Aug 262014
 

All of our processes contain variation. Understanding variation is vital when deciding how to improve our processes and services.

David Williams

David Williams

Variation is the natural fluctuation that we see in our processes. For example, the number of times the phone rings at work a day is never constant. The differing number of times it rings a day is the variation we see in this process.There are two different types of variation, “common cause” variation and “special cause” variation.

An example of how variation works…

Every day I drive to work. It normally takes me about 55 minutes, if there are no unusual occurrences, but this does vary. It rarely takes exactly the same time to drive to work due to levels of traffic, weather, or the timing of traffic signals. These time differences are expected. It is common cause variation.

One day, there was an accident on the Motorway. My journey to work took 94 minutes. This is special cause variation. If this happened to you, would you change your route to work every other day just because of this single occurrence?

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Jun 092014
 
Marcus Longley

Marcus Longley

Prudent healthcare is a big idea, or it is nothing.

But big ideas are not always welcome in public policy – they tend to disrupt ‘business as usual’. While we are spending our precious, finite thinking time on what the big idea really means, we might just neglect all those other equally vital, but more pressing, objectives, like safer care and balancing the books… And anyway, big ideas come and go, don’t they?

Public services know how to deal with latest Ministerial big ideas. The time-honoured approach is to thank the Minister profusely for providing vital new direction and insight, talk about it a lot in conferences organised for that purpose, include the new catch-phrases in every possible document… then re-badge all the things you were doing already using the new label, and get back to the day job.

But before health boards and trusts kill off prudent healthcare in this way, let’s just recognise that its three key planks cannot just be swallowed up into business as usual.

First, a prudent healthcare system will really empower people to maximise their own wellbeing, often recognising that that there are no clinical fixes. Chronic conditions are often, by definition, incurable, and good healthcare is about helping people to minimise their impact on what matters most to them in their lives. So people with chronic conditions – most of our patients – should routinely be offered a wide menu of support, from information and skills training, to individual and peer group support, often provided by the third sector, so that they can find things which work for them. Choice and diversity here are vital – one size will not fit all.

Second, when it comes to clinical intervention, prudent healthcare depends on patients really choosing what’s best for them. That means finding new ways of supporting patients really to think through what would be best for them, and creating the expectation that they will often say “No”.  And if they say “No”, we have to have alternatives to offer them (see above).

Third, it means re-defining what good care means. Under prudent healthcare, the key issue is what patients think about their care, not as they leave the hospital, but months down the line. A perfect operation which the patient wishes they hadn’t had two years later, is a huge waste of time and effort, on so many counts.

So … All we need, then, is a whole new swathe of non-clinical service provision, supported but not provided by the NHS; a re-thinking of the clinical encounter, with new systems to support that; and a new way of measuring our performance, with patient-defined and reported outcome measures routinely collected and compared on thousands of clinical interventions.

That’s not ‘business as usual’.

We need to hear the managerial squealing of brakes across NHS Wales, as our leaders realise that this is big change, fit for a big idea, requiring a new direction.

For further information, read Achieving prudent healthcare in NHS Wales or visit the prudent healthcare section of the 1000 Lives Improvement  website.

Marcus Longley is Director of the Welsh Institute for Health and Social Care and Professor of Applied Health Policy

Jun 092014
 

 

Professor Peter Bradley

Professor Peter Bradley

Achieving prudent healthcare in NHS Wales is a new paper published by Public Health Wales which outlines the findings of four workshops set up to test ‘prudent healthcare’ in the real world. 

What is prudent healthcare? The Minister has defined it as, “Healthcare that fits the needs and circumstances of patients and actively avoids wasteful care that is not to the patient’s benefit.” In practice this looks like safe, effective care delivered without delays. I think we’d all agree we would like to be guaranteed healthcare like that.

In the paper, we have summarised the principles of prudent healthcare as:

  • Minimise avoidable harm.
  • Carry out the minimum appropriate intervention.
  • Promote equity between the people who provide and use services.

The workshops raised several points of interest, but there was general agreement form the staff and service users present that the current system’s faults and occasional failings could be fixed by applying these principles.

The third one is key to successfully applying these principles. We know that when people are involved in their healthcare, and are given complete information and genuine choice, they often choose the less risky options, which usually are the least expensive. For example, if we advise people about pharmaceutical side-effects, they are more likely to want to try changing their lifestyle rather than being prescribed medicines.

The workshops also looked at some specific questions:

  1. What happens now that does harm or little good?
  2. What happens now in an expensive way, which could be done in a more cost effective way?
  3. What would the pathway look like if organised around the minimum intervention principle?

There are huge gains to be made in quality, improved patient outcomes and cost-effectiveness from reducing delays in the system. We sometimes automatically put people through the system because we are set up to deliver certain treatments or interventions rather than offering people a lower level of intervention that would be of equal benefit to them, and possibly more!

The perspective of the people who use our services is vital. They can alert us to delays and wastage in the system and have an equal role to play in ensuring they receive the treatment that is right for them. We have to learn to listen and involve them more. The future of our health service depends on it.

