Board meeting – 2nd September 2009 Agenda Item 12

Title of report The North West Advancing Quality Alliance (AQuA)

Summary In Lord Darzi’s report ‘High Quality Care for All’ (2008) he asked ‘each SHA to establish a formal Quality Observatory, building on existing analytical arrangements, to enable local benchmarking, development of metrics and identification of opportunities to help frontline staff innovate and improve the services they offer’ The North West Quality Observatory will be known as the Advancing Quality Alliance (AQuA). it will provide the necessary infrastructure to bring together the principle work streams of knowledge, measurement and capability. The central idea is that AQuA will align the current Advancing Quality work, the North West Improvement Alliance and numerous existing knowledge feeds (eg NICE, Map of Medicine, the Information Centre) into one coherent, comprehensive and easy to access service, including a web-based system. This will allow North West staff to access evidence-based quality measures and metrics – both local and national – as well as information on developing the capability and capacity within their teams or organisations to deliver successful service improvement. AQuA will focus on clinical pathways, integrating the outputs of the Clinical Pathway Groups and delivering 6 regional improvement goals across the quality domains of safe, effective and patient experience, as well as supporting organisations in developing their local priorities.

Actions requested The Board is asked to note the contents of the report and support the philosophy and development of the Advancing Quality Alliance in the North West.

SHA Strategic Aim supported by this paper:

Be recognised as a world-leading health system

SHA Strategic Objectives supported by this paper:

8 - Build capability and capacity of commissioners through e.g. World Class Commissioning, Transforming Community Services, system management 9 - Build capability and capacity of providers through e.g. Transforming Community Services, Foundation Trust Programme, system management 13 - Develop expertise and become a high quality regional system manager providing leadership across the system

Equality and Diversity Assessment outcome:

To be undertaken as part of the work programme, if approved.

Risks Attached to this project/initiative:

Insufficient support is achieved from the anticipated membership both as individuals and organisations, to deliver sufficient improvement activity The scope of the organisation becomes too broad and loses focus on the identified priority areas

Public and/or patient involvement:

This will take place in conjunction with the SHA Communications team and Inspirations North West to ensure that improvements in

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quality focus on the experience of the patient.

Resource implications:

The report contains an estimated cost of £1.25m recurrent per annum with a one-off sum of £55,000 for set up costs in Year 1. Work will be done on providing detailed costs as part of the work programme, if approved. A Programme Director has already been identified to take this work forward.

Communication strategy:

Effective communications will play a critical role in the success of this programme. The Executive Director of Strategic Communications has contributed to the development of this paper, and will be a key partner as the work programme develops. A comprehensive communications strategy for AQuA will be developed.

Type name and job title here

Type e-mail address here Strategic Aim: Improve the health and wellbeing for all of the North West population Strategic Objectives

1 - Ensure people live longer and reduce inequalities in life expectancy 2 - Reduce the impact of illness on people’s quality of life 3 - Reduce lifestyle-related illness 4 - Identify region-wide health needs

Strategic Aim: Optimise the delivery of quality healthcare in the most appropriate setting Strategic Objectives

5 - Enable delivery of safe, effective health and healthcare services which provide patients and the public with the best possible experience 6 - Enable effective resource prioritisation in the North West system 7 - Improve the efficiency of the health service and value for money

Strategic Aim: Be recognised as a world-leading health system Strategic Objectives

8 - Build capability and capacity of commissioners through e.g. World Class Commissioning, Transforming Community Services, system management 9 - Build capability and capacity of providers through e.g. Transforming Community Services, Foundation Trust Programme, system management 10 - Work closely with partners to ensure delivery of the Vision 11 - Build capability in the SHA and ensure it is an exemplar organisation across all of its internal functions 12 - Lead and manage the system during economic instability and maximise the NHS contribution to wider North West economic stability 13 - Develop expertise and become a high quality regional system manager providing leadership across the system 14 - Engage and communicate effectively with public and SHA staff 15 - Develop a leadership culture that fosters innovation and best practice across a range of activities

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ADVANCING QUALITY ALLIANCE (AQUA)

