Healthcare Improvement Scotland aims to continuously improve healthcare quality and safety in Scotland. It runs national improvement programs focused on areas like patient safety, healthcare associated infections, and person-centered care. Through measurement and data collection, the Scottish Patient Safety Program has demonstrated significant reductions in infection rates, improved compliance with best practices, and decreased mortality and length of stay in critical care units. The goal is to spread effective improvement strategies nationwide to benefit all Scottish patients.

1. T h e S c o t t is h A p p r o a c h t o
R e f o r m in g H e a lt h c a r e – Q u a lit y ,
E f f ic ie n c y a n d P r o d u c t iv it y
National Healthcare Conference, 22 March 2012
Frances Elliot | Chief Executive

2. T H E P R E S E N T A T IO N
T h e S c o t t is h n a t io n a l c o n t e x t f o r
q u a lit y in h e a lt h c a r e
M y o r g a n is a t io n
O u r a c t iv it y
W h a t c a n y o u le a r n ?

3. N H S S C O T L A N•D5.1 million population
• One integrated NHS system
• £10.3 billion
• Integrated health and social care
• 14 territorial boards
• Special boards
– Healthcare Improvement Scotland
– NHS Education for Scotland
– NHS Health Scotland
– NHS National Services Scotland
– Scottish Ambulance Service
– State Hospital
– Golden Jubilee National Hospital
– NHS 24

4. T H E S C O T T IS H C O N T E X T

5. Q U A L IT Y A M B IT IO N S
M u t u a lly b e n e f ic ia l p a r t n e r s h ip s b e t w e e n
p a t ie n t s , t h e ir f a m ilie s a n d t h o s e d e liv e r in g
h e a lt h c a r e s e r v ic e s w h ic h r e s p e c t in d iv id u a l
n e e d s a n d v a lu e s a n d w h ic h d e m o n s t r a t e
c o m p a s s io n , c o n t in u it y , c le a r c o m m u n ic a t io n
a n d s h a r e d d e c is io n -m a k in g .
T h e r e w ill b e n o a v o id a b le in ju r y o r h a r m t o
p e o p le f r o m h e a lt h c a r e t h e y r e c e iv e , a n d a n
a p p r o p r ia t e , c le a n a n d s a f e e n v ir o n m e n t w ill
b e p r o v id e d f o r t h e d e liv e r y o f h e a lt h c a r e
s e r v ic e s a t a ll t im e s .
T h e m o s t a p p r o p r ia t e t r e a t m e n t s ,
in t e r v e n t io n s , s u p p o r t a n d s e r v ic e s w ill b e
p r o v id e d a t t h e r ig h t t im e t o e v e r y o n e w h o

6. Q U A L IT Y A N D E F F IC IE N C Y –
G E T T IN G T H E B A L A N C E
R IG H T

7. N A T IO N A L P E R F O R M A N C E
F R A M E W O R K 2 0 11

8. Q U A L IT Y O U T C O M E IN D IC A T O R S
e a lt h c a r e n d e r 7 5 m o r t a lit y
e x p e r ie n c e ra te
ta ff e ng a g e m e nt
a t i e n t /u s e r
a n d p o t e n t ia l
re p o rte d o u tc o me
me a s ure s
e a lt h c a r e
a s s o c ia t e d
in f e c t io n e lf -a s s e s s e d
g e n e r a l h e a lt h
me rg e nc y
a d m is s io n e r c e n t a g e o f t im e
r a t e /b e d d a y s in la s t 6 m o n t h s
o f lif e s p e n t a t

9. TR A N S P A R E N C Y
e f in it io n o f t r a n s p a r e n t : a llo w in g
lig h t t o p a s s t h r o u g h s o t h a t o b je c t s
b e h in d c a n b e e a s ily s e e n ; e a s ily
u n d e r s t o o d ; o f s u c h a k in d t h a t t h e
t r u t h b e h in d it is e a s ily p e r c e iv e d ;
c le a r a n d u n m is t a k e a b le
f t e n d e s c r ib e d in t e r m s o f h o w
in d iv id u a ls b e h a v e a n d
o r g a n is a t io n s f u n c t io n e . g . w it h
c a n d o u r , in t e g r it y , h o n e s t y , e t h ic s ,
c la r it y , f u ll d is c lo s u r e , le g a l

10. H E A L T H C A R E IM P R O V E M E N T
S C O TL A N D
S e t u p b y a n A c t o f S c o t t is h
P a r l i a m e n t o n 1 A p r i l 2 0 11.
T w o k e y f u n c t io n s :
E n h a n c in g a n d p r o t e c t in g t h e
s a f e t y a n d w e llb e in g o f a ll p e r s o n s
w h o u s e s e r v ic e s p r o v id e d u n d e r
t h e n a t io n a l h e a lt h s e r v ic e a n d
in d e p e n d e n t h e a lt h c a r e s e r v ic e s .
U n iq u e ly in t h e U n it e d K in g d o m w e
f u lf il b o t h a n im p r o v e m e n t a n d
s c r u t in y r o le w it h r e g a r d t o h e a lt h
s e r v ic e s .

