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Leadership for Improvement in Scotland
Professor Jason LeitchNational Clinical Director
Scottish Government
@jasonleitch
Write down your job title on a piece of paper
In one sentence, write down what you do for a living
Scotland’s Context
Alcohol related deaths registered in Scotland (1979-2016)
Source: National Records of Scotland 2017
% of adults overweight & obese in Scotland 2003-2016
Source: Scottish Health Survey
Source: Health Scotland 2015 and ScotPHO June 2015
• 5 million people
• £13 billion
• 3 Regions
• 14 Health Boards
• 8 Support Boards
• Health and social care integration since April 2016
Scotland’s Approach
“Strong evidence for an innovation is necessary but not
sufficient to result in its adoption”
Mark Freeman, 2012, The International Journal of Management Education
•
Juran’s Trilogy
Qu
ality Imp
rove
me
nt
• Monitor Key Process Indicators against targets
• Take Action when not meeting targets
• Regulatory approach
• Process and system improvement
• Reduce Variation
• Align outputs to customer needs
• Continuous & part of daily work
• Science of Improvement
• Inspection-looking for the “Bad Apples”
• Retrospective Review
• Risk Management
NEW PUBLIC MANAGEMENTTargets, sanctions, inspections
QUALITY IMPROVEMENT
MOBILISING SOCIAL ACTION
Ou
tcom
es
Time
Getting to the Third Curve
Sharing power
Keeping power
Ceding power
PERFORMANCE MANAGEMENT
QUALITY IMPROVEMENT
CO-PRODUCTION
Aims:To deliver the highest quality healthcare services to the people of Scotland
For NHSScotland to be recognised as world-leading in the quality of healthcare it provides
Strategic Direction of Change
Improving Population Health
“By what method?...only the method
counts”
W Edwards Deming
DESIGN DESIGN DESIGN DESIGN APPROVE
Conference Room
Real World
The Typical Approach…
IMPLEMENT
DESIGN
TEST & MODIFY
TEST & MODIFY
APPROVEIF NECESSARY
Conference Room
Real WorldTEST &
MODIFY
The Quality Improvement Approach
START TO IMPLEMENT
Our change theory
A clear and stretch goal
A method
Predictive, iterative testing
Scotland’s Results
NHSScotland Hospital Standardised Mortality Ratio
January 2011 – September 2017
Rate of Ventilator Associated Pneumonia (VAP) for Scotland’s 2 Paediatric Intensive Care Units
April 2013 – October 2017
EachVentilator Associated
Pneumonia costs between
£6,000- £22,000
Source: BJMP 2009:2(2) 16-19
% 30 day Mortality of ICD 10 A40/A41
A case of sepsis costs approximately £1,400 per day
Source: Scottish Trauma Audit Group, 2010
Total rate of restraint for all reporting mental health wards
Total rate of cardiac arrest for 9 hospitals reporting 2012 - 2016
Scottish Stillbirth Rate (per 1000 births) 2000 - 2015
‘My neonatal colleagues in Edinburgh tell me that they notice more small babies in the cots now - they would previously not have made it to the unit of course…’
Dr Catherine Calderwood, Chief Medical Officer for Scotland
Leading for
Improvement
High Impact Leadership Behaviours
….over 1,700 leadership walkrounds have been conducted in Scotland.
Since 2008…….
Scotland’s Hospital Safety Huddles
Continuously improve quality and safety every day
Improve staff engagement and empowerment
Improve patient and family experiences
I always felt supported in my role – the huddle
has made it better
Gives me an overview of the whole hospital -who needs help Feels like we are
one team working together
Gives me real time information that is
being acted on
Population around 50,000
Coatbridge
10 miles east of Glasgow
40% of population living in one of Lanarkshire’s “15 most
deprived data zones”
18th century centre of Iron Making
27-30 Month Review
In Scotland..... 73% of children are meeting their developmental milestones
at their 27-30 months review
In Coatbridge......81% of children are meeting their developmental
milestones at their 27-30 month review
Source: NHS Lanarkshire
How did they do it?
Practitioner Leadership
Health Visitor Engagement
Early Years Collaborative Support
Improvement Methodology
High Impact Leadership Behaviours
1. Which behaviours are hardest?2. Which behaviours are easiest?3. What will you do differently when
you get back to your team?
Choluteca Bridge, Honduras
1998
@jasonleitch
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