Several people will be on their way from Wales to the BMJ/IHI International Forum in London next month. While there they’ll see innovation and best practice from around the world. It’s an opportunity to meet experts in quality improvement and patient safety and bring new knowledge back to Wales.
I’ve recently been reflecting on the ideas and examples I heard at the IHI National Forum last December. Here are five (and a half) lessons I learned, recognising a huge debt to Brent James and others who willingly shared their presentations with me so I could fully get to grips with what they were saying.
Lesson 1 – The quality improvement mindset is the opposite of top down management – and that is important
The frontline is where change matters because this is where we interact with patients. To change NHS Wales we need to follow Deming’s principle: Organise everything around value-added processes on the frontline – i.e. focus on the bits that will really make a difference to patients. Change needs to start here to be really effective.
Lesson 2 – Improvement has more to do with left brain than right brain
Innovation is fun. We all like to come up with ideas and then see if they work. But Bellin Health’s ‘High Performance Healthcare’ model indicates that a scientific approach to providing standardised levels of care is important to improving quality.
We don’t always have to do something new – what is more important is making sure the right things are done at the right time, in the right place and to the right people. Then, valuable improvement energy must be focussed on business critical problems and within a clear context of measurement and alignment with what else is happening in the system.
Lesson 3 – Quality and cost saving can and must be delivered together
The evidence from the QUEST initiative in American hospitals shows that improved quality and lower costs (or better control of costs) go together. We’ve also done some work on this, publishing a white paper last year. However, it’s very important that we set out with a focus on quality, not a focus on improving costs – better quality helps reduce costs; just trying to reduce costs won’t improve quality.
Lesson 4 – There is now an evidence base for high performance
The 10 most important elements in high performance have been identified in the QUEST hospitals. In the past we have had intuitive opinions, but now we have evidence-based key features that we should be looking to replicate in NHS Wales. We are fortunate to have Eugene Nelson speaking at the next 1000 Lives Plus National Learning Event on Tuesday 11 June to describe this ground breaking work.
Lesson 5 – Reducing harm from sepsis and surgical site infections are winnable fights
Some healthcare organisations have seen mortality due to sepsis drop by two thirds. Infections after c-sections have been virtually eliminated in many hospitals. It shows that deaths and harmful events can be stopped in Wales – the ways we can make this happen are out there.
Lesson 5 and a half – We are on the right track with Improving Quality Together (but there is still work to do!)
If we can reach the point in NHS Wales where everyone truly believes that they have two jobs – to do their job and to improve their job – then this will result in improvements being initiated everywhere by everyone.
Improving Quality Together is a way of delivering this mass participation – but we need training, coaching and data for actionable measures to keep track of the improvements taking place and to evaluate them.
Let’s keep talking
I’d be interested to hear your comments on these lessons. Do they reflect what you know about the work going on in NHS Wales? What do you find intriguing? What makes you pause and go ‘hmmm’? Do comment.
Or, if you are at the International Forum next month, 1000 Lives Plus will be running the NHS Wales stand. Please stop by and say hello. If you can’t make it, then we’ll be blogging throughout the week to keep you up-to-date!