Published on March 7, 2014
The Not-So-Secret Ingredients for Scotland’s Health Care Transformation Professor Jason Leitch Clinical Director The Quality Unit, Scottish Government @jasonleitch
Lucy and Lewis
• 5 million people • £12 billion • 14 Health Boards • 8 Support Boards • Integrated delivery • Moving towards social care integration
Public Finances Fall in Government expenditure
Scotland’s Demographics 1911 - 2011 2011 1911 1971 1951 1991 1931 Source: Scotland 2011 Census
Alcohol Related Mortality UK Countries 1990-2005 Source: Office for National Statistics 2007
People living in more deprived areas in Scotland develop multimorbidity 10 years before those living in the most affluent areas
Aims: To deliver the highest quality healthcare services to the people of Scotland For NHSScotland to be recognised as worldleading in the quality of healthcare it provides
2020 Vision/Quality Ambitions “Safe, effective and person-centred care which supports people to live as long as possible at home or in a homely setting.”
ROUTE MAP TO THE 20:20 VISION 12 Priority Areas for Action Health of the Population Early Years Innovation Health Inequalities Quality of Care Value & Financial Sustainability Efficiency & Productivity Prevention Workforce Primary Care Integrated Care Safe Care Unscheduled and Emergency Care Person Centred Care Care for Multiple and Chronic Illnesses
Getting to the Third Curve MOBILISING SOCIAL ACTION Outcomes QUALITY IMPROVEMENT NEW PUBLIC MANAGEMENT Targets, sanctions, inspections Keeping power Ceding power Sharing power Time
Implementing at scale…. can it be done? Will Ideas Execution
“By what method?... only the method counts” W Edwards Deming
The Typical Approach… Conference Room DESIGN DESIGN DESIGN DESIGN APPROVE Real World IMPLEMENT
The Quality Improvement Approach Conference Room APPROVE DESIGN IF NECESSARY Real World TEST & MODIFY TEST & MODIFY TEST & MODIFY START TO IMPLEMENT
Large scale change….. developing our thinking over time From the industrial era - doing
Large scale change….. developing our thinking over time To the social era - connecting
Our change theory A clear and stretch goal A method Predictive, iterative testing
Aims To Further Improve the Safety of People in Acute Adult Healthcare 1. Reduce Harm 95% of people in acute adult health care free from harms in the Scottish Patient Safety Index by 2015: Cardiac Arrest Catheter Acquired Urinary Tract Infections Pressure Ulcers Falls 2. Reduce Hospital Associated Mortality Reduce HSMR by 20% by 2015.
NHSScotland Surgical Safety Briefings
NHSScotland Surgical Mortality
Rate of staphylococcus aureus bacteraemia (including MRSA) cases across NHSScotland was 0.30 per 1,000 acute occupied bed days (2006–2013)
Rate of identifications of CDI across NHSScotland was 0.37 per 1,000 occupied bed days among patients aged 65 & over (2008 – 2013)
Hospital Standardised Mortality Ratio Scotland: 2006 to Sep 2013
The Early Years Collaborative Ambition “To make Scotland the best place in the world to grow up.” Provide the Leadership System to support quality improvement across the Early Years Collaborative
90% of children at Grassmarket nursery school will receive a bedtime story
“He wants me to do stuff with him like his garage. Now he takes my hand.” “He sits and cuddles in. He’s bonding with me. He is listening to me.” “Now he wants to sit with me. He didn’t do that before, he just ran around...” “He is starting to turn the pages by himself and he is noticing if I miss a page.”
Mental Models for Leadership Volume Value
High Impact Leadership Behaviours
High Impact Leadership Framework
Engage Across Boundaries Create Vision and Build Will Driven by People and Community Develop Capability Deliver Results Shape Culture Engage Across Boundaries
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