SDM, as part of the national Ask 3 Questions campaign.

Speaking after the event, Emma said:

“Being at Expo with the Rightcare Team was an excellent opportunity not only to link with some amazing thought leaders on ‘Person and Community Centred Care’, of which Shared Decision Making and Self-Management Support (SMS) are aspects of this approach, but also to speak to a range of members and NHS colleagues about what AQuA can offer in support.

“I was delighted to give two presentations on our work. The first with Dr Alf Collins, Dr Al Mulley and Professor Matthew Cripps, looked at closing the Perception Gap in relation to SDM, with my section focusing on AQuA’s expertise and experience in putting the theory into practice.

“In the second we discussed some of our top tips for embedding SDM into practice, focusing on our experience from the past 5 years of working with teams to embed SDM and SMS at both team and organisational level.”

The aim of NHS Expo is to bring clinicians and managers from across the NHS to explore how to innovate and use technology to improve care and treatment to patients.

This year’s conference continued to explore the latest developments in health and care and the continued vision behind the NHS Five Year Forward View, with keynote speeches from NHS England boss Simon Stevens, Sir Bruce Keogh, and Health Secretary Jeremy Hunt.

The two-day event was a great opportunity for the AQuA team to talk about their work with members and wider colleagues across the NHS, and patients to discuss how SDM can help improve their relationships with clinicians and experience of care.

We look forward to attending NHS Expo once again in 2017. For more information about our work on Shared Decision Making, including individual case studies, please visit our website.

Advanced Improvement Practitioner - Applications Now Open

We are now welcoming applications from members to take part in the next round of our Advanced Improvement Practitioner (AIP) programme.

Running from November to May 2017, this in-depth course is designed to support senior staff to develop their skills and capabilities to lead and facilitate improvements across their organisations, and health and care systems.

The programme is ideal for members who are leading services or tasked with service transformation, including roles in quality, assurance, improvement, or even organisational development.

Participants will take part in modules on:

• Quality improvement theory and practice -  including key policy contexts, models and methodologies for improvement, systems thinking and organisational strategies, person-centred transformation, and developing theories for large-scale change
• Approaches and execution of change and engagement - models and principles for successful change, testing and implementation, improvement culture, how to build engagement, and managing and engaging people, communities and stakeholders
• The role of an improvement leader - covering the key habits of improvers, how to create conditions for learning and improvement, resilience, and system leadership

Full information about the programme is available in our information pack. 

To apply, please complete our application form and return to lucy.davies@srft.nhs.uk by 12pm on Wednesday 12 October.

Applicants must have the support of an Executive Sponsor or their line manager in order to apply.

If you would like a further discussion about the programme, please contact liz.twelves@srft.nhs.uk.

Learning to Improve - Getting the Right Kind of Practice - David Fillingham

How do we learn? Two examples spring to mind from my experiences this summer.

The first: my four year old grandson kicking a football in his back garden, being coached by his ever patient Dad to get more power and accuracy so that the ball landed in the back of the net at least some of the time. After an afternoon’s practice, some gentle praise and constructive feedback he was getting it between the posts more often than the England football team; maybe a ray of hope for the 2032 World Cup?

The second: it’s Olympic year and watching titans such as Andy Murray and Jessica Ennis-Hill turning in medal winning performances made me think of their own countless hours of diligent practice.

Practice is critical to learning. Yet it’s not necessarily true that all practice makes perfect. Recent research into the neurophysiology of learning has demonstrated that it requires the right kind of practice to get good at something – whether it’s kicking a ball, an Olympic event or improving healthcare. You need to practice not only frequently but also correctly. You need to practice with lots of supportive feedback so you learn from your mistakes and don’t hard-wire self-defeating habits into your attitudes and behaviours.

As it is for grandsons and Olympians, is it also true for health care systems? After two decades of striving to apply improvement method to the NHS are we getting any better at it? And what constructive feedback might help us to improve the way we improve? My own perspective is that of someone who has made many mistakes and not always sufficiently learned from them.

We have had a succession of national bodies leading improvement in the NHS in England: the NHS Modernisation Agency, then the NHS Institute for Innovation and Improvement, followed by NHS Improving Quality, and now, after the coming together of Monitor and the Trust Development Authority, NHS Improvement. I was privileged to lead the first of those bodies, the NHS Modernisation Agency, from 2001 to 2004 and I have worked closely in support of each of the successor organisations.

The NHS has never been more in need of effective national leadership for improvement than it is right now. Overwhelming service and financial pressures are placing a tremendous strain on front line staff and in many places standards of care are beginning to slip.

The formation of NHS Improvement gives me hope. Its new leadership, Ed Smith (Chair), and Jim Mackey (Chief Executive), are on record as saying that they want to see a step increase in investment in improvement method as a response to the challenges we face.

So, if we are to go through another cycle of ‘practice’ – with a new national improvement strategy due in the Autumn of 2016 – how can we make sure it is the ‘right kind of practice’? What sort of reflection might help us to avoid some of the mistakes of the past?

Here are four suggestions based on my own experience. Why not use the comments function below to say what your list would look like?

1. The NHS Modernisation Agency was successful at engaging clinicians in its work but it was much less effective at engaging boards and senior leaders. Investment in strengthening the ability of NHS boards’ to lead quality and safety improvement should be given the highest priority. Without it improvement won’t take hold in a sustainable way.
2. The Department of Health, NHS and other national bodies may provide funding and set overall direction, but it is NHS organisations and front line staff who are the real ‘customer’ for improvement support. We need to generate buy in and give all NHS organisations a genuine stake in being part of an ‘improvement movement’.
3. The wicked problems we face can’t be solved by organisations working in isolation. The ‘Sustainability and Transformation Plans’ in England create an ideal opportunity to develop improvement capability across whole systems of care not just in institutions.
4. If national improvement organisations attempt to deliver all improvement support themselves they pull talented people with good improvement experience away from front line delivery. I’d like to see NHS Improvement keep its core team relatively small and for them to work through a variety of regionally based partners. The aim should be to keep improvement practitioners close to the action, and to network them together in a vibrant learning community. 

The UK Improvement Alliance is made up of organisations whose mission it is to improve health and the quality of healthcare and who are seeking to learn and apply the lessons of the past. We aim to be a strong partner to NHS Improvement in England and its equivalents in Scotland, Wales and Northern Ireland.

Meeting the extraordinary challenges which the NHS faces is a daunting task. To succeed we’ll need to be on top of our game. Let’s commit ourselves to the ‘right kind of practice’ that which is imbued with the spirit of humility, reflection and learning.

This blog was orignally published by the UK Improvement Alliance (UKIA). To find out more about their work, please visit their website, or follow them on Twitter @theUKIA.