DSPy a system for AI to Write Prompts and Do Fine Tuning
Special Interest Session 1: Safety, Collaboration and Spread Across Boundaries
1. Safety, Collaboration and
Spread Across Boundaries
Andrew Longmate
National Clinical Lead for Patient Safety
Ann Holmes
Deputy Chief Nursing Officer and Chief Midwife
6. Safe Ambition
There will be no avoidable
injury or harm to people from
healthcare they receive, and
an appropriate, clean and safe
environment will be provided
for the delivery of healthcare
services at all times
7. To transform the
safety of acute care
thereby improving
care and radically
reducing needless
death and harm.
8. Triple Aim QualityAmbitions 12 PriorityAreas for Improvement
PersonCentered PersonCentered Care
Safe Safe Care
PrimaryCare
Unscheduled and EmergencyCare
Integrated Care
Care for Multiple and Chronic Illnesses
EarlyYears
HealthInequalities
Prevention
Workforce
Innovation
Efficiencyand Productivity
Effective
ROUTE MAP TO THE 2020 HEALTH AND SOCIAL CARE VISION FOR SCOTLAND
Healthofthe Population
Value and Sustainability
QualityofCare
9.
10.
11. Extended ambition
By December 2015
•20% reduction in hospital
mortality
•95% of patients will be free
from avoidable harm in our
hospitals
12. 11.8% - 9037 less than expected deaths
NHSScotland HSMR
(up to December 2012) 0.93
0.97
13. Further increase safety in acute
hospitals
Reduce avoidable harm and
death
Reduce Hospital Associated
Mortality
Reduce HSMR by 20%
95% of people experiencing
acute care free from harms in
SPSI
Reliable rescue MRSA
C Diff
VAP CRBSI
SSI
Prevent Hospital Associated Venous Thrombosis and Embolism
Medicines Safety
Insulin: out of range glucose Anticoagulants
Team Working and
Communication
CHF
Stroke
Improve Management of
Chronic Conditions
Safety Briefings
SBARWHO Checklist
Sepsis MSSA
Prevent HAI
Palliative and end of
life care at home or in
a homely setting
Anticipatory planning
Supported discharge and decision making
Primary-secondary care collaboration
Prevent
harms
Pressure
Ulcers
Falls
Evidence based care
bundles
Heart Failure, Stroke,
MI, PVC, Community
Acquired Pneumonia
Population Health
Hospital Safety Brief
No missed doses
E ColiCAUTI
Best use of IT solutions
Medicines Reconciliation
High Risk Medicines
Improve Flow and
Demand-Capacity
imbalance for
unscheduled care
14. HAI Taskforce
By Dec 2015 95% of
people experiencing
acute care will be free
from these avoidable
harms
Scottish Patient safety Indicator
SPSI
15. SCOTTISH PATIENT SAFETY INDICATOR
[SPSI]
• Reducing key preventable harms
• Centred on the person
• Building on and integrating the SPSP, LBC, HAI
work
• Ward based (multidisciplinary) team work
• Spread improvement science, expand capability
and capacity
• Catalyst for true improvement work to prevent
some of our more important harms, focus on
some harms not yet addressed
• A specific aim for SPSP
17. Our change theory
•A clear and stretch goal
•A method
•Predictive, iterative testing
•Reliable implementation
•Doing the common things
uncommonly well
21. Psychological safety: create an environment
where no one is hesitant to voice a concern and
caregivers know that they will be treated with
respect when they do.
Organisational fairness; caregivers know they
are accountable for being capable,
conscientious and not engaging in unsafe
behaviour, but are not held accountable for
systems failures.
A learning system where engaged leaders hear
patients’ and front line care givers’ concerns
regarding defects that interfere with the delivery
of safe care and promote improvements to
increase safety and reduce waste.
22. Every unit in a care system, clinical or
otherwise should start the day or
procedure with a briefing or huddle.
“What are we doing today ? Here’s
what we are thinking…..Who’s here to
help us ? Do we have what we need ?
And what barriers or constraints are in
our way ?
23. Just the usual things from me…if
everyone could pay attention
during the pauses, that would be
geatly appreciated…
…and if anyone sees anybody doing
anything daft; particularly if its me;
then please speak up and let them
know
27. Just the usual things from me…if
everyone could pay attention
during the pauses, that would be
geatly appreciated…
…and if anyone sees anybody doing
anything daft; particularly if its me;
then please speak up and let them
know
33. Some Scientific Premises
1. Most people are trying hard most of the time to do
a job they can be proud of.
2. All improvement is change (though not all change is
improvement).
3. Fear is an enemy of improvement.
4. All measurement systems to assess performance
will eventually come under the control of the
measured.
5. It is very hard to improve unless you know how you
are doing.
33
34. Some Rules of the Road
1.The needs of the patient come
first.
2.Trust each other.
3.The key task is to learn.
4.Blame won’t help.
34
35. One thing
• That you have seen today or seen at the posters ?
• That you can contribute to the spread of ?
• How are you going to do it ?
36. Create the Conditions (J Bloor)
•Purpose
•Leadership
•Time (commitment, priority,
resilience)
•Connections to people
•Connections to information
37. Leadership
•Topic is a key strategic initiative
•Goals and Incentives aligned
•Executive sponsor assigned
•Day-to-day managers identified
•Spread aim statement developed
Better Ideas
•Develop the case
•Describe the
ideas
Set up
•Adopter audiences
•Successful sites
•Structured
enhancements
•Key partners
•Initial spread plan
Knowledge management
Measurement and feedback
A Framework for Spread
2nd
Edition the Improvement Guide
Langley, Moen, Nolan, Nolan, Norman, Provost
Social System
Communication of awareness and technical
knowledge
•Key messengers
•Peer-to-peer interaction
•Technical support
•Transition issues
WILL, IDEAS,
EXECUTION,
INFRASTRUCTURE...
38.
39.
40.
41.
42. What will it take ?
•Integration, integration, integration
•Winning the hearts and minds of the
staff
•Spread
•Focusing on improvement not targets
•Leadership
•Measurement that has meaning
•Integration into daily work
•Creating infrastructure – people, IT
•Creating capability and capacity
44. “Systems awareness and
systems design are important
for health professionals, but
are not enough. They are
enabling mechanisms only. It is
the ethical dimension of
individuals that is essential to a
system’s success. Ultimately,
the secret of quality is love.”
Avedis Donabedian
Our national context. Our national aim – driven by the Scottish Patient Safety Programme and led by the Scottish Government
So this is our aim – OUR aim – mine and yours – a bold aim – one which, as you will hear today and tomorrow, we are not quite sure what is all means – but we can be sure that ....
Data from at least 9 out of 10 Boards with Data available on Extranet. Each month has an average sample size of 2949 procedures
We share Derek ’ s vision for the 3 rd curve – however we are here – right here – in the improvement zone and we must concentrate our will and our work and our effort in this zone – to hold the gains and to drive forward .... Is important is the AUC (area under the curve) of all three curves combined We are not jumping from one curve to the next But we are utilising the collective impact of all three curves We will never be out of or off the improvement curve This work is so important that it will never be finished.