Changing Organisational Culture

How to help change an organisation’s culture toimprovement and patient care?

See NHS Improving Quality’s Richard Jeavon’s blog post Learning together to improve patient safety, in which he describes how the new national patient safety collaborative programme will enable frontline teams to involve patients and their families in making healthcare safe.

Also see the A Promise to Learn – a commitment to act, in which Don Berwick highlighted that key to implementing the Francis recommendations is a shift in culture, and also this blog post from the King’s Fund, Now is the time to transform NHS cultures.

For practical information on transforming culture, see:

• NHS Institute’s Transforming Patient Experience
• King’s Fund’s patient-centred leadership and leadership and engagement for improvement in the NHS: together we can
• Measuring and assessing organisational culture in the NHS
• Patient Safety First’s 'How to' guide on human factors
• Department of Health’sOrganisational Transformational Change: Belief – Behave – Be Sure
• What makes a top hospital? Organisational Culture
• How Does Leadership Make Difference to Organisational Culture and Effectiveness?

Using clinical communities to improve quality

Gaps are often found between how healthcare should be delivered, as defined by high-quality evidence, and the care that patients actually receive.  This Health Foundation reportintroduces the clinical community to support and secure improvements in health systems across multiple sites.

See also:

• Closingthe Gap through Clinical Communities
•  Quality improvement through clinical communities: eight lessons for practice
•   Engaging clinicians in a quality agenda

Quality and Productivity Cochrane Topics/Case Studies

NHS Evidence has published some case studies of innovative practices so that organisations can learn from one another.  Also the Cochrane Topics section has some ‘implications for practice’ to help inform local practices. There was one new addition last month.

Home administration of intravenous diuretics to heart failure patients: Increasing productivity and improving quality of care

This month’s tool: How to Understand Differences Between Individuals

Understanding individual differences and the way in which individuals react to the world around them can help improve communications between staff and aid the delivery of change projects.

See this tool at the NHS Institute and also at NHS Scotland Quality Improvement Hub.

Monitoring Safety

If you want to know how better to monitor patient safety, you may be interested in these two thought papers, recently published by The Health Foundation:

• Measuring and monitoring safety: an acute care perspective

In this thought paper, Dr Carol Peden offers reflections on the measurement and monitoring of safety from the perspective of a practising clinician based at a busy district general hospital.

• Identifying risks and monitoring safety: the role of patients and citizens

This thought paper considers the role of patients and citizens in the identification of risk and the measurement and monitoring of safety within healthcare. It discusses opportunities for patients, their families and carers, as well as the wider public, to become part of an integrated system for ensuring the safety of care.

See also:

• The Health Foundation’s Safety Management section, and The measurement and monitoring of safety report.
• NHS Safety Thermometer

Improving Hip Fracture Care

The Nuffield Trust has published Focus on hip fracture which explores the quality of care and outcomes of treatment for hip fracture, drawing on 10 years’ of hospital inpatient activity data.

See also the latest National Hip Fracture Database (NHFD) report.  You may also find the following documents useful:

• NHS Institute’s Focus on: Fractured Neck of Femur and Fractured Neck of Femur facts.
• Hip Quality Improvement Programme
• Creating exceptional patient experience in hip fracture care
• Fractured neck of femur - rapid improvement programme
• Improving Care for Hip Fracture Patients in WA
• Improving hip fracture care by using the Bone and Joint Canada toolkit to reduce delays and improve clinical processes for an aging population

Quality and Productivity Cochrane Topics/Case Studies

NHS Evidence has published some case studies of innovative practices so that organisations can learn from one another.  Also the Cochrane Topics section has some ‘implications for practice’ to help inform local practices. There were two new additions last month.

Improving the quality of care for men with lower urinary tract symptoms: shared decision making

This month’s tool: Provocation to Help Solve Problems

Provocations help you challenge a way of thinking. By starting from an outrageous idea or scenario, you are able to suspend judgement and make connections and associations more freely.

See this tool at the NHS Institute and also at NHS Scotland.

Improving services for patients with long-term conditions

See this report published by the Health Foundation, Sustaining and spreading self-management support.

The evaluation provides valuable insight into how to sustain changes in clinical practice to more effectively support people with long-term conditions.  See also the Health Foundation’s long-term conditions topic.

The King’s Fund has also published Delivering better services for people with long-term conditions: building the house of care. It describes a co-ordinated service delivery model – the ‘house of care’ – that aims to deliver proactive, holistic and patient-centre

See also their reading list on improving care for long-term conditions.

See also Healthcare Improvement Scotland, NHS Wales’ Designed to Improve Health and the Management of Chronic Conditions in Wales, and NHS Scotland’s Food For Thought: Anticipatory Care, Self-Management and Community-Led Health Improvement Approaches for People with Long-term Conditions.