QUALITY OBSERVATORY PLAN

NHS North West

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EXECUTIVE OVERVIEW

The North West Quality Observatory will be known as the Advancing Quality Alliance (AQuA). It will provide the infrastructure to organise the delivery of system-wide improvements focussed on ambitious and challenging goals. AQuA will align disparate activities and the efforts of clinical leaders and managers to achieve these goals – recognising that by coming together as an Alliance, more can be achieved collectively than might otherwise be achieved individually. AQuA will organise the three principal work streams of knowledge, measurement and capability and aligns activities across the North West to deliver 6 core quality improvement goals across the quality domains of safe, effective and experience, as well as supporting organisations in the delivery of their own determined priorities. The scope of work will be ALL settings where healthcare is delivered and will be equally applicable to primary care, general practice, mental health, ambulance services and hospital trusts. AQuA will focus on clinical pathways integrating the outputs of the Clinical Pathway Groups and providing a focal point for the development of clinical leaders and other key staff to support improvement activity. Key skills and competencies in improvement methodology will be provided to clinicians and staff. AQuA will organise the purposeful application of these skills through co-ordinated programmes such as learning collaborative focussed on agreed goals. AQuA will support ambitious improvement in population health and in systems of care delivery. It will support PCT members in their commissioning of evidence based treatment/care, including the development of a suite of appropriate indicators. It will support all providers (primary, community and hospital based) to deliver safer, more effective treatment/care and an improved patient experience. AQuA will network the NW improvement community via its web portal – enabling organisations to acquire, share, assimilate and apply evidence based knowledge. The portal will also enable organisations and their clinicians to measure and compare their improvement through a suite of indicators. AQuA will also provide, through the Improvement Alliance, an ongoing series of programmes which will to enable its members to deliver their locally developed quality improvement plans. AQuA members will agree six whole system measures from three quality domains. They will agree measurable stretch goals for each of the measures. The Alliance will track these measures over time to determine whether the implemented changes are resulting in improvement. In addition, key measures of outcome and process will be identified by the eight clinical pathway groups. Wherever possible, metrics will be sourced from the MQI portfolio or other available data sources. These measures will form the spine of the knowledge and metrics development for AQuA. They will also be available to commissioners to use in their CQUIN and proposed as core content for NW quality accounts.

We propose five changes to our current quality infrastructure which we believe will support the delivery of the whole system aims, optimise the use of AQuA by individuals and organisations and support the work of the clinical pathway groups. Changes I&II focus on alignment of priorities and resources, change III builds the improvement community, change IV describes the technical support for change and change V aligns and maximises opportunities afforded by an organised improvement function. Change 1: Agree a common purpose and shared vision which permits different approaches to operations and strategy and affords opportunity for alignment. Change II: Agree delivery of a small number of strategically important stretch goals to focus change efforts, simplify the agenda and increase the likelihood of success. Change III: Establish the Advancing Quality Alliance as a vibrant community of improvers who are systematically developing world class improvement capability and capacity through collaboration, networking and knowledge exchange. Change IV: Provide technical support and an IT platform for defining quality pathways, measuring quality and building capability using National providers and locally developed guidance on implementation. Change V: Develop, Local, Regional, National and International coalitions to accelerate the pace of change and optimise shared learning opportunities.

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INTRODUCTION In Lord Darzi’s report High Quality Health Care for All (June 2008), he invited us all to unite in sharing in a new vision of the NHS, with quality woven into its very fabric. He also painted a picture of a drive for improvement coming from NHS staff themselves, based on a conviction about the power of quality as a driver for change. In the North West we are already creating this vision. A number of agencies are helping to drive us towards our vision of quality embedded into every aspect of health care. These include the North West Quality Board, the North West Quality Observatory (AQuA), the Leadership Academy, the Clinical Leaders Network and the Inspirations programme. A major impetus comes from the PCTs of the North West’s and their programme to develop as practitioners of World-Class Commissioning. By focussing predominantly on clinical pathways, AQuA offers PCTs the opportunity to make sustainable improvements through delivering evidence based commissioning and developing new systems of care. Re-dressing the historical focus on acute care and directing improvement support to agreed priorities rather than geographical locations. There is still much work to be done to achieve our vision, but proof of the efforts made to do so lie in the fact that the Healthcare Commission graded the North West in 2008/9 as having moved up to second place from eighth nationally, for its quality of services. Defining ‘Quality’ Quality is the organising principle in the North West health system and NHS North West is keen to ensure that the work in progress continues to evolve within a new systematic drive for improvement. This will bring about improved safety for patients, evidenced based treatment /care and better patient experience wherever they receive healthcare. Embedding Quality into the North West System No one can get away from the fact that lifestyles are poor in the North West, which has the highest rates in England for deaths from heart disease and stroke, long-term mental health problems, alcohol-related hospital stays, hospital admissions for depression, anxiety disorders and for schizophrenia, as well as high rates of cancer deaths and low life expectancies for both men and women compared with the national average. NHS Chief Executive, David Nicholson has coined the concept of QUIPP – Quality Innovation, Productivity and Prevention- as a driving force for the kind of transformation of health that the region needs. With expected financial constraint from 2011 we must prepare ourselves to acquire assimilate and apply knowledge of effective evidenced based treatments and care systems. We must also provide organisations with the capacity to innovate and their staff with the competency and confidence to test and rapidly adopt changes so that quality improvement can thrive in economically challenging circumstances.