11. V IS IO N
T o d e liv e r e x c e lle n c e in
im p r o v in g t h e q u a lit y o f
t h e c a r e a n d e x p e r ie n c e
o f e v e r y p e r s o n in
S c o t la n d e v e r y t im e t h e y
a c c e s s h e a lt h c a r e .

12. IN T E G R A T E D C YC L E O F
IM P R O V E M E N T

13. IM P R O V E M E N T
T h e c o m b in e d a n d u n c e a s in g e f f o r t s
o f e v e r y o n e – h e a lt h c a r e
p r o f e s s io n a ls , p a t ie n t s a n d t h e ir
f a m ilie s , r e s e a r c h e r s , p a y e r s ,
p la n n e r s , a d m in is t r a t o r s , e d u c a t o r s
– t o m a k e c h a n g e s t h a t w ill le a d t o
b e t t e r p a t ie n t o u t c o m e , b e t t e r
s ys te m p e r fo r m a n c e , a n d b e tte r
p r o f e s s io n a l d e v e lo p m e n t . ”
a t a l d e n P , Da v id o f f F . Qu a l . S a f .

14. IM P R O V E M E N T
W e r u n t h e S c o t t is h P a t ie n t S a f e t y
P r o g r a m m e , a P a e d ia t r ic S a f e t y P a t ie n t
P r o g r a m m e a n d a r e d e v e lo p in g n e w
n a t io n a l p r o g r a m m e s f o r p r im a r y c a r e ,
m e n t a l h e a lt h , m a t e r n it y s e r v ic e s a n d
p e rs o n c e ntre d c a re
W e a ls o h a v e a n u m b e r o f o t h e r
im p r o v e m e n t p r o g r a m m e s , f o r e x a m p le
H e a lt h c a r e A s s o c ia t e d In f e c t io n ( H A I) ,
c a r d io v a s c u la r d is e a s e , n e u r o lo g ic a l
c o n d it io n s
T h e S c o t t is h Q u a lit y Im p r o v e m e n t H u b
W e s u p p o r t n a t io n a l in it ia t iv e s s u c h a s

15. The Improvement Guide, API

16. S IX Q U E S T IO N S F O R
H E A L T H C A R E P R O V ID E R S
D o e s e v e r y o n e in t h e s y s t e m k n o w
w h a t w e a r e t r y in g t o a c h ie v e ?
A r e w e p r io r it is in g t h e im p r o v e m e n t s
lik e ly t o h a v e t h e b ig g e s t im p a c t o n
t h e a im a n d s t o p p in g t h o s e t h a t h a v e
lit t le im p a c t ?
Is e v e r y o n e c le a r a b o u t t h e m e a n s o f
s e c u r in g im p r o v e m e n t s t o w a r d s o u r
a im ?
A r e w e a b le t o m e a s u r e a n d r e p o r t
p r o g r e s s o n o u r a im ?
D o w e k n o w h o w a n d w h e r e t o d e p lo y
r e s o u r c e s w h e n im p r o v e m e n t is
s lo w e r t h a n r e q u ir e d ?
D o w e h a v e a w a y o f t e s t in g a n d
in n o v a t in g a n d t h e n s p r e a d in g n e w
le a r n in g ?

17. T H E C O S T O F Q U A L IT Y
H a v in g t o r e d o o p e r a t io n s a n d
in t e r v e n t io n s
R e a d m is s io n s – in it ia l p r o b le m n o t
f ix e d
H e a lt h c a r e a s s o c ia t e d in f e c t io n
D e la y e d d is c h a r g e s
P o o r c o m m u n ic a t io n
D r u g in t e r a c t io n s a n d r e a c t io n s
P o o r p a t ie n t f lo w a lo n g c a r e
p a th w a ys
C o m p la in t s a n d lit ig a t io n .

18. TR U S T
T r u s t a n d t r a n s p a r e n c y a r e a lw a y s
lin k e d
T h e u n im p e d e d f lo w o f in f o r m a t io n is
e s s e n t ia l f o r h e a lt h y r e la t io n s h ip s
a n d f o r o r g a n is a t io n a l h e a lt h
Ib s e n d e f in e s “ v it a l lie s ” a s t h e
o p e r a t iv e f ic t io n s t h a t c o v e r a
m o r e d is t u r b in g t r u t h in t r o u b le d
f a m ilie s
In o r g a n is a t io n s t h e y p la y a r o le in
a t t e m p t in g t o k e e p e m b a r r a s s in g
t r u t h s f r o m s u r f a c in g .

