10 March 2020
HSCQI showcases quality and innovation to visiting European health experts
The Institute for Healthcare Improvement (IHI) is a global organisation that uses improvement science to advance and sustain better outcomes in health across the world. Last month the Health and Social Care Quality Improvement Network (HSCQI) in Northern Ireland hosted a European IHI Conference in Belfast at the excellent QIIC unit, in the South Eastern Trust. Over 75 delegates from across 33 organisations and 11 European countries attended the Health Improvement Europe Alliance Conference. The NI Trusts input into the conference programme to showcase some of the innovative work in Quality Improvement in NI Health and Social Care System.
The Western Trust presented on the NI Flow Coaching Academy, a one-year action learning course to train clinicians and managers in team coaching skills and improvement science. The course teaches skills of quality improvement, engagement and social movement. The coaches put their skills into practice by leading Big Room meetings which bring together staff from each step of the patient journey and enables them to assess, diagnose and iteratively test changes to improve patient flow. Coaches actively engage in experiential learning through co-coaching a care pathway team. Coaching pairs are composed of a clinical coach, who works within the pathway, and a flow coach, external to the pathway.
Advancing improvement approaches in Primary Care
Dr Caren Walsh, hosted delegates at her Grosvenor Road Surgery (GRS) to see the how the application of QI tools and the fostering of a QI culture over the last 2 years is transforming her GP Practice. The practice is an excellent example of how Primary Care is embracing QI. The weekly QI meetings involve the whole team and whilst these initiatives have taken place amidst severely limited time and high care demand, the transformation in the Practice (Doctors’ Office) has been noted by the whole team and has resulted in greater productivity, the tackling of many ‘wicked problems’ and the fostering of greater joy and team wellbeing in work.
Wellness Recovery Network in South Eastern Trust
The Wellness Recovery Network is a peer led support group ran by people with lived experience of various mental health conditions who have been on a journey of hope, recovery and finding a sense of wellness after being in a place of despair. The Network aims to reduce stigma by promoting and supporting conversations about mental health, recovery and focusing on wellness. During the extremely moving visit the network members of individuals and family members shared their experiences of attending the monthly support group meetings or weekly singing group and the impact these sessions have had on their recovery and wellness. Some members of the Network have over time moved into now volunteering in the Network.
Real Time Patient Feedback informing Real Time Improvement – Belfast Trust
Belfast Trust showcased their introduction of real time patient feedback in wards and units in the City Hospital. Each ward/unit is visited twice per month by a Patient Experience Officer who surveys patients and then undertakes the NHS Safety Thermometer Audits (Classic, Medication, Mental Health, Maternity and Paediatric). The ward is provided with a report within 24 hours. The patient survey is based around 9 domains which capture the breadth of the patient experience. Wards can see clearly how they perform in each domain and the free text comments are invaluable for complimenting individuals, reporting examples of staff providing compassionate care and of course suggestions for improvement, which have included reducing noise at night, introducing a kind care bundle, pain relief and medications information.
Site Visit to a Northern Ireland Integrated Care Prototype in the Northern Trust
The European delegates visited Antrim Area Hospital to find out more about how Health and Social Care Trusts in NI are commissioned to provide hospital, community and social care services. This distinguishes NI from the rest of the UK, where social care is provided by local government. The arrangements in NI provide advantage in addressing population health issues however such advantage has been limited by the lack of alignment between Trust services and Primary Care, which are commissioned separately, and by limited too by cross sectorial working. The Integrated Care Prototype for NI seeks to address these challenges by creating an integrated commissioning model, and working with other statutory bodies and communities, with shared decision making and shared responsibilities for population health outcomes. Examples discussed included Frailty and Diabetes with interaction with service users and carers on the day. This visit gave an opportunity to see what is being achieved first hand and meet with those involved from primary care, hospital, community care, service users, carers, third sector and local government.
Managing Frail Elderly Patients across Both Acute and Community Settings in the Southern Trust
With the catchment population for Southern Trust expanding, and disproportionately for frail older people, this visit emphasised the need to develop services to provide support for elderly citizens. At Craigavon Area Hospital the European delegates heard how the Trust has introduced improvements to help manage the care of frail elderly people.
- Acute Care at Home – a consultant geriatrician led multi-disciplinary service that provides active treatment by healthcare professionals in the person’s home and prevents Emergency Department attendance/acute admission and/or facilitates prompt discharge from an acute hospital bed. Acute hospital care can be associated with adverse health outcomes, particularly for older people, confusion is made worse, confidence is lost and social networks are disrupted. There is also growing evidence on deconditioning effects of hospital stays, particularly among older people. In the first 7 months of 2019/2020 the service saved an estimated 5,535 bed days: this equates to a 26 bedded ward at 100% occupancy, or a 29 bedded ward at 89% occupancy.
- Discharge to Assess – Discharge to Assess enables patients identified as fit to return to their own home to be assessed in a timely manner by multi-disciplinary professionals in a familiar environment. This streamlines the patient pathway involving the patient and carers in the discharge planning process and eliminates unnecessary delays.
- Older Person’s Assessment Unit –The unit has an environment that is more suited to the older person, calmer than Emergency Departments, with a layout more suited to the needs of elderly patients. Evidence indicates that circa 80% of patients were re-directed from CAH acute admission through the OPAU.
Nurturing future talent, coaching for high performance: Ulster Rugby
In addition, to the health care setting visits across the region some of the delegates visited Kingspan Stadium to explore how Ulster Rugby are nurturing future talent and coaching for high performance. Ulster Rugby Academy Manager, Kieran Campbell and Jo Hopkins, who is a consultant with the British Olympic programme, highlighted the work of the Ulster Rugby Academy to nurture talent, and the work Ulster Rugby do to manage high performance for their professional team.
The feedback from the conference delegates and the IHI was very positive with the site visits particularly being highlights of the two days. It was a great opportunity to put the excellent work in QI in region on the European map and new connections were made which will progress further collaboration on improvement.
Massive thanks to all involved across the HSC in the planning and hosting of the conference.