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THE ARCHITECTURE OF QUALITY IN THE NORTH WEST AQuA provides the infrastructure to organise the delivery of system improvements focussed on ambitious and challenging goals. AQuA will enable the organisation of disparate, but related, activities to be aligned and focussed on contributing to the delivery of these goals as well as their other purposeful activity. North West Quality Board Chaired by NHS North West’s Chief Executive, Mike Farrar, this provides vision and leadership for quality improvement and innovation across the region, by developing capability through improvement programmes. It will agree the 6 core quality improvement goals (whole system measures) and support work with organisations to achieve their delivery. In collaboration with leaders from the Trusts and PCTs, the board is stimulating debate on quality and pushing the boundaries of health care provision to achieve the NHS North West’s ambition to be known for its world-class health system. The North West Quality Board believe that through coming together as an Alliance we can achieve collectively more than we might achieve individually. This belief predates the national requirement for an Observatory; however, they believe that the Observatory will be a useful vehicle in which our proposed support mechanisms can be organised. The North West Quality Observatory will report to the Quality Board and will align existing programmes of work, develop a community of improvers and deliver the environment required to nurture innovation. In addition, it will act as a technical partner for building capability in improvement and developing robust knowledge and metrics services which support all clinical teams to improve their daily work. This paper describes the emergent plans and structure of the North West Quality Observatory hitherto known as the Advancing Quality Alliance (AQuA).

‘THE ADVANCING QUALITY ALLIANCE (AQUA)’ The primary aim of the Advancing Quality Alliance will be to network and support constituent organisations to deliver local quality improvement collaboratively and at pace through improved access to support structures for building capability, measuring for quality and knowledge management. Two secondary aims will be:

• To facilitate a programme of collective activity to deliver transformational change across the whole system in three domains of safety, effectiveness and experience

• To build a distributed network of organisations and individuals to lead system improvement.

Figure 1 – illustrates the observatory function which will be developed through consultation. The observatory structure and National / Regional programmes which already contribute to the Quality agenda (Appendix 1) and therefore require alignment into AQuA to avoid duplication, confusion and maximize impact.

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A FRAMEWORK FOR EXECUTION The Institute for Healthcare Improvement (IHI) uses a simple mantra to describe the essential elements for strategic improvement: Will, Ideas, and Execution. You have to have the will to improve, you have to have ideas about alternatives to the status quo, and then you have to make it real — execution. AQuA will be designed to consistently improve system-level performance through developing:

1. The ability to deliver on the agreed 6 key quality improvement goals and other locally agreed priorities, by coordinating a portfolio of projects.

2. Supporting local management and supervision of activities aimed

to deliver local performance improvement which will contribute to the system wide priorities.

3. Continual development of a sufficient number of employees who are

capable of leading initiatives to produce system-level results, including active involvement of clinical leaders

. SCOPE OF WORK

The members of AQuA will work together to deliver unprecedented improvement in healthcare quality for patients in the North West. In the first instance the scope of work will be limited to healthcare settings including primary care, general practice, mental health, ambulance services and hospital trusts*. This will compliment the work of the SHA and Public Health Observatory who will continue to develop and improve population health (promotion and primary prevention). * We anticipate that as we progress we will see more improvement activity which requires partnership with local authorities. In the future, we will reserve the right to extend the scope to include social care settings (if the situation necessitates) and envisage inviting social care organisations to become members, however, this will not be an immediate priority for the Alliance. FOCUS AND ALIGNMENT Change I: Agree a common purpose and shared vision which permits different approaches to operations and strategy and affords opportunity for alignment. These core values and ambitions will serve to unite members and provide a framework for alignment of existing programmes and development of the support structure. They will NOT, however, restrict organisations from developing their individual operational plans or strategy development to supplement the agreed priorities. Diversity of approach will be seen as desirable and will generate opportunity for further learning.