19. S C O T T IS H P A T IE N T
S A F E TY P R O G R A M M E

20. S P S P WO R K S TR E A M S
C r it ic a l C a r e
– Ventilator acquired pneumonia bundle, central line bundle
G e ne ra l Wa rd
– Early rescue
– Communication
M e d ic in e s M a n a g e m e n t
– Medicines reconciliation
P e r io p e r a t iv e
– Surgical pause, surgical checklist
– Infection prevention/control, prevention of venous
thromboembolism
L e a d e r s h ip
– Safety walkrounds
– Executive leadership, board patient safety profile

21. MEAS UREMENT AND
D A TA

22. T o e n d o f 2 0 11:
• 61% reduction in Ventilator Associated Pneumonia rate
• 70% reduction in Central Line Bloodstream Infection rate
• There were 14 central line infections in intensive care units in Scotland in 2011
• There were zero central line infections in intensive care units in March, June and
December 2011
• 19% improvement in compliance with critical care multidisciplinary rounds and
daily goals
• 24% improvement in critical care mortality
• 0.5 day reduction in ICU length of stay
• 90% reduction in ward C. difficile rate
• 40% reduction in ward Staph aureus bacteraemia rate
• 20% improvement in compliance with surgical briefing
• 18% improvement in medicines reconciliation
H S M R – u p t o e n d o f S e p t e m b e r 2 0 11 i m p r o v e d b y
9 .3 %

23. VA P R A TE
( P E R T H O U S A N D V E N T IL A T O R D A YS )
20
18 61% reduction
16
14
12 9.11
10
8 3.54
6
4
2
0
10
08
11
09
8
1
0
9
8
1
9
0
8
0
1
9
l-0
l-1
l-0
l-1
r- 0
r- 1
r- 0
r- 1
-0
-0
-1
-1
n-
n-
n-
n-
ct
ct
ct
ct
Ju
Ju
Ju
Ju
Ap
Ap
Ap
Ap
Ja
Ja
Ja
Ja
O
O
O
O

24. 75
80
85
90
95
100
Jun-08
Aug-08
Oct-08
85%
Dec-08
Feb-09
Apr-09
Jun-09
Aug-09
Oct-09
Dec-09
Feb-10
Apr-10
Jun-10
Aug-10
Oct-10
Dec-10
V A P B U N D L E C O M P L IA N C E
Feb-11
Apr-11
Jun-11
7% improvement
Aug-11
92%
Oct-11
Dec-11

25. (
0.5
1.5
2.5
3.5
0
1
2
3
4
Jan-08
Mar-08
May-08
Jul-08
Sep-08 2.8
Nov-08
Jan-09
Mar-09
May-09
Jul-09
Sep-09
Nov-09
Jan-10
C E N T R A L L IN E
Mar-10
May-10
IN F E C T IO N R A T E
Jul-10
P E R T H O U S A N D L IN E D A YS )
Sep-10
Nov-10
Jan-11
70% reduction
Mar-11
0.84
May-11
Jul-11
Sep-11
Nov-11

26. Ja
80
85
90
95
100
n-
08
Ap
r- 0
8
Ju
l-0
8
89%
O
ct
-0
8
Ja
n-
09
Ap
r- 0
9
Ju
C O M P L IA N C E
l-0
9
O
ct
-0
9
Ja
n-
10
Ap
r- 1
0
Ju
l-1
0
O
C E N T R A L L IN E B U N D L E
ct
-1
0
Ja
n-
11
Ap
r- 1
1
Ju
l-1
1
O
ct
5% improvement
-1
94%
1

27. % C O M P L IA N C E W IT H
M U L T I-D IS C IP L IN A R Y
R O U N D S A N D D A improvement
100
19% I L Y
G OALS
95
90 93%
85
80 74%
75
70
65
60
Nov-09
Nov-11
Nov-08
Nov-10
Jan-09
Jul-10
Jan-11
Jul-08
Jul-09
Jul-11
Jan-10
May-11
Mar-10
Sep-10
Mar-11
Sep-09
Sep-08
Mar-09
May-09
May-10
Sep-11

28. Ja
10
12
14
16
18
20
22
24
26
28
30
n-
08
Ap
r- 0
8
Ju
l-0
8
O
ct
-0
8
18.2%
Ja
n-
09
Ap
r- 0
9
Ju
l-0
9
O
ct
-0
9
Ja
n-
% IC U M O R T A L IT Y
10
Ap
r- 1
0
Ju
l-1
0
O
ct
-1
0
Ja
n-
11
Ap
r- 1
1
Ju
l-1
1
O
ct
24% improvement
-1
1
13.9%