For further information, read Achieving prudent healthcare in NHS Wales or visit the prudent healthcare section of the 1000 Lives Improvement website.

Dr Peter Bradley is the director of Public Health Development in Public Health Wales. Follow Peter on Twitter @pbradley1965

May 152014
 
Liz Smith

Liz Smith

There was something different about this year’s Quality Forum and it took me a poster tour to work out what it was.

As an abstract reviewer, when that 5 pm deadline in November looms and my inbox becomes full, I am always inspired by the number and variety of proposals people submit. The way these abstracts are written is important; they need to make people say, “Tell me more”.

And that’s the same with the sights and sounds you are bombarded with from all the stands at the Forum. They need to grab your attention and draw you in. They need to make you want to hear more.

This year, I agreed to host a number of the poster tours. These involve moving between posters stands and giving a few minutes to each presenter to share the work they came to display and discuss, and to take any questions. There had been thousands of submissions from people who wanted to share their work on a poster at the forum, and only 700 had been accepted. Continue reading »

May 132014
 
Helen Price

Anitha Uddin

In April, I was fortunate to attend the International Forum on Quality and Safety in Healthcare in Paris. It was an eye-opening experience that taught me so much.

A particular idea I took away was that quality improvement should not be considered an extra-curricular activity; it should be embedded into current practice. And since student nurses are the ones who will be working in healthcare in the coming years, it needs to remain the bedrock of our education.

That’s why I found the nursing discussion session so inspirational. I met nurses from around the globe who all shared a similar vision about healthcare and quality improvement, and we discussed everything from policy and education, to current nursing practices and quality improvement. Continue reading »

May 092014
 
Andrew Cooper

Andrew Cooper

We recently launched the Ask about Clots campaign in Wales.

It aims to increase public awareness over the risk of developing a blood clot while in hospital. The health campaign’s simple message encourages individuals to ask about their personal risk so that they can be assessed and treated appropriately.

As we know, the major consideration for any campaign is what will actually engage people and motivate them to take the desired action?

In developing Ask about Clots, we focussed on three main areas which we believed were necessary to enable and encourage people to start asking! Continue reading »

May 022014
 
Mike Davidge

Mike Davidge

When Don Berwick features the Dalai Lama in a keynote presentation, you know something is going on.  When he compounds that by linking health to an 18th century British clockmaker and talks about being kind to one another and the benefits of charity giving, you might be forgiven for thinking he’d sort of lost the plot.

Well maybe except for two things.  Firstly, it was his delivery.  The keynote was delivered in his very understated style.  Those reassuring East Coast tones lend gravitas and are so reminiscent of Alastair Cooke – not the England cricket captain but the BBC’s long time US correspondent – and his Letters from America.  We trust this man not to lead us astray. Continue reading »

May 022014
 
Tim Heywood

Tim Heywood

The main hall of the Palais des congrès in Paris is an enormous space. For fans of trivia, it was the venue for the Eurovision Song contest in 1978. The 3000 plus delegates at the Quality Forum may have been there for a very different reason, but there was something about the design of the building and the international mix of the delegates, that kept nostalgic thoughts of the 1970’s returning to my mind (Israel won Eurovision that year, if you are interested).

This was my second visit to the Forum – my first was 6 years ago, the year that the 1000 Lives Campaign was launched, and it struck me how even 2008 is starting to feel like a long time ago. Caught in the cycle of daily work it is easy to fall into the trap of thinking that nothing much changes about the issues we confront and the opportunities we have to change them. Having the opportunity to take a step back and take a different view of your own work context was a good reminder of how mistaken that is. Continue reading »

Apr 222014
 
Dr Simon Noble

Dr Simon Noble

62% of people in Wales believe that air travel is the main cause of blood clots, according to research we worked on for the Ask about Clots campaign. And it’s a damaging misconception – because there is a far greater risk of develop a clot when in hospital.

In fact, you are 1000 times more likely to develop a clot during or in the 90 days following hospital treatment. That’s why the misconception is a fatal one, because blood clots can cost lives.

Through my work with Lifeblood, we’ve tried to raise awareness that blood clots are the most common cause of preventable hospital deaths. And the more people know about clots, the more likely it is we’ll be able to prevent them.

Ask about Clots Infographic 3 Parts Continue reading »

Mar 032014
 

A member of our student community, Ilaria Pignatelli, is the Campaign Manager for Ask One Question. She tells us about their simple pledge for NHS Change Day.

Ilaria Pignatelli

Ilaria Pignatelli

We ask a lot of questions through medical school. History taking and skills practice bring up some valid questions, but are we always asking the right ones?

The thought of visiting hospital can be a scary and unpleasant experience for many patients, so after asking all the routine questions; why not ask: “What can I do to improve your stay?”

The Ask One Question campaign is doing just that. It’s a world-wide, student-led healthcare improvement initiative, encouraging students to ask their patients: “What can I do to improve your stay?” and, when possible, act on their requests. It was started by students in Cardiff who have already gained recognition outside of Wales.1, 2 Continue reading »