Healthcare quality strategy for NHSScotland

2. Executive Summary

What is the Quality Strategy?

'putting people at the heart of our NHS'

In December 2007, the Better Health, Better Care Action Plan (2007) made a series of commitments to improve the health of everyone in Scotland and to improve the quality of healthcare and healthcare experience. The related programmes and initiatives have already enhanced the quality of healthcare within NHSScotland. The Quality Strategy is a development of Better Health, Better Care which builds on the significant achievements of the last few years such as the further improvements we have made in waiting times, our approach to tackling Healthcare Associated Infection and improvements we have made to ensure the safety of patients in our hospitals. It has been informed by a wide range of discussions involving people working in NHSScotland, patients and carers and by a series of events in early 2010 involving independent primary care contractors.

The Healthcare Quality Strategy will ensure that we maximise the contribution of NHSScotland to the wider Purpose of the Scottish Government to create sustainable economic growth and opportunities for everyone in Scotland to flourish. The Quality Strategy will have a direct and positive impact on these goals through the improvements it will make in supporting everyone in Scotland to live longer healthier lives and to participate more productively both economically and socially. Increased effectiveness, efficiency and productivity of the health sector in Scotland will make a significant and direct contribution to economic growth.

In Better Health, Better Care we set out our proposal to create a mutual NHS in Scotland where staff, patients and carers fully understand their rights and responsibilities, and what they should expect from their NHS. A mutual NHS is an underpinning requirement of person-centred healthcare, so we will continue to pursue this as part of this Quality Strategy.

'best possible care compassionately and reliably'

The Quality Strategy builds on these foundations and is about three things:

• It is about putting people at the heart of our NHS. It will mean that our NHS will listen to peoples' views, gather information about their perceptions and personal experience of care and use that information to further improve care.
• It is about building on the values of the people working in and with NHSScotland and their commitment to providing the best possible care and advice compassionately and reliably by making the right thing easier to do for every person, every time.
• It is about making measurable improvement in the aspects of quality of care that patients, their families and carers and those providing healthcare services see as really important.

'making the right thing easier to do'

Firstly, we start with what people have told us are their priorities:

• Caring and compassionate staff and services;
• Clear communication and explanation about conditions and treatment;
• Effective collaboration between clinicians, patients and others;
• A clean and safe care environment;
• Continuity of care; and
• Clinical excellence.

'measurable improvement'

Secondly, the Quality Strategy makes explicit connection between these patient priorities and the values of the people working for and with NHSScotland.

'we also know about the correlation between staff experience and staff
wellness with the patient experience and patient outcomes'

Staff have long shared the vision of high quality healthcare services in Scotland. Indeed for many the drive to make a difference; caring for, supporting and enabling others is what motivated them to work in health and is completely aligned with their professional values and aspirations. Capturing and sustaining this enthusiasm and commitment is what underpins quality healthcare in effective organisations and enables the culture of quality to thrive. We already know from extensive research about the links between staff engagement and enhanced organisational performance. We also know about the correlation between staff experience and staff wellness with the patient experience and patient outcomes. It will be important therefore to balance our drive for quality, productivity and efficiency, with the support and development for staff to feel engaged, valued and empowered in leading and driving quality in their communities, services, wards and departments.

Thirdly, we identify in the Quality Strategy the actions most likely to lead to improvements in these priority areas. We have built these improvement interventions from three healthcare Quality Ambitions.

'...commitment to equality of experience and outcomes...'

The Quality Ambitions

Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making. 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. The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.

These three Quality Ambitions will provide the focus for all our activity to support our aim of delivering the best quality healthcare to the people of Scotland and through this making NHSScotland a world leader in healthcare quality. They explicitly reflect the things people have told us they want and need and are based on the internationally recognised six dimensions of healthcare quality (Institute of Medicine):

• Person-centred;
• Safe;
• Effective;
• Efficient;
• Equitable; and
• Timely.

Our shared pursuit of the three Quality Ambitions will make significant and positive impacts on efficiency and productivity. Through this we will sustain the unprecedented improvements we have made in waiting times and in access to primary, secondary and emergency healthcare services. We will also strive to ensure that the high quality health services we deliver are provided on the basis of our ongoing commitment to equality of experience and outcomes - to everyone in Scotland, no matter who they are, or where they live.