29. Ja
3
3.5
4
4.5
5
5.5
6
n-
08
Ap
r- 0
8
Ju
l-0
8
O
4.8
ct
-0
8
Ja
n-
09
Ap
r- 0
9
Ju
l-0
9
O
ct
-0
9
Ja
n-
10
Ap
r- 1
0
Ju
l-1
0
O
ct
-1
0
Ja
n-
11
Ap
r- 1
1
Ju
l-1
1
4.3
O
IC U A V E R A G E L E N G T H O F S T A Y
ct
-1
1
½ day improvement

30. G E N E R A L WA R D
C . D IF F IC IL E R A T E
( P E R T H O U S A N D P A T IE N T D A YS )
2.5 1.15 90% reduction
2
1.5
1 0.12
0.5
0
10
08
11
09
8
1
0
9
8
1
9
0
8
0
1
9
l-0
l-1
l-0
l-1
r- 0
r- 1
r- 0
r- 1
-0
-0
-1
-1
n-
n-
n-
n-
ct
ct
ct
ct
Ju
Ju
Ju
Ju
Ap
Ap
Ap
Ap
Ja
Ja
Ja
Ja
O
O
O
O

31. G E N E R A L WA R D S A B
R A TE
0.6P
( E R T H O U S A N D O C C U P IE D B E D
0.35
0.5 A Y S )
D 40% reduction
0.4
0.3
0.21
0.2
0.1
0
11
10
08
09
12
8
9
0
1
8
9
0
1
9
0
1
8
l-1
l-1
l-0
l-0
r- 0
r- 0
r- 1
r- 1
-0
-0
-1
-1
n-
n-
n-
n-
n-
ct
ct
ct
ct
Ju
Ju
Ju
Ju
Ap
Ap
Ap
Ap
Ja
Ja
Ja
Ja
Ja
O
O
O
O

32. 84
86
88
90
92
94
96
98
Jul-08
Sep-08
E WS
Nov-08
92%
Jan-09
Mar-09
May-09
Jul-09
Sep-09
Nov-09
Jan-10
Mar-10
P E R C E N TA G E
May-10
Jul-10
Sep-10
Nov-10
Jan-11
C O M P L IA N C E W IT H
Mar-11
May-11
Jul-11
95%
Sep-11
Nov-11
Jan-12

33. P E R C E N TA G E
C O M P L IA N C E W IT H
S U R G IC A L B R IE F IN G
100
95
94%
90
85
80
75 20% improvement
70
65
74%
60
55
50
09
08
11
10
9
8
0
1
0
8
1
9
8
9
1
0
l-0
l-1
l-1
l-0
r- 0
r- 1
r- 0
r- 1
-0
-1
-0
-1
n-
n-
n-
n-
ct
ct
ct
ct
Ju
Ju
Ju
Ju
Ap
Ap
Ap
Ap
Ja
Ja
Ja
Ja
O
O
O
O

34. P E R C E N T A G E C O M P L IA N C E W IT H
P E R I-O P B R IE F IN G S
95%
92%

35. P E R C E N TA G E
C O M P L IA N C E W IT H
M E D I C I N E S 18% improvement 82%
100
R E C O N C IL IA T IO N
95
90
85
80 64%
75
70
65
60
55
50
11
10
08
09
08
09
10
11
08
11
09
10
0
8
9
1
-1
-0
-0
-1
v-
v-
v-
v-
b-
b-
b-
b-
g-
g-
g-
g-
ay
ay
ay
ay
No
No
No
No
Fe
Fe
Fe
Fe
Au
Au
Au
Au
M
M
M
M

36. TH E N E W TR A N S P A R E N C Y
n e v e r y d a y lif e w e liv e in a g lo b a lly
n e t w o r k e d s o c ie t y
h e m o b ile p h o n e e q u ip p e d w it h a
c a m e ra , a nd C C TV, m e a ns tha t e a c h
o f u s is , m o r e o r le s s , a lw a y s u n d e r
s c r u t in y a n d o n d is p la y
h is n e w , in v o lu n t a r y t r a n s p a r e n c y
r e c o g n is e s t h a t t h e r e is n o s u c h
t h in g a s s e c r e c y

37. R E C O M M E N D E D R E A D IN G
FOR B OARD MEMB ERS
How well does your organisation
measure up in terms of
transparency?
Do you have a mechanism to
encourage difficult conversations
in your senior management team,
in governance committees and at
the board level?
How do your staff raise sensitive
and difficult issues?
What support do they receive
when they do?

38. KEY MES S AGE
D o n o t b e c o n t e n t w it h
m e d io c r it y .
D o y o u r jo b s o w e ll t h a t n o b o d y
c o u ld d o it b e t t e r . ”
a r t in L u t h e r K in g

39. U S E F U L W E B S IT E S
w w w . h e a lt h c a r e im p r o v e m e n t s c o t la n d . o
w w w . s c o t la n d p e r f o r m s . c o m
w w w . s c o t t is h p a t ie n t s a f e t y . p r o g r a m m e .