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Change II: Agree delivery of a small number of strategically important stretch goals to focus change efforts, simplify the agenda and increase the likelihood of success. Organisations will be encouraged to develop their local quality improvement plans. They will access content expertise, metrics and improvement expertise from AQUA. However, they will also agree to contribute to some bold system goals for each of the domains of quality highlighted in the Darzi review. AQuA members will agree six whole system measures from three quality domains. They will agree measurable stretch goals for each of the measures. The Alliance will track these measures over time to determine whether the implemented changes are resulting in improvement. In addition, key measures of outcome and process will be identified by the eight clinical pathway groups. Wherever possible, metrics will be sourced from the MQI portfolio or other available data sources. These measures will form the spine of the knowledge and metrics development for AQuA. As this is work in progress it is impossible to preempt the emergent issues however, to illustrate a high level dashboard for AQuA a worked example is shown below: SAFE EFFECTIVE EXPERIENCE Measure 1 Medication Mortality Transfers Measure 2 Infection AQ / NICE

pathway Satisfaction

BUILDING CAPACITY AND CAPABILTY FOR IMPROVEMENT Change III: Establish the Advancing Quality Alliance as a vibrant community of improvers who are systematically developing world class improvement capability and capacity through collaboration, networking and knowledge exchange. The AQuA will work with the established communities to act as a system integrator, developing a shared vision, values and aims, connecting work streams, building capability for improvement, archiving knowledge and providing help with measurement for improvement. In this role AQuA will strive to become a ‘network of networks’ as well as a support function to assist with rapid delivery of goals. The focus in years 1-3 will be to optimise the connectivity and outputs of clinical networks (examples in Appendix 1) and to understand how to support the wider community of networks.

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EXTENDING THE IMPROVEMENT COMMUNITY Change IV: Provide technical support and an IT platform for defining quality pathways, measuring quality and building capability using National providers and locally developed guidance on implementation. Work stream 1: Knowledge Our ambition for AQuA is that it will provide a ‘one-stop’ for commissioners, providers, system leaders, clinical staff and patients to access clinical evidence which will describe the current ‘evidence based pathway’ for the condition of interest. Our schematic (figure 1) illustrates some of the National and Local partners and organisations with whom we will wish to discuss knowledge feeds e.g. NICE, Map of Medicine, NHS Information. We will also be building a contemporaneous library of knowledge about best practice in conjunction with the regional librarians. Our aim is to archive best practice and promote sharing through electronic medium and collaborative learning in the Improvement Alliance. A full work plan with objectives and timescales will be produced for this work stream by January 1st 2010. Work stream 2: Metrics and Measures AQuA will focus on the development and adoption of metrics prioritised by leadership (whole system measures) and clinical pathway groups. We already have unique experience and expertise with the development of quality measures through our work in the Advancing Quality Programme (Appendix 2). In this programme we have worked with acute trusts to agree and establish systems for data definitions, capture and analysis for the last 12 months. The lessons learnt will be taken forward into our AQuA programme which will now broaden the scope of measures from the acute care window (currently measured by the Advancing Quality Programme) into more ambitious measures at critical touch points along the care continuum. A pilot for measuring pathways is being led by the mental health chief executive community. Our ambition is to work with the expertise of the Public Health Observatory, to develop a system which provides easy access to data for improvement from a wide range of providers (NHS Information, Dr Foster, CHKS, TIS, advancing quality). Wherever possible this data will be benchmarked for comparison. In addition we appreciate that a large number of clinical areas have no recognised or easily accessible data sets which can be used for comparison. We intend to develop the capability of AQuA faculty and Member organisations to develop responsive and individualised measurement plans which can be used to track progress over time. A full work plan with objectives and timescales will be produced for this work stream by January 1st 2010.

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Work stream 3: Improvement Capability AQuA will act on behalf of its members to determine the range of capability programmes available. It will also work to signpost members to content and its relevance. It will seek to determine the extent to which its members wish to develop a centralised improvement function for the North West. The Alliance will continue to support a range of providers and will act on behalf of its members to commission improvement capability building wherever necessary. Evidence from other large healthcare systems suggests that there would be significant value in developing a cadre of clinical and system leaders who are able to lead change and have the quality improvement skills to radically re-design their work. Some of this work is underway in the portfolio of the Leadership Academy and in organisations accessing programmes offered by local and national programmes. However, currently there is limited understanding of the knowledge and skills framework for improvement and therefore uptake is variable and application unpredictable. We propose to identify, on behalf of our members, the improvement knowledge and skills required by:

• Executives & Boards • Clinical Leaders • Operations Managers • Frontline Teams • Improvement Advisors

Once defined these frameworks will be described and suggestions made with respect to the number of personnel which the system requires to reach a tipping point, whereby the momentum becomes self sustaining and the centralised training function reduced to a minimum. For example, evidence from the Kaiser system in California suggests that each organisation (400 beds or less) requires at least 1.5 Improvement Advisors who work with the Board and Improvement Advisors at their headquarters to manage the organisations portfolio of improvement. Applying this model to the North West would require us to develop skills in a minimum of 100 staff. In addition to providing and commissioning training we will build improvement capability in frontline teams through the design and development of learning collaboratives and other media. We will support frontline teams to network, develop improvement skills and learn together via a programme of improvement programmes. A full work plan with objectives and timescales will be produced for this work stream by October 31st 2009. Access portal & web development Plans are underway to determine the technical specification for the web portal for AQuA which will form the primary access point for NHS North West. We anticipate that the web portal will have comparable functionality to that developed by the Public Health Observatory. The web portal will have three primary functions:

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• A single point of access for quality pathways, metrics and improvement support, including signposting to agreed electronic resources for knowledge dissemination (NHS Evidence, Map of Medicine & NICE) and metrics (NHS Information, Dr Foster / CHKS & Public Health Observatory.)

• A single point of access for archiving and transferring knowledge about implementation of quality pathways, metrics and improvement i.e. best practice vignettes, leadership reports, lessons from improvement collaboratives

• A single point of access for tracking progress on system measures of mortality, safety, effectiveness and experience

The web portal and web development will be coordinated by the NHS North West Executive Director of Strategic Communications in collaboration with the leadership team of AQuA. A full project plan for web development will be developed by October 31st 2009. Change V: Develop, Local, Regional, National and International coalitions to accelerate the pace of change and optimise shared learning opportunities. NHS North West has a longstanding reputation for working collaboratively with a range of partners from the NHS and other statutory and non-statutory organisations. On a regional footprint, a North West Economic Summit took place in July, and was attended by senior decision-makers from all NHS organisations who agreed actions on how to deliver QUIPP. This led to sub-regional and local meetings being set up that are now exploring how to improve the quality and efficiency of services by working together, and considering how the Quality Observatory might help deliver these aspirations. Nationally, the Advancing Quality programme has formed the Advancing Quality SHA Collaborative, which was set up to share our experience of implementation with other SHAs, and to add pace to the development of the programme. We are also exploring how the Quality Observatory will interface with national bodies such as NHS Evidence and the Information Centre. Internationally, we have strong links with Premier in the US who are our Expert Partner in developing metrics and systems to deliver Advancing Quality. In addition, the Improvement Alliance works in partnership with the Institute of Healthcare Improvement and the Patient Safety First Campaign to ensure the North West has access to the most up-to-date thinking on service improvement. We will continue to build on these partnerships and explore ways to collaborate wherever possible as the Advancing Quality Alliance develops.

Organisational and Governance Structures

Quality BoardJane CummingsNHS North West

Executive Director

David Dalton Host Chief Executive

Talib YaseenProgramme Director

M PowerDirector

Improvement Alliance

Metrics & Measures Knowledge

Clinical Pathways

L MasseyAssociate Director

J JaskolkaAssociate Director

R DennisProgramme

Manager

Director

Analyst

Improvement Advisor

Content Developer

Director

Web Developer

Librarian

Project Assistant

Clinical Director

Clinical Pathway Groups

Clinical Leaders Network

Informatics Network

Steering Groups (x4)

NHS North West Board

Advancing Quality

Integration of AQ Governance September 2010

Friday, August 14, 2009

AQuA Organisational Structures for Observatory Governance

Figure 2: Organisational structure and oversight for AQuA Oversight for the AQuA will be managed in three core, but interconnected, functions which will each be led by a steering group and a Director. This format has already been tested through the governance arrangements set up for the Advancing Quality Programme and shown to be effective. Interim arrangements have been made for governance for AQuA and will include the migration of the governance arrangements for the advancing quality programme at a pace to be agreed. The final governance arrangements will be reviewed and agreed by the Quality Board in 2010. ORGANISATIONAL REPORTING STRUCTURES The Regional Quality Board The AQUA steering groups (knowledge, metrics, clinical pathways and improvement) will report to the Regional Quality Board which comprises NHS North West executives, senior leaders (CEOs, medical directors, nurse directors and improvement experts) from acute, specialist, mental health and primary care Trusts across the North West. Each geographical region (Mersey and Cheshire, Greater Manchester and Cumbria and Lancashire) are represented. The Quality Board meets quarterly and reports directly to the NHS North West Board. The Quality Board, chaired by the SHA CEO is primarily responsible for setting and agreeing the programme of support for improvement activity. Jane Cummings (Executive Director of Nursing, Performance, Quality and Commissioning, NHS North West) is the SHA Director responsible for leading the quality framework agenda, the relationship

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with the NHS North West Board and the communication between the two boards.

