Healthcare quality strategy for NHSScotland

5. Making it Happen

'Real improvement and consistent quality will come from the efforts and actions of
health professionals and both clinical and non-clinical NHS staff at all levels.'

The Quality Strategy will need to be owned by everyone in Scotland with a recognition that quality is at the heart of everything we do. It will require senior leaders in the NHS and other service providers to be focused on and be inspired by the aim of world-leading healthcare quality. Real improvement and consistent quality will come from the efforts and actions of health professionals and both clinical and non-clinical NHS staff at all levels, and most importantly those delivering direct care to patients and their families. This will mean that we need to work more effectively in partnership with professional groups, colleges and staff representatives to implement this strategy by ensuring that we set out the ambitions in a way which provides the basis for an alignment of individual, team, system and organisational goals.

Achieving change of this scale requires:

• Leadership at all levels;
• Shared ownership - winning hearts and minds;
• Partnership with staff, involvement of patients and carers;
• Embedding quality in day-to-day work;
• Creating the right infrastructure - people, IT;
• Energy and commitment - tying it all together;
• Focusing on the right outcomes and targets; and
• Developing meaningful measures, evidence and analysis.

'...important changes in culture and approach will be required
to ensure that staff are equipped and supported...'

The people delivering healthcare services across NHSScotland have already confirmed their commitment to making the changes needed to share a focus on our Quality Ambitions. Clinical leads, senior doctors and nurses, AHPs, senior managers, and many other healthcare and supporting staff have attended a series of events throughout 2009/10 providing input to this strategy, and demonstrating their individual and collective commitment. Throughout these discussions, we know that we are starting from a very strong foundation (for example our approach to establishing Managed Clinical Networks) but we equally recognise that important changes in culture and approach will be required to ensure that staff are equipped and supported to provide the high quality healthcare to which we aspire, all the time. To support this we will ensure that the Knowledge and Skills Framework is aligned to the Quality Ambitions, and that contracts, job descriptions and annual appraisals are used flexibly and more explicitly to support staff in pursuing improvements in healthcare quality.

'...compelling to, and shared by, partners in the rest
of the public sector, and in the third sector.'

Our approach to implementing the Quality Strategy will recognise the different, and sometimes multiple roles that individuals have in implementing the actions required to achieve our aims. We will communicate the vision of a high quality NHS to the people in Scotland in a number of ways to ensure that it is compelling to all. We will do this in a way which makes it clear that every person in Scotland, no matter who they are, or where they are, has an important role to play to ensure our healthcare services are the best they can be now, and for generations to come. The vision also needs to be compelling to, and shared by, partners in the rest of the public sector, and in the third sector.

We will therefore take a partnership approach to communication and implementation which is simultaneously:

• Person-based;
• Staff-based; and
• System-based.

Person-based

Our communication approach will set out the vision for high quality Scottish healthcare services. It will explain what this means for every individual, in terms of their rights and expectations, and the responsibilities they will have for learning, taking action to maintain their own health, managing their ill-health, collaborating in respectful partnerships with healthcare staff, and feeding back their experiences and outcomes to support a continuous cycle of improvement.

Staff-based

We will continue to work with and through all staff working in and with NHSScotland to develop and implement quality improvement interventions we can use to drive person-centredness, clinical effectiveness and patient safety. To support this approach we will also explore training and skills development approaches they will need to support their practice - such as The Effective Practitioner, a NES online learning programme in development.

Our staff are our greatest resource and we must ensure that they can use their knowledge and skills to best effect for service users and carers. There is evidence to suggest that effective clinical teams and effective management practices can both have a direct impact in reducing mortality. In addition, measures to enhance staff health and wellbeing have been shown to improve the patient experience and outcomes, reduce absenteeism, increase productivity and organisational efficiency. We will therefore continue to invest in developing clinical leaders, supporting best practice in managing staff in order to enhance the employee experience and the delivery of high quality care.

We shall also continue to pursue with primary care contractors the process we have begun to ensure that their energy, creativity and dedication are released for the benefit of patients.

System-based

'...staff health and wellbeing have been shown to improve
the patient experience and outcomes...'

In order to support staff, patients and carers to implement the inventions that will support the actions required to deliver the vision for health and healthcare services in Scotland, we need to identify and remove any hurdles and barriers presented by the current approaches to policy development and delivery. Responsibility for taking this action lies primarily with NHS senior management and with Scottish Government Ministers and officials. However, feedback from staff, patients and carers will inform the continuous cycle of improvement required to ensure that the wider system continues to support and facilitate the delivery of high quality health and healthcare services in Scotland.

'...a clear and unambiguous reinforcement of the policy
priorities for health and healthcare in Scotland. '

The initial actions required at the system level involve a clear and unambiguous reinforcement of the policy priorities for health and healthcare in Scotland. These will include a commitment to improving health and healthcare services quality improvement, embedding the concept of mutuality in pursuit of improved quality, achieving best value in everything we do, and through ensuring maximum integration and continuity of services. We shall also explore with primary care contractors the conditions which would have to be met - and the benefits which would accrue - if we were to move increasingly to a high trust/low bureaucracy culture. They also include a simplification of the policy and delivery landscape with the introduction of a new approach to ensure that existing and new initiatives are appropriately aligned with the Quality Strategy aims, and that their impact on these aims is transparently communicated and properly measured and monitored. There will be a more robust review of HEAT, ensuring that we have a set of national targets which is evidence based and clearly aligned with the quality aims.

'...ensure that existing and new initiatives are appropriately
aligned with the Quality Strategy...'

System-based changes will reinforce the commitments set out in Better Health, Better Care, focusing on the shift required from top-down approaches to bottom-up, the appropriate balance between performance management and continuous improvement and the focus required on getting it right for every person, every time by reducing inappropriate and unnecessary variation.

'...public sector partners and the third sector have a major role to play...'

There will be a refreshed commitment to working closely with community planning partners in the delivery of the Quality Strategy vision and the wider Local and National Outcomes, recognising that public sector partners and the third sector have a major role to play in supporting people across Scotland in making the changes required to achieve the world-leading health and healthcare services to which we aspire.

Working in partnership

This Quality Strategy will underpin all that we do. We propose that it will extend to cover the activities of NHSScotland which are primarily focused on preventative and anticipatory care and are in pursuit of reducing health inequalities and in improving health. It will form the basis for our relationship with independent contractors.

We further propose that this strategy provides a basis for NHSScotland to work with partners through Community Planning Partnerships and in the third sector in securing progress towards the Quality Ambitions, and the higher level outcomes agreed locally and nationally through the Single Outcome Agreements and the National Performance Framework. An example of this is the support required from other public sector partners in establishing the Keep Well health checks through providing follow-up activities to promote wellbeing and healthier lifestyles. Reshaping Care for Older People is a major programme that is being designed, developed and delivered as a partnership across NHSScotland and local government with active engagement from the third sector and community and patient/carer interests.