Ambulatory Emergency Care

This report from the Health Foundation and Nuffield Trust explores patterns of emergency admissions across England for people with ambulatory care sensitive conditions.

Aggregate rates of emergency admissions for ACS conditions are commonly used to measure how well the health system is preventing unplanned hospital use.

See also:

NHS Institute’s Ambulatory Emergency Care

The King’s Fund briefing  Emergency hospital admissions for ambulatory care-sensitive conditions

Case studies: Developing a New Model of Emergency Care - The Middlesbrough Experience
Ambulatory Emergency Care – The Logical Way to Go
A Flexible Approach to Ambulatory Care at Pennine Acute Hospitals
Treating Emergency Patients in a Day - The Weston Experience tithe potential for reductions

Quality and Productivity Cochrane Topics/Case Studies

NHS Evidence has published some case studies of innovative practices so that organisations can learn from one another.  Also the Cochrane Topics section has some ‘implications for practice’ to help inform local practices. There were two new additions last month.

Stratified cancer pathways: redesigning services for those living with or beyond cancer

Remote monitoring of cardiac devices: benefits of reduced hospital-based surveillance

This month’s tool: Driver Diagrams

A simple way to show how an overall improvement goal can be broken down into its underpinning drivers and projects.

See driver diagrams at the NHS Institute,  NHS Scotland and the Institute for Healthcare Improvement.

A&E Pressures

With all the recent news about unsustainable pressures in A&E, you may be interested in this report from the NHS Confederation: Emergency care: an accident waiting to happen?

Also see this blog post in NHS Voices More money isn’t enough – only change across the whole NHS will tackle A&E pressures.

NHS England has also released an A&E improvement plan.

You may also be interested in the Foundation Network’s Emergency Care and Emergency Services 2013 – View from the frontline

Improving Quality and Safety

See Quality and safety in the NHS. This study of NHS cultures and behaviours found that the quality of care in the English NHS is too often compromised by a lack of clearly defined goals, too much regulation and highly variable staff support.  It includes recommendations for improving patient safety.

NHS Trust Development Authority’s Delivering High Quality Care for Patients

The Berwick Report. A promise to learn: a commitment to act: improving the safety of patients in England

NHS Confederation’s Changing care, improving quality

See also these tools and websites:

Harm Free Care’s NHS Safety Thermometer

NHS Improvement’s Quality and service improvement tools

First steps towards quality improvement: A simple guide to improving services

Quality and Productivity Cochrane Topics/Case Studies

NHS Evidence has published some case studies of innovative practices so that organisations can learn from one another.  Also the Cochrane Topics section has some ‘implications for practice’ to help inform local practices. There were no new additions last month.

This month’s tool: Patient Perspectives

This tool describes the different ways in which you can canvas patient opinion and gain their perspective to inform any service improvement you are planning.

See Patient Perspectives tool and Picker Institute Europe’s ‘Improving Patients’ Experience Fact sheets’

Seven-Day Services

NHS Improving Quality has published the presentations from its recent 'Seven Day Services Learning Exchange' event:

• NHS services seven days a week - making it a reality
• 7 day working: can you tame a wicked problem?
• Towards 7 day working - A whole system change

You may also be interested in the following:

• Equality for all: Delivering safe care, seven days a week - case studies – NHS Improvement
• Seven Day Consultant Present Care - Academy of Medical Royal Colleges
• Delivering a 12 hour, 7 day consultant presence on the acute medical unit – Royal College of Physicians
• Implementing seven day services in Imaging Departments: Good Practice Guidance - National Clinical Imaging Advisory Group

Implementing Improvement

You may be interested in these two new publications from the Health Foundation:
 
Lining Up: How do improvement programmes work?

This learning report looks at lessons from the Health Foundation’s Lining Up research project – an investigation into interventions to reduce central line infections. It explores the reasons why potentially promising improvement programmes might fall short when implemented in a new setting.

Quality improvement made simple This guide looks at organisational or industrial approaches to quality improvement. This is not a ‘how to’ guide. Instead, it offers a clear explanation of some common approaches used to improve quality, including where they have come from, their underlying principles and their efficacy and applicability within the healthcare arena

Quality and Productivity Cochrane Topics/Case Studies

NHS Evidence has published some case studies of innovative practices so that organisations can learn from one another.  Also the Cochrane Topics section has some ‘implications for practice’ to help inform local practices. There were no new additions last month.

This month’s tool: Listening - Needs and Gets Matrix

The 'Listening Needs and Gets Matrix' is a way of developing understanding between departments so that they are able to work together more effectively.

See Listening - Needs and Gets Matrix, and Identifying niggles in your workspace