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hief Executive Leadership (Host)

ther with the SHA Executive Director rovide leadership oversight to the Strategic Development of AQuA and the

rogramme Director (AQuA)

ovide operational and strategic leadership for QuA, working to develop relationships with regional and national

ry roles of the Programme Director will be to:

servatory at National meetings.

y are satisfied.

siness model through consultation and

d accountability for governance of the observatory. th portfolio

stimated Cost

taffing costs of the structure are £750k per annum with stimated one-off set up costs of £55k and recurrent costs for overhead and

C The host Chief Executive will, togepplanned strategic alignment of existing and new programmes which will be co-located at Salford Royal. The host CEO will also continue to provide leadership to the Improvement Alliance Steering Group and the Improvement Alliance Director via a direct line management arrangement. He will work with the Programme Director (AQuA) to develop the vision, governance and business arrangements for AQuA and the Improvement Alliance. P The Programme Director will prAprogrammes of work and act as the interface with the Chief Executive community, SHA and senior clinical leaders. He will have operational responsibility for coordinating the AQUA steering groups (knowledge, metrics, clinical pathways and improvement) in conjunction with the Directors of each portfolio. The prima

• Act as the ambassador for the North West ob

• Ensure that DH minimum requirements for the function of the Observator

• Establish a clear interface with the Public Health Observatory. • Further develop the bu

negotiation. • Operational and financial management of the observatory. • Oversight an• Integration and coordination of the work portfolios wi

directors. E The estimated serunning costs of £500k per annum. Estimated annual costs are therefore £1.25m per annum plus £55k one off cost in year one.

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Recruitment of Members and Funding Arrangement During the start up phase, pump priming for AQuA has been provided by NHS North West therefore all organisations who are members of NHS North West are automatically members of AQuA. Between January 2010 and March 2010 we will be describing the AQuA purpose, vision, function and benefits in a technical brief which will be circulated to Chief Executives and Clinical Quality leads. Given the opportunity for co-design we anticipate that ALL organisations will have a desire to participate in the programme, however, sign up to the AQuA network is voluntary. The option to ‘opt out’ will be available via discussion with the NHS North West Executive team. Organisations will be advised that the decision to opt out must be made (in writing) to Jane Cummings (Executive Director of Quality) by 15th February 2010. AQuA will be funded primarily via membership contributions from NHS North West Organisations. The cost will be divided between the participant organisations, if 64 organisations participate this will equate to approximately £20k per organisation per annum. It is proposed that actual contributions will be calibrated by organisational size. NHS North West will provide limited funding aligned to core functions such as web development, library functions and IT coordination / support. Location & hosting arrangement AQuA will be located at an NHS North West Foundation Trust (Salford Royal NHS Foundation Trust) where it will be co-located with other related activities. Launch and Marketing of AQuA We will develop a market brand for the AQuA which will be agreeable to members and reflective of its ambition. System Consultation has already begun with key clinical networks and improvement partners via the Improvement Alliance. Key Milestones of note are:

• Improvement Alliance Listening and Sharing Event (September 2009) • Monthly On-line webex information sessions / updates for AQuA

members (from September) • Consultation Process (Executives & Clinical leaders, September -

December 2009) • Clinical Leaders Network Event (November 2009) coordinated by

Steve Henderson • NHS North West Quality Conference (April 2010)

Key Milestones (Months 1-6)

ID Task Name Start Finish DurationAug 2009 Sep 2009 Oct 2009 Nov 2009

16/8 23/8 30/8 6/9 13/9 20/9 27/9 4/10 11/10 18/10 25/10 1/11 8/11 15/11 22/11 29/11