Implementation of this Quality Strategy will be the means by which we ensure that the longer-term transformational challenges are addressed. In the short term the NHSScotland Efficiency and Productivity Strategic Oversight Group will support Boards to identify immediate opportunities for achieving efficiencies based on the Delivery Framework which was published in June 2009 that are consistent with, and in the context of, the Quality Strategy.

'The Quality Strategy builds on a firm foundation'

How will we make it happen?

The Quality Strategy builds on a firm foundation as many of the things we are already doing across NHSScotland in primary care, in health improvement, in hospitals and in other healthcare environments are the right things. However, we also need to do some new things, to do some things differently,to stop wasteful activity, and to focus on evidence-based activities which yield the maximum benefit. We will have to reduce unjustified variation to minimise the potential for harm. We will have to involve the people of Scotland to a greater extent in the 'co-production' of health and healthcare. We also need to reflect the changing cultures, expectations, needs and context for healthcare service delivery so that future generations can also enjoy high quality healthcare services that are responsive to their needs and expectations.

'...need to do some new things, to do some things differently...'

In order to pave the way for implementation there are a number of underpinning things we will do. These include the following:

Commitments

• We will build on NHSScotland's integrated delivery arrangements, encouraging whole system improvement through mutually beneficial partnerships between clinical teams and the people in their care.
• We will continue to pursue the health improving activities NHSScotland is already undertaking in partnership with other bodies through the implementation of our health improvement and public health strategies, including Equally Well and pursuing a Health Promoting Health Service.
• We will review the alignment and contribution of the work we are doing across the range of other strategies and initiatives, reinforcing and joining-up those which clearly support the Quality Strategy aims, and
  re-positioning or indeed, scaling down or stopping those which do not.
• We will ensure that we create the necessary governance, measures and delivery structures across NHSScotland so that the interventions we pursue are clearly and appropriately integrated, aligned and managed. This will include the clear alignment of the set of national targets for NHSScotland ( HEAT²) with the ambitions of the Quality Strategy.
• We will involve everyone in Scotland, by communicating the messages of our shared vision for healthcare quality so that everyone can play their part in making it happen.
• We will support Boards to share and spread their exemplars of high quality healthcare, and pursue their local commitments to take new action to improve quality.
• We will set out our Quality Ambitions and related priority areas for national action and will produce a regular report on progress.
• We will work with and through people - our most valuable asset - our leaders, service users, health professionals and support staff to create and sustain a culture where quality can thrive and the contribution of every individual to quality is recognised and valued.

The Quality Strategy Driver Diagram sets out the priority areas for action and the specific improvement interventions we will focus on to enable us to achieve our three Quality Ambitions.

The Quality Strategy Driver Diagram

How will we measure and report progress?

A Quality Alliance will be formed, which will report progress on a regular basis with reference to a small set of high-level Quality Outcome Measures, selected to monitor progress towards the Quality Ambitions, and with reference to progress in implementing the improvement interventions.

The suite of 12 national Quality Outcome Measures proposed in this Quality Strategy requires further detailed development and definition through consultation across NHSScotland, and is as follows:

• healthcare experience;
• staff experience;
• staff attendance;
• Healthcare Assoicated Infection ( HAI);
• emergency admissions;
• adverse events;
• Hospital Standardised Mortality Rate ( HSMR);
• proportion of people who live beyond 75 years;
• patient reported outcomes;
• patient experience of access;
• self assessed general health; and
• percentage of last 12 months of life spent in preferred place of care.

'...NHSScotland national HEAT targets will be aligned with the Quality Strategy.'

The NHSScotland national HEAT targets ³ will be aligned with the Quality Strategy, and will set out the national targets which have been planned and agreed with NHSScotland as the priority areas for progress each year. Performance against the HEAT targets will therefore provide shorter term measures of progress toward the Quality Ambitions. In 2011/12, the HEAT targets will include a small number of new targets agreed with NHSScotland to provide greater alignment with the Quality Strategy. These will replace targets which have been met in 2010/11, hence ensuring that there will be no increase in the total number of national NHSScotland targets. There is a clear short-term commitment to reduce the overall number of HEAT targets.