1 101d05/01/201018/08/2009Improvement Alliance Consultation & Programme Tests

2 84d25/12/200901/09/2009Member Consultation

3 44d30/10/200901/09/2009Plan Clinical Leaders engagement event

4 79d01/01/201015/09/2009Knowledge Work stream programme plan development

5 79d01/01/201015/09/2009Metrics Work stream programme plan development

6 35d05/10/200918/08/2009Improvement Alliance programme plan development

7 91d05/01/201001/09/2009Programme(s) Alignment

8 44d30/10/200901/09/2009Web site development to launch

9 91d05/01/201001/09/2009Web data portal development

10 22d30/09/200901/09/2009Development of Brand / Logo

11 44d30/10/200901/09/2009Business Model development

12 51d15/03/201004/01/2010Technical Brief Circulation

13 22d03/02/201005/01/2010Opt Out period

14 1d01/04/201001/04/2010AQuA ‘go live’ date

Dec 2009

6/12 13/12 20/12 27/12

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Appendix 1 Advancing Quality The Advancing Quality programme is the first of its kind in the UK and will ensure patients have an overall better experience in hospital, and ultimately a better quality of life. Patients will also have more say and influence, as their opinions and experiences of care they receive in hospital will be taken into account and acted on. The programme, which launched on October 1, 2008, will provide incentives to hospitals to improve the quality of care provided to patients. The quality will be measured in three ways:

• Clinical outcomes: evidence-based measures that demonstrate the quality of care and treatment

• Patient-reported outcome measures which will show if patients' quality of life has improved following surgery

• Patient experience: we will record the patient’s experience of the care provided.

Advancing Quality is focused on improving the quality of care in five key treatment areas and two development areas *:

• Heart attack • Heart failure • Heart bypass operation • Pneumonia • Hip and knee replacement • Stroke* • Mental Health*

If successful, the programme will save lives, reduce re-admissions, reduce complications and decrease the length of stay in hospital for patients. It will also help to reduce costs. Improvement Alliance In September 2008, NHS North West agreed to embark on a system consultation exercise to determine the improvement landscape. This commenced in April 2009 and is due to complete in September 2009. Based on this consultation we will describe and share:

• Reported achievements in quality improvement • Organisational aims / ambitions • Capability / capacity for Improvement • Desirable characteristics of an improvement support function (as

described by NHS North West organisations).

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NHS North West has invested in a one year scoping exercise, run by the Improvement Alliance, to determine the depth of improvement expertise within organisations, conduct a gap analysis of capability and capacity building for improvement and test the delivery of pilot programmes. Pilot programmes include implementation of the Patient Safety First Campaign (in collaboration with the Patient Safety Action Team and the NPSA), Stroke 90-10 (in collaboration with the Health Foundation), Boards on Board (in collaboration with the Leadership Academy and the Institute for healthcare Improvement) and a Safety Networks pilot (in collaboration with the Health Foundation). Findings from the Improvement Alliance scoping exercise and pilot programmes will be presented to the Chief Executive community in January 2010 along with an outline programme for its continuance as a fee paying member organisation supporting organisations in NHS North West as part of AQuA. Hosted at Salford Royal NHS Foundation Trust we anticipate that the Improvement Alliance will be a trading partner of the NHS North West Quality observatory. In this role it will:

• Define the system requirements for improvement capacity and capability

• Work with key partners to integrate mission critical knowledge and skills into the commissioning of existing programmes

• Develop, commission and test innovative capability building programmes which will support the distributed leadership of improvement

• Connect and optimise the potential of frontline improvers via a faculty network which will also serve as a local peer review body for improvement.

Inspiration North West

NHS North West has invested in a two-year pilot project ‘Patient Opinion’ which harnesses patient feedback on hospital and community services to inform service development and improvement. In September 2008, we extended our commitment and agreed to fund a two-year programme to develop a North West Services Experience strategy. Inspiration North West aims to:

• Benchmark best practice • Develop patient experience measures • Identify and celebrate ‘Brilliant Basics and Magic Moments’ • Pilot new approaches and methodologies to support best practice

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A service experience Board, chaired by a CEO has been established to oversee the work and to ensure that opportunities for improving patients' experiences of the health service are supported through the development of effective commissioning, staff training and development of patient-focused leadership and management.

Energise for Excellence The Energise for Excellence programme is an embryonic social movement that is being lead by NHS NW with NHS SC and has the support of the CNO, Dame Christine Beasley and the other 8 SHAS. It had the potential to transform nursing care and the experience of patients and staff and epitomises the way quality needs to be based on a powerful blend of process and inspiration. The programme incorporates several areas of measures and metrics all of which fit within the domains of safety, effectiveness and experience and aim to improve the quality of care patients receive and link to the QIPP agenda. The key areas include:-

• Staffing levels using an evidence based approach to acuity and dependency

• Nursing metrics – process and outcome • Patient Experience • Staff Experience

The programme builds on the work that has been piloted in the NW with nursing metrics and patient experience and also the work initiated by SC to determine appropriate staffing levels. NHS North West has developed seven evidence based measures of nursing quality: falls assessment, food and nutrition, pain management, pressure ulcers, medication prescribing / administration, patient observations and infection control. The aim is to look beyond a performance exercise to an energising campaign to pursue excellence in care, so that a whole movement for change and improvement occurs because the nursing staff really cares about the treatment they give their patients and engage in on-going improvement. The programme is currently focused on Acute Care but will be extended to Community, Primary and Mental Health care. North West Public Health Observatory (NWPHO) NWPHO is an integrated part of public health intelligence in the Centre for Public Health at Liverpool John Moores University and the North West region and is also a member of a national network of other public health observatories across England, Wales, Ireland and Scotland (the APHO). NWPHOs lead areas for the APHO are alcohol, substance use, violence, dental health and working with the Health Protection Agency.

They make all our public health intelligence, routine and bespoke datasets accessible via a range of interactive web-based tools. They aim to make the data accessible to a range of audiences through different front pages that run from a single integrated dataset for efficiency and accuracy. Included with NWPHO tools are links to a range of national and international public health data tools to provide for access to wider related datasets. NWPHO produce or co-produce a range of different reports from: bespoke situational analyses, in particular focussing on new and novel ways to illustrate health patterns and investigate health inequalities; through bi-monthly synthesis reports that draw together intelligence, policy and evidence on a range of topics; to our new series of monthly reports that will focus on a particular routine national dataset each issue. All reports are published here on our website, with links to associated datasets and online tools. Leadership Academy The North West Academy for Leadership has been created within a strategic framework, where leadership development activity is designed and delivered in the North West and is responsible for ensuring leadership development activity is routed in the support of the Chair/Chief Executive community and owned by them. The Academy has been developed as a virtual organisation that will provide a sustainable approach to leadership development and be part of a broader talent management strategy which will identify, develop and track individuals who are identified as having the potential for senior leadership roles and co-ordinate a range of development opportunities to promote the calibre and effectiveness of health care leaders in the North West, evidenced through the showcasing of their work nationally and internationally.

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Appendix 2 Clinical Networks for Integration by AQuA in years 1-3

Clinical Advisory Council

The Clinical Advisory Council was established to provide some formal clinical input into the various work streams of the SHA. The monthly Council meeting is co-chaired by the Medical Director and the Director of Nursing, and its members come from a broad range of clinicians who can both provide their clinical opinion to specific queries raised by other SHA teams, and act as a conduit for information to be circulated as appropriate across all the relevant clinical networks.

Clinical Pathway groups and Clinical Leadership Fellows

The eight clinical pathway groups (CPGs) set up as part of Lord Darzi’s NHS Next Stage Review have now refreshed their membership and are embarking on the implementation and further development of the recommendations in this report. To support this process, NHS North West has funded fourteen Clinical Leadership Fellows who will work with the CPG Chairs on a one year secondment. Based in the organisations of the clinical pathway leads the Fellows come from a range of professional backgrounds including medicine, nursing, midwifery and the allied health professions. As well as supporting the work of the CPGs, they will also undergo a structured leadership programme with the aim of developing clinical leaders at all levels across the North West.

Clinical Leaders Network

The Clinical Leaders Network (CLN) is a professional leadership network for clinicians which began as a two year pilot in NHS North West in 2006, and is now established nationally as a mainstream clinical leadership and engagement network. The network brings together a broad range of local clinical champions to promote positive, transformational change across the NHS. It has three core principles:

o To support clinical leadership engagement o To improve NHS clinical service delivery o To enable clinicians to influence policy by giving them direct

access to local and national policy leads

Members receive a structured programme of service improvement based on monthly Action Learning Sets, where they are given the opportunity to actively debate concerns, undertake problem solving and plan practical action that will improve the quality of their care services.

Clinical Health Informatics Leads

In order to develop the understanding of Health Informatics-enabled change, the North West has engaged a group of clinical leaders who will become experts in their organisations and able to champion the role of Health Informatics in supporting service delivery. Each of the 63 organisations has nominated a senior clinician as their representative, and these now form a group which aims to foster the engagement of clinical staff in the service reform and implementation agenda through attendance at regular meetings, lectures, and participation in action learning